R e s e a r c h A r t i c l e W h a t C l i n i c a l C o m p e t e n c i e s d o w e e x p e c t f r o m P h y s i o t h e r a p y S t u d e n t s a t t h e U n i v e r s i t y o f t h e W e s t e r n C a p e ? A B S T R A C T The p u rp o se o f this study is to identify the clin ica l co m p eten cies that are exp ected o f p h ysio th era p y stu d en ts a t the U niversity o f the Western Cape. A list o f t e n categories o f clinical com petencies w as f ir s t co m p iled fr o m the literature a n d a d m in is­ tered to 2 lecturers, 5 clinical sup erviso rs a n d 10 f in a l y e a r students, to elicit th eir p e rsp e c tiv e s o f exp ected clinical com petencies. B a se d on the outcom e o f this, a list o f eig h t categories o f com petencies w as a d m in istered to 7 lecturers, 5 0 clin ica l sup erviso rs a n d 31 f in a l y e a r students. P a rticip a n ts were requested to ra n k the co m p eten cies in o rd er o f w h a t w as considered to be essential. The an a lysis o f 79 responses revealed sim ila rities am ong lecturers, clin ica l sup erviso rs a n d stu d en ts in the ranking o f three com petencies, b u t disp a rities in the ranking o f fiv e com petencies. R ea so n s f o r the disparities, a n d the im p a ct o f the disp a rities on stu d en ts are discussed. F u rth er research is recom ­ m e n d ed to identify the reasons f o r the disparities. K E Y W O RD S: C L IN IC A L C O M P E TE N C IE S, C L IN IC A L SU P E R V ISO R S, LE C T U R E R S, STU D E N T S, R A N K IN G TY SO N SIM UZIN G ILI SEYI LADELE A M O S U N IN TR O D U C TIO N A m ajo r c h a lle n g e in p h y s io ­ th e ra p y e d u c a tio n is th e ta sk of enab lin g s tu d e n ts to d ev e lo p clinical com petencies (Potts, 1996). P h y sio ­ th e ra p y s tu d e n ts are ex p ected to c o m p lete c e rtain h o u rs of s u p e r­ v ised clinical practice w h ich in clu d e a considerable a m o u n t of co m p e­ te n c y -b a se d a s se ssm e n ts o ften ca rried o u t b y th e lecturer a n d the clinical supervisor. A ssessm en t of th e com petencies p re sen ts a chal­ le n g e to s tu d e n ts , le c tu re rs a n d clinical su p erv iso rs because of the com plexities of th e clinical en v iro n ­ m e n t (O ldeadow , 1996). L ecturers are expected to d e te rm in e w h ich b e h a v io u r s c o n s titu te a clinical co m p e te n c e th a t s tu d e n ts s h o u ld h av e acquired d u rin g th e p a rtic u la r clinical block. Clinical su p erv iso rs are ex p ected , th ro u g h d ire c t a n d in d ire c t s u p e rv is io n , to e n h a n c e stu d e n ts ' levels of com petency. Since th ere are considerable n u m b e rs of CORRESPONDENCE: P rof Seyi L adele A m o su n D e p a rtm e n t of P h ysiotherapy, U n iv ersity of th e W estern C ape P riv ate Bag X I7, Bellville, 7535 Tel: (021) 959 2542 (w) (021) 903 0476 (h) clinical su p erv iso rs, th eir p ersp ec­ tives of expected clinical co m p ete n ­ cies v a ry (N ay er, 1995; C ro ss & H icks, 1997). The lack of explicit criteria for expected clinical co m p e­ ten cie s re s u lts in d iffe ren c es of o p in io n o n w h a t is e x p e c te d of stu d en ts. This lead s to great d issatis­ faction a m o n g stu d e n ts (A m osun & D antile, 1996; C ross & H icks, 1997). D isparities in o p in io n of expected clinical c o m p e te n c ie s h a v e b e e n attrib u te d to differences in definition of co m p eten ce (H ag er & G onczi, 1996). In th e p a st, asse ssm e n t of p ro fe ssio n a l c o m p e te n c e ce n tre d m a in ly o n p e rfo rm a n c e . Later, p ro fe ssio n a l c o m p e te n c e w a s v iew e d as th e p o ssession of d esir­ ab le a ttrib u te s , in c lu d in g k n o w l­ edge, skills a n d abilities (such as pro b lem solving, analysis, c