Development of autonomy on placement: perceptions of physiotherapy students and educators in Australia and the United Kingdom.

OBJECTIVES: This paper explores the decision-making processes involved in giving physiotherapy students responsibility on clinical placement and the impact on their developing professional autonomy. METHODS: The qualitative study, using semi-structured interviews, involved physiotherapy students and clinical educators (CEs) from two higher education institutions, one in Australia, and the other in the United Kingdom (UK). FINDINGS: Findings led to the development of a heuristic framework of 'graduated supervision,' a process of progressively less direct observation and monitoring of students as clinical proficiency improved. By focusing on the measured exposure of students to increasing complexity and inverse levels of supervision, the framework captures tacit practices, and consistent, yet varied facilitation strategies adopted across specialties, and evident in clinical education settings in both countries. The framework formalizes, for the first time, assumptions and expectations previously unacknowledged. Factors identified as affecting students' progress toward autonomy include the student/CE relationship, the development of mutual trust through ongoing dialogue, and the importance of formal discussions at the commencement of a clinical placement to establish learning goals, preferred supervision styles and learner responsibilities. CONCLUSION: Insights have significance for the CE community, and students who at times have to second-guess what is required of them and how they might excel on clinical placement.

Education for integrated working: A qualitative research study exploring and contextualizing how practitioners learn in practice.

Integrated working can be a means of providing efficient and cost-effective care, which benefits both service users and health professionals. However, it does require readiness of practitioners to work in new and innovative ways to achieve integration. This paper describes the findings of a qualitative study exploring the nature of practice-based education and training underpinning successful integrated care teams using an ecological systems theory lens. Nine teams in the West Midlands region of the United Kingdom (UK) participated in this study. A total of 27 participants were involved in semi-structured interviews during which they shared their views and experiences of learning in practice. Thematic analysis of interview transcripts highlighted the shifting context of working in integrated teams impacting on learning, the influence of leadership on education and training, the nature of in-service training, and the knowledge-sharing culture. The findings highlight that the learning climate is highly dependent on the leadership ethos in the practice context, which influences the allocation of time and resources for training and clinical supervision. Whilst formal education and training has an important role to play in fostering integrated working, informal learning is pivotal to successful integration and potentially has greater impact making it worthy of further study.

A qualitative research synthesis exploring professional touch in healthcare practice using the threshold concept framework.

Touch is an integral part of human life. Consequently, touching and being touched are also fundamental to healthcare practice. Despite a significant literature on touch, it is rarely conceptualized or discussed in terms of the student journey from layperson to practitioner. We chose to explore professional touch using the threshold concepts framework (TCF), which provides a theoretical model for exploring the way in which learners encounter, engage with and understand fundamental concepts in a discipline. This qualitative research synthesis (QRS) describes the use of the TCF to identify key issues involved in developing and using professional touch. Through a cross-professional analysis and synthesis of recent international literature, we aimed to identify key characteristics of the transitional journey for professional touch. Three orders of analysis were applied, employing a methodology described by Major and Savin-Baden (An introduction to qualitative research synthesis: managing the information explosion in social science research, Routledge, London, 2010). Following identification of threshold characteristics in the overall sample of articles, second order analysis revealed the nuances of professional touch associated with the characteristics. The final synthesis led to identification of five themes: touch as dialogue; being changed by touch; multiple boundaries of touch; multiple meanings of touch and influences on touch. Whilst providing support for some assertions within the literature, this QRS also offers new insights into the complexity of professional touch. Given the paucity of explicit learning and reflection around professional touch in training programmes of health professionals, the TCF reveals ways in which professional preparation might be improved to promote understanding of the role and impact of touch in practice.

Empowerment of physiotherapy students on placement: The interplay between autonomy, risk, and responsibility.

BACKGROUND: Knowledge of the effects on students of clinical educators' giving or withholding responsibility on placement is limited. The associated empowering, or disempowering impact indicates the need for research on what grounds such decisions are made. AIM OF STUDY: The study aimed to explore clinical educators' perspectives on the importance of giving student physiotherapists increasing levels of responsibility on clinical placement, and the factors considered when giving or withholding responsibility. METHODS: A grounded theory methodology underpins this United Kingdom (UK) based study. The phase of the study reported in this article involved 26, semi-structured interviews with clinical educators, each followed by the completion of a diamond ranking exercise. FINDINGS: Three themes emerged: 1) the ubiquity of risk; 2) the relationship between trust and trustworthiness; and 3) graduated supervision. The first theme, acknowledged that risk is ever-present and that clinical educators are used to managing it, balancing risk and responsibility given to students. The second theme highlighted the importance of developing trust/trustworthiness as a foundation for a sound working relationship between student and clinical educator. The third theme focusing on graduated supervision as a means of empowering students to take on increasingly demanding responsibilities on placement. CONCLUSIONS: The study illustrates the complex relationship between risk, trust, responsibility, and developing student autonomy. A strategy is proposed to provide an empowering alternative to the tendency to increase surveillance and/or limit the responsibility for students who lack confidence or capability in taking responsibility on clinical placement. Future research could aim to test the strategy more widely.

