Abstract
BACKGROUND:
Limited evidence exists regarding practice educators’ and practice tutors’ experience of, and training in, student supervision in the physiotherapy workplace. This knowledge would inform universities of their learning needs and help to enhance the practice-based experience for physiotherapy students.
OBJECTIVE:
The aim of this study was to create a profile of physiotherapy practice educators’ and practice tutors’ student supervision experience, university support available to them during practice placement and training undertaken by them. This study was undertaken in the Republic of Ireland.
METHODS:
An online survey was designed and circulated via the Irish Society of Chartered Physiotherapists’ database of physiotherapy members.
RESULTS:
One hundred and ninety-two practice educators and 71 practice tutors participated. Findings indicate that the 1:1 model of practice education is the predominant model of practice education employed in the Republic of Ireland. 70% of practice educators currently receive support from a practice tutor. Fifty-five percent of practice educators undertake student supervision 2-3 times per year. However, 56% of practice educators and 48% of practice tutors had not undertaken training in student supervision in the year prior to the study. A decline was also noted in the uptake of student supervision among clinicians with 16–25 years clinical experience.
CONCLUSION:
This study provides an insightful profile of physiotherapy practice education in the Republic of Ireland. Findings are encouraging, with data highlighting that most practice educators are supported by practice tutors. Recommendations include the need for further investigation of the apparent decline in student supervision among experienced clinicians. Consideration of the learning needs of practice educators and practice tutors is encouraged as well as a review of the accessibility and flexibility of training resources provided.
Introduction
Early origins of professional education of physiotherapists date back to the 1800’s, when trainees engaged in apprenticeship-type training models based in hospital settings [1]. Since its inception, the structure of the practice-based component of physiotherapy education remains similar to these apprenticeship-style origins. This is in contrast to the academic component of physiotherapy education, which has evolved in terms of its pedagogical style and delivery embracing new approaches to the delivery of physiotherapy education both virtually and in face-to-face contexts [2, 3]. Nonetheless, performance-based assessment of the physiotherapy student on practice placement is a complex task, due to challenging decision-making undertaken by the clinician based on their observation of a student’s performance over a block of practice-based learning. Despite the criticality of practice education and this performance-based assessment process which determines students’ readiness for independent practice, physiotherapy clinicians undertake student supervision on a largely voluntary basis, and are not mandated to undertake further education to fulfil this role [2–4]. These clinicians, also known as clinical educators or practice educators provide up to one third of the overall education on physiotherapy education programmes[2–4]. Furthermore, they have a significant role in student progression and gatekeeper of patient safety. Despite this, limited knowledge exists regarding their student supervision and assessment experience or educational training undertaken for this role. This knowledge would inform physiotherapy education providers of practice educators’ needs in order to deliver an optimal learning experience and a robust and standardised assessment process ensuring physiotherapy students’ readiness for independent practice. This could also provide the impetus for further review and reform of practice education in physiotherapy programmes.
Limited knowledge also exists regarding the uptake of student supervision roles among clinicians. Literature describes challenges that may discourage clinicians from undertaking student supervision such as lack of knowledge and training regarding efficient models of practice education and fear of increased workload [5–7]. Further, the complexity of roles and demands placed on clinicians, particularly in relation to the dual nature of the educational and clinical roles they support [6, 8] and the significant responsibility undertaken in preparing physiotherapy students for independent clinical practice [7, 8] may act as further inhibitors towards the uptake of student supervision. Thus information regarding practice educators’ length of experience in student supervision, and knowledge of their engagement with training related to student facilitation and performance-based assessment would provide universities with information which would help direct development of supports and training for those engaged in this role. While current evidence [9, 10] recommends building sustainable, longitudinal programmes of training for practice educators in order to maintain currency and build educational expertise, one may miss vital gaps and key opportunities to make this a worthwhile exercise without knowledge of the current level of expertise and training among this cohort. Thus, new knowledge in this area is vital to identify priorities reflective of practice educators’ and students’ needs and would contribute to a meaningful debate on whether this training requires a more standardised approach across all physiotherapy education programmes, and whether it should be a mandatory requirement for those in the role of practice educator.
