A mandala of faculty development: using theory-based evaluation to explore contexts, mechanisms and outcomes.

Demonstrating the impact of faculty development, is an increasingly mandated and ever elusive goal. Questions have been raised about the adequacy of current approaches. Here, we integrate realist and theory