Assessment of Clinical Placements in a B.Sc. Physiotherapy Program

The research aim of this paper was to assess clinical placements in a B.Sc. Physiotherapy Program. The research was carried out by Jose M Frantz, PhD an Associate Professor, University of the Western Cape, South Africa and Anthea J. Rhoda, MSc, a lecturer at the same University. It was printed in The Internet Journal of Allied Health Sciences and Practice. July 2007, Volume 5 Number 3. The researchers’ objective was to evaluate existing clinical venues for physiotherapy students at the University of Western Cape, South Africa. They used both quantitative and qualitative methods, using a validated seventeen-item questionnaire using a Likert scale which ranged from 1-5, (1 representing strongly disagree to 5 representing strongly agree) for the quantitative information. Five open ended questions were used for qualitative research and themes were identified. Clinicians’ attitudes along with student positive and negative responses were recorded and the data analysed. Points on areas to improve were also highlighted.

This report will look at Literature reviewed by the researchers, Methodology used, Findings and Analyses, Ethical Considerations and finally a Conclusion with a reflective insight on the paper.

Literature Review

(Ridley 2008 p16) states the function of a literature review is to show how related work in the field shapes and influences your research. Ridley states that there are multiple purposes of a Literature Review including:

• looking at historical background of the area to be studied.
• finding out the place in which the study will fit in with current research.
• relevant theories and concepts.
• definitions and terminology relevant to the research.
• related research in the field and shows how the study extends or challenges this, or addresses a gap in work in the field.

It also provides supporting evidence for the issue which the research is addressing, thereby underlining its significance.

In all areas of research, literature reviews are used to inform researchers of the background to research projects and to provide context and ideas for the design of new studies. (Wynn Harlen & Ursula Schlapp, SCRE 18/11/99 The Scottish Council of Research in Education).

Literature review is carried out by the researchers by implementing an in-depth search into the subject they are looking at. They will read widely around the subject, comprehensively searching work done by others so that they are aware of where their own work stands in relation to these studies.

Frantz and Rhoda reviewed the question set by Dunn S and Hanford B, in the Journal of Advanced Nursing, 1997, which was, Undergraduate nursing students’ perceptions of their clinical learning environment. Dunn and Hanford identified that ‘interpersonal relationships play an enormous role in the students perceptions of the clinical learning environment’ and that staff and patients can have major influence in development. Frantz and Rhoda have used these findings to support their research and state that clinical experiences encountered by student in their undergraduate program can influence the quality of education and the ability for physiotherapists to adapt to clinical roles upon graduation. Frantz and Rhoda have also taken the point made by Dunn and Hanford that collaboration is essential for optimum student learning.

Methodology

The Philosophical Approach to the study can be described as Phenomenological. It concentrates on the direct experiences of the students on placement and their thoughts.

The overall approach used for the study was a mixed one. The researchers have used quantitative and qualitative methods.

Definition of quantitative. (Oxford Dictionary of English 2005)

Concerned with or measured by quantity

Definition of qualitative. (Oxford Dictionary of English 2005)

Concerned with or measured by quality 2. Describing the quality of something in size, appearance, etc.

For quantitative research Frantz and Rhoda have used a questionnaire format with 17 items assessed by a Likert scale.

Quantitative research therefore is concerned with the collection of measurable data so that it can be analysed effectively. It is the use of facts and figures, and does not concern itself with emotion and feelings.

For qualitative responses, five open ended questions were added for the students to have further input explaining their experiences.

Qualitative research therefore looks at responses that deal with attitudes, beliefs and motivations of the study group.

Hammel & Carpenter 2004, state that scientific evidence such as found through quantitative research is the best source of evidence based practice in the Health services and Qualitative research is not seen as part of the evidence based process.

However, Frantz and Rhoda have identified that using both quantitative and qualitative methods will achieve the best results for the purpose of their study. This is a balanced approach to research.