The aim of this study was to create a profile detailing practice educators’ and practice tutors’ student supervision experience, university supports available to them and training undertaken. In Ireland two key roles exist to support physiotherapy students in the workplace; practice educators and regional placement facilitators/ practice tutors. Practice educators are clinicians whose primary role is in service provision but who voluntarily undertake student supervision on an ad-hoc basis. Practice tutors/ regional placement facilitators are qualified clinicians who have a dedicated educational role in the workplace facilitating both students and practice educators, but do not carry a service load. These roles are unique to allied health professions in the Republic of Ireland and were introduced in the mid 2000’s in order to address increased student intake across the health professions [11]. For the purpose of this paper, the term practice tutor will be used to describe the dedicated educational role provided by both practice tutors and regional placement facilitators. The term practice educator will be used to describe clinicians in a primarily clinical role who undertake student supervision when required.
Method
A survey design was employed for this study which was conducted in the Republic of Ireland. This survey was part of a larger national study which investigated stakeholders’ perceptions of the current performance-based assessment process of physiotherapy students in the workplace and determined their preferences for developing this process [5, 13]. Research ethics approval was granted by the EHSREC committee at the University of Limerick (2016_02_03_EHS). Permission was granted from the Irish Society of Chartered Physiotherapists (ISCP) to disseminate the survey through their database of members (as there is no existing national database of practice educators). Eligibility was restricted to those who had been involved in student supervision and student performance assessment in the previous two years. Each participant provided confirmation of this and indicated their consent to participate in the first question of the online survey. The survey retrieved information from participants regarding the length of clinical experience accrued as a physiotherapist and as a practice educator or practice tutor, frequency of student supervision, number of students typically supervised by them, and information regarding any training undertaken in the area of student supervision/ assessment in the previous two years which would be recognised as formal CPD (Continuing Professional Development). No identifiable details were required from any of the participants; IP addresses were used as a check to ensure that participants did not respond to the survey link twice. The surveys remained open for four weeks, with two reminders sent via the ISCP. Data was exported to excel and descriptive statistics were used to describe findings from both educator cohorts. Only completed surveys were included in the final data analysis. Duplicated entries were removed by checking IP addresses initially, followed by gender, followed by age respectively.
Results
Response rate and demographics
One hundred and ninety-two practice educators and 71 practice tutors returned complete surveys. The response rate for practice tutors was close to 100% based on the number of practice tutors employed at the time in a practice education context. This figure included both full-time and part-time staff engaged in this role, and any physiotherapists in acting practice tutor roles over this time. It was more difficult to determine the response rate for the practice educator group, as no central database exists for practice educators in Ireland but it was estimated at 65–70% based on practice educators who would have been involved in student supervision in the previous two years. Table 1 provides demographic details for the study cohort.
Demographic details of practice educators and practice tutors
Demographic details of practice educators and practice tutors
Participants provided information regarding the number of students they supervised on each practice placement and the how often they undertook student supervision per year (Table 2).
Numbers of students supervised per placement and frequency of student supervision
Numbers of students supervised per placement and frequency of student supervision
Participants answered questions regarding training undertaken to develop their skills in student supervision and mentoring in the workplace. One question related to how many training events they had undertaken related to student supervision in the previous year while the second asked participants how regularly they felt they should undertake training on student supervision (Table 3).
Training undertaken in student supervision
Training undertaken in student supervision
This study provides a profile of practice educators’ and practice tutors’ experience of student supervision in the discipline of physiotherapy in the Republic of Ireland. It included only those who had supervised physiotherapy students and had been involved in their assessment in the two years prior to the survey, due to the inclusion criteria of the larger study [13]. The information obtained from this research provides valuable information for physiotherapy education providers in an Irish context which may inform the development of learning resources and support for these work-based educators.
Demographic data
Demographic data regarding gender profile collected from both groups was consistent with that of the national cohort of qualified physiotherapists [14]. Of note from our findings was a decline in uptake of student supervision roles among clinicians with 16–25 years of clinical experience (Table 1). A similar trend was shown for the practice tutor cohort, but this may be explained by the fact that these posts were implemented during the mid-2000’s. Therefore no practice tutor could have achieved more than 10–12 years experience within this role at the time the study was undertaken. Thus, it appears that student supervision is commonly undertaken among physiotherapists with up to 15 years clinical experience but undergoes a decline thereafter. Some reasons for this may include the movement of senior clinicians to management roles or part-time employment which may affect their ability to undertake supervision roles. Nonetheless, it is a concerning development, as ultimately it indicates a potential loss of senior expertise in the education of the future physiotherapy workforce, and highlights an area demanding immediate focus and further investigation.
