Kristin Lo

Enhancing positive attitudes towards disability: evaluation of an integrated physiotherapy program.

Purpose: This study explored whether attitudes towards disability in second year undergraduate physiotherapy students could be enhanced by an on-campus integrated curriculum program. Methods: A pre-post design was used. Year 2 (pre-clinical) students participated in a 12-week program focused on optimising attitudes towards people with acquired or developmental neurological disability. The Discomfort subscale of the Interaction with Disabled Persons scale, rated on a six-point Likert scale, was applied prior to and at completion of the 12-week program, and compared to year 4 students, just prior to graduation. Qualitative data from year 2 reflective narratives was also gathered. Results: Forty-seven second year and 45 fourth year physiotherapy students participated. The difference in Discomfort subscale scores between weeks 1 and 12 of year 2 was statistically significant (p = 0.0016). The difference in Discomfort subscale scores between year 2 week 1 and year 4 students was also statistically significant (p = 0.040). There was no significant difference in attitudes between students at the end of year 2 and the end of year 4 (p = 0.703). Qualitative data supported the development of more positive attitudes towards neurological disability across the 12 week year 2 pre-clinical program. Conclusion: Student attitudes towards people with acquired and/or developmental neurological disabilities can be enhanced through an on campus integrated curriculum program. Implications for Rehabilitation Student attitudes towards disability can be enhanced through an on campus integrated curriculum program. Pre-clinical student attitudes towards disability can achieve levels comparable to that found in senior students following field work experience.

Group interventions to promote mental health in health professional education: a systematic review and meta-analysis of randomised controlled trials

Effects of interventions for improving mental health of health professional students has not been established. This review analysed interventions to support mental health of health professional students and their effects. The full holdings of Medline, PsycINFO, EBM Reviews, Cinahl Plus, ERIC and EMBASE were searched until 15th April 2016. Inclusion criteria were randomised controlled trials of undergraduate and post graduate health professional students, group interventions to support mental health compared to alternative education, usual curriculum or no intervention; and post-intervention measurements for intervention and control participants of mindfulness, anxiety, depression, stress/distress or burnout. Studies were limited to English and short term effects. Studies were appraised using the PEDro scale. Data were synthesised using meta-analysis. Four comparisons were identified: psychoeducation or cognitive-behavioural interventions compared to alternative education, and mindfulness or relaxation compared to control conditions. Cognitive-behavioural interventions reduced anxiety (−0.26; −0.5 to −0.02), depression (−0.29; −0.52 to −0.05) and stress (0.37; −0.61 to −0.13). Mindfulness strategies reduced stress (−0.60; −0.97 to −0.22) but not anxiety (95% CI −0.21 to 0.18), depression (95% CI −0.36 to 0.03) or burnout (95% CI −0.36 to 0.10). Relaxation strategies reduced anxiety (SMD −0.80; 95% CI −1.03 to −0.58), depression (−0.49; −0.88 to −0.11) and stress (−0.34; −0.67 to −0.01). Method quality was generally poor. Evidence suggests that cognitive-behavioural, relaxation and mindfulness interventions may support health professional student mental health. Further high quality research is warranted.