Design

The research design is the overall plan for the study. There are two basic categories of research design, Experimental and Non Experimental. This paper is non-experimental, which can also be called Descriptive. It is cross sectional in design.

The study does not try to change behaviour or conditions and things are measured as they are, therefore it takes the form of a non-experimental or descriptive format of study. The design of this particular study is cross-sectional as defined on the website http://www.sportsci.org/jour/0001/wghdesign.html

In cross-sectional studies variables of interest in a sample of subjects are assayed once and the relationships between them are determined.

The researchers have decided to use the questionnaire in a quantitative and qualitative manner and use the results without intervention or alteration to the sample study group.

Method

The method used by Frantz and Rhoda was a questionnaire. Their questionnaire had been used in another study but was sent for peer review to determine its appropriateness in this particular research.

A questionnaire is a set of printed or written questions with a choice of answers, devised for the purposes of survey or statistical study (Oxford Dictionary of English 2005)

In this case the questionnaire is a seventeen item instrument, using a Likert scale. Answers range from strongly agree to strongly disagree. This part of the questionnaire deals with quantitative data as described above. Frantz and Rhoda also added five open ended questions which allow further input from the students which gives them a chance to explain their answers in more depth. This forms the qualitative approach to the study.

(Gillham 2002) points out that the answers in a structured questionnaire have already been determined by the researchers. This can be seen in the 17 item instrument of the first part of Frantz & Rhoda’s questionnaire. Semi structured questionnaires have open questions. We can see that the researchers have used a mixture of both to determine their answers.

A mixed approach is appropriate to gain more from the students’ responses than the answers that the researchers have already pre-determined, albeit on a sliding scale from 1-5 (1 = strongly disagree to 5 = strongly agree).

The target population for the study were all physiotherapy students registered for clinical practice in their third and fourth year. The total sample should have consisted of 332 responses. The sample was in fact only 61% of this figure as many students decided not to participate in the study by not filling out the questionnaires.

Results & Data

The students rotated through various placements, the number of placements depending on which year they were in. The most students rotated through primary settings which were community health centres and district hospitals, followed by tertiary hospitals, special schools, secondary hospitals, community settings (service centres for the elderly and NGO’s) and specialized areas.

Each student had the opportunity to fill in a questionnaire relating to their placements. Out of a total response of 61%, 44% had been at a fourth year placement, 40% at a third year placement and 16% at a placement that accommodated both years.

The research found that overall the students were satisfied with the clinical placements they are expected to attend as part of the BSc physiotherapy program.

However when these results were broken down the researchers’ findings was different. The level of satisfaction, with clinical placements according to setting, was not as high and areas were highlighted where students were more dissatisfied than satisfied. Areas identified where there was least satisfaction, were community settings. There were a lower percentage of students rotating through this particular setting than all but specialized settings.

The results gained from the qualitative part of the questionnaire i.e; the open ended questions helped back the findings from the initial quantitative results. The students expressed their dissatisfaction when they were able to say how they felt emotionally about their individual placements. Frantz and Rhoda identified quotes from students that helped to qualify their findings from the quantitative part of the study. The qualitative answers also identified that 33% of students were of the opinion that the clinicians were unwilling to help and students had a negative opinion of them.

The findings also highlight that 48% of students who were in a tertiary placement and 44% community placement felt unprepared for the placement, but by the end of the placement block 72% and 100% of the students felt confident to work in these areas.

Data

The data was analysed using SPSS for the quantitative data. This is a Statistical Package for the Social Sciences. It uses predictive analytics for the objective of improving business processes to meet organisational goals (SPSS.com).

The open responses that the students added were analysed by Frantz and Rhoda and a third member by grouping responses into themes. To confirm the credibility of this data a focus group was held at the end of the academic year.

