Identifying and navigating suspected serious pathologies: New-graduate physiotherapists' perspectives and developmental needs.

BACKGROUND: Physiotherapists in Australia play a vital first-contact role in identifying suspected serious pathologies and navigating their management pathways. Current literature highlights challenges faced by physiotherapists including implications of ineffective identification and management of suspected serious pathologies, yet the perspectives of new-graduate physiotherapists related to this area of practice remain unknown. OBJECTIVE: The aim of this study was to explore new-graduate physiotherapists' perspectives and developmental needs related to identifying suspected serious pathologies and navigating their management pathways in patients with musculoskeletal complaints. DESIGN: and Method: A qualitative study using a reflexive thematic analytical approach was undertaken. Eighteen semi-structured interviews were conducted. Thematic analysis was utilized on the interview data. RESULTS: Four key themes were generated: (1) Physiotherapists as advocates; (2) Navigating uncertainties and complexities; (3) Safe and accessible workplace support builds confidence; and (4) Importance of direct learning opportunities. CONCLUSION: New-graduate physiotherapists recognize their imperative role as first-contact practitioners in identifying and navigating suspected serious pathologies yet also experience significant uncertainties. The findings highlight key developmental needs, including supportive workplaces, established referral frameworks and direct learning opportunities during pre-professional training.

Fostering collaborative practice through interprofessional simulation for occupational therapy, physiotherapy, dietetics, and nursing students.

Literature regarding simulation for learning interprofessional collaborative practice (IPCP) indicates a need to include a range of health professions and to focus on students' development of team communication and conflict resolution skills in day-to-day healthcare delivery. This study evaluated the impact of interprofessional simulation for occupational therapy, physiotherapy, dietetics, and nursing students on interprofessional collaboration competencies, specifically collaborative communication and conflict resolution during day-to-day interactions, and their intention for IPCP during placement. A series of simulations featuring the potential for interprofessional conflict and involving explicit coaching on communication and conflict resolution were conducted. A single cohort pre-test post-test design included the Students' Perceptions of Interprofessional Clinical Education Revised (SPICE-R), the Interprofessional Collaborative Competencies Attainment Survey (ICCAS), and an open response survey question on future intended practice. A total of 237 students participated in the simulation experience. Overall scores and scores on all IPCP competencies in the ICASS (n = 193) and SPICE-R (n = 226) improved for all professions post-simulation. The mean score of the ICCAS increased for 98% of the respondents and similarly the mean score of the SPICE-R increased for 71% of the respondents. Open-ended responses indicated students' intentions to pursue self-leadership in IPCP. Students who participated in an interprofessional simulation reported perceived improvements in IPCP competencies and were encouraged to initiate IPCP when on placement in the practice setting.

Writing for the role: A qualitative exploration of new graduate physiotherapists' transition to practice of clinical documentation.

INTRODUCTION: Clinical documentation is an integral component of effective physiotherapy practice. Minimal research has explored how new graduate physiotherapists transition to practice of documentation. OBJECTIVE: To understand new graduate physiotherapists' experiences and support needs for transitioning into this professional role, from the perspectives of new graduates and clinical supervisors. METHODS: This study utilized the qualitative methodology of reflexive thematic analysis, situated within a critical realist framework and informed by Duchscher's stages of transition theory. Semi-structured interviews of 16 new graduate physiotherapists (less than two years post-graduation) and seven clinical supervisors (of new graduate physiotherapists) were subjected to inductive analysis, where codes were organized into themes and subthemes. RESULTS: Three overarching themes were generated with associated subthemes. Variable preparedness for documentation identified that new graduates were equipped with the basics of documentation, yet challenged by unfamiliarity and complexity. Documentation practices evolve over time outlined experiences of new graduates developing a "written voice" and improving documentation efficiency. Workplace support is necessary irrespective of preparedness, discusses: i) opportunities to practice, reflect and refine skills, ii) protected time for documentation, and iii) access to templates and examples. CONCLUSION: New graduate physiotherapists enter the workforce with variable levels of preparedness for clinical documentation, and may experience challenges when facing unfamiliar contexts and clinical complexity. Understanding expectations and engaging in opportunities to improve documentation skills were perceived as beneficial for enhancing new graduate practice of clinical documentation across workplace settings. Implications for workplace support to promote safe and effective practice of documentation are discussed.

How to maximise asynchronous video resources that have been co-produced with patient partners.

Ensuring that health professional education is person centred is vital in the pursuit of person-centred clinical care. However, the volume of person-centred care content varies broadly in health professional education. One acknowledged approach to designing curriculum that is person-centred is to embed resources that have been co-produced by patients with lived and living experience. In this article, we aim to provide a guideline for the inclusion of asynchronous interdisciplinary video resources that have been co-produced by patients with lived and living experience.

