Study at Master's Level by Practising Physiotherapists

Exploration of mentor and mentee perspectives of a mentored clinical practice programme to improve patient outcomes in musculoskeletal physiotherapy

Background

A recent randomised controlled trial has demonstrated the impact on practice of an educational programme for clinicians. Mentored clinical practice in musculoskeletal physiotherapy resulted in clinically significant improvements in both physiotherapist performance and patient outcomes. The objectives of this study were to explore mentor and mentee perceptions of a mentored clinical practice programme, in order to identify key factors in the process to improve patient outcomes.

Methods

Employing a case study design of a mentoring programme that led to improved patient outcomes, mentored clinical practice was explored from multiple perspectives using a grounded theory strategy of enquiry to derive a theory of mentored clinical practice grounded in the views of the participants. Semi-structured interviews with a purposive sample of mentors and mentees were employed along with qualitative observations of mentored clinical practice. Data analysis and collection were concurrent, with analysis an iterative process deriving inductive analytical categories from the data through constant comparison.

Findings

Highly informative themes of how the complex interaction between mentor, mentee, patient and environment worked successfully were identified from the data. The mentors’ knowledge, additional perspectives, critical analysis and facilitatory style were enabling factors, as were mentees’ motivation, openness to criticism and commitment to reflect on practice. Themes around potential threats to the mentees’ development were also identified. Overloading or contradictory feedback and lack of relationship with mentees were barriers that mentors could bring; fear, defensiveness, routine working, people-pleasing and lack of experience were potential mentee barriers. A model emerges from the data demonstrating how these themes interact, providing guidance to mentors and mentees to optimise the effectiveness of mentored clinical practice.

Conclusion

This study provides a sound basis for future mentored clinical practice, producing a model from key themes from a case study where impact on clinician performance and patient outcomes are established.

Professional and Personal Physical Therapist Development through Service Learning in Collaboration with a Prisoner Reinsertion Program: A Qualitative Study

There is a great concern whether Physical Therapy students upon completion of their educational program are ready and equipped with the requisite skills to construct and implement a successful patient intervention with culturally diverse groups. The purpose of this study is to describe the professional and personal physical therapist development of Physical Therapy students after participating in Solidarity Activities in Collaboration with a Prisoner reinsertion program as a service-learning course. A qualitative approach was used. A convenience sample of twenty physical therapy students doing service learning and one teaching professor were included. Student diaries were analyzed. Semi-structured interviews were done to explore five students’ and the professor’s judgements. Internal and external observations and filling out structure field-notes were also used as data triangulation in order to build the conceptual model. The main findings include that the application of knowledge and practice of skills in different environments are the most important skills attained with this service learning. Five key themes emerged from the data analysis, namely: application of knowledge, adaptation to different environments, improving communication with patients, assisting people and providing treatment with self-confidence. A recommendation is that Physical Therapy programs include workplace practice in different environments to enhance the development of professionalism among students.

Which Learning Activities Enhance Physical Therapist Practice? Part 2: Systematic Review of Qualitative Studies and Thematic Synthesis

OBJECTIVE

Post-professional physical therapy expertise requires career-long participation in learning activities. Understanding physical therapists' lived experience of learning activities provides novel insight into how best to enhance physical therapist practice from the perspective of the learner. The purpose of this study was to explore qualified physical therapists' experiences, beliefs, and perspectives with regard to learning activities and professional development.

METHODS

Eight databases were searched for studies published from inception through December 2018. Study selection included mixed-methods and qualitative studies exploring physical therapists' experiences, perspectives, beliefs, and attitudes. Thematic synthesis was performed, and the GRADE-Confidence in the Evidence from Reviews of Qualitative research was used to assess the level of confidence in the findings. A total 41 studies with 719 participants were included.

RESULTS

The key findings include physical therapists' perceptions that worthwhile post-professional learning requires more than attendance at professional development courses. Physical therapists perceived that worthwhile learning requires connection with others and being "taken out of one's comfort zone." Sufficient time and accessible, trustworthy resources were also valued.

CONCLUSIONS

Moderate- to low-level evidence suggests that the choice of professional development activities and education design for qualified physical therapists should consider the inclusion of connected activities, activities that take participants out of comfort zones, time to practice, and trustworthy resources that are easily accessible. Future research should evaluate the effectiveness of learning activities encompassing these factors, prioritizing those that minimize the barriers of time and distance.

