Core components of communication of clinical reasoning: a qualitative study with experienced Australian physiotherapists

Communication is an important area in health professional education curricula, however it has been dealt with as discrete skills that can be learned and taught separate to the underlying thinking. Communication of clinical reasoning is a phenomenon that has largely been ignored in the literature. This research sought to examine how experienced physiotherapists communicate their clinical reasoning and to identify the core processes of this communication. A hermeneutic phenomenological research study was conducted using multiple methods of text construction including repeated semi-structured interviews, observation and written exercises. Hermeneutic analysis of texts involved iterative reading and interpretation of texts with the development of themes and sub-themes. Communication of clinical reasoning was perceived to be complex, dynamic and largely automatic. A key finding was that articulating reasoning (particularly during research) does not completely represent actual reasoning processes but represents a (re)construction of the more complex, rapid and multi-layered processes that operate in practice. These communications are constructed in ways that are perceived as being most relevant to the audience, context and purpose of the communication. Five core components of communicating clinical reasoning were identified: active listening, framing and presenting the message, matching the co-communicator, metacognitive aspects of communication and clinical reasoning abilities. We propose that communication of clinical reasoning is both an inherent part of reasoning as well as an essential and complementary skill based on the contextual demands of the task and situation. In this way clinical reasoning and its communication are intertwined, providing evidence for the argument that they should be learned (and explicitly taught) in synergy and in context.     

Practicing physiotherapy in Danish private practice: an ethical perspective

Despite an increasingly growth of professional guidelines, textbooks and research about ethics in health care, awareness about ethics in Danish physiotherapy private practice seen vague. This article explores how physiotherapists in Danish private practice, from an ethical perspective, perceive to practice physiotherapy. The empirical data consists of interviews with twenty-one physiotherapists. The interviews are analysed from a hermeneutic approach, inspired by Ricoeur’s textual interpretation of distanciation. The analysis follows three phases: naïve reading, structural analysis and comprehensive analysis. Four main themes are constructed: Beneficence as the driving force; Disciplining the patient through the course of physiotherapy; Balancing between being a trustworthy professional and a businessperson; The dream of a code of practice. Private practice physiotherapy is embedded in a structural frame directed by both political and economical conditions that shape the conditions for practicing physiotherapy. It means that beneficence in practice is a balance between the patient, the physiotherapists themselves and the business. Beneficence towards the patient is expressed as an implicit demand. Physiotherapeutic practice is expressed as being an integration of professionalism and personality which implies that the physiotherapists also have to benefit themselves. Private practice seems to be driven by a paternalistic approach towards the patient, where disciplining the patient is a crucial element of practice, in order to optimise profit. Physiotherapists wish for a more beneficent practice in the future by aiming at bridging ‘to be’ and ‘ought to be’.     

Exploring continuous clinical placement for undergraduate students

Clinical placements are integral to health professional preparatory courses. These placements allow for the application of classroom-based learning into real patient care situations. In doing so, they provide opportunities for applying theoretical knowledge into practice contexts, skills development and socialisation into the chosen profession. However, despite its recognised importance across health professions, little has been written about optimal structures for supporting clinical learning. This paper presents one group of findings from a larger qualitative study aimed at exploring health professional student’s clinical experiences and their impact on career intentions. Findings reported here present a group of undergraduate midwifery student’s perspectives on a “home” hospital clinical placement model where continuous clinical placements were taken in the same agency (or hospital group) for 2 days per week over the final 2 years of their course. Two main themes emerged from the data analysis, these being, ‘familiarity’ and ‘continuity’. It is concluded that continuous placements in the same clinical setting have the potential to offer greater opportunities for learning and early professional socialisation than traditional block (Monday to Friday) placements. They can offer a more integrated approach to classroom theory and its application into practice.     

Survey of the perceived professional, educational and personal needs of physiotherapists in primary care and community settings

The emphasis of UK Government policy on primary-care-based services has led to more physiotherapists working in the community. The aims of the present study were to identify the perceived professional, educational and personal needs of community physiotherapists, and to determine good practice in meeting these needs. A survey of physiotherapists working in 15 National Health Service community trusts in the West Midlands was carried out in September 2000. The survey questionnaire was developed through focus groups and mailed to a random sample of 200 community physiotherapists. The response rate was 67%, and the median age group of the respondents was 21-30 years. The participants worked mainly in 'urban but not inner city' areas, most commonly in domiciliary (31%, n = 38) and general practitioner surgery/health centre (26%, n = 32) locations. Fifty-one per cent (n = 66) of respondents had no specific learning objectives for continuing professional development (CPD); those with such objectives were more positive as to their helpfulness than those without them (Mann-Whitney U-test z = 2.519, P = 0.012). Fifty-three per cent (n = 68) also often/very often found it problematic getting cover for their caseloads so that they could take part in CPD activities. Access to library resources and use of computers were problems, as were confidence in appraising literature and opportunities to discuss research evidence with colleagues. Fifty-nine per cent (n = 77) of respondents indicated that they often/very often felt stressed by the size of their caseloads. Colleague support included mentorship, peer review, journal clubs, clinical interest groups and multidisciplinary in-service training; respondents with experience of these resources expressed more positive attitudes to them than those without (Mann-Whitney U-test z = 2.871, P < 0.0005 for each). Forty-two per cent (n = 54) indicated that there were problems with safety issues. This study has identified needs that will have an impact on the ability of community physiotherapists to meet the demands of clinical governance. National Health Service management at all levels has a responsibility to facilitate the education, training and support of community physiotherapists.     