o m m u ­ nication, p a tte rn recognition), an d ap p ro p ria te a ttitu d e s in th e context of a chosen set of professional task. It is believed th a t co n cen tratin g o n the p erfo rm an c e of th e task w ith o u t d u e re g ard for th e attrib u te s is th e p rim e reaso n m an y professionals lap se into a n a rro w v iew of com petence. N e w b ie (1992) d e fin e d clinical com petence as th e m a ste ry of a b o d y of re le v a n t k n o w le d g e a n d th e acquisition of a ra n g e of relevant skills w hich in clu d e in terp erso n al, clinical a n d technical com ponents. S o u th g a te (1994) also d e fin e d clinical co m p eten ce as th e ability a n d th e w ill to select a n d p erfo rm relev an t clinical tasks in th e context of th e social en v iro n m e n t, en su rin g th a t h ea lth pro b lem s of in d iv id u a ls a n d g ro u p s are re so lv e d in a n efficient, effective, e c o n o m ic a n d h u m a n e m an n er. Sim ilarly, in an u n d a te d d o cu m en t, th e Professional B oard fo r P h y s io th e ra p y d e fin e s p h y s io th e r a p y c o m p e te n c e as a sig n ific a n t b e h a v io u r o r a c tiv ity p erfo rm ed in a specific settin g or en v iro n m e n t to a specified s ta n d a rd (South A frican M edical a n d D ental Council). S tu d e n ts are expected to d e m o n ­ s tra te " k n o w le d g e " , " sk ills" a n d " a ttitu d e s" co m p atib le w ith co m p e­ te n t clinical practice (Cross & Hicks, 1997). T h ese th re e d o m a in s are s u b d iv id e d f u r th e r in to m o re d e ta ile d ca te g o ries. A sto n -M c C rim o n (1986) id e n tifie d e le v e n categories of com petencies n am ely (in ra n k in g o rd e r of im p o rta n c e ) p ro fe ssio n a l eth ics a n d a ttitu d e s , c o m m u n ic a tio n sk ills, p e r s o n a l qualities, trea tm e n t skills, ev a lu a tio n of p atien t, a n d p la n n in g of trea t­ m e n t. O th e r ca te g o rie s in c lu d e im p le m e n ta tio n of c lien t care services, research skills, professional 10 SA J o u r n a l o f P h ysio t h er a py 1998 V o l 54 No 4 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) g ro w th , a d m in istra tiv e skills a n d th e o re tic a l k n o w le d g e . A n o th e r s tu d y id e n tifie d five ca te g o ries n a m e ly c o m m u n ic a tio n skills, p a tie n t assessm ent, trea tm e n t p la n ­ ning, perfo rm an ce of treatm en t, an d professional b e h a v io u r (Sanford et al, 1993). D eclute and L adyshew sky (1993) id e n tifie d seven categ o ries n a m e ly p a tie n t a sse ssm e n t, tre a t­ m e n t p lan n in g , im p le m e n tatio n of trea tm e n t p lan, com m u n icatio n w ith p atie n t/fa m ily , m a n ag e m en t skills, d o c u m e n ta tio n a n d p ro fe ssio n a l behaviour. The Professional B oard fo r P h y s io th e ra p y also id e n tifie d e le v e n c a te g o rie s of co m p ete n ce. T hese are p ro fe ssio n a l b e h a v io u r a n d a ttitu d e s , c o m m u n ic a tio n , e x a m in a tio n a n d asse ssm e n t, d esig n in g a trea tm e n t p ro g ram m e , a n d u tilis a tio n of th e ra p e u tic p ro c e d u re s. O th e r c a te g o rie s are c o u n se lin g , d e v e lo p in g e d u c a ­ t i o n a l / in s tru c tio n a l serv ices, m a n a g e m e n t a n d a d m in is tra tio n , research, co n su ltatio n , a n d d e v e l­ o p in g p h y sio th e ra p y services as p a rt of a h ea lth care plan. T he U n iv e rs ity o f th e W estern C ape (UWC) offers a fo ur-year BSc d e g re e p ro g r a m m e in p h y s io ­ th era p y . T h ird a n d fo u r th y e a r stu d e n ts s p e n d six w eeks a n d fo u r w eeks respectively ro tatin g th ro u g h the follow ing clinical blocks sp re ad o v er th e