Physiotherapy student contribution to the delivery of health services and the transition from student to new graduate

Clinical education in physiotherapy is arguably the most important contributor to developing safe and competent new graduate physiotherapists and supporting the transition from student to new graduate. However, with increasing demand for clinical placements and a fiscal health environment, there is a growing need to identify how physiotherapy students contribute to the delivery of health services. This also raises the need to investigate how clinical placements impact the transition from student to new graduate. This thesis, comprising of five studies, examines the student contribution to the delivery of health services and how physiotherapy students transition to new graduates.

The first study investigated the direct patient care activity of individual physiotherapy students during 5-week clinical placements in three clinical areas: cardiorespiratory, musculoskeletal and neurorehabilitation. Clinical activity data, measured by occasions of service (OOS) and length of occasion of service (LOOS), was obtained from five Queensland public health sector hospitals totalling 300 weeks of clinical activity data. The clinical educator to student (CE:student) ratio, which describes the clinical educator full time equivalent supervising the number of students participating in the same clinical placement were also collected. The average OOS completed by an individual student during a cardiorespiratory placement was 98.3 OOS, 74.0 OOS for a musculoskeletal placement and 72.4 OOS in a neurorehabilitation placement. In the three clinical areas, the total number of OOS provided by students in each week increased from week 1 to week 4 and plateaued in week 5. A main effect existed between LOOS and weeks (F = 402.1, p < 0.001) and LOOS and clinical area (F = 1331.5, p < 0.001). In each clinical area the average LOOS reduced each week. There were differences between hospitals in each clinical area in the average OOS completed per student during a clinical placement. The average OOS per student per 5-week clinical placement block was not different between CE:student ratios in each of the three clinical areas.

The second study investigated the direct patient care activity of a group-of-students and how this compared to the direct patient care activity of a junior and senior physiotherapist. Study 2 also examined the impact of clinical area and CE:student ratio on the student contribution to the delivery of health services. Clinical activity data were obtained from physiotherapy students and physiotherapists working at five Queensland public health sector hospitals in the clinical areas of cardiorespiratory, musculoskeletal, neurorehabilitation and orthopaedics. Data were collected from 135 groups of physiotherapy students (408 individual student clinical placements) representing 2040 weeks of clinical activity data. The average OOS/day a group-of-students participating in a collaborative clinical placement was 10.6 OOS/day. A higher CE:student ratio produced more OOS/day in three of the four clinical areas. Clinical area and CE:student ratio accounted for 39% of the variance in average OOS/day a group-of-students completed. On average a group-of-students were able to meet the direct patient care activity of a junior and senior physiotherapist by week 2 of a 5-week clinical placement.

The third study was a qualitative exploration of the perspectives of new graduate and experienced physiotherapists on the student contribution to the delivery of health services. Focus groups with a semi-structured interview guide were conducted at five Queensland public health sector hospitals with new graduates and experienced physiotherapists. Focus group interviews were transcribed verbatim and a thematic analysis conducted. Three main themes were identified: tangible student contribution, non-tangible student contribution and factors that influence the student contribution. Factors that influenced the student contribution included meaningfulness of activities, autonomy, efficiency, students struggling with clinical practice and the CE:student ratio.

The fourth study investigated the change in direct patient care activity from student to new graduate. The clinical activity data of 412 student clinical placements representing 2060 weeks of clinical activity and 445 weeks of new graduate clinical activity data were obtained from five Queensland public health sector hospitals. Data were obtained from students on clinical placement across four clinical areas: cardiorespiratory, musculoskeletal, neurorehabilitation and orthopaedics. OOS and LOOS data were collected in weeks 4 and 5 of a 5-week clinical placement to determine the change in percentage of direct patient care, average OOS and average LOOS from physiotherapy student to new graduate. Students spent on average 56% of their time in direct patient care activities compared to 80% for new graduates (p < 0.001). In each clinical area students completed significantly less OOS than new graduates (p < 0.001) completing approximately half as many OOS. Students LOOS was greater than new graduate in all clinical areas with an approximate difference of 30%.

The fifth study examined the perspectives of new graduate and experienced physiotherapists on the transition from student to new graduate in five Queensland public health sector hospitals. Focus groups with a semi-structured interview guide were conducted, transcribed verbatim and thematically analysed. Four themes emerged: preparedness for practice, protected practice, independence and affirmation of practice and performance expectations. Furthermore, three key strategies to enhance the transition from student to new graduate were identified. These were organisational, clinical placement experiences and self-efficacy.

This research program demonstrated that physiotherapy students contribute to the delivery of health services by primarily providing direct patient care but also in supporting the health service and staff development. The clinical area and CE:student ratio are important considerations when planning for student clinical placements and maximising the student contribution. There is a gap between student and new graduate practice, and transition to independent clinician poses many challenges which necessitates the need for stakeholders to work together to support the transition from student to new graduate.