Developing interprofessional education online: An ecological systems theory analysis.

This article relates the findings of a discourse analysis of an online asynchronous interprofessional learning initiative involving two UK universities. The impact of the initiative is traced over three intensive periods of online interaction, each of several-weeks duration occurring over a three-year period, through an analysis of a random sample of discussion forum threads. The corpus of rich data drawn from the forums is interpreted using ecological systems theory, which highlights the complexity of interaction of individual, social and cultural elements. Ecological systems theory adopts a life course approach to understand how development occurs through processes of progressively more complex reciprocal interaction between people and their environment. This lens provides a novel approach for analysis and interpretation of findings with respect to the impact of pre-registration interprofessional education and the interaction between the individual and their social and cultural contexts as they progress through 3/4 years of their programmes. Development is mapped over time (the chronosystem) to highlight the complexity of interaction across microsystems (individual), mesosystems (curriculum and institutional/care settings), exosystems (community/wider local context), and macrosystems (national context and culture). This article illustrates the intricacies of students' interprofessional development over time and the interactive effects of social ecological components in terms of professional knowledge and understanding, wider appreciation of health and social care culture and identity work. The implications for contemporary pre-registration interprofessional education and the usefulness and applicability of ecological systems theory for future research and development are considered.

Impact of the Accreditation of Clinical Educators scheme: reflections from one higher education institution.

OBJECTIVE: To provide a critically reflective account of clinical educators' experiences of the Accreditation of Clinical Educators (ACE) scheme, launched by the Chartered Society of Physiotherapy in 2004, and its impact on practice. DESIGN: A qualitative methodology with three elements: focus group interviews during the accreditation process, and completion of a questionnaire at its conclusion and 6 months following completion. All data were transcribed and analysed using the constant comparative method. PARTICIPANTS: Seventeen participants provided initial feedback through focus group interviews. Thirteen participants completed all three phases of the inquiry. The sample was purposive. RESULTS: Three main themes emerged: getting to grips with reflection: a benefit for CPD; the relationship between professional recognition, competence and confidence; and perceived impact within the educators' scope of influence. CONCLUSIONS: This small-scale study of the outcomes of clinical educators' engagement with the ACE process suggests that it contributes to their personal and professional development by helping them to gain experience of portfolio building and reflective writing, and increasing confidence in their own competence through providing acknowledgment of having achieved a recognised standard. The ACE scheme appears to impact positively on clinical educators' approaches to supporting students on clinical placement. However, positive effects also extend to colleagues and clients.

Impact of oral assessment on physiotherapy students' learning in practice.

Given that all of us are potential users of health and social care services, the rigorous assessment of student health professionals in practice should be of common interest. However, rigorous assessment of practice-based learning is notoriously challenging. One would expect assessment in the context of the workplace to be an indicator of fitness for purpose and for practice. However, some indication that health professional students, including physiotherapists, are less fit for practice on qualification than might be desirable suggests a need to rethink assessment practices. Drawing on insights from students, clinical educators, and university visiting tutors in the United Kingdom, this article offers a rationale for combining assessment by observation of performance with a formal oral assessment. We argue that complementarity between the two types of assessment when combined means they allow us to gain a holistic impression of the student's overall performance. We illustrate how the oral component of assessment influences how students go about learning and highlight its perceived 'added value' in terms of helping students prepare for employment. Our findings are theorised in terms of the extent to which assessment aligns with learning activities and learning outcomes, which we believe is vital in health professional programmes. The purpose of this qualitative study was to explore the views of students, clinical educators, and university visiting tutors on assessment strategies used in clinical practice. Our objectives were to develop our understanding of the contribution made by each element of assessment to our overall view of student capability. On this basis we would determine whether both assessment components were deemed necessary by all of the stakeholders.

Reflective practice and clinical supervision: an interprofessional perspective.

BACKGROUND: In the United Kingdom, the drive to encourage reflective practice through clinical supervision, as a means of ensuring quality of provision in nursing and other health care professions, is now well-embedded, not only in policy but also in practice. However, debate and critique of these concepts is limited. AIM: The aim of this paper is to draw on research, conducted with undergraduate occupational therapy students and qualified physiotherapists, in order to contribute to the debate about the functions of clinical supervision and reflective practice in nursing and other health care professions. DISCUSSION: Upholding the notion that clinical supervision has the potential to constitute a form of surveillance, we counter the assumption that it is inevitably confessional in nature. A social constructionist perspective is used to illustrate how clinical supervision might involve a complex interplay of factors that dispel notions of predictability, control and rationality. CONCLUSION: Despite acknowledging tensions, we argue that clinical supervision is both necessary and beneficial. It can be advantageous to individual practitioners and professional groups in enhancing practice and accountability, and promoting professional development.