tw o years:- sp in a l u n it, in ten siv e care u n it, co m m u n ity re h a ­ b ilita tio n , g e ria tric s, p a e d ia tric s , n e u r o -m u s c u la r d is o rd e rs , a n d a g e n e ra l b lo ck c o n sistin g of o rth o p ae d ics, re sp ira to ry a n d n e u ro ­ logical d iso rd e rs . L e c tu re rs are p rim a rily responsible for assessing th e clinical c o m p e te n c e o f th e stu d e n ts at the e n d of each block (oc casio n ally a s s is te d b y clinical s u p e rv is o rs) a n d d u r in g clinical exam ination. C urrently, different aspects of the p h y s io th e ra p y e d u c a tio n p r o ­ g ra m m e in U W C are b ein g e v a lu ­ a te d in o rd e r to e n su re quality. A n e a rlie r s tu d y o n b u r n o u t a m o n g p h y s io th e r a p y s tu d e n ts re p o rte d th a t th ird a n d fo u rth y ea r stu d e n ts fo u n d th e e v a lu a tio n s o f clinical c o m p e te n c ie s v e ry stre ssfu l (A m o su n & D antile, 1996). P ersonal o b serv atio n s rev ealed th a t the situ a ­ tion w a s fu rth e r w o rse n e d b y the c o m m e n ts o f e x te rn a l e x a m in e rs w h o in sin u a te d th a t failure in one clinical ex am in atio n w a s indicative of p o o r clinical com p ete n ce. The s tu d y c o n c lu d e d th a t it w as neces­ sary to id en tify th e stressful factors a n d m ake necessary ad ju stm en ts. As a sta rte r, th e c u r re n t s tu d y w a s carried o u t to id en tify the clinical com petencies ex p ected of p h y sio ­ th e ra p y s tu d e n ts a t UW C. Earlier stu d ies w ere b a se d essentially o n the p e rs p e c tiv e s of p h y s io th e ra p y le c tu re rs a n d clinical su p e rv is o rs o nly (O nuoha, 1994), b u t final y ea r s tu d e n ts w h o h av e b ee n ex p o sed to clinical e d u c atio n for at least tw o y ears, w ere in c lu d e d in this stu d y sam ple. Therefore, th e objectives of this s tu d y were: 1. To id en tify th e clinical co m p e­ ten cies p h y s io th e r a p y le c tu re rs TABLE I: LIST OF EXPECTED CLINICAL COMPETENCIES (Loomis, 1985; Declute & Ladyshewsky, 1993; Sanford et al, 1993) Categories of competencies Implementation of treatment0 Programme planning0 Patient assessment Communication skillsb Documentation11 Professional behaviour Theoretical knowledge Safety of the patient Professional growth Management skills related to direct patient care Components of the competencies Treatment techniques, performance of effective treatment and progression of treatment techniques. Planning treatment services, identifying prim ary problems and inclusion of the family in the planning process. General assessment procedures including history taking, performance of assessment, selection of appropriate assessment procedures and re-assessment. A rt of listening, verbal and non verbal communication, confidentiality of patients' information and explanation of treatment of the patient. Recording, correct charting of information, and writing progress notes. Socially commendable qualities, personal characteristics and professional ethics, and appearance. Technical knowledge, knowledge of basic sciences such as anatomy, physiology, pathology, and psycho-social influences. Awareness of safety factors, safe handling techniques, and modification of treatment in the interest of safety. Contributing and participating in research related activities and further education. Managerial and administrative activities related to the well-being of the patient, adherence to operational procedures. "Incorporated later into "Implementation o f treatment plan" for the second phase o f study. Incorporated later into "Communication skills" for the second phase o f study. SA J o u r n a l o f Ph ysio t h er a py 1998 V o l 54 No 4 11 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) expected of students. 