Practice education provision
Support on placement
The majority (70%) of practice educators indicated that they currently receive the support of a practice tutor while engaging in student supervision. This is a positive development in terms of addressing practice educator needs, and addresses many challenges related to performance-based assessment through the sharing of supervision and assessment roles between practice educator and practice tutor [5, 12]. Nonetheless, a significant minority of practice educators in the study reported that their university-based support consisted of midway visits or phone contacts only, emphasising concerns regarding limited support and communication channels for some remotely-based practice educators [5, 15]. This may threaten the uptake of student supervision and thus the sustainability of physiotherapy education programmes as well as challenging the robustness of performance-based assessment when undertaken by sole assessors [16–19]. Recent evidence in an Irish context showed that practice educators’ prioritised the need for support from either a practice tutor or a fellow practice educator when undertaking student assessment in the workplace, over and above any other suggested changes to the current assessment process [13]. This was explained by practice educators’ desire to share the responsibility of high stakes decisions regarding students’ readiness for independent practice [5, 13]. Physiotherapy students also shared this opinion, perceiving that a second assessor lent more credibility and trustworthiness to the assessment process [12, 13].
Traditional models
Eighty five per cent of practice educators surveyed indicated that they supervised one student per placement (1:1 model), with 13 % undertaking a paired model (two students per educator). This highlights that the traditional apprenticeship model of practice education continues to be the most commonly employed model of practice education for physiotherapy students in the Republic of Ireland. This is important when one considers the global challenges of placement capacity juxtaposed against a plethora of evidence supporting collaborative models of work-based learning [20–23]. The need for advancement of student learning in the workplace through shared learning opportunities and inter-professional learning as well as maintaining currency with international practice education delivery challenges the persistence of the 1:1 model. However, it must also be acknowledged that successful execution of non-traditional models of practice education requires preparation, education, facilitation and significant support [22, 23] which may not be readily available through current methods of training delivery. Thus, our findings may encourage universities to review content, accessibility and flexibility of delivery of current training resources and lead them to consider how best to promote and support educators in the uptake of collaborative and non-traditional models of practice education.
Practice tutor model
The practice tutor model in the Republic of Ireland involves the employment of a dedicated educational role in the workplace to facilitate both the student and the educator. Recent evidence in an Irish context has highlighted several benefits of this model including the shared responsibility that occurs between the practice educator and practice tutor during assessment and supervision, a benefit endorsed by both students and practice educators [5, 13]. Further, practice tutor sites have been perceived as centres of excellence for student facilitation, due to the throughput of students there [5, 12]. The practice tutor model has also been successfully piloted in Canada and boasts similar benefits [24]. Our findings suggest however, that some practice tutor sites may not be engaging at full student capacity, which may deny some students the benefits of the learning and assessment experience associated with these sites as highlighted in recent studies [5, 12]. At the time of their implementation in the mid-2000s, it was recommended that each practice tutor post would support six students in the workplace (pro rata). While we did not ask practice tutors for their full-time / part-time employment status in this study, practice tutors are generally employed on sites where multiple students are facilitated. Our data indicates an anomaly in this respect, highlighting that up to 40% of practice tutors may only supervise one student at a time and 20% may undertake student supervision just once a year. (See Table 2). This raises concerns, particularly when these roles have been shown to provide a solution in part to the global issue of placement capacity due to the number of students facilitated at these sites. Our data questions the recommended operationalisation of the practice tutor role and raises the question, that if not engaged in this support role, what other roles may be taking them away from this critical function. Thus, it is imperative that universities and practice tutor sites engage in a meaningful way to provide clear accountability for these dedicated educational roles in order to protect and utilise to its full potential, the supported learning experience for practice educators and students, while continuing to develop and grow educational expertise on these sites [5].
