Christine Bithell

The 2:1 Clinical Placement Model: Perceptions of clinical educators and students

Summary Background and Purpose The need to increase availability of practice placements for undergraduate physiotherapists is now critical, particularly since higher student numbers have been commissioned with the implementation of the National Health Service Plan ( DoH, 2000 ). Exploration of non-traditional placement models which promote peer learning and accommodate more students has been proposed ( Baldry Currens and Bithell, 2000 ). This paper examines perceptions of clinical educators and students regarding the 2:1 model (two students placed with one educator), both as a learning experience and with regard to practical aspects of its management. Methods Thirty-four 2:1 placements in 12 National Health Service trusts were studied. Clinical educators new to the 2:1 model, and students from six academic institutions participated. Qualitative in-depth interviews and questionnaires were conducted in the final placement week. Interviews were audio-taped and transcribed verbatim. Data (original words and phrases from interviews and questionnaires) were subjected to a six-part content analysis and coded into emerging themes and issues. Findings were checked with peers from six groups of clinical educators and one group of students. Findings Thirty-seven clinical educators and 61 students were interviewed; questionnaires were returned from 34 clinical educators (91.9%) and 59 students (96.7%). At interview 35 clinical educators were willing to use the 2:1 model again, and in questionnaires almost all students valued peer discussion (98.3%) and peer support (81.4%). 2:1 models were considered feasible in all clinical specialties studied and for all student years. Interaction with peers was perceived to enhance the quality of placement learning, although clinical educators expressed uncertainty regarding relevant teaching and learning strategies. Although clinical educators expected difficulties in managing competition and difference between students, these aspects were rarely problematic in practice. Placements were most successful and time management most efficient when students treated more than 50% of the clinical educators caseload. Conclusions The 2:1 model was perceived as successful by clinical educators and students in all years of study. It has potential to enhance student learning, and is appropriate for use in a variety of clinical settings.

Evidence-based Physiotherapy

Evidence-based practice is a significant movement of fundamental importance in delivery of healthcare throughout the developed world. This editorial examines some of the issues for physiotherapy and suggests that some concepts embodied in evidence-based medicine should not be imported uncritically into an evidence-based physiotherapy practice.

Clinical Education: Listening to different perspectives

Summary Background and purpose This study sought to identify and address attitudinal and organisational barriers to increased undergraduate clinical placements in one region. An understanding of the perspectives of key stakeholders was essential to the development of increased placement provision. Methods A qualitative research design used in-depth interviews and focus group discussions with four groups of key informants: service managers, clinical educators, recently qualified physiotherapists, and third-year physiotherapy students. Interviews were taped and transcribed, and data were coded and analysed. Transcripts and emerging issues were checked with informants to confirm accuracy and interpretation. Emerging issues were further tested with groups of peers. Findings Clinical education as a core role of professional physiotherapists was agreed in principle but found to be conditional and a secondary role in practice. The role carried little prestige, and clinical educators required greater support from managers and clinicians. Improved education and preparation for the role of clinical educator were requested. Benefits of students in the workplace were recognised, although their extent was uncertain. A standard method for calculating placement capacity was not found. Educators were reluctant to delegate their own caseloads to students. Non-traditional models of placement and supervision were not widely used or valued by managers and clinicians, although supported by students and recently qualified physiotherapists. Conclusion A complex picture emerged and no single solution to placement shortages was found. The perspectives of stakeholders are influenced by the differing pressures under which they experience clinical education. An understanding of these perspectives has informed a range of possible solutions to placement shortages.

Perceptions of speech and language therapy amongst UK school and college students: implications for recruitment

BACKGROUND Communication disorders affect both sexes and people from all ethnic groups, but members of minority ethnic groups and males in the UK are underrepresented in the speech and language therapy profession. Research in the area of recruitment is limited, but a possible explanation is poor awareness and understanding of speech and language therapy as a profession. AIMS To investigate factors influencing attitudes to a career in speech and language therapy amongst UK school and college students focusing on the similarities and differences between males and females, and between minority ethnic and white students. METHODS & PROCEDURES A total of 651 male and female school and college students from a range of ethnic groups and all close to selecting degree courses completed a questionnaire designed to examine the attitudes and awareness of speech and language therapy. Eleven semi-structured follow-up interviews were conducted to help understand the questionnaire findings. Quantitative and qualitative analyses examined differences in attitudes and the awareness of speech and language therapy amongst these groups. OUTCOMES & RESULTS Overall, one-third of participants said they knew nothing about speech and language therapy, and males were significantly less familiar with it. Less than half the participants were aware that speech and language therapy is a degree course, and minority ethnic participants were significantly less likely to know this. Compared with males, females were almost five times as likely to say they would consider a career in speech and language therapy. Participants with relatives in health-related jobs were significantly more likely to consider speech and language therapy than those without such relatives. Compared with white participants, minority ethnic participants said they placed greater importance on studying for a degree, a profession and a scientific career, and were more influenced by a careers prestige and a high salary. CONCLUSIONS In order to increase the ethnic and gender diversity of speech and language therapists, the profile of the profession needs to be raised with increased awareness of the degree level courses, the scientific, evidence-based nature of the work, and current salary scales.

