Majority of students were highly satisfied with their clinical education experience. The survey findings showed that students learning needs were met, and that they received good support and supervision. Participants reported high level of satisfaction as majority of responses were between agree to strongly agree on all the items of survey tool. Percentage of participants response to each item of the questionnaire on Likert scale presented in table 3 below.
Table 3: Students’ perspectives about clinical education
Items
|
Number of responses
|
5 - Strongly Agree
|
4 - Agree
|
3 - Undecided
|
2 - Disagree
|
1 - Strongly Disagree
|
Total
|
Provided with the objectives of the clinical placement on the first day
|
34
|
35%
|
56%
|
3%
|
6%
|
0%
|
100%
|
Clinical education is in alignment with the objectives of the placement
|
34
|
35%
|
47%
|
9%
|
6%
|
3%
|
100%
|
There is a link between educational objectives and expectations of the clinical educators from students
|
34
|
32%
|
62%
|
3%
|
3%
|
0%
|
100%
|
There is compatibility between theoretical curriculum and clinical activities.
|
34
|
26%
|
53%
|
15%
|
0%
|
6%
|
100%
|
Clinical educator provides full support to students
|
34
|
26%
|
53%
|
12%
|
6%
|
3%
|
100%
|
Clinical educator deal with student effectively
|
34
|
23%
|
56%
|
15%
|
3%
|
3%
|
100%
|
Clinical educator has a good understanding of the physiotherapy curriculum that students' studied at their University/College.
|
34
|
23%
|
47%
|
18%
|
12%
|
0%
|
100%
|
Clinical educators have necessary cooperation with students.
|
34
|
21%
|
71%
|
6%
|
3%
|
0%
|
100%
|
Clinical educators allow students to make decisions in patient care planning
|
34
|
29%
|
59%
|
9%
|
3%
|
0%
|
100%
|
There are sufficient number of patients for learning
|
34
|
26%
|
62%
|
6%
|
3%
|
3%
|
100%
|
There are enough facilities within the department as well as in the hospital.
|
34
|
21%
|
65%
|
12%
|
3%
|
0%
|
100%
|
There is always a supervision during the clinical training.
|
34
|
24%
|
62%
|
12%
|
3%
|
0%
|
100%
|
One to one performance evaluation of the clinical placement is provided
|
34
|
21%
|
68%
|
12%
|
0%
|
0%
|
100%
|
Median, minimum, maximum and percentile statistics for each item of the questionnaire presented in figure 1 below.
Figure 1 Median and IQR Statistics
Findings of the qualitative study showed several factors affecting physiotherapy clinical education in the United Arab Emirates. Those factors were related to students, clinical educator and other academic aspects of physiotherapy program delivered at the host institution. Factors affecting clinical education are presented under these three themes. Extracts of participant interviews were useful to interpret and report the qualitative study.
Theme 1: Factors related to student
Student’s interest, learning style, personality, culture, and the ability to cope with uncertain situations in clinical placements are the factors that affected their clinical education experience.
Interest
The placement focus did not match with students’ interest. This was reported by several clinical educators and students. For example, below extracts from clinical educator and student shows that students’ interest is an important factor which affected their clinical education experience.
Our outpatient department focuses on musculoskeletal conditions and the inpatient focuses on neurological rehabilitation. I found some students were really interested in and willing to be in the outpatient’s unit than inpatients. (CE 11)
In the last rotation I was in stroke unit. I didn’t like neuro, so it was a bit difficult. (ST 5)
Learning style
According to clinical educators, individual student learning style was another factor that influenced their clinical education experience.
I can’t paint them all with the same brush. My last student was excellent but the one before that was not really very good. (CE 7)
You find students who are very inquisitive. On the other hand, there might be a passive student who would need a lot of prompts. (CE 25)
Culture
The local culture was another factor that affected clinical education in the context of this study. Students were all females and represented traditional Arabic culture. It was evident from participant interview quotes that students were very conservative and hesitant to handle male patients and work with male clinical educators.
I have seen many students expressed concerns to see a male patient. (CE 1)
I am man, so a female student takes more time to become familiar with me. When handling male patients there is some shyness. (CE 12)
I am a little bit shy in dealing with male patients especially if they are locals. (ST 5)
Coping with challenges
Students’ ability to cope with challenging situation was also a factor that affected clinical education. According clinical educators, each student’s ability to cope with uncertainties was not the same and this affected their clinical education experience which was acknowledged by few students.
In one of the sessions we have had two students and me. Patient was not onboard with what the plan of treatment was, and in an agitated state, and was not agreeing with the plan of care. One student was leading the session at that time, she got nervous and almost gave up, and wouldn’t want to talk to the patient at all. I think, she was just taken back by the whole situation and couldn’t cope up with it. On the other hand, the second student did take over and she was able to really communicate with that patient in a way that the patient left the session agreeing to plan of care. (CE 25)
I treated patient with amputation and psychological issues, and I felt like crying. (ST 1)
Timing was not easy, and it was too long without break. (ST 6)
Theme 2: Factors related to clinical educator
Clinical educator workload, teaching strategies and knowledge of physiotherapy curriculum taught to the students were the factors belonging to clinical educators which affected clinical education.
