SA JOURNAL OF PHYSIOTHERAPY 2006 VOL 62 NO 1 23 A REPORT ON THE PERSEPTIONS OF PARTICIPANTS OF A PHYSIOTHERAPY CLINICAL FACILITATOR WORKSHOP R E S E A R C H A R T I C L E INTRODUCTION Clinical education forms an important component of the curriculum of health professionals. Clinicians and clinical educators facilitate the students’ acquisi- tion of clinical skills. Hesketh et al (2001) however state that colleagues engaging in medical education have “little or no formal training as educators” McLeod et al (2003) further highlight that “there is a tacit assumption that expertise in practice will translate into proficiency in teaching”. Acknowledging these concerns, many training institu- tions have implemented courses for supervisors involved in clinical education. Courses are also available specifically for physiotherapy clinical educators (Cross 1992, Fourie et al 2003,Mbambo 1999, Moore 2001;Strohstein et al 2002). In South Africa these courses and workshops are based on needs identified by the training institutions, facilitators/ supervisors and clinicians (Fourie et al 2003; Mbambo 1999). In the Western Cape Province three universities offer physiotherapy programmes. In order to manage clinical education in this region, a Clinical Co-ordinating Committee (CCC) was formed. One of the aims of this committee is to support clinicians and supervisors involved in clinical training of physiotherapy students. Therefore a yearly clinical facilitators workshop is offered. It aims to develop educational knowledge, skills and atti- tudes in the participants. The purpose of the present study was to evaluate parti- cipants’ perceptions of the workshop and it’s impact on their practice as clinical educators. METHODOLOGY A descriptive study was undertaken to establish the following: - Participants’ needs and expectations of the workshop - Whether the workshop had addressed the stated needs - Participants’ suggestions for follow- up workshops - Participants’ perceptions about whether the workshop has influenced their practice as clinical supervisors This project was registered with the Human Research Committee of the Health Sciences Faculty at Stellenbosch University. The study sample consisted of all participants attending a 20-hour clinical facilitators workshop in January 2004. Written informed consent to participate in the study was obtained and confiden- tiality was assured. A total of 15 physio- therapists working with students from the three universities in the Western Cape attended the workshop. The workshop was interactive in nature and comprised of mini-lectures, role-plays, reflective strategies, discus- sions and tasks to apply new skills. The topics presented in the workshop addressed knowledge, skills and atti- tudes necessary for effective clinical education and were based on findings in the literature and previous workshops (Cross 1992, Fourie et al 2003, Mbambo 1999, Strohstein et al 2002). Three questionnaires, developed by the researchers, were used in this study. They were based on the literature (Cross 1995; Fourie et al 2003, Hesketh et al 2001, Hewson 2000, Irby 1994), informal feedback of previous workshops and peer review from colleagues of the CORRESPONDENCE TO: A. Rhoda Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape Private Bag X17 Bellville 7535 Tel: (021) 959-2542 (work) E-mail: arhoda@uwc.ac.za ABSTRACT: Clinical education is the cornerstone of the training of health professionals. Many training institutions offer courses in clinical education. Fifteen participants of a 20-hour physiotherapy clinical facilitators workshop formed part of this descriptive study. The aim of the study was to evaluate their perceptions of the workshop and the impact it had on their practice. Data were captured using three sepa- rate questionnaires, consisting of closed- and open-ended questions. Descriptive statistics were used to analyse the data. Results indicated that participants regarded the topics presented as important, that their needs had been met and that they enjoyed the workshop immensely. Furthermore, they reported that the content of the workshop had an impact on their practice. Many participants requested follow-up workshops on clinical education. It can be concluded from the above results that a workshop addressing educational aspects is an appropriate method of supporting colleagues involved in physiotherapy clinical training. KEY WORDS: CLINICAL EDUCATION, FACILITATORS WORKSHOP, PERCEPTIONS. A Frieg , MPhil Med Sciences (Rehabilitation)1; A Rhoda, MscMed Sciences (Rehabilitation)2 1 Senior lecturer, Department of Physiotherapy, Health Sciences Faculty, Stellenbosch University. 