Reflective Practice

Clinical practice workbooks

Developed by: 
Pauline Chiarelli
Institution: 
The University of Newcastle
Teaching and Learning Strategy: 

As a part of initial introductory clinical placements in years 1 and 2, students complete Clinical Practice Workbooks. The workbooks are designed to enhance the clinical experience by encouraging student to seek out, perform and document specific structured tasks, and to reflect on their performance. Workbook activities require students to relate the clinical impairments documented in assessment tasks to the patients' quality of life assessed through discussions with patients. In addition, the workbooks encourage students to learn about the physiotherapist's work environment through tasks that require reflection on management and safety issues, manual handling, and equipment use. Clinical reasoning is enhanced through tasks that require the student to discuss observations from patient charts or interviews that are necessary for clinical decision-making. Students present a patient case to their peers following their first placement, and presentations are guided by their clinical workbook activities.

Course Name: 
The clinical practice workbooks are used in years 1 and 2 as part of the learning process for the students' clinical placements. The initial clinical placements are half-day placements that introduce the students to the clinical environment. Students attend a clinical site for one afternoon a week for 7 weeks. Students attend two clinical sites in year 1 (semester 2), and two sites in year 2 (semester 1) for 7 weeks each. Clinical workbooks are tailored to each year, with specific questions and reflective activities that represent the competencies that students should be focused on for each unit. Clinical workbooks in year 1 are part of Physiotherapy II, which focuses on basic treatment skills. Clinical workbooks in year 2 are part of Physiotherapy III, where the focus is on electrophysical agents.
Year Level: 
First Year
Expected Outcomes: 

Year Level : (First and Second)
 
The clinical workbooks are intended to enhance learning from the clinical placement experience, by requiring the student to document and reflect on their experiences. For example, in year 1 the students learn about the physiotherapist's work environment through workbook items encourage students to seek out induction information such as clinic management, safety and manual handling policies. Year 1 students are also required to reflect on the impact that physical deficits have on a patient's quality of life after they have performed one or more measurements on a patient (ROM, strength and balance), and interviewed them about aspects of activities of daily living. In year 2 students begin to explore clinical reasoning, documentation and outcome measures used in the clinical setting by describing and reflecting on patients whom they have observed or treated. They are also required to describe aspects of safety with electrophysical agents and exercise equipment, including patient explanations, warnings and consent. It is expected that these activities enhance the clinical placement experience by providing the student with specific goals to be achieved and allowing the student to reflect on how effective they were at achieving those goals.
 

Effective Aspects: 

The opportunity that students have to reflect on their own progress, shortcomings and strengths, and the process of comparing their learning experiences at different clinical site makes this activity an effective self-directed learning process.

Evaluation: 

Marking the clinical workbooks gives teaching staff a better picture of the student's insight into the clinical experience, and of the students' ability to transfer learning tasks to the practical setting. Reflective tasks indicate whether the students are able to express how their actions and observations affect patient outcomes and level of care. Formal evaluation of the students' perceptions about the usefulness of completing the workbooks has not yet been undertaken.

Evaluation Outcomes: 

There has much variation in the quality and quantity of responses to the reflective tasks, but the majority of students appear to put quite a lot of time into their clinical workbooks.

Plans for Changes/Developments in Future: 

Yes. We would like to further structure some of the workbook tasks, to encourage students to spend more time on reflective tasks, and less time on other tasks.
 
A change to the distribution and submission of completed workbooks is currently being trialed. An internet version of the workbooks has been developed, so that students can submit their workbooks online. The online version allows for only limited text for some activities, and for other activities students are allowed to expand their responses as they wish.

For Further Details
Contact Name: 
Suzanne Snodgrass
Contact Faculty/School: 
School of Health Sciences
Contact Institution: 
The University of Newcastle
Contact Link: 
http://www.newcastle.edu.au/fmhs/physio/

Self evaluation of ‘student therapist’ using video

Developed by: 
Dr Tania Pizzari
Institution: 
La Trobe University
Teaching and Learning Strategy: 

Each student is required to work with two other students and make a video of themselves performing three physiotherapy assessment and treatment techniques taught in the first semester. One student acts as the patient, while the other student controls the video camera and also critiques the "student therapist" using the assessment sheet utilized during practical examinations of this subject.
 
Once the video is complete the "student therapist" is required to watch the video and complete a self-evaluation of their performance using the assessment sheets.
At least one week later the video process is repeated. The same or different techniques are chosen to be performed. The student therapist self-evaluates the performance on the second video and receives a written evaluation from the observing student.
 
The student is then required to compile a report based on the observing students critique and their self-evaluation of both video sessions. The report briefly summarises each technique, provides an in-depth critical appraisal of their performance, discusses what was done well and what needs improvement, compares the observation between the student observer and their own self-evaluation and includes a section about changes over time (from video one to video two).

Course Name: 
The practice is used in a subject called Physiotherapy Skills A (PTY11PSA).
Year Level: 
First Year
Expected Outcomes: 
  • To develop an appreciation of current level of skill when performing various physiotherapy assessment and treatment technique
  • To be able to accurately reflect on their performance of techniques and understand the potential implications of their performance on the patient
  • To be able to identify deficits in performance and prompt improvements in performance during the second video
  • To become familiar with the marking criteria used for assessment in the subject
     
Effective Aspects: 

The use of a video camera to tape the performance ensures that the student experiences the pressure associated with appearing on camera, prior to experiencing the pressures associated with practical exams.
 
The need to perform a variety of techniques in their entirety, with no assistance from notes and in front of two peers and a video camera makes students realise any potential deficits in their learning.
Critical analysis of performance included in the report ensures that the student must understand the implications of their performance (good or bad) for the patient. The theory of assessment and treatment techniques needs to be understood.

Evaluation: 

All assignments are handed in and marked, contributing 10% of the mark for this subject.
 
The practice is also evaluated on Quality Assessment forms filled out by students regarding this subject.

Evaluation Outcomes: 

The practice continually receives positive feedback from students regarding the usefulness of the assignment in showing them deficits in their knowledge and practical skills. Students comment on the pressure of performing the technique under such conditions with no assistance from peers or notes. They comment that it makes them realise how much they have to know and how much more they have to practice to be independent with techniques.

Plans for Changes/Developments in Future: 

No

For Further Details
Contact Name: 
Dr Tania Pizzari
Contact Faculty/School: 
School of Physiotherapy
Contact Institution: 
La Trobe University
Contact Link: 
http://www.latrobe.edu.au/physiotherapy/