IMPACT

This study adds to the profession's understanding of physical therapists' lived experience of learning activities, providing novel insight into how best to enhance physical therapist practice from the perspective of the learner.

Exploring taught masters education for healthcare practitioners: a systematic review of literature

BACKGROUND

Masters-level education is a key pathway of professional development for healthcare practitioners. Whilst there is evidence that Masters-level education leads to career enhancement, it is unclear how the programme pedagogy contributes to this. The objective was to: (1) examine the programme pedagogies and context that supports learning, and (2) synthesise the outputs, outcomes and impact of Masters-level healthcare programmes.

METHODS

A systematic review was conducted according to the Cochrane Collaboration handbook and is reported in line with PRISMA. Using pre-defined key terms and eligibility criteria, two reviewers independently searched Medline, ERIC, Web of Science, ProQuest, and CINAHL Plus databases from inception to 14th November 2016, reference lists of retrieved articles and selected websites. Data were extracted independently. The Mixed Methods Appraisal Tool was used to assess methodological quality. A Weight of Evidence Framework enabled evaluation of the overall quality of evidence. Data were synthesised using thematic qualitative analysis.

RESULTS

Thirty-five studies were included. All studies were retrospective, evaluated programmes in nursing (n = 19), physiotherapy (n = 6), general and family medicine (n = 4), public health (n = 3), dentistry (n = 1), interdisciplinary (n = 1), and occupational therapy (n = 1). Most studies were rated low in methodological quality, with an overall low to moderate weight of evidence for programmes' outcomes and impact. Pedagogies that promote social participation and knowledge co-construction, reflection, learner-centred approach, relevance and authenticity influenced outcomes and impact.

CONCLUSION(S)

Notwithstanding the low to moderate weight of evidence, the review identified multiple positive outcomes of Master-level education for healthcare practitioners. Whilst the pedagogies that contributed to such positive outcomes were examined in some studies, there is a need to further explore links between programme pedagogy, outputs, outcomes and impact. A cultural approach to evaluation may capture how M-level education drives changes.

Evaluation of the clinical effectiveness of a work-based mentoring programme to develop clinical reasoning on patient outcome: A stepped wedge cluster randomised controlled trial

BACKGROUND

Despite persistent calls to measure the effectiveness of educational interventions on patient outcomes, few studies have been conducted. Within musculoskeletal physiotherapy, the effects of clinical mentoring on postgraduate physiotherapists have been explored, but its impact on patient outcomes is unknown. The objective of this trial was to assess the effectiveness of a work-based mentoring programme to facilitate physiotherapist clinical reasoning on patient outcomes.

METHODS

In a stepped-wedge cluster RCT in the musculoskeletal physiotherapy outpatient departments of a large NHS organisation, 16 physiotherapists were randomised by cluster to receive the intervention-150 hours of mentored clinical practice-at one of 3 time periods; control was usual training. 441 patients submitted outcome measures: Patient-Specific Functional Scale (PSFS) (primary outcome measure), EQ-5D-5L, patient activation and patient satisfaction (secondary outcome measures). A further secondary outcome measure of physiotherapist performance was collected by an independent assessor observing the physiotherapists practice.

RESULTS

80.0% of intervention patients achieved clinically significant PSFS scores compared with 63.8% of control patients. Binary logistic regression analysis modelling for time, cluster and patient characteristics showed strong statistical evidence for this difference (p = 0.023; odds ratio 4.24, 95%CI 1.22, 14.79). Physiotherapist performance scores improved from a mean of 47.8% (SD 3.60) pre-intervention to a mean of 56.0% (SD 4.24) (p<0.001). There was no statistical evidence for differences between groups on other secondary outcomes.

CONCLUSION

This is the first study that we aware of that provides patient outcomes measurement of an established educational intervention in physiotherapy, providing evidence that this type of intervention positively impacts patient outcomes and physiotherapist performance. This provides a basis for further research in education across other healthcare disciplines and outcome measures.

The perceived barriers and facilitators in completing a Master's degree in Physiotherapy

BACKGROUND

Participating in postgraduate study is daunting and as yet there is a dearth of literature on what students' experiences are when obtaining their Master's degree in Physiotherapy.