2 Lecturer, Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape. JRLMAR 2006 PRINT 9/3/06 9:05 am Page 23 24 SA JOURNAL OF PHYSIOTHERAPY 2006 VOL 62 NO 1 academic departments. As these educa- tional workshops are only presented once a year we were not able to conduct a pilot study but requested academic colleagues to peer-review the drafts. As the language of instruction of the work- shop was English, we expected all par- ticipants to have a good command of English and did not deem it necessary to translate the questionnaires. The first questionnaire was adminis- tered at the commencement of the pro- ceedings. This questionnaire consisted of 23 open- and closed ended questions about the participants’ background in clinical supervision and their expecta- tions of the workshop. The second questionnaire was com- pleted on the last day of the workshop after the proceedings ended. Twenty-six questions evaluating the participants’ perceptions of and feedback on the work- shop were included in this question- naire. Again, open- and closed ended questions, including Lickert scales, were utilized. After three months the third ques- tionnaire was sent by mail to all the participants. They completed this ques- tionnaire in their own time and sent it back in stamped return envelopes. Participants who had not returned the questionnaires by a specified due date, were telephonically reminded to do so. Questionnaire 3 consisted of 18 ques- tions establishing the impact the work- shop had on their practice as clinical supervisors through the preceding three months. Quantitative data were entered into Excel and analysed using frequency tables, pie charts and box and whisker graphs. The assistance of a statistician was sought for the analysis of the data. The answers to the open-ended questions (qualitative data) were transcribed by an independent typist and the responses later grouped by the researcher accord- ing to themes generated in the data. RESULTS Response rates: Fifteen colleagues attended the work- shop and all agreed to participate in the survey, signing informed consent. The response rate of the 1st question- naire was 100% (15/15) and of the 2nd questionnaire 93% (14/15). The 3rd questionnaire was returned by 13 parti- cipants (87%), but one of these indicated that he/she was no longer involved in student supervision and therefore had not completed the 3rd questionnaire. Hence, data from this questionnaire were only available from 12 participants (80%). Figure 1 depicts whether the partici- pants were clinicians employed in the health sector, university employed supervisors or both. Figure 2 illustrates that the supervisors were involved with student supervision between 0 - 7 years (median of 2,7 years). The vast majority of participants (13/14,- one did not answer this ques- tion) indicated that they enjoyed their involvement with physiotherapy students. They enlarged on this, stating that they felt stimulated and encouraged to keep up to date (7 responses), could learn much from the students (3 responses) and loved observing students grow into professionals (3 responses). On the other hand, participants found it least enjoyable to be involved with marking students’ work (3 responses) and dealing with unprofessional behaviour of the students (4 responses). When asked why they decided to attend the workshop, most indicated that they wanted to improve their clinical facilitation skills (Figure 3). It was interesting to not that 40% of partici- pants expected to improve their clinical skills, an aspect not addressed at the workshop at all. The box and whisker graphs in figure 4 show the importance that was attributed to the various topics that were planned Clinician, 7 Both, 2 Supervisor, 6 Figure 1: Capacity in which the participants were involved in student education (n=15). 