2. To id en tify th e clinical co m p e­ tencies clinical su p erv iso rs expected of stu d en ts. 3. To id en tify th e clinical co m p e­ te n c ie s p h y s io th e ra p y s tu d e n ts p re su m e d w e re expected of them . 4. To com p are th e resp o n ses of lecturers, clinical su p e rv iso rs a n d stu d en ts. M E T H O D O L O G Y The stu d y w a s co n d u c te d in tw o phases. U sing th e D elphi technique, th e aim of th e first p h a se w a s to d e v e lo p a s u rv e y in s tr u m e n t to o b tain th e clinical com petencies th at w e re e x p e c te d of p h y s io th e ra p y stu d en ts. Initially, a list of te n cate­ gories of expected clinical co m p e­ ten cies w a s c o m p ile d fro m th e av ailab le lite ra tu re (Loom is, 1985; D e c lu te & L ad y sh e w sk y , 1993; S anford et al, 1993). The co m p ete n ­ cies p e rta in e d to th e k n o w le d g e , skill a n d a ttitu d e necessary for the d eliv ery of safe a n d o p tim al p atien t care (Table I). The list of co m p ete n ­ cies re c o m m e n d e d b y th e P ro fe ssio n a l B o ard fo r P h y s io ­ th e ra p y in S o u th A frica w a s n o t u sed in th e first p h a se because th e d o c u m en t containing th e list w as u n d a te d . T he d e v e lo p e d list of com petencies w as given to a conve­ n ien t sam p le of five clinical p h y sio ­ th erap ists, te n 4 th y e a r stu d e n ts a n d tw o le c tu re rs (fro m UW C). P articip an ts w ere ask e d to indicate ag reem en t or d isag re em en t w ith the item s o n th e list, a n d to a d d to the list if necessary. In v iew of th e responses in th e first p h ase, a list of eight categories of e x p e c te d c o m p e te n c ie s w a s d ev e lo p e d for th e second p h ase of th e s tu d y (Table II). The list w as a d m in iste re d to lecturers (n=7) a n d 4 th y e a r p h y s io th e ra p y s tu d e n ts (n=31) at UW C, as w ell as clinical s u p e r v is o r s (n=50) id e n tifie d b y h e a d s of p h y s io th e ra p y d e p a r t­ m en ts w ith in th e C ap e M etro p o litan area. The p a rtic ip a n ts w ere asked to r a n k th e ca te g o rie s of e x p e c te d TABLE III: RANKING OF CLINICAL COMPETENCIES ACCORDING TO YEARS OF CLINICAL EXPERIENCE. MEAN OF RANKING SCORES (RANKING ORDER) Categories of Total 2-5 years 6-10 years >10 years competencies sample (N=79) (n=59) (n=8) (n=l 2) Patient assessment 2.0(1) 2.0(1) 1.5(1) 2.6(1) Implementation of treatment 2.8(2) 2.6(2) 1.6(2) 4.3(5)° Theoretical knowledge 3.0(3) 3.0(3) 2.0(3) 3.5(4) Safety of patient 3.8(4)* 4.0(4) 3.0(5) 3.2(3) Communication skills 3.8(5)* 4.1(5) 2.9(4) 3.2(2) Professional behaviour 4.6(6) 4.6(6) 3.3(6) 5.4(6) Management skills related to 5.6(7) 6.0(7)* 4.5(8) 5.6(7) direct patient care Professional growth 5.8(8) 6.0(8)* 4.3(7) 6.3(8) ‘ Standard deviations used to adjust tied ranks. “Statistically significant difference (p<0.05) in mean ranking scores between lecturers, clinical supervisors and students. Figures in parentfiesis indicate ranking order o f the competencies TABLE II: RANKING OF CLINICAL COMPETENCIES BY LECTURERS, CLINICAL SUPERVISORS AN D STUDENTS. MEAN OF RANKING SCORES (RANKING ORDER) Categories of Total Lecturers Clinical Students competencies sample supervisors (N=79) (n=7) ’'tII 00CNIIc Patient assessment 2-0(1) 2.0(1) 2.1(1) 1.9(1) Implementation of treatment 2.8(2) 3.4(5) 2.5(2) 2.9(2) Theoretical knowledge 3.0(3) 3.0(2)* 2.9(3) 3.1(3) Safety of patient 3.8(4)* 3.0(3)* 3.7(5) 4.1(5) Communication skills 3.8(5)* 3.1(4) 3.1(4) 5.1 (6)° Professional behaviour 4.6(6) 4.4(6) 4.4(6) 4.9(4) Management skills related to 5.6(7) 4.7(7) 5-2(7) 6.5(7) direct patient care Professional growth 5.8(8) 5.4(8) 5.5(8) 6.5(8) ‘ Standard deviations