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Abtract: The development of an instrument to measure physiotherapy educators' attitudes towards failing to fail student underperformance on placement

Dr Jennifer Cleland, University of Aberdeen

This project is a collaboration between medicine (Aberdeen) and physiotherapy (RGU).

Difficulty assessing students’ clinical performance is an issue in the training of all healthcare professionals who undergo a combined theoretical and practical professional training. Accurate assessment of student performance on clinical placement is essential: underperforming students are likely to ultimately fail or become incompetent healthcare professionals. However, clinical assessments do not always accurately reflect healthcare student performance (e.g., Norman et al. International Journal of Nursing Studies 2002;39:133–45; Bogo et al. Clinical Supervisor 2007;26:99–117; Dudek et al. Academic Medicine 2005;80(Suppl):84–7).

Literature relating to assessment of the clinical performance of physiotherapy students is limited. The available data suggests similarities with medical education e.g., supervisors place different importance on different characteristics (Cross & Hicks. Physiotherapy 1997;83:249–60), assessors are not clear as to the required standards, grades do not always accurately reflect ability (Alexander. Assessment and Evaluation in Higher Education 1996; 21: 357-66). However, there have been no explorations of placement supervisor attitudes, cognitions and beliefs about reporting student underperformance, and any related research has been atheoretical (e.g., Meldrum et al. Physiotherapy 2008; 94: 212-219) so lacks generalisability. Work using a theoretical approach is required to explore the “failure to fail” phenomenon in physiotherapy, to identify what issues need to be addressed to underpin accurate assessment of student performance on clinical placement.

Understanding of the phenomenon of “failure to fail” has been advanced by Cleland’s recent work, leading to the development of a questionnaire measuring the reasons clinical supervisors do not fail underperforming medical students (Cleland et al. Medical Education 2008: 42: 800–809). This questionnaire uses the theory of planned behaviour (TPB: Ajzen. Org. Beh. Human Dec. Proc.. 1991; 50: 179-211) to assess in what ways cognitions influence behaviour in this area (in submission to Medical Education).

Objectives, aims and methods

  • Modify Cleland et al.’s questionnaire for physiotherapy using focus groups with RGU physiotherapy educators (four focus groups, 4-8 people in each group) to identify question content and agree question wording. A TPB schedule will be used to structure the focus group discussions. Participants will be selected purposively in order to reflect broad areas of clinical practice, level of teaching responsibility, etc. The focus groups will be audio-taped with consent, and transcribed verbatim for analysis. Framework analysis will be used.
  • Pilot the modified questionnaire for readability and interpretability with 10 physiotherapy educators, modify if required.
  • Measure questionnaire test-retest reliability with physiotherapy placement supervisors. This will be carried out by a member of the University of Aberdeen’s Medical Statistics Team who led the analysis of the original medical educator questionnaire. Baseline analysis will include calculation of Cronbach’s alpha to examine the internal consistency of the instrument, factor analysis and data reduction techniques to identify clusters of questions which form specific constructs. Test retest analysis will include comparison of baseline and follow-up responses using the Wilcoxon signed ranks test, Bland and Altman plots and calculation of limits of agreement.
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