Prescribing exercise therapy for the management of musculoskeletal pain: new-graduate physiotherapists' perceptions and perceived training needs.

BACKGROUND: Pain management is a challenging area of practice for new-graduate physiotherapists during the transition from student to clinician. The attitudes and beliefs of new-graduate physiotherapists toward the use of exercise therapy as part of the management of musculoskeletal pain remain relatively unknown. PURPOSE: The aim of the study was to investigate the perspectives of new-graduate physiotherapists toward prescribing exercise therapy in musculoskeletal pain management, and their perceptions of training and support needs in this area of practice. METHODS: A qualitative study with a general inductive approach was used to investigate new-graduate physiotherapists' perspectives. Semi-structured interviews were conducted with 16 participants. Interview data was subjected to thematic analysis. RESULTS: Four themes were generated following analysis: 1) Balancing the value of exercise with practical challenges; 2) Communication and education are inherent in exercise; 3) Influence of support and training; and 4) The benefits of direct experience. CONCLUSION: New-graduate physiotherapists acknowledge the pivotal role of exercise in managing musculoskeletal pain. Direct learning experiences in pre-professional training that develop knowledge and skills required for delivering exercise therapy were highly valued. New-graduates recognize pain management as a skill that requires further development and identify the importance of opportunities for professional development in exercise therapy.

"A great tool to open your eyes": new graduate physiotherapists' perceptions and use of social media for learning.

BACKGROUND: Social media offer opportunities for informal learning and are increasingly adopted by health professionals as learning tools. However, little is known of how new graduate physiotherapists engage with social media for learning. PURPOSE: This study aimed to explore new graduate physiotherapists' perceptions and use of social media as learning tools during their transition into professional practice. METHODS: This study used a qualitative general inductive approach. New graduate physiotherapists (n = 16) were recruited through purposive snowball sampling and participated in semi-structured interviews. Data were subjected to a general inductive analytical method. RESULTS: Four themes were generated: 1) social media as tools for learning; 2) navigating and engaging with social media as a learner; 3) thinking critically about social media; and 4) relevance to practice. CONCLUSION: New graduate physiotherapists use social media as adjunct learning tools which can be positioned within several frameworks, including the Situated Learning Theory. However, new graduates voice uncertainties regarding information credibility, the importance of critical thinking skills in navigating information, and concerns regarding blurred work-life boundaries. Recommendations are made for research to further understand social media as emerging learning tools, especially for new graduates who are experiencing insufficient workplace support.

The Health Literacy of First Year Physiotherapy and Speech Pathology Students and Their Perceived Future Roles in Supporting Their Clients' Health Literacy.

BACKGROUND: Allied health professionals are well positioned to assess and support their clients' health literacy (HL); however, they report being deficient in HL knowledge and skills. OBJECTIVE: To explore allied health students' HL and their perceptions of their roles in supporting clients' HL. DESIGN: A mixed-methods cross-sectional study was undertaken in August 2022 amongst allied health students enrolled in graduate-entry masters programs at the University of Tasmania. Data collected included the Health Literacy Questionnaire (HLQ) (n = 30) and qualitative telephone interviews (n = 6). RESULTS: Allied health students' confidence in the knowledge domain of the HLQ was rated as 28.57 from a maximum possible score of 50. Similarly, the students' confidence in the skills domain of the HLQ was rated as 14.87 from a maximum possible score of 25. Four themes were generated from the qualitative interviews: (1) valuing HL, (2) an innate part of their future roles, (3) contributors to their own HL, and (4) advocacy and their decision to study allied health. CONCLUSION: This study provides a preliminary insight into the HL of allied health students and highlights the strong perception held by allied health students that supporting clients' HL is a large component of their future roles.

Exploring new-graduate physiotherapists' preparedness for, and experiences working within, Australian acute hospital settings.

BACKGROUND: New-graduate physiotherapists experience a steep learning curve when transitioning from student to clinician. The acute hospital setting is known to present unique challenges for health clinicians, however, the preparedness of new-graduate physiotherapists for working within this setting remains unclear. PURPOSE: The aim of this study was to investigate new-graduate physiotherapists' experiences of working in acute hospital settings and their perceptions toward how their pre-professional training prepared them for this setting. METHODS: A qualitative study with a general inductive approach was used. Semi-structured interviews with new-graduate physiotherapists working in acute hospital settings were undertaken (n = 14). Interview data were subject to thematic analysis. RESULTS: Four themes were generated from the data: 1) multifactorial and high-pressure nature; 2) managing relationships; 3) realizing responsibility; and 4) constructing realistic experiences. CONCLUSION: The acute hospital setting presents unique obstacles and additional challenges when transitioning from student to clinician. New-graduates value the role of pre-professional training in their preparation for this context, however, new-graduates reflected on being sheltered from some areas of practice as students. Recommendations are suggested for education providers to adapt pre-professional training, and for employers to implement workplace strategies, which may support new-graduate physiotherapists in the acute hospital setting.