OBJECTIVES

The aim of this study was to gain insight into the perceived barriers and facilitators in completing a Master's degree in Physiotherapy.

METHOD

Semi-structured, in-depth interviews were conducted with 10 physiotherapists who had completed a Master's degree in Physiotherapy from a university in South Africa, representative of coursework and dissertation Master's degrees, completed within the stipulated time period as well as taking longer to complete the degree. The topics covered a range of speciality areas. The interviews were transcribed, sent for member checking and analysed thematically.

RESULTS

Within 10 interviews data saturation was reached. Two themes were identified: research environment and support, both of which were seen as either a facilitator or a barrier, depending on the participant. The theme of research environment was divided into categories of workplace and data collection. The second theme, support, was also seen as either a barrier or a facilitator. This theme encapsulated the categories of supervisor support, workplace support and a personal support network.

CONCLUSION

The research environment and support are two major factors that can influence the experience of obtaining a master's degree in physiotherapy, both positively and negatively.

CLINICAL IMPLICATIONS

With increasing numbers of physiotherapists obtaining postgraduate degrees, universities need to facilitate the process of obtaining the degree, which will ensure more physiotherapists with postgraduate degrees, thereby strengthening the profession.

Physiotherapy postgraduate studies in South Africa: Facilitators and barriers

Aim

To investigate the facilitators and barriers to attaining a postgraduate physiotherapy degree in South Africa.

Methods

A quantitative, cross-sectional design using an internet-based survey was employed. The population of the study included all qualified physiotherapists who had completed community service and who were on the South African Society of Physiotherapy e-mailing list at the time of the study.

Results

In all, 425 valid responses were received. The study participants were predominantly white women with a mean age of 36.9 and the majority were working in private practice. A total of 20.5% of respondents had completed a master's or doctoral degree in physiotherapy, while a further 13% of respondents were registered for a postgraduate degree in physiotherapy at the time of the study. Study participants who had obtained a postgraduate degree identified the same main barriers (namely cost/lack of financial support, family commitments and lack of time) and the same main facilitators (namely gaining of expertise, fulfilment of a personal goal and improvement of patient care) as participants who had not obtained a postgraduate degree. Participants who had not obtained a postgraduate degree were significantly more likely (p < 0.05) to report concerns regarding their own ability and a lack of motivation as barriers to further study.

Conclusion

South African physiotherapists with and without a postgraduate degree reported common facilitators and barriers to pursuing postgraduate studies. In order to ensure that a greater number and diversity of physiotherapists see postgraduate studies as a worthwhile career option, stakeholders in health and education in both the South African public and private sectors need to be engaged to limit the barriers to postgraduate study and seek novel methods of making postgraduate study a more attractive option from a personal development and career perspective.

Study at Master's Level: A Qualitative Study Exploring the Experience of Students

The aim of this qualitative study was to explore the experience of students engaged in Master's level study. Six students who had completed the taught component of their degree programme before embarking on their dissertation took part in a focus group.

The themes that emerged included the costs involved, perceived benefits, impact on practice and course-specific comments. The costs were seen in terms of stress related to course work and a lack of support. The perceived benefits included an increase in personal and professional confidence and growth, the development of critical and analytical skills, more career options and enthusiasm for practice. The impact on practice involved changes in relationships within the workplace, expectations of others and workload responsibilities.

The findings could enable future students to make an informed choice in their decision to embark on study at Master's level and could further inform managers of services and educators involved in programme development and delivery.

Embedding Evidence-based Practice Education into a Post-graduate Physiotherapy Program: Eight Years of pre-Post Course Evaluations

BACKGROUND AND PURPOSE

Little has been published about the effectiveness of training postgraduate physiotherapy coursework students in research methods and evidence-based practice (EBP) theory. Graduate qualities in most universities include lifelong learning. Inclusion of EBP in post-graduate coursework students' training is one way for students to develop the knowledge and skills needed to implement current best evidence in their clinical practice after graduation, thereby facilitating lifelong learning. This paper reports on change in confidence and anxiety in knowledge of statistical terminology and concepts related to research design and EBP in eight consecutive years of post-graduate physiotherapy students at one Australian university.