There were seven themes identified from the open responses. These were;

• the placement experience
• orientation
• assistance from staff
• feedback
• poor experience and learning opportunities in community setting
• adequate amount of clinical

Discussion

Understanding gained from the research:

The understanding gained from the research was that overall students were positive about their learning experiences from the clinical placement, gaining skills and confidence throughout. However the students it seems would have liked more support from the clinicians who they were involved with especially those in a community setting. It would seem that they preferred the more hands on settings as community setting has a different approach and focuses more on community empowerment, health promotion and project development.

Implications for practice

In the findings, students made recommendations about improving placement as a learning experience. The training institution was to address the problem. By addressing this problem and the problem of not enough supervision time, further generations of students could benefit even more from their clinical placement.

Limitations of the study

There were some limitations to the study. First of all the response rate was only 61%. A more accurate picture could have been gained had all students filled in the questionnaires. There was only one study done and was not repeated so findings are limited to that study. The competence of the students was not taken into account or the views of the clinicians at the settings in which they were learning.

Recommendations for further research

Further research could be done to gain a fuller understanding of the problems, possibly target the students who gave negative feedback to see where the placement had failed in its goal. Clinicians’ views and feedback could be analysed in more depth and the level of competency of the students prior to placement could be researched.

Ethics

Moral principles that govern a person’s behaviour or the conducting of an activity (Oxford Dictionary of English 2005)

When looking at ethics (Birley & Moreland 1998 p24) identified four main issues.

1. Respect for persons involved.

A person’s confidentiality has to be respected and their identification should not be possible. If a person does not wish to take part in a study their decision should also be respected. Any person taking part in the study should be allowed to check what is reported in the research is accurate to what they have said or written.

2. Respect for truth.

Authenticity is vital with no bias being shown.

3. Openness.

Data collection methods should be made available to the reader without confidentiality being compromised. Confidentiality always being the main priority.

4. Record keeping.

Records have to be kept of all data (when, where, how and from whom) to back -up validity and reliability checks.

From the paper it is clear the authors did not acquire written or verbal consent for their research. The questionnaires were filled out by the students and it was taken that this was consent by the students to participate in the study. The students also had the option of not filling the questionnaires in. The aims of the study and the benefits to be gained from it were explained to the students at the end of every five week block but it is unclear whether the students realised that the responses were to be used in a Research paper. This does question Frantz and Rhoda being ethical in their methods of data collection and the use of those results obtained.

Conclusion

Frantz and Rhoda concluded clinical placement proved a positive experience for physiotherapy students. The researchers identify that students, clinicians and academics have to improve their relationships for best use to be made of placements. Communication and collaboration are vital for the students to have a good experience in the clinical setting. The training institution has to address student confidence at the start of their placement as this was identified as a problem in the study.

Reflective Conclusion

While writing this essay I have gained great insight into how research is carried out. I have observed in particular the use of a questionnaire to collect information for a study and the effectiveness of using Quantitative and Qualitative methods to obtain results.

I have realised that:

Researchers must be thorough in their Literature Review and have a clear understanding where their particular study will fit in with other relevant research. It must not be a waste of time or resources.

The methodology chosen has to be appropriate for the subject matter researched and how the results are obtained has to be clearly defined. In this case the questionnaire had already been used before which in some ways is only repeating a study that has already been carried out. It was not adding anything new to previous research and was only relevant to their particular University.

Results and data have to be analysed in a fair and correct manner. Using results and data that suits the objective of the researchers will not give a true reflection of the study that has been carried out.

Ethical issues have to be given more consideration and participants must have a clear understanding of what they are participating in while giving their full consent.

The Warwick Medical website suggests that values come through in wishes, preferences, perceptions, choices, expectations, hopes, fears etc. The students researched by Frantz and Rhoda express these wishes etc through the open ended questions in the questionnaire. Values of this nature have a part to play in research of this kind when experiences of the individual are being analysed.

My conclusion is that for this kind of study related to the health sector, a combination of both Evidence Based Practice and Values Based Practice is the best way to carry out a study and obtain results which can be used to implement improvement to the question targeted by the research.