used to adjust tied ranks. “Statistically significant difference (p<0.05) in mean ranking scores between lecturers, clinical supervisors and students. Figures in parenthesis indicate ranking order o f the competencies 12 SA J o u r n a l o f P h ysio th era py 1998 V o l 54 No 4 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) clinical com petencies o n a n eight- p o in t scale, ran g in g from 1 (m ost essential) to 8 (least essential). The p artic ip a n ts w ere in fo rm ed of their rig h ts to refrain from tak in g p a rt in th e study. The q u estio n n aire w as co m p leted a n o n y m o u sly to m a in ­ tain confidentiality. The d a ta of sev en ty n in e responses (7 lecturers, 28 stu d e n ts a n d 44 clin­ ical su p e rv is o rs) w e re a n a ly s e d u s in g d e s c rip tiv e statistics. The m ean score for each clinical com pe­ tence w a s d e te rm in e d . U sing the m e a n scores, the com petencies w ere ra n k e d a n d s ta n d a r d d e v ia tio n s w e re u se d to ad ju st tied ranks. A m e a n sk ew e d to w ard s 1.0 in d icated a c o m p e te n c e c o n sid e re d h ig h ly e sse n tia l. O n e w a y an a ly sis of variance (ANOVA) w as u sed to test th e differences in the m ean scores b e tw e e n th e th re e g ro u p s of p articipants. RESULT T he to tal g ro u p of p a rtic ip a n ts r a n k e d th e com petency, p a tie n t assessm en t, as the m o st essential clinical c o m p e te n c e e x p e c te d of p h y sio th e ra p y stu d e n ts (Table II). T he sam e table presen ts th e o rd e r in w h ic h th e clinical co m p e te n c ie s w ere ra n k e d sep arately b y lecturers, clinical su p e rv iso rs a n d stu d e n ts. B etw een th e three g ro u p s of p artici­ p a n ts , a sig n ific a n t d iffe ren c e (p<0.05) w as o bserved in the m ean r a tin g scores fo r c o m m u n ic a tio n skills. All th e p articip an ts, irrespective of th e y e a rs of clinical ex p e rie n c e (2-35 years), ra n k ed p a tie n t assess­ m e n t as th e m o st essential clinical c o m p e te n c e e x p e c te d of p h y s io ­ th e ra p y s tu d e n ts (Table III). H o w e v er, p a rtic ip a n ts w ith m o re th a n 10 y ea rs clinical ex p e rien ce significantly (p<0.05) scored im p le ­ m en tatio n of trea tm e n t lo w er th a n partic ip a n ts w ith less experience. DISCUSSION The p rim a ry p u rp o se of this stu d y w a s to identify the clinical com pe­ tencies th a t are expected of p h y sio ­ th e ra p y s tu d e n ts a t UW C. The seco n d ary p u rp o s e w as to com pare th e ra n k in g of th e com petencies by lectu rers, clinical su p e rv iso rs a n d stu d en ts. The list of th e eight clinical com petencies d e v e lo p e d at th e en d of th e first p h a se of this s tu d y w as co m parable to th e lists of clinical com petencies dev elo p ed in earlier stu d ie s (A ston-M c C rim o n , 1986; D eclute & L adyshew sky, 1993) a n d b y th e P ro fe ssio n a l B oard for Physiotherapy. The s tu d y also revealed th a t there w ere sim ilarities a m o n g lecturers, clinical su p erv iso rs a n d stu d e n ts in the ra n k in g of three com petencies. A ll th e p a r tic ip a n ts a g re e d th a t p a tie n t asse ssm e n t w a s th e m o st e sse n tia l co m p e te n c e , w h ile m a n ag e m en t skills re la ted to direct p a tie n t care a n d professional g ro w th w ere co n sid ered th e least essential o f e x p e c te d c o m p ete n cies. The ra n k in g of p a tie n t assessm en t as the m o st e sse n tia l c o m p e te n c e is in ag reem en t w ith th e o utcom e of the s tu d y by D eclute & L ad y sh ew sk y (1993). T h ere w e re d is p a ritie s in th e ra n k in g of five co m p ete n cies. C linical su p e rv iso rs a n d s tu d e n ts a g re e d