Several strategies for clinical partners and universities are perceived to enhance physiotherapy student engagement in non-metropolitan clinical placements: a mixed-methods study

Identifying features of quality in rural placements for health students: scoping review

OBJECTIVES

To explore and synthesise the evidence relating to features of quality in rural health student placements.

DESIGN

Scoping review.

DATA SOURCES

MEDLINE, CINAHL, Embase, ProQuest, Informit, Scopus, ERIC and several grey literature data sources (1 January 2005 to 13 October 2020).

STUDY SELECTION

The review included peer-reviewed and grey literature from Organisation for Economic Co-operation and Development listed countries that focused on quality of health student placements in regional, rural and remote areas.

DATA EXTRACTION

Data were extracted regarding the methodological and design characteristics of each data source, and the features suggested to contribute to student placement quality under five categories based on a work-integrated learning framework.

RESULTS

Of 2866 resulting papers, 101 were included for data charting and content analysis. The literature was dominated by medicine and nursing student placement research. No literature explicitly defined quality in rural health student placements, although proxy indicators for quality such as satisfaction, positive experiences, overall effectiveness and perceived value were identified. Content analysis resulted in four overarching domains pertaining to features of rural health student placement quality: (1) learning and teaching in a rural context, (2) rural student placement characteristics, (3) key relationships and (4) required infrastructure.

CONCLUSION

The findings suggest that quality in rural health student placements hinges on contextually specific features. Further research is required to explore these findings and ways in which these features can be measured during rural health student placements.

Urban ideals and rural realities: Physiotherapists navigating paradox in overlapping roles

OBJECTIVES

Rural practitioners who develop a sense of belonging in their community tend to stay; however, belonging means neighbours become patients and non-clinical encounters with patients become unavoidable. Rural clinical experiences expose students to overlapping personal and professional relationships, but students cannot be duly prepared to navigate them because ethical practice standards primarily reflect urban, and not rural, contexts. To inform such educational activities, this study examines rural physiotherapists' strategies for navigating overlapping relationships.

METHODS

Constructivist grounded theory guided iterative recruitment of 22 physiotherapists (PTs) living and practising in rural, northern or remote (RNR) communities in British Columbia, Canada, and analysis of their experiences navigating overlapping relationships.

RESULTS

PTs routinely navigate overlapping relationships while mindful of practice standards, neighbourly and community expectations, personal well-being and patient welfare. While off-duty, they balance opposing expectations and manage various responsibilities to achieve contradictory goals such as being a professional who protects patient confidentiality while being an active and cordial community member. While on-duty, they face ethical dilemmas where deciding not to treat acquaintances potentially denies access to care but allows for clearer personal-professional boundaries and deciding to treat contravenes (urban) practice standards but could allow for customised patient care based on knowledge gained through both clinical and social interactions.

CONCLUSION

Overlapping relationships are a rural norm. Urban ethical practice standards imposed on rural contexts put RNR practitioners in a paradoxical situation where clinical and social interactions must be but cannot be partitioned. Examining the identified strategies through the lens of paradox theory shows sophisticated cognitive framing of the conflicting and interrelated aims inherent to living and practising in RNR communities. Consequently, introducing a paradox mindset in educational activities could be explored as a way to prepare students for the ethically complex overlapping relationships that they will need to navigate during RNR clinical experiences.

Supporting health students on rural placements: A scoping review

OBJECTIVE

To review Australian literature on initiatives used to provide support for pre-registration health students undertaking a rural placement.

DESIGN

A scoping literature review.

SETTING

Rural, regional and remote areas of Australia.

PARTICIPANTS

Publications were sourced from scientific databases including Ebscohost and CINAHL. Grey literature and journal citations were searched to identify other relevant articles.

MAIN OUTCOME MEASURE

Identification of the various initiatives used to support students, evaluation of the success of these initiatives, and the feasibility and sustainability of implementing these initiatives.

RESULTS

There were 36 articles included in the final analysis. The findings identified support initiatives specific to individual professions, not on supporting health students as a whole cohort. The key findings were grouped into identification of support initiatives and the alignment of these to students feeling a sense satisfaction, belonging and connectedness. Constraints to support health students undertaking rural placements identified disparity and inequity of support initiatives available for health students with medical students provided more support than other health students.

CONCLUSION

This review highlights the importance of students developing a sense of belonging and building connections to community, which are strongly aligned with rural placements and student satisfaction. The need for socio-cultural, organisational and institutional support is linked to higher student satisfaction and intention to practice rurally. A centralised collation of support initiatives would benefit students, higher education institutions and stakeholders in their efforts to attract students to undertake rural placements and be immersed in these unique learning experiences.

Investigating physiotherapy stakeholders' preferences for the development of performance-based assessment in practice education

OBJECTIVES

Discrete choice experiments (DCEs) are used in healthcare to measure the relative importance that stakeholders give to different features (or attributes) of medical treatments or services. They may also help to address research questions in health professional education. Several challenges exist regarding the performance-based assessment process (PBA) employed in physiotherapy practice-based education, a process which determines students' readiness for independent practice. Evidence highlights many commonalities among these challenges, but it is unknown which factors are the most important to stakeholders. The use of DCE methodology may provide answers and help to prioritise areas for development. Thus, this study employed DCE to identify clinical educators', practice tutors and physiotherapy students' preferences for developing the PBA process in physiotherapy.

DESIGN

Attributes (aspects of the PBA process known to be important to stakeholders) were derived from focus group interviews conducted with three groups; physiotherapy students, clinical educators (practising clinicians) and practice tutors (dedicated educational roles in the workplace). These attributes included the PBA tool, grading mechanisms, assessors involved, and, feedback mechanisms. Preferences for each group were calculated using a logistic regression model.

RESULTS

Seventy-two students, 124 clinical educators and 49 practice tutors (n=245) participated. Priorities identified centred primarily on the mandatory inclusion of two assessors in the PBA process and on refinement of the PBA tool.

CONCLUSION

Employment of DCE enabled the prioritisation of stakeholder-informed challenges related to PBA in physiotherapy practice-based education. This corroborates findings from previous qualitative work and facilitates a prioritised pathway for development of this process.

Juggling roles and generating solutions; practice-based educators' perceptions of performance-based assessment of physiotherapy students

OBJECTIVES

Physiotherapy lacks the significant body of evidence that underpins performance-based assessments in disciplines such as medicine and nursing. In particular, very few studies have examined stakeholder perspectives of the process. This study set out to explore the perceptions of clinicians who undertake student assessment in the workplace in order to inform further development of performance-based assessment in physiotherapy.

DESIGN

A qualitative, descriptive design was employed where focus group interviews were utilised for data collection. Inductive thematic analysis was used to analyse the data.

PARTICIPANTS

Clinical educator and practice tutor volunteers affiliated with three Irish universities participated in one of seven focus groups (n=46).

RESULTS

Two themes were identified; 1) Tensions in the clinical learning environment, 2) An optimal PBA process. The first theme describes clinical educators' struggle with juggling multiple roles and highlights the challenges of sustaining a balance between student mentoring and patient care. The second theme outlines factors perceived to contribute to an optimal performance-based assessment process; these include maintaining aspects of the current process and expanding the employment of dedicated educational roles in the workplace.

CONCLUSION

Our findings illustrate a complex working environment for clinicians involved in student supervision and assessment. A dedicated educational role was perceived to provide a more standardised and rigorous approach to performance-based assessment. These findings provide critical stakeholder-centred insights, which may inform development of this process by addressing critical aspects deemed to facilitate and challenge clinical educator's roles as assessors.