Physiotherapy students' empathy towards Australians living in rural settings: A pre-test post-test evaluation of a stand-alone rural simulation activity.

OBJECTIVE: To investigate how a rural simulation activity influenced physiotherapy students' rural empathy, and to explore students' perception of the activity. SETTING: A metropolitan university in Queensland, Australia. PARTICIPANTS: Second year undergraduate physiotherapy students. DESIGN: A single cohort pre-test post-test evaluation was undertaken to evaluate a rural simulation activity. Participants received the rural simulation activity, featuring an immersive video and telehealth simulation with a standardised patient portrayed by an actor. Participants undertook a structured debrief and guided reflection following the simulation. Outcome measures included the Rural Comprehensive State Empathy Scale (R-CSES) and the Satisfaction with Simulation Experience Scale. Group interviews were undertaken regarding participant perceptions of the activity. Wilcoxon Rank-Sum tests were used to analyse survey data, and group interview data were subject to thematic analyses. RESULTS: A total of 102 students undertook the activity, with an outcome measure response rate of 92.2% (94/102). Intra-personal rural empathy increased following the activity as demonstrated by the overall R-CSES score [pre-test: 101.5 (90-110.75) vs post-test 107 (100-120); p = <0.001; r = 0.39]. There was high satisfaction with the experience [mean SSES score = 18/21]. Two themes were generated from the group interview data: (1) effect on perceptions of rural practice and (2) feedback regarding the simulation. CONCLUSION: A rural simulation activity using an immersive video, standardised patient, and a structured debrief increased physiotherapy students' empathy towards Australians living in rural settings. Students were satisfied with the activity and felt that it improved their understanding of the challenges of rural healthcare.

Higher quality of care in emergency departments with physiotherapy service models.

OBJECTIVE: To investigate the quality of care provided by EDs with physiotherapy services compared to those without, using established musculoskeletal process and outcome quality indicators (QIs). METHODS: An analysis was undertaken of prospective observational and chart audit data collected from 628 patients who presented with a musculoskeletal injury in any of the eight participating EDs in Queensland in 2016-2017. The care provided was scored against 46 musculoskeletal QIs. Quality of care was first compared between EDs with physiotherapists to EDs with a limited physiotherapy service, and second between EDs with primary contact physiotherapists to EDs without. χ2 and Fisher's exact tests were used to identify significant results. RESULTS: In the first comparison, EDs with physiotherapists performed significantly higher on 15 QIs and EDs with only limited physiotherapy performed higher on two QIs. In the second comparison, EDs with primary contact physiotherapists performed significantly higher on 17 QIs when compared to EDs without and three QIs demonstrated significance in favour of EDs without primary contact physiotherapists. Performance differences occurred across both process and outcome QIs, including musculoskeletal assessment, diagnostics, pain assessment and management, fracture management, medication safety, mobility, patient information, referrals and follow-up, re-presentations and patient experience. CONCLUSIONS: EDs with physiotherapists provide at least equivalent or higher quality of care for patients with musculoskeletal injuries than those EDs with limited access to physiotherapists. This may be because of their specialised training in musculoskeletal diagnosis and treatment, as well as the impact of teaching and mentoring for other ED clinicians.

New-graduate physiotherapists' training needs and readiness for telehealth.

INTRODUCTION: The COVID-19 pandemic has necessitated a rapid transition to telehealth for the delivery of many Australian physiotherapy services. Little is known about new-graduate training needs in this method of service delivery.Aim.To explore the readiness and specific training needs of new-graduate physiotherapists for telehealth service delivery in Australia. METHODS: Qualitative individual telephone interviews of new-graduate physiotherapists (n = 16) and two videoconference focus groups of supervisors of new-graduate physiotherapists (n = 7) were undertaken. Thematic analysis was used. RESULTS: Two global themes each with three organizing themes were generated. The two global themes were "support needs for novice practitioners" and "how to best prepare for telehealth." DISCUSSION AND CONCLUSION: New-graduate physiotherapists and supervisors perceive that pre-professional exposure to, and practical skills training for, telehealth is essential. Elements such as undertaking physical assessments via telehealth, verbal communication, and effective clinical reasoning in telehealth assessment and treatment were highlighted as areas of need. Both stakeholder groups perceived that the rapid transition to telehealth challenged the self-efficacy of new-graduates as they did not have clinical experience to rely on. The preparation, and ongoing support of new-graduates to adopt telehealth in the workplace is considered critical given the shift in Australian healthcare to online platforms.