8 7 6 5 4 3 2 1 0 -1 N u m b e r o f y e a rs Median = 2.7 25%-75% = (1,6) Non-Outlier Range = (0,7) Figure 2: Number of years participants were involved in student supervision (n=15). JRLMAR 2006 PRINT 9/3/06 9:05 am Page 24 SA JOURNAL OF PHYSIOTHERAPY 2006 VOL 62 NO 1 25 for the workshop, indicating that most participants found the chosen topics very important or important. For questionnaire 2, which was com- pleted by 14 participants immediately after the workshop, the following results were found: Most participants rated the workshop as excellent (Figure 5). When asked to expand on their ratings, they indicated that the course was well orga- nized (5 responses), that expectations were met (2 responses), facilitators’ knowledgeable and the atmosphere relaxed (3 responses) and that their understanding of their roles was much clearer (3 responses). The only negative comments referred to the fact that there were insufficient breaks (2 responses). Thirteen respondents (93%) felt that their needs, as indicated by them at the beginning of the workshop, had been met (Figure 6). Most felt they were much clearer now about their roles, knew more about learning styles, had better insight into different approaches they could use to enhance student learning and were clearer regarding student eva- luation than before. When asked which of their needs had not been met only two participants answered, indicating that there should be more clarity regarding standards and expectations of the universities and clarity on how to handle critical incidents. Suggestions regarding aspects to change at a similar workshop were minimal. These included encour- aging more clinicians to attend and incorporating more role-play during the sessions. Seven participants (50%) indicated that they would welcome more workshops on clinical teaching and opportunities to share their experi- ences throughout the year. As indicated in the methodology sec- tion, a third questionnaire was sent to the participants three months after the workshop. The sample size for this ques- tionnaire was 12, as two did not return the questionnaire and one was not involved in clinical teaching anymore. Participants indicated on the Lickert scales that most of the 13 main topics that were addressed during the work- shop had an impact on their current practice as supervisors (Table 1). Giving feedback and the initial interview were the topics rated the highest in this regard, whereas the perusal of forms 12 10 8 6 4 2 0 reason1 reason2 reason3 reason4 reason5 reason6 reason7 reason8 33% 7% 20% 0% 73% 27% 40% 20% Figure 3: Reasons why participants attended the workshop (multiple responses permitted; n=15). Legend: Reason 1: My Head of Department advised me to attend Reason 2: The university advised me to attend Reason 3: I have heard ... that this is a relevant workshop Reason 4: Attendance is a requirement for my employment Reason 5: I want to improve my clinical facilitation skills Reason 6: I need CPD points Reason 7: I want to improve my clinical skills Reason 8: Other Re fle ct iv e pr ac tic e Le ar ni ng s ty le s A du lt le ar ne r M is si on s ta te m en ts Fo rm ul at in g ob je ct iv es In iti al in te rv ie w Le ar ni ng c on tr ac t St ra te gi es Fe ed ba ck M et ho ds o f e va lu at io n St ud en t e va lu at io n Ev al ua tio n fo rm s U ni ve rs ity e xp ec ta tio ns undecided not important important very important 0 Median 25%-75% Min-Max Figure 4: Participants’ perception regarding the importance of the topics (n=15). JRLMAR 2006 PRINT 9/3/06 9:05 am Page 25 26 SA JOURNAL OF PHYSIOTHERAPY 2006 VOL 62 NO 1 used in evaluation had no impact on the practices of 3 participants. When asked to comment on how their involvement in students’ clinical educa- tion had changed after participating in the workshop, the following comments were offered: capable of trying different strategies to enhance student learning (4 responses), more active and enjoyable involvement (4 responses), renewed interest in students (2 responses), rela- tionship with students improved and easier to let students take initiative (1 response each). Aspects that the participants wanted to be addressed at follow-up workshops included: clarity regarding university expectations and standards, more infor- mation regarding academia and the curriculum, managing students with personal problems and more discussions on how to give feedback constructively. One participant suggested a support group for those involved with clinical education and two others requested refresher courses / follow-up sessions throughout the year. DISCUSSION By presenting the annual facilitator workshop the Clinical Co-ordinating Committee honours its mission and acknowledges