Variable levels of stress and anxiety reported by physiotherapy students during clinical placements: a cohort study.

OBJECTIVES: Healthcare students are at risk of high stress and anxiety, particularly during clinical placements. This study measured the stress and anxiety levels of physiotherapy students during clinical placements, how stress/anxiety changed over time, effect on academic performance, factors influencing stress/anxiety and coping strategies. DESIGN: A prospective cohort study using surveys collecting quantitative and qualitative data. SETTING: Three sites where physiotherapy students from one university undertook clinical placements. PARTICIPANTS: 109 students across 159 placements. MAIN OUTCOME MEASURES: The State-Trait Anxiety Inventory (STAI [Y2]) provided a baseline measure of general stress level and propensity for anxiety. Perceived stress and anxiety were measured using visual analogue scales (VASs) at baseline and weekly over the 5-weeks duration of placements. A questionnaire sought students' perceptions of factors affecting stress/anxiety and coping strategies. RESULTS: VAS stress/anxiety scores were highly variable between participants. Higher VAS scores were seen at Weeks 3 and 4 compared to Week 5 and placements earlier in the academic year. Baseline VAS scores were significantly associated with Weeks 1-5 VAS scores. Higher VAS scores were associated with poorer academic results. Stress/anxiety were affected by patient complexity, assessments, workload, poor health and family issues. Most participants felt supported by clinical educators/peers, and used coping strategies including exercise and taking breaks. CONCLUSIONS: Physiotherapy students demonstrated highly variable stress/anxiety levels during clinical placements, with higher levels negatively affecting academic performance. Baseline measures of perceived stress/anxiety could potentially highlight students at risk of high levels of stress/anxiety during clinical placements, allowing more targeted interventions. Australian New Zealand Clinical Trials Registry (ACTRN12618000302257).

Reconsidering inherent requirements: a contribution to the debate from the clinical placement experience of a physiotherapy student with vision impairment.

BACKGROUND: Clinical placements in acute hospitals present challenges for students with vision impairment who are being educated as health care professionals. Legislation in Australia supports reasonable adjustments to education, thus students with vision impairment have completed accredited courses and gained professional registration. However the implementation of inherent requirement statements suggesting that adequate visual acuity is required to complete a physiotherapy program may create barriers to access for such students. METHODS: We describe features that contributed to a successful physiotherapy clinical placement in an acute hospital setting for a student with vision impairment and use this experience to prompt debate about the use of inherent requirement statements. FINDINGS: Planning, consultation, collaboration and problem solving commencing from the time of program entry were integral to clinical placement preparation for this student. Individualised adjustments (including a support worker for reading screens and medical records) and the student's specific qualities (professionalism, communication, problem solving, memory, kinaesthetic abilities) contributed to a successful outcome. DISCUSSION: Reflecting on this experience and published inherent requirements, there is an apparent lack of involvement of people with disability in the development of inherent requirement statements; we question the need for this level of regulation; and discuss the potential impact of inherent requirement statements on the health workforce. This experience demonstrated that an individualised approach to reasonable adjustments for a student with a disability was successful in an acute hospital setting. The implementation of inherent requirement statements may systemically reduce the capacity of education providers to develop such bespoke solutions and deserves further debate.