Clinician’s Commentary on Mori et al.

Clinical placements make up a substantial and important portion of physiotherapy students’ education.¹–⁴ They provide opportunities for students to apply the knowledge and skills they have learned in their academic coursework to real-world situations and with real patients under the guidance of a skilled and licenced physiotherapist. The factors that contribute to a positive and high-quality placement experience have been well described in the literature.²,³,⁵,⁶ Among them are (1) the ability and willingness of a clinician to mentor students by teaching and giving effective feedback, (2) a welcoming learning environment with a detailed orientation to the work environment, (3) clearly outlined student expectations, (4) the university’s preparation of a student for the placement, and (5) the student’s willingness to learn.²,³,⁵,⁶

Students do not begin their clinical training as masters of their skills but rather as novice clinicians who require the time and opportunities provided by their clinical placement experiences to refine and improve these skills.³,⁴ Receiving feedback from their clinical instructors (CIs), other health professionals, and even peers is essential for students to develop their skills and move along the continuum from novice clinician to proficient, entry-level physiotherapist.⁷ Clinical placement experiences are critical to the education of physiotherapists, and indeed to all health professionals.

However, not just students benefit from feedback. As Mori and colleagues state, CIs and clinical sites also need feedback to establish and improve the clinical placement experience and learning opportunities for students, as well as foster a collaborative relationship between the academic programmes and their partner clinical sites.¹ Feedback helps both the programme and the clinical site to determine whether a particular clinical environment is appropriate for the level of learner, and the feedback that CIs receive enables them to better develop their skills as mentors and educators.⁸

Giving feedback is no easy task, especially constructive feedback, and to do it well requires a knowledge of feedback principles, training, and practice.⁷ Few physiotherapy students have enough training and practice to provide effective feedback to CIs or sites, particularly if their placements are not going well. This lack of experience in giving feedback adds another layer of complexity given the power differential between CIs, who provide a summative assessment of the students’ performance, and the students. For these reasons, Andrews and colleagues have advocated for the use of a post-placement questionnaire to gather student feedback because it will contribute to the ongoing quality assurance processes for clinical education.⁹

In their study, Mori and colleagues undertook a Delphi process to update the student evaluation of placement form used by physiotherapy education programmes across Canada. The National Association for Clinical Education in Physiotherapy (NACEP) developed the original form more than 10 years ago; an updated form would ensure that it aligns with current best practices in clinical education. The authors included in this process representatives of all key stakeholders in physiotherapy clinical education – in addition to academics, representatives from centre coordinators of clinical education, CIs, and students – highlighting the importance of fostering the relationship between educators and clinical sites.

After three rounds of the Delphi process, an expert panel finalized the evaluation form, which included three sections: (1) “The Site,” (2) “The Clinical Instructor,” and (3) “Feedback and Assessment of the Student.” The three sections, and the items in them, encompass many of the factors identified as contributing to a positive clinical placement experience.

The final form, currently adopted and being implemented by NACEP physiotherapy programmes, is a useful tool that students can use to provide meaningful feedback about their learning experience to the sites, CIs, and their physiotherapy programme. Each item on the form highlights the processes and behaviours that, if they occurred, should set the foundation for a positive placement experience. The items themselves can encourage CIs and sites to think about how clinical placement experiences are structured, and the feedback provided by a student for each item provides a scorecard of how well each aspect is being executed. This updated form will assist physiotherapy programmes and clinical sites to work collaboratively to improve students’ clinical education experience, and ultimately strengthen the profession.