This methodology adopted a five-stage framework developed by Arksey and O’Malley, which Levac and colleagues further elaborated by including aspects of quality appraisal. These stages are described in more detail below, in specific relation to this study’s aim (24,25).
Stage 1: Identifying the research question
The main question that will guide this review is, "What are existing models of community- based clinical education for undergraduate physiotherapy students?”
The subsequent sub-questions that will pave the way for the review are as follows:
- What are the clinical education models that exist for physiotherapy discipline? What is/has been the practice?
- How have community-based clinical education models been put to practice?
- What are the enablers and barriers of the identified clinical education models?
- Does any clinical education model utilize decentralized training platforms to ensure clinical competence through community engagement and social learning?
The study will adopt the Participants Concept Context (PCC) model to determine the eligibility of the research question (28).
Stage 2: Identifying relevant literature
A comprehensive search strategy will be developed for this review to harness related studies. The electronic databases will include PubMed, Pedro, MEDLINE and CINAHL, Google scholar, academic search using EBSCOhost via the University of KwaZulu-Natal and Cochrane library. Keywords will be separated by Boolean terms "AND,"; "OR,"; "NOT." The final step will be the search of the reference lists. The initial list of keywords will include, but not limited to: “clinical education,” “training,” “teaching and learning,” “undergraduate physiotherapy education,” “decentralized” or “distributed,” “community-based,” “community-engaged,” “primary health care,” “physiotherapy” / “physical therapy” and “curriculum.” A pilot study was conducted to determine the feasibility of the study (Table 2).
Stage 3: Study selection
The study research question will be utilized to guide the development of the inclusion and exclusion criteria for the proper selection of the relevant studies.
Peer-reviewed articles published in English that focus on the following theory will be included:
- Studies published in English
- Models of undergraduate physiotherapy community-based clinical education
- Undergraduate physiotherapy curricula on clinical education
- Decentralized clinical training: training conducted away from the university and central training academic hospitals (including rural sites, primary health clinics, or community health centers, district hospitals, and regional hospitals.)
- Opinion papers on community-based clinical education for undergraduate physiotherapy students
- Commentaries on community-based clinical training for undergraduate physiotherapy students
Charting of Data
A data-extracting tool (Table 3) will be created to organize and keep all data retrieved from studies during the scoping review.
Two independent reviewers utilizing the sample of the included studies will evaluate this tool. The information from studies will consist of: author, year of publication, site location, study population, institution description (CHC, Primary health clinic, hospital, community, home), site description (rural, peri-urban or urban), duration of the training at the site, aim or purpose of the study, methodology, essential results, model aspects, and recommendations. This information will be continuously updated throughout the scoping review process. All eligible studies will be uploaded on to Mendeley referencing software, and replicate studies will be removed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Fig.1) will be used to report the screening results (26).
Collating, summarizing and reporting results
This review will adopt a mixed-method analysis of the results of the selected studies, qualitative and quantitative analysis. Extracted data that will be analyzed quantitatively include numerical summaries of article type, duration of rotation, site description, location (rural, urban, peri-urban), and the aspects of the model. A descriptive-analytical method will be conducted using the Statistical Package for Social science Version 23. Thematic analysis will be used for the qualitative data from the reviewed studies to synthesize and interpret critical issues and themes arising from the included studies.
The Mixed Method Appraisal Tool (MMAT) (Appendix 1) version 2018 will be used to appraise the quality of the selected studies, as recommended by Levac et al., 2010 (25). Three reviewers (NCT, VC, and SC) will be involved in the critical appraisal process. Two reviewers will capture methodological quality criteria, according to MMAT (27). A third reviewer who is an expert in MMAT application will oversee the complete process, adding rigor to the process. The MMAT allows a concomitant appraisal of methodological quality of five study categories: qualitative research, randomized controlled trials, non-randomized studies, quantitative descriptive studies, and mixed methods studies (28).