Physiotherapy clinical educators’ perceptions of student fitness to practise

BackgroundHealth professional students are expected to maintain Fitness to Practise (FTP) including clinical competence, professional behaviour and freedom from impairment (physical/mental health). FTP potentially affects students, clinicians and clients, yet the impact of supervising students across the spectrum of FTP issues remains relatively under-reported. This study describes clinical educators’ perceptions of supporting students with FTP issues.MethodsBetween November 2012 and January 2013 an online survey was emailed to physiotherapy clinical educators from 34 sites across eight health services in Australia. The self-developed survey contained both closed and open ended questions. Demographic data and Likert scale responses were summarised using descriptive statistics. The hypotheses that years of clinical experience increased clinical educator confidence and comfort in supporting specific student FTP issues were explored with correlational analysis. Open text questions were analysed based on thematic analysis.ResultsSixty-one percent of the 79 respondents reported supervising one or more students with FTP issues. Observed FTP concerns were clinical competence (76%), mental health (51%), professional behaviour (47%) and physical health (36%). Clinicians considered 52% (95% CI 38-66) of these issues avoidable through early disclosure, student and clinician education, maximising student competency prior to commencing placements, and human resources. Clinicians were confident and comfortable supporting clinical competence, professional behaviour and physical health issues but not mental health issues. Experience significantly increased confidence to support all FTP issues but not comfort. Student FTP issues affects the clinical educator role with 83% (95% CI 75-92) of clinicians reporting that work satisfaction was affected due to time pressures, emotional impact, lack of appreciation of educator time, quality of care conflict and a mismatch in role perception. Educators also considered that FTP issues affect service delivery and impact on those seeking health care.ConclusionsStrategies to support student FTP have potential to positively impact on students, clinicians and clients. Collaboration between these stakeholders is required, particularly in supporting mental health. Universities are strategically placed to implement appropriate support such as communication support.

Proactive Student Engagement with Fitness to Practise

Fitness to practise (FTP) is fundamental to health professional education and health service delivery, impacting on both practitioner and client wellbeing. Literature exploring FTP support policies primarily identifies retrospective student support and management. This study describes student perceptions of an innovative FTP policy which supports students and staff to proactively identify FTP management strategies prior to entering the clinical environment. Forty-nine final year physiotherapy students were surveyed regarding their perceptions of self-declaring FTP. Ordinal data from Likert scales were reported using descriptive statistics. Thematic analysis was undertaken for open text responses. The response rate was 88%. Forty-two percent of students stated that they had experienced FTP concerns during the course. Concerns included physical and mental impairment and clinical competence issues. The majority of students (80%) indicated that they were “comfortable” or “very comfortable” in self-declaring FTP issues. Confidentiality, positive relationships with staff and a supportive environment enhanced likelihood of declaration. Eight students (19%) met with university staff to develop management strategies and all rated these meetings as “helpful” or “very helpful.” Students had positive perceptions of self-declaring their FTP to enable early development of management strategies. This strategy successfully navigates sensitive ethicolegal issues, empowering students to take responsibility for their own FTP.

Physiotherapy clinical educators’ perspectives on a fitness to practice initiative

ABSTRACT Context: Health practitioner registration boards require health professionals to evaluate and maintain “fitness to practice” (FTP). This encompasses the professional behavior, clinical competence, and freedom from impairment required for safe and effective service provision. We developed and implemented policies to promote student self-assessment and support of FTP that were pre-emptive and designed to be helpful and sought clinician feedback on this initiative. Method: An innovative student-centered FTP approach was devised with consideration of defensible ethico-legal practice. A survey explored clinical educators’ perceptions of the FTP policy and the associated education and support. Closed and open survey questions were analyzed using descriptive statistics, qualitative evaluation, and thematic analysis. Results: Seventy-nine physiotherapy clinical educators from 34 sites across eight Australian health services returned surveys. Educators had positive perceptions of policy components, particularly incorporating professionalism as a hurdle requirement and the attendance and incident reporting policies. Conclusions: The benefits of a student-centered FTP approach included clarity and consistency in managing FTP issues and facilitation of student awareness through active engagement in maintaining their FTP. To our knowledge, this paper is the first to report a comprehensive approach to the range of FTP issues incorporating student self-declaration of issues that may affect desirable progression through clinical placements. The policy and program of education and support are likely to be generalizable to health professional training programs that utilize workplace training.