METHODS

Pre-survey/post-survey instruments were administered to students in an intensive 3-week post-graduate course, which taught health research methods, biostatistics and EBP. This course was embedded into a post-graduate physiotherapy programme from 2007 to 2014. The organization and delivery of the course was based on best pedagogical evidence for effectively teaching adult physiotherapists. The course was first delivered each year in the programme, and no other course was delivered concurrently.

RESULTS

There were significant improvements in confidence, significantly decreased anxiety and improvements in knowledge of statistical terminology and concepts related to research design and EBP, at course completion. Age, gender and country of origin were not confounders on learning outcomes, although there was a (non-significant) trend that years of practice negatively impacted on learning outcomes (p = 0.09). There was a greater improvement in confidence in statistical terminology than in concepts related to research design and EBP.

CONCLUSION

An intensive teaching programme in health research methods and biostatistics and EBP, based on best practice adult physiotherapy learning principles, is effective immediately post-course, in decreasing anxiety and increasing confidence in the terminology used in research methods and EBP. Copyright © 2016 John Wiley & Sons, Ltd.

The effect of work-based mentoring on patient outcome in musculoskeletal physiotherapy: study protocol for a randomised controlled trial

BACKGROUND

Despite persistent calls to measure the effectiveness of educational interventions on patient outcomes, few studies have been conducted. Within musculoskeletal physiotherapy, the effects of postgraduate clinical mentoring on physiotherapist performance have been assessed, but the impact of this mentoring on patient outcomes remains unknown. The objective of this trial is to assess the effectiveness of a work-based mentoring programme to facilitate physiotherapist clinical reasoning on patient outcomes in musculoskeletal physiotherapy.

METHODS/DESIGN

A stepped wedge cluster randomised controlled trial (CRCT) has been designed to recruit a minimum of 12 senior physiotherapists who work in musculoskeletal outpatient departments of a large National Health Service (NHS) organization. Participating physiotherapists will be randomised by cluster to receive the intervention at three time periods. Patients will be blinded to whether their physiotherapist has received the intervention. The primary outcome measure will be the Patient-Specific Functional Scale; secondary outcome measures will include the EQ-5D, patient activation, patient satisfaction and physiotherapist performance. Sample size considerations used published methods describing stepped wedge designs, conventional values of 0.80 for statistical power and 0.05 for statistical significance, and pragmatic groupings of 12 participating physiotherapists in three clusters. Based on an intergroup difference of 1.0 on the PSFS with a standard deviation of 2.0, 10 patients are required to complete outcome measures per physiotherapist, at time period 1 (prior to intervention roll-out) and at each of time periods 2, 3 and 4, giving a sample size of 480 patients. To account for the potential loss to follow-up of 33%, 720 sets of patient outcomes will be collected.All physiotherapist participants will receive 150 hours of mentored clinical practice as the intervention and usual in-service training as control. Consecutive, consenting patients attending treatment by the participating physiotherapists during data collection periods will complete outcome measures at baseline, discharge and 12 months post-baseline. The lead researcher will be blinded to the allocation of the physiotherapist when analyzing outcome data; statistical analysis will involve classical linear models incorporating both an intervention effect and a random intercept term to reflect systematic differences among clusters.

TRIAL REGISTRATION

Assigned 31 July 2012: ISRCTN79599220.

The definition and application of Pilates exercise to treat people with chronic low back pain: a Delphi survey of Australian physical therapists

BACKGROUND

Pilates exercise is recommended for people with chronic low back pain (CLBP). In the literature, however, Pilates exercise is described and applied differently to treat people with CLBP. These differences in the definition and application of Pilates exercise make it difficult to evaluate its effectiveness.

OBJECTIVE

The aim of this study was to establish consensus regarding the definition and application of Pilates exercise to treat people with CLBP.

METHODS

A panel of Australian physical therapists who are experienced in treating people with CLBP using Pilates exercise were surveyed using the Delphi technique. Three electronic questionnaires were used to collect the respondents' opinions. Answers to open-ended questions were analyzed thematically, combined with systematic literature review findings, and translated into statements about Pilates exercise for people with CLBP. Participants then rated their level of agreement with these statements using a 6-point Likert scale. Consensus was achieved when 70% of the panel members strongly agreed, agreed, or somewhat agreed (or strongly disagreed, disagreed, or somewhat disagreed) with an item.