its role in the develop- ment of staff involved in clinical educa- tion of physiotherapy students. This is in agreement with Wilkerson and Irby (1998) and Hewson (2000) who highlight the importance of staff development in these critical skills when referring to the medical education. This study investigated the partici- pants’ perceptions of such a workshop for physiotherapy educators and the good response rate allows for interpre- tation of the results representing this group well, in spite of the small sample size. However, limitations of the study include that the participants were all volunteers and that, due to the fact that this course is only presented once a year, we could not conduct a pilot study. Participants ascertained the view advocated by physiotherapists (Baldry- Currens and Bithell 2000; Cross 1992, Mbambo 1999) regarding the impor- tance of development of their paeda- gogic skills. It is possible that, as 13 of the 14 participants indicated they already enjoyed their involvement with students, they attended the workshop in order to Topic Huge Some No Undecided Total impact impact impact Reflective practice 5 6 - 1 12 Learning styles 3 8 - 1 12 Adult learner 4 7 - - 11 Mission statements 3 5 2 - 11 Formulating objectives 5 6 - - 11 Initial interview 8 4 - - 12 Learning contract 6 5 1 - 12 Strategies to use to 6 4 - 2 12 facilitate learning Giving feedback 6 5 - - 11 Methods of 4 5 2 1 12 evaluation Student evaluation 5 5 1 - 11 Forms used in 4 4 3 1 12 evaluation University 6 4 1 1 12 expectations Table 1: Impact the workshop had on participants’ practice. Yes, 13 P a rtia lly, 1 Figure 6: Participants’ percep- tions on whether or not their needs had been met (n=14).Poor Fair Good Excellent 0 Le ng th o f c ou rs e Ti m e of d ay G en er al o rg an is at io n C ou rs e co nt en t Le ve l o f i np ut C os t v er su s w or th Fa ci lit at or s Median 25%-75% Min-Max Figure 5: Participants’ rating of the workshop (n=14). JRLMAR 2006 PRINT 9/3/06 9:05 am Page 26 SA JOURNAL OF PHYSIOTHERAPY 2006 VOL 62 NO 1 27 specifically improve their facilitation skills. Indeed, they confirmed this when giving reasons for their attendance. It seems as if the organizers had chosen to include content that the parti- cipants found appropriate as most rated the planned themes as very important to them prior to the workshop. It was however surprising that a number of participants (40%) expected to improve their clinical skills as well. While we acknowledge the opinion that teachers in health care require clinical and educa- tional expertise (Harden and Crosby 2000), this workshop focused only on advancing the participants’ educational competencies. As a great deal of effort was made to co-ordinate the workshop it was gratify- ing for the organizers to see that parti- cipants rated the workshop so positively (Figure 5). By also rating the course content as excellent, they confirmed a need for inclusion of these paedagogic topics in these courses. Most partici- pants pointed out that their needs were addressed (Figure 6). They also rein- forced that the workshop had a sustained positive effect when they indicated after three months that most topics had a huge impact on their practice. Seeing that “reflective practice” was rated highly, it is not surprising that so many participants viewed related topics (learning contract, giving feedback, ini- tial interview, adult learner) to have had a great impact in their practice. The importance of developing reflective skills in the novice health-care practi- tioner is confirmed by many authors (Cross 1992 & 1995, Parsell and Bligh 2001; Pololi et al 2001, Schˆn 1997 in Challis 2001). Many authors agree that the clinical teacher’s role as an assessor is an impor- tant one (Harden and Crosby 2000; Hesketh et al 2001; Irby, 1994, McLeod et al 2003,). Perceptions of participants of this study also rated topics relating to student assessment as important prior to commencement of the workshop (Figure 4). After three months they also indicated that having discussed these topics had made an impact on their prac- tice (Table 1). Surprisingly, information on “forms used for student evaluation” did not influence practice much but, see- ing that most participants were involved with student supervision for a while (Figure 2), it could be that they were already very familiar with these forms. In both the 2nd and 3rd