th a t, a fte r p a tie n t a sse ss­ m en t, th e next com petence expected of stu d e n ts w a s im p le m e n tatio n of treatm ent. H o w e v e r lecturers gav e a less th a n av erag e ra n k in g to this com petence. F or lecturers, th eo re t­ ical k n o w led g e w a s next in ranking. This difference b e tw e e n th e expecta­ tions of lecturers a n d clinical s u p e r­ visors could h av e b ee n influenced b y th eir perceived roles in clinical e d u c a tio n . L e c tu re rs a re u s u a lly expected to assist stu d e n ts acquire theoretical k n o w led g e co n sid ered to be the basis for d e v e lo p m e n t in clin­ ical p ra c tic e (M a rg e tso n , 1996), w h ile clinical s u p e r v is o r s are e x p e c te d to fa c ilita te s tu d e n ts ' learn in g in the clinical en v iro n m en t (O nuoha, 1994). A n o th er noticeable difference w as in the ra n k in g of th e p a tie n ts' safety. S u rp risin g ly , clinical s u p e rv is o rs ra n k e d safety of p atien ts lo w er th a n lecturers. In p e rso n a l co m m u n ica­ tio n s w ith th e a u th o rs , clinical su p e rv iso rs o ften ex p ressed great concern a b o u t th e safety of patien ts allocated to stu d en ts. Is th e ra n k in g b y clinical su p erv iso rs a reflection of g re a te r confidence in s tu d e n ts to en su re the safety of p atients? It w as also o b s e rv e d th a t th e s tu d e n ts ra n k e d p ro fe ssio n a l b e h a v io u r h ig h e r th a n lectu rers a n d clinical su p erv iso rs, w hile the lectu rers a n d clinical su p erv iso rs ra n k e d c o m m u ­ n ic a tio n sk ills h ig h e r th a n th e stu d en ts. The possible reasons for su ch ra n k in g co u ld n o t b e d e d u c e d im m ediately. In co m p ariso n w ith earlier stu d ies re p o rtin g o n th e p e rs p e c tiv e s of lectu rers, clinical p h y s io th e ra p is ts a n d stu d en ts, th ere are sim ilarities in e x p e c te d c o m p e te n c ie s b u t so m e differences in th e ra n k in g of the c o m p ete n cies. A sto n -M c C rim o n (1986) re p o rte d th a t lectu rers ra n k ed co m m u n icatio n skills v e ry low in o rd e r of im p o rtan ce, co m p ared to a n av e rag e ra n k in g in this study. A ston- M c C rim o n (1986) also re p o rte d o n a g ro u p of clinical p h y sio th e ra p ists ra n k in g hig h ly p rofessional b e h a v ­ iour, w h ile S a n fo rd et al (1993) re p o rte d o n a n o th e r g ro u p of clinical p h y s io th e ra p is ts w h o g a v e a n av e rag e ra n k in g to th e sam e co m p e­ tence. H o w e v er in this study, clinical su p erv iso rs gav e a b elo w av erag e ra n k in g to p rofessional behaviour. A s tu d y o n p h y sio th e ra p y stu d e n ts in A u s tra lia c o n s id e re d a p p r o p ria te theoretical k n o w le d g e a m o re essen­ tial com petence th a n im p le m e n ta­ tio n of tre a tm e n t (O ld m ea d o w , 1996). In this study, th e stu d e n ts ra n k e d im p le m e n tatio n of trea tm e n t hig h er th a n theoretical know ledge. It is w o rth w h ile to id e n tify th e reasons for th ese disparities. A nalysis of th e resp o n ses b ase d on years of clinical experience of p artic­ ip a n ts also sh o w e d differences in ra n k in g of expected com petencies. N ex t to p a tie n t assessm ent, p artici­ SA J o u r n a l o f P h ysio t h er a py 1998 V o l 54 No 4 13 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) p a n ts w ith n o t m o re th a n 10 years of clinical ex p e rien ce ra n k e d im ple- m en tio n of trea tm e n t a n d theoretical k n o w le d g e as th e m o st esse n tial co m p ete n cies. H o w e v e r, p a r tic i­ p a n ts w ith m ore th a n 10 years of clinical experience ra n k e d c o m m u ­ nication skills a n d safety of patien