Workload
According to clinical educators, it was hard for them to manage their dual role of providing health services and at the same time train students on site. Few students reported that their clinical educators did not provide adequate attention to their learning. Therefore, clinical educator workload was a major factor that affected clinical education in the given context.
When the clinical case load is so busy, the time you have for students is often prioritized off and sometimes you are trying to teach students at a particular time, but you might be pulled in several directions to attend MDT meeting and/or other things. (CE 16)
It’s hard for us to have the main responsibility in fairness to students and the practitioner who must continue the same amount of work in the same quality with the added load of doing education to students. (CE 21)
Clinical educators don’t concentrate on us. They concentrate more on the patients. (ST 7)
Teaching strategies
Inconsistency in teaching strategies applied by clinical educators was another factor that affected clinical education within the context of this study. Participants reported that bed side teaching and empowering students to make decisions were some of the strategies enhanced clinical education experience for students, whereas unsupervised practice opportunities hindered their learning experience.
We make them do the presentation to the team. They reflect on their theory to a case and present. Often, we ask them to reflect why they made that decision and what their clinical reasoning is? (CE 9)
Sometimes they use to send me alone to see the patients, but I was scared and nervous. I understand that they want us to be confident, but we do not have much experience. (ST 2)
Some of the educators were friendly, flexible and welcoming. One therapist supported me in being independent but not all of them are same. (ST 3)
Knowledge of physiotherapy curriculum
Clinical educators reported that they were not fully aware of the physiotherapy curriculum taught at the college. Participant demographic information was useful to understand the diversity among clinical educators. They qualified from different countries and their experiences varied. Hence, it was vital for them to get in-depth background of what students have learnt at the university so that they can adapt the learning activities for students in clinical settings. Therefore, limited knowledge of physiotherapy curriculum for clinical educators was also a factor that affected clinical education in the UAE.
We don’t know what they have learnt. I don’t have enough knowledge and background of the curriculum and rely on the student information about their background. (CE 13)
We didn’t have much information about what they have studied and learnt. (CE 23)
Theme 3: Other academic factors
Physiotherapy faculty involvement, placement expectations, clinical education model, and peer learning were the other factors from academic aspect that affected clinical education in the context of this study.
Physiotherapy faculty involvement in clinical education
According to clinical educators, academic staff were not involved in teaching and assessment of students in clinical education. Participants reported that faculty involvement would have strengthened clinical education. Clinical educators expected the academics to provide support to students to bridge theory-practice gap and jointly assess students’ performance. In the given context, faculty were not involved in clinical education and this affected clinical education.
We meet with the faculty clinical supervisors once a week, but it needs to be more of a practical session. Maybe we can do assessment and treatment session together with the student, so we can correct them. It would make the marking better way. (CE 4)
It would be better if somebody allocated to students with a dedicated time to go through specific topics and see patients with students within the protected time. (CE 16)
More faculty involvement is needed to focus on the student and to take the burden out the clinician. Perhaps they can observe the patient care and discuss about it. (CE 21)
Placement expectations
The findings showed that there was a mismatch in expectations among students, clinical educators, and the college. Clinical educators have reported that there were inconsistencies in the expectations set to them by the college regarding students’ level of knowledge and skills. Similarly, students raised concerns about the way their clinical educators have graded their performance in clinical placements.
We were asked to consider them when they were in the fourth year, they like a new graduate but that level was not there. (CE 14)
If we could have an understanding about what we expect from students, so when they come they already have some idea of what kind of conditions they are going to see, what type of a setting it is, so that is not so much of a shock. (CE 3)
Some of the educators put low marks without reasons even if the student did very well. But I want to know the reasons for low scoring so that I can work on those areas. (ST 5)
Clinical education model
Clinical educators reported that the placement duration was very short, and students expressed concerns with the unintegrated nature of placements. Shorter duration did not help students to settle in a new place. Additionally, placements did not run parallel to theory courses. Below quotes from participant interviews confirm that both these factors affected clinical education.
Placement for 4 weeks are quite shorter. Students take some time to get oriented to the hospital, so, perhaps longer placements for 6 to 8 weeks may be the student would be more benefited. (CE 16)
We need more time, one month is not enough to achieve all the learning objectives. (ST 7)
I think the clinical placements should go along with the courses so that we can get real-time experience and benefit. For example, if we learn about assessment of a condition then we should simultaneously apply in real patients. (ST 5)
Peer learning
According to clinical educators, there was peer learning opportunities for students in clinical placement. This helped them to overcome difficult situations and promoted self-directed learning. Hence, peer learning was reported as one of factors that positively influenced clinical education.
There is some self-directed learning when they are together and discussing cases. (CE 17)
The pairing helps because there are two of them, so they do not feel overwhelmed and they always consult each other. So, it makes it more calming for them. (CE 3)
In this mixed methods study, findings of quantitative study showed high level of students’ satisfaction with clinical education. Conversely, the qualitative study findings showed mixed responses and identified several factors affecting clinical education within the context of the study.