An online fitness to practise specific module alters physiotherapy students’ health knowledge, perceptions and intentions

Health professional students experience fitness to practise (FTP) issues but commonly do not seek help. Strategies to support students’ FTP in preparation for clinical placement are warranted. This article adds further insights into curriculum to support students’ FTP. The purpose of the study was to gain insight into students’ perception, levels of confidence, knowledge, understanding and help-seeking intentions regarding FTP issues and their supports. Year 3 and 4 Bachelor of Physiotherapy students provided open-ended responses regarding the impact of undertaking an education module to increase their awareness of FTP issues and associated support systems. After completing the module, students were more confident to define FTP, able to identify support systems and more likely to seek help for FTP issues. They were less likely to self-manage FTP issues although this was not statistically significant. After viewing the curriculum students increased their awareness of where to seek help from 52/68 (77%) to 50/50 (100%). Students also increased their understanding of what to do if a peer had an FTP issue from 31/68 (45%) to 46/50 (92%). The factors that both facilitate and discourage help-seeking behaviour were discussed. An FTP specific module altered students’ perceptions, levels of confidence, knowledge and understanding regarding FTP issues. It also increased students’ intentions to seek help. Strategies to support students’ FTP issues were described with discussion of strategies to improve the FTP specific module. Lo, K., Cracknell, A., Hopmans, R., & Maloney, S. (2018). An online fitness to practise specific module alters physiotherapy students’ health knowledge, perceptions and intentions. New Zealand Journal of Physiotherapy 46(2): 79-87. doi:10.15619/NZJP/46.2.05

What impact do students have on clinical educators and the way they practise

The clinical education setting plays an important part in teaching students about the real world of clinical practice. Traditionally the educational relationship between student and clinical educator has been considered one-way, with students being the ones that benefit. This review focuses on the areas of clinician practice and behaviour that students are reported to influence through clinical placements and as such, determine the overall impact students can have on supervising clinicians. Electronic searches were conducted across MEDLINE, EMBASE, PsychINFO and CINAHL in July 2016. Retrieved articles were filtered to find those which presented data relating to students in the clinical setting. Data was extracted and analysed independently by two authors through thematic analysis. Twenty-eight studies met the inclusion criteria. Results showed that practitioners enjoy the act of teaching. Clinical student presence encourages clinicians to solidify their knowledge base, stimulates learning and causes them to re-evaluate their practice. Practitioner skills were further developed as a results of students. Clinical educator workload and time spent at work increased when a student was present with time management being the predominant challenge practitioners faced. Studies demonstrated that clinicians feel they benefit by students periodically becoming the teacher. Student placements in clinical practice cause an increase in practitioner workload and lengthen their work day. These perceived limitations are outweighed by the many benefits described by supervising clinicians. Providing clinical education can enrich both the practice, and the practitioner, and the aforementioned advantages should be highlighted when offering or considering the expansion of clinical placements.

Student–clinician agreement in clinical competence as a predictor of clinical placement performance in Australian undergraduate physiotherapy students

ABSTRACT Objectives: The opportunity for student self-reflection and the accuracy of that reflection are critical to the acquisition of professional competencies. The relationship between student–clinician agreement and clinical performance in physiotherapy students has not yet been investigated. The aim was to determine whether a simple measure of student–clinician agreement assessed midway during a clinical placement predicts final placement score. Participants: 100 undergraduate Monash University Bachelors of Physiotherapy students and their clinical educators. Main outcome measures: Assessment of Physiotherapy Practice (APP). Method: Clinician and student ratings of student performance across all clinical placements from January 2012–June 2013 at two time-points (midway and final) were entered into a purpose-built, web-based platform, and then averaged across the number of placements undertaken. The relationship between midway student–clinician agreement (student minus clinician APP score) and final APP score (determined by the clinician) was analyzed via forward regression. Sub-group comparisons were performed investigating the stability of the relationship across placements. Results: On average, midway agreement was associated with a −0.50 (95% CI −0.67 to −0.33) unit decrease in final placement APP% score. This model was highly statistically significant (p < 0.001) but only explained 24% of the total variance (based on the adjusted r-squared statistic). This relationship was similar in early and late placements. Conclusions: Student–clinician agreement is related to clinical performance. A midway evaluation may provide an important opportunity to identify students “at risk” of poor clinical outcomes enabling timely implementation of support strategies. Further work is required to improve the predictive accuracy of the proposed model.