Competencies for entry-level rural and remote physiotherapy practice: a Delphi approach.

INTRODUCTION: Rural physiotherapy is a challenging area of practice that requires clinicians to respond to the unique factors that contribute to rurality. This study aimed to outline an introductory set of competencies that contribute to effective physiotherapy practice in rural Australia. METHODS: A three-round Delphi study was undertaken using a panel of expert physiotherapists. The panel was asked to provide open-ended responses to the following question: 'What unique knowledge, skills, abilities, attributes or other characteristics do physiotherapists need to possess, or learn in order to provide effective physiotherapy specifically in a rural or remote setting?' These responses were then thematically analysed to create competencies. The competencies were evaluated in the subsequent rounds by the Delphi panel. Consensus was set at 80%. Rural and remote experts were determined through criteria including duration of practice, established expert frameworks, and self- or peer nomination. The publicly accessible Australian Physiotherapy Association database was used to access the contact details of 222 physiotherapists working in rural and remote locations across all Australian states and territories. Seventeen expert physiotherapists met inclusion criteria and consented to participation. RESULTS: Seventeen expert physiotherapists completed round one with a 100% response rate. Analysis of the expert panel responses yielded an initial 24 competencies. The second round had a response rate of 94.1%, and the third round 93.8%. A final set of 19 competencies was established. The knowledge, skills and attributes featured in the competencies relate to responsivity to rural locality, adapting to individual community needs and problem solving in response to challenges to practising in rural and remote locations. CONCLUSION: This study has introduced a set of competencies that may contribute towards effective physiotherapy practice in the rural setting. The competencies provide a common language for physiotherapists and their employers, and may be used to guide training or mentorship in this setting.

An exploration of workplace mentoring preferences of new-graduate physiotherapists within Australian practice.

BACKGROUND AND PURPOSE: The transition from student to physiotherapist involves a steep learning curve typically characterised by stress, anxiety and a lack of confidence in clinical and professional skills. Workplace mentoring is widely used to mediate this transition. The aim of this study was to explore new-graduate physiotherapists' preferences for workplace mentoring and perceived characteristics of effective mentoring to mediate workplace transition. METHODS: A qualitative study with a general inductive thematic approach was used. Semi-structured interviews of 15 employed new-graduate physiotherapists were undertaken within their first 3-6 months of clinical practice. RESULTS: Four themes emerged that were associated with effective mentoring from the new-graduates' perspective: (1) accessibility of mentoring and support, (2) the ideal mentor, (3) individualised to the mentee and (4) desire for self-determination. DISCUSSION AND CONCLUSION: This study is the first to explore new-graduate physiotherapists' preferences for workplace mentoring in their transition into the workplace and clinical practice. It has identified important characteristics of physiotherapists and other clinicians who support the transition of new-graduate physiotherapists into the practice setting. Enhancing workplaces through support for the development of these characteristics can contribute to the effective integration of the newest members of the profession and may enhance their development and retention in practice.

New-graduate physiotherapists' perceptions of their preparedness for rural practice.

OBJECTIVE: Providing health care in a rural or remote setting requires physiotherapists to adapt to a number of unique challenges. New-graduates working in rural or remote settings must respond to these challenges in addition to those of being a novice practitioner. This study investigated the perceived preparedness of new-graduate physiotherapists for work in rural or remote settings. DESIGN: A qualitative general inductive approach. SETTING: Rural and remote Queensland. PARTICIPANTS: New-graduate physiotherapists   working in rural or remote locations were contacted via a snowballing recruitment strategy. MAIN OUTCOME MEASURE: Semi-structured interviews. RESULTS: Four key themes emerged from the data: (a) adjusting to rural life, (b) embracing opportunities, (c) stepping up to the plate and (d) preparing through authentic experiences. CONCLUSION: New-graduate physiotherapists perceived rural and remote practice to be a challenging but valuable opportunity with many social and professional rewards. The complex clinical demands and unique cultural factors inherent in rural and remote locations were experienced as additional obstacles to the transition from student to clinician. New-graduate physiotherapists were satisfied that their entry-level training provided the necessary skills required to practise rurally and remotely; however, they expressed 'shock' at the rapid adaptations needed to provide effective service in these settings. New-graduates are confident that exposure to authentic rural and remote clinical practice during their training was integral to their preparedness.