Service Learning: The Process of Doing and Becoming an Occupational Therapist

ABSTRACT

The purpose of this phenomenological study was to explore the perceptions and experiences of entry-level occupational therapy students participating in a service-learning experience designed to provide preventive occupation-based social skills groups to low-income urban youth attending after-school care. Reflective journals and focus groups were used to study how the students made sense of their experience. Qualitative data analysis resulted in six major themes revealing the process of professional growth over the eight-weeks. Professional reasoning progressed from mechanical procedural reasoning to flexible forms of conditioning reasoning. Findings emphasize the critical role of active participation in real-life contexts on learning how to become an occupational therapist. Study findings provide a discussion about the possibilities of preparing future occupational therapy practitioners to address society's occupational needs in emerging practice areas.     

Students’ opinions about the effects of preclinical patient contacts on their learning

Several reasons have been given why students should have contacts with real patients early in the undergraduate medical curriculum, i.e., in the preclinical phase. However, it is not clear exactly what effects early patient contacts have with regard to knowledge construction and the development of clinical reasoning skills. We sought students’ views of the effects of preclinical real patient contacts on their learning, knowledge construction and development of clinical reasoning. Twenty-four students in the third and last preclinical year of a 6-year undergraduate medical programme were divided into three focus groups which met twice, after which saturation was reached. The discussions were recorded and transcribed. Summaries of the discussions were approved by the students after some modifications. Atlas-ti software was used to create a coding framework resulting in identification of main themes and sub themes. Early patient contacts motivate students to study, help them understand the impact of illness on patients’ lives, and enhance professional socialisation and memory processes. Students distinguish between analytic and non-analytic clinical reasoning in connection with real patients. Analytic reasoning involves clinical and basic science knowledge. Non-analytic reasoning involves pattern recognition and is made possible by experiential learning from different patient contacts. The students indicate that seeing real patients early in their training has several positive effects on their learning. The contacts enhance knowledge construction and clinical reasoning. Although our results will have to be validated by quantitative, observational and experimental research, they imply that educational benefits are to be gained from real patient contacts in the preclinical phase of medical education.     

Configuration of occupational therapy,professionalism and experiential learning — An integrated introductory course

The professional obligations of an occupational therapy faculty include the need to provide students with means to develop a sound professional identity and facilitate a positive and coherent professional socialisation process. This article proposes that, through calculated construction of an introductory occupational therapy course, one can relate to these issues. It suggests basing the course content on Mosey's concept of ‘the configuration of occupational therapy’, in answer to possible problems in professional identity, and at the same time working to develop the basic professional socialisation dimensions — knowledge, skills and art of therapy. It uses experiential learning theory, both as an instrument for the examination of students learning styles and for choosing teaching methods.     

Steps towards evidence‐based foot‐care for children: Behaviour and opinions of health professionals

Allied health professionals (AHPs) working with children need the appropriate knowledge, skills and experiences to provide high‐quality care. This includes using research to drive improvements in care and ensuring that knowledge and practices are consistent and build upon the best available evidence. The aim of this work was to understand more about the shared behaviours and opinions of health professionals supporting children's foot health care; how they find information that is both relevant to their clinical practice as well as informing the advice they share. A qualitative design using semi‐structured, one‐to‐one, telephone interviews with AHPs was adopted. Thematic analysis was used to generate meaning, identify patterns and develop themes from the data. Eight interviews were conducted with physiotherapists, podiatrists and orthotists. Five themes were identified relating to health professionals: (a) Engaging with research; (b) Power of experience; (c) Influence of children's footwear companies; (d). Dr Google – the new expert and (e) Referral pathways for children's foot care. The findings indicate that the AHPs adopted a number of strategies to develop and inform their own professional knowledge and clinical practice. There could be barriers to accessing information, particularly in areas where there is limited understanding or gaps in research. The availability of online foot health information was inconsistent and could impact on how AHPs were able to engage with parents during consultations.