AVOIDING THE MISMATCH BETWEEN EXPECTATIONS OF AND PERFORMANCE OF PHYSIOTHERAPY STUDENTS ON OLDER ADULTS PLACEMENTS

¹Keele University, School of Allied Health Professions, Newcastle-under-Lyme, United Kingdom

Background: Older adults are frequently a challenging population to manage within physiotherapy practice due to their complexity of presentation resulting from factors such as several comorbidities and frailty. As such, skilled clinical reasoning and effective prioritisation is required by healthy professionals in order to best manage their rehabilitation. These challenges are often further compounded by factors requiring admission to secondary care. Given that older adults are the largest users of healthcare services, student physiotherapists need to learn how to best manage this population. However, it is often difficult for students undertaking older adult focused placements early in their training to manifest these complex skills.

Purpose: The aim of this study was to explore physiotherapy educators’ perceptions of the requirements for effective clinical education of physiotherapy students on older adult placements.

Methods: Purposive sampling was used to recruit physiotherapists working in a secondary care hospital in the United Kingdom (N=15) with a range of experience (2-30 years) working in clinical areas that included interactions with older adults. Data were collected utilising semi-structured interviews and a phenomenological approach. Audio recordings were transcribed verbatim and thematic analysis was undertaken. Findings from the theme ‘The Educational Experience’ are presented.

Results: Fifteen participants (all qualified physiotherapists) of varied grade and experience discussed the requirements of physiotherapy practice in the management of older adults including the complexity of presentation, the skilled clinical reasoning required to best plan rehabilitation, and the requirement to demonstrate effective interpersonal skills in order to maximise success. They recognised the importance of experiential learning. However, there was a dichotomy to their discussions around educating physiotherapy students. They understood the challenges faced by students with the level of their knowledge and skills dictated by their point in their training programme, the reality of patient contact versus the conceptualisation of patient care within higher education, and the impact of more limited life experience on interpersonal skills. However, when asked what they wanted from their students, they cited skills around complex clinical integration and clinical reasoning including an ability to ‘think outside the box’, prioritise effectively where there are several comorbidities, and to understand all aspects of broader holistic management. Participants articulated the additional challenges of acute care, where time pressures required students to ‘hit the road running’, and the difficulty of balancing the need to assess students at set points with giving them time to learn the required skills and attributes.

Conclusions: The management of older adults requires complex clinical reasoning and problem-solving skills. Whilst participants appreciated the constraints on student knowledge and skills they articulated expectations that would be challenging for many students to achieve.

Implications: Complex clinical reasoning and problem-solving are high level cognitive skills and there is a question about the point in their training where most students can be expected to effectively demonstrate/utilise these skills on placement. There is a need to explore strategies to avoid a mismatch between expectations and actual performance, which may negatively impact on both the student and educator experience.

Funding acknowledgements: This study was not funded

Keywords:
Expectations
Students
Mismatch

Topics:
Education: clinical
Older people

Did this work require ethics approval? Yes

Institution: Keele University

Committee: University Ethics Review Panel

Ethics number: No number provided