On a positive note, 55% of practice educators indicated engagement in student supervision 2-3 times per year, highlighting a growing population of experienced practice educators in the physiotherapy profession. It also emphasises the significant responsibility borne by this cohort in the preparation of students for the workforce. The need for this expertise has been identified by physiotherapy students in a recent study where they perceived greater knowledge regarding student supervision and assessment among those practice educators who undertook student supervision on a regular basis [12]. Thus our findings in this regard are encouraging. However, a significant minority (40%) of practice educators indicated undertaking student supervision just once a year. Evidence highlights that physiotherapy students and educators perceive more grading inconsistencies among inexperienced practice educators than those who regularly undertake student supervision and assessment [5, 12]. Thus, the need to maintain currency in supervision and assessment practices among practice educators who undertake student supervision infrequently needs to be carefully considered. Moreover, the financial costs required to deliver training to these sites needs to be weighed against the quality assurance offered by placement sites providing infrequent practice placements in making this decision. When current evidence overwhelmingly supports the benefits of the practice tutor model among practice educators and students [5, 13], it may well be a more worthwhile investment to devote time, effort and finances to the wider implementation of these dedicated educational roles in the workplace.
Training
Fifty-six percent of practice educators and 48% of practice tutors surveyed had not engaged in training related to student supervision in the previous year. According to current evidence [9, 10] ongoing faculty development is essential for maintaining standards in practice education and assessment. This finding is concerning, particularly among the practice tutor cohort who are employed in dedicated educational roles. On the other hand, 57% of practice educators and 66% of practice tutors indicated that training is desirable once or twice a year. This acknowledges the need for training among the study cohort and warrants a comprehensive review by universities of current methods of training delivery for practice educators and tutors, including consideration of accessibility of training programmes and incorporation of e-learning or blended learning methods.
Limitations
Our findings may have been limited by our criterion which allowed only practice educators and practice tutors who had experience of student supervision and assessment in the two years prior to the survey to participate. This was one of the inclusion criteria for the main study [13]. Nonetheless, we argue that the data collated provides a clear profile of the current status of practice education within physiotherapy, which is what we set out to achieve. In order to maximise the reach of the study, the survey was disseminated through the Irish Society of Chartered Physiotherapists’ (ISCP) database of members. This may have influenced the response rate as not all practising physiotherapists in the Republic of Ireland are members of the ISCP. The authors chose this dissemination route as the optimum method of dissemination due to the absence of a central database of practice educators in the Republic of Ireland. However, we acknowledge that this may have excluded some practice educators and tutors from participating.
Conclusion
This study provides a profile of practice education within the discipline of physiotherapy in the Republic of Ireland. Findings highlight that the 1:1 model of practice education is the predominant model employed in practice education in physiotherapy in the Republic of Ireland, highlighting the need for universities to consider how best to promote other models of practice education in light of placement capacity challenges. Additionally, our findings recommend further review of the capacity of practice tutor sites to ensure that they are accountable for the provision of learning and support for students and educators as recommended in original guidelines for this model of practice education and supported by current evidence [5, 24]. A review of content, accessibility and flexibility of training resources provided by universities to educators is recommended to maintain and develop the quality of the practice education experience within physiotherapy programmes in the Republic of Ireland. Furthermore, consideration should be given to whether training should be mandatory for practice educators undertaking student supervision and assessment. Finally, the apparent decline in the number of senior clinicians (15–25 years clinical/ student experience) undertaking student supervision requires further examination and clarification to prevent the potential loss of valuable clinical expertise in practice placement learning. This decline is particularly concerning if due to reasons other than career progression within the physiotherapy workforce and demands closer analysis, with innovative solutions required to promote the value of all physiotherapists as educators whether early or late career, in fulltime or part-time employment. In summary, the recommendations from this study are as follows: Further investigation is needed to analyse the apparent decline in uptake of student supervision among physiotherapists with > 15years clinical experience. Further investigation of capacity and student intake at practice tutor supported sites is warranted. Consideration and promotion of non-traditional models of practice education is advocated. Consideration by universities, health service managers and placement providers of practice educator and practice tutor learning needs, and accessibility/ flexibility of training resources provided is recommended. Consideration of the need for mandatory training of practice educators and practice tutors by universities, health service managers and placement providers, in order to maintain and develop expertise in student support and facilitation for the protection of the student, the future physiotherapy workforce and patient care.