Single subject experimental design: a case for concern?

Introduction Single subject experimental designs are said to be the answer to some of the problems encountered by group studies in clinical settings (Ottenbacher, 1986). In this paper I intend to offer a critique of this method, because I am concerned that it may be accepted, without sufficient debate, as a mainline route to the evaluation of clinical practice. Before we invest our limited time and resources, we need to be sure that our methods have scientific credibility and methodological soundness.

Relationships between physiotherapists' level of contact, cultural awareness and communication with Bangladeshi patients in two health authorities

Summary A questionnaire survey of all physiotherapists employed by two health authorities was undertaken in order to assess their contact, general knowledge and attitudes with regard to Bangladeshi patients. The findings indicated that contact with Bangladeshi people increased awareness of their culture and customs but this did not result in fewer problems in their physiotherapy management. Communication was found to be the greatest problem and more qualified interpreters and cultural awareness training are suggested as solutions.

Musculoskeletal Physiotherapy in Primary Care Sites: Survey of English NHS trusts

Summary Objective To determine the extent of GP/health centre-based musculoskeletal physiotherapy services provided by NHS trusts in England; to ascertain the value of relocation to primary care settings as perceived by physiotherapy service managers; to discuss implications; and to identify issues for further research. Methodology A postal survey, using a questionnaire with closed and open questions, was carried out. Questionnaires were sent to physiotherapy service managers in all 325 NHS trusts in England who supplied a musculoskeletal physiotherapy service. Questionnaires were piloted before the main study. Results A response rate of 76.3% (n = 248) was obtained. Of trusts responding to the survey, 80% provided musculoskeletal physiotherapy services located in GP/health centres. Rapid expansion in services was perceived to be demand-led with 47.8% of managers planning future expansion. Of physiotherapy service managers 60.6% considered that the provision of this service increased physiotherapy membership of the primary healthcare team which was advantageous for the physiotherapy profession; 49.8% believed the service offered increased benefits to patients. The risk of isolation from peers was raised by 48.8% of managers. Professional isolation, the risk of professional fragmentation, the impact of restricted on-site resources on the quality of patient care, and staffing issues were identified as issues that needed to be addressed. Conclusions The issues raised by this study require consideration during the development of primary care trusts. Managers perceived that a shift in location of physiotherapy services will have implications for equitable service provision. The rapid expansion of these services will require manpower planning and, in the shorter term, may threaten quality in other core areas of physiotherapy practice.

Perceptions of occupational therapy compared with physiotherapy and nursing among minority ethnic and white United Kingdom school and college students: implications for recruitment

There is currently a recruitment crisis in occupational therapy in the United Kingdom and also evidence that minority ethnic groups are underrepresented in the profession. This study comprised 651 self-completion questionnaires and 43 depth interviews with minority ethnic and white school and college students to investigate factors influencing attitudes to careers in occupational therapy. Occupational therapy was much less well known than nursing or physiotherapy and, compared with the white participants, the minority ethnic group participants were less familiar with it. Differences were also found in what the minority ethnic and the white participants wanted from careers. Significantly, the minority ethnic participants were more likely to regard doing a degree as important but were also less aware that occupational therapy was studied at degree level. The participants tended to perceive similarities between occupational therapy and nursing and the implications of this are discussed. In conclusion, while 1 in 10 participants would consider a career in occupational therapy, with lower proportions from the minority ethnic than the white participants, many characteristics of careers considered important by these students applied to occupational therapy. Efforts should be made to increase awareness of occupational therapy with, for example, emphasis placed on degree level study, job security and the level of responsibility and professional nature of the career.

Professional Knowledge in Professional Development

From time to time it is pleasing to be able to devote an entire issue to articles that focus on a single topic. This issue affords us the opportunity to look inward at ourselves and consider our development as a profession.

Aims and Aspirations

A mission statement: To disseminate high quality, original research in physiotherapy and facilitate continuing education for physiotherapists and other health care professionals