ts as th e m o st essential com petencies. It seem s w h a t clinical su p erv iso rs a n d lecturers expected of stu d e n ts w a s influenced b y years of clinical experience. This can o nly lead to fru stratio n am o n g th e stu d en ts. P a rtic u la rly im p o r ta n t to th e h ea lth care professions is stu d e n t satisfaction w ith clinical ed u c atio n b e c a u se th is c o m p o n e n t o f th e c u rricu lu m has a n im p act o n profes­ sional a ttitu d e , career com m itm ent, a n d re te n tio n (Stith et al, 1998). The d isp arities o b serv ed in th e p e rsp e c ­ tives of th e p artic ip a n ts in this s tu d y m a y g en erate g re at dissatisfaction am o n g stu d e n ts w ith clinical e d u c a­ tion. B etw een clinical su p e rv iso rs a n d stu d e n ts, there w a s ag reem en t in th e ra n k in g of six com petencies. B etw een lecturers a n d clinical s u p e r­ visors, th ere w a s ag reem en t in the r a n k in g of five co m p ete n cies. B etw een le c tu re rs a n d s tu d e n ts , there w a s ag reem en t in o nly three com petencies. Therefore, at clinical exam inations or en d of clinical block ev a lu a tio n s co n d u c te d b y lecturers, th e disp arities in th e persp ectiv es of th e lecturers a n d th e stu d e n ts could lead to fru stratio n s a m o n g students. T his s u p p o r ts a re m a rk fro m s tu d e n ts expressed earlier th a t they fin d th e ev a lu a tio n d u rin g th e clin­ ical blocks v e ry stressful (A m osun & D antile, 1996). The d isp arities in the persp ectiv es of th e clinical s u p e rv i­ sors a n d th e s tu d e n ts co u ld also fru stra te stu d e n ts ' learn in g efforts in clinical e d u c a tio n . T h erefo re, an a g re e m e n t a m o n g le c tu re rs a n d clinical su p erv iso rs o n th e clinical com petencies expected of stu d en ts, a n d the ra n k in g of the com petencies, w ill co n trib u te significantly to alle­ v iate the fru stratio n of th e stu d en ts. It w ill also a ssist s tu d e n ts to e v a lu a te th e ir o w n p ro g re ss in le a rn in g a n d w ill m a k e th e ir le a rn in g m e a n in g fu l a n d pu rp o sefu l. LIM ITATIONS O F TH E S TU D Y The outco m e of this s tu d y w o u ld h a v e b e e n m o re re le v a n t if th e p a rtic ip a n ts in th e sec o n d p h a se w ere asked to ra n k the list of co m p e­ tencies expected b y th e Professional Board for P h y sio th e ra p y in S outh Africa. H o w e v er th e list of co m p e­ ten cies d e v e lo p e d fo r th is s tu d y c o m p a re fa v o u ra b ly w ith th e c o m p e te n c ie s e x p e c te d b y the P ro fe ssio n a l B oard fo r P hysiotherapy. Also, th e s tu d y d id n o t id en tify the reasons w h y the p artic ip a n ts ra n k ed the co m p ete n ­ cies in a p a rtic u la r order. R estricting this stu d y to p artic i­ p a n ts involved in o nly one of the e ig h t p h y s io th e r a p y e d u c a tio n p ro g ram m e s in S o u th Africa m akes it im possible to g eneralise the d ata o btained. It is re co m m en d ed th a t fu rth e r research be carried o u t in o th e r p h y s io th e r a p y e d u c a tio n p ro g ram m e s to id en tify if th ere are d is p a ritie s in e x p e c te d clinical com petencies, a n d the reasons for su ch disparities. C O NC LU S IO N A s p h y s io th e ra p y s tu d e n ts are b e in g p re p a re d to face th e chal­ lenges of th e profession, required clinical c o m p e te n c ie s s h o u ld be clearly defined. There is a n ee d for th e lecturers a n d th e clinical s u p e r­ visors a t UW C to com e to agreem en t o n th e clinical com petencies, as w ell as the ra n k in g of th e com petencies, expected of p h y sio th e ra p y stu d en ts. 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