RESULTS

Thirty physical therapists completed all 3 questionnaires and reached consensus on the majority of items. Participants agreed that Pilates exercise requires body awareness, breathing, movement control, posture, and education. It was recommended that people with CLBP should undertake supervised sessions for 30 to 60 minutes, twice per week, for 3 to 6 months. Participants also suggested that people with CLBP would benefit from individualized assessment and exercise prescription, supervision and functional integration of exercises, and use of specialized equipment.

LIMITATIONS

Item consensus does not guarantee the accuracy of findings. This survey reflects the opinion of only 30 physical therapists and requires validation in future trials.

CONCLUSION

These findings contribute to a better understanding of Pilates exercise and how it is utilized by physical therapists to treat people with CLBP. This information provides direction for future research into Pilates exercise, but findings need to be interpreted within the context of study limitations.

A systematic review of outcome and impact of master's in health and health care

BACKGROUND

The 'human resources for health' crisis has highlighted the need for more health (care) professionals and led to an increased interest in health professional education, including master's degree programmes. The number of these programmes in low- and middle-income countries (LMIC) is increasing, but questions have been raised regarding their relevance, outcome and impact. We conducted a systematic review to evaluate the outcomes and impact of health-related master's degree programmes.

METHODS

We searched the databases Scopus, Pubmed, Embase, CINAHL, ERIC, Psychinfo and Cochrane (1999 - November 2011) and selected websites. All papers describing outcomes and impact of health-related Master programmes were included. Three reviewers, two for each article, extracted data independently. The articles were categorised by type of programme, country, defined outcomes and impact, study methods used and level of evidence, and classified according to outcomes: competencies used in practice, graduates' career progression and impact on graduates' workplaces and sector/society.

RESULTS

Of the 33 articles included in the review, most originated from the US and the UK, and only one from a low-income country. The programmes studied were in public health (8), nursing (8), physiotherapy (5), family practice (4) and other topics (8). Outcomes were defined in less than one third of the articles, and impact was not defined at all. Outcomes and impact were measured by self-reported alumni surveys and qualitative methods. Most articles reported that competencies learned during the programme were applied in the workplace and alumni reported career progression or specific job changes. Some articles reported difficulties in using newly gained competencies in the workplace. There was limited evidence of impact on the workplace. Only two articles reported impact on the sector. Most studies described learning approaches, but very few described a mechanism to ensure outcome and impact of the programme.

CONCLUSIONS

Evidence suggests that graduates apply newly learned competencies in the field and that they progress in their career. There is a paucity of well-designed studies assessing the outcomes and impact of health-related master's degree programmes in low- and middle-income countries. Studies of such programmes should consider the context and define outcomes and impact.

Ready for a paradigm shift? Part 1: introducing the philosophy of qualitative research

The manual therapy professions have almost exclusively focused on the use of quantitative research to help inform their practices. This paper argues that a greater use of qualitative research will help develop a more robust and comprehensive knowledge base in manual therapy. The types of knowledge used in practice and generated from the two research paradigms are explored. It is hoped that an understanding of the philosophical and theoretical underpinnings of qualitative research may encourage more manual therapists to value and use this approach to help further inform their practice; for some, this may involve a paradigm shift in thinking.

The impact of a musculoskeletal masters course: developing clinical expertise

A common aim of Masters (MSc) courses in the UK, accredited by the Manipulation Association of Chartered Physiotherapists (MACP), is to promote the clinical expertise of practitioners. Few studies have explored the extent to which this is achieved and understanding is further hampered by the contested nature of expertise. This paper reports on the impact of an MACP approved MSc on practitioners and offers a conceptual model of their development towards clinical expertise. A qualitative theory-seeking case study was used, drawing on the procedures and processes of grounded theory. Twenty-six semi-structured interviews were conducted with eleven alumni from one MACP approved MSc programme. Dimensional analysis and the constant comparative method of data analysis, was used to build the conceptual model. Prior to enrolment, practitioners uncritically accepted knowledge from others and followed habitual routines with their patients. Their diet of informal CPD appeared ineffective in developing these attributes. The impact of the MACP approved MSc involved three developmental aspects of clinical expertise: critical understanding of practice knowledge, patient centred practice and capability to learn in, and from, clinical practice. These inter-related aspects of knowledge, practice and learning offer a conceptual model of the development towards clinical expertise. The most powerful experience to trigger change was direct observation and feedback of their clinical practice by an MACP educator; this highlights the value of clinical mentors facilitating less experienced colleagues. The implementation of such mentorship within departments may offer a cost effective and manageable way to support CPD within the workforce.