question- naires respondents requested that they would value more workshops address- ing topics related to clinical teaching. It seems as if once supervisors have been exposed to these educational courses, they tend to request follow-up sessions (Pololi et al 2001, Mbambo 1999). Staff developers should take cognisance of this and therefore our committee will certainly try to address this need. While most participants indicated that the workshop clarified the university expec- tations, many still requested more infor- mation regarding academic programmes and specific departmental expectations. This aspect is particularly important, as students might be very confused when the expectations of clinical educators and academic staff are incongruent. CONCLUSION The findings indicate that the 15 participants of this clinical supervisor workshop for physiotherapists found it very successful and as a result this aspect of staff development should be continued. We will take cognisance of the suggestions that were made when planning future workshops. In order to get a more comprehensive evaluation of our workshops, we plan to investigate students’ perception regarding super- visors who have attended the course. It is suggested to assess participants’ teaching competencies in a before- and-after design using valid and reliable instruments such as the Teaching Effectiveness Instrument as advocated by Copeland and Hewson in 2000. In the long term we hope to be able to successfully enhance the teaching skills of all our colleagues involved with under- graduate physiotherapy clinical training. By doing so we acknowledge our mis- sion to train independent reflective health-care professionals under the guidance of colleagues who hold knowl- edge, skills and attitudes appropriate for a competent educator. ACKNOWLEDGEMENTS: We wish to gratefully acknowledge Dr M Kidd, Stellenbosch University, for his advice on statistical matters and the participants of the workshop for their willingness to be included in this study and their effort in completing the ques- tionnaires. REFERENCES Baldry Currens, J.A., Bithell, C.P. (2000) Clinical Education. Physiotherapy 86(12) :645-653 Challis M. (2001) Building an effective pro- gramme for clinical teachers: the role of the staff developer. Medical Teacher 23(3):270-275 Copeland, H.L., Hewson, M.G. (2000) Devel- oping and testing an instrument to measure the effectiveness of clinical teaching in an aca- demic medical center. Academic Medicine 75(2):161-166 Cross, V. (1992) Clinicians’ needs in clinical education Physiotherapy 78(10):758-761 Cross, V. (1995) Perceptions of the ideal clin- ical educator in physiotherapy education. Physiotherapy 81(9): 506-513 Fourie, J.A., Rhoda, A., Frieg, A. (2003) Clinical Facilitators’ Workshop Physio Forum 17(3):20 Harden, R.M., Crosby, J. (2000) AMEE Guide No 20: The good teacher is more than a lec- turer - the twelve roles of a teacher. Medical Teacher 22(4):334-347 Hesketh, E.A., Bagnall, G., Buckley, E.G., Friedman, M., Goodall, E., Harden, R.M., Laidlaw, J.M., Leighton-Beck, L., McKinlay, P., Newton, R., Oughton, R. (2001) A frame work for developing excellence as a clinical educator. Medical Education, 35:555-564 Hewson, M.G. A theory-based faculty devel- opment program for clinician-educators. Academic Medicine 75(5):498-501 Irby, D.M. (1994) What clinical teachers in medicine need to know. Academic Medicine 69(5):333-342 Mbambo, N.P. (1999) Physiotherapy clinical educator’s needs. South African Journal of Physiotherapy 55(4):16-19 McLeod, P.J., Steinert, Y., Meagher, T., McLeod, A. (2003) The ABC of pedagogy for clinical teachers. Medical Education 37: 638-644 Moore, A. (2001) The manual therapist as an educator - editorial Manual Therapy 6(1):1-2 Parsell, G., Bligh, J. (2001) Recent perspec- tives on clinical teaching. Medical Education 35:409-414 Pololi, L., Clay, M.C., Lipkin, M., Hewson, M., Kaplan, C., Frankel, R.M. (2001) Reflections on integrating theories of adult education into a medical school faculty development course. Medical Teacher 23(3):276-283 Strohstein, J., Hagler, P., May, L. (2002) Assess- ing the need for change in clinical education practices. Physical Therapy 82(2):160-173 Wilkerson, I., Irby, D.M. (1998) Strategies for improving teaching practices: a comprehensive approach to faculty development. Academic Medicine 73:387-396 JRLMAR 2006 PRINT 9/3/06 9:05 am Page 27