Master's level study: learning transitions towards clinical expertise in physiotherapy

BACKGROUND

Evidence suggests that practitioners who successfully complete a UK Master's level course, accredited by the Manipulation Association of Chartered Physiotherapists (MACP), enhance their clinical practice and demonstrate attributes of clinical expertise. What remains unclear is the process by which practitioners change and enhance their practice. Greater understanding of the learning process would help to inform programme design and delivery, and enhance the quality of the educational experience and impact for practitioners.

OBJECTIVE

To explain the learning process experienced by physiotherapists on completion of an MACP-approved Master of Science (MSc) course.

DESIGN

A naturalistic inquiry was conducted using a single theory-seeking case study. Dimensional analysis was used to develop a substantive theory of the learning transition.

PARTICIPANTS

Twenty-six semi-structured interviews were carried out with 11 alumni from one MACP-approved MSc programme.

RESULTS

The learning transition was from uncritical practice knowledge with routine, therapist-centred clinical practice to critical understanding of practice knowledge that enabled patient-centred practice and the capability to learn in, and from, practice. This development towards clinical expertise was primarily facilitated by critical evaluation of practice knowledge, particularly through mentorship in clinical practice. This highly challenging experience was helped by high levels of support from the mentor. The learning transition varied between participants and depended on a host of moderating factors.

CONCLUSION

This is the first documented theoretical explanation of how physiotherapists enhance their clinical practice and develop attributes of clinical expertise within an MACP-approved MSc course. This explanatory theory may be of value for educational programmes that seek to facilitate practitioners' development towards clinical expertise. This study also offers a novel model of learning transition that may be applicable to other educational settings.

The impact of Masters education in manual and manipulative therapy and the 'knowledge acquisition model'

This study aimed to explore the professional and personal impact that a clinical Masters program of manipulative therapy education had on the lives of individuals who had undertaken the course and was a follow-on study of participants' career pathways following Masters education (Green et al., 2008). Seven graduates from the program took part in a focus group. The narrative data obtained was independently verified prior to two researchers conducting a systematic, thematic content analysis. Three key themes were identified and the 'knowledge acquisition model' developed. Findings revealed that studying at Master's level is a 'life changing' and rewarding experience that develops individuals in three key domains; professionally, personally and intellectually. During Masters education students described a journey of multi-compartmental development whereby their knowledge-base was challenged and their existing cognitive framework deconstructed. Progression through the program resulted in the development of a new, clearer framework for thinking and understanding that extended, universally, into all aspects of their lives; clinically, managerially, emotionally, politically and intellectually. Participants also described two cultures for career progression in the UK National Health Service (NHS). Findings could help students considering undertaking Masters level education, employers and clinical mentors of these practitioners and academic educators.

The influence of a postgraduate clinical master's qualification in manual therapy on the careers of physiotherapists in the United Kingdom

Over the last decade there has been potential for manual therapists to extend their roles and develop their careers. In order to explore the career pathways of a group of postgraduate manual therapists and to identify the influence of Master's education on those careers, a postal questionnaire was sent to all graduates from a clinically based programme (response rate 62.3%, n=48, with representation from each year over a 10-year period). All the respondents were still working in physiotherapy and the majority had a clinical element to their role (83%). The new career framework, which seeks to enable therapists to progress their careers and retain a clinical work load is demonstrated within this sample, with 6.2% achieving Consultant Therapist roles, 14.4% in Extended Scope Practitioner posts and 16.6% working as Clinical Specialists. Positive contributions from Master's education were the status of the qualification, improved clinical skills and increased confidence. Negative factors were less clinical 'hands-on' within their roles, lack of time and an increase in management responsibilities. Findings suggest that Master's education has enabled the participants to take on the new roles that have resulted from a raft of political imperatives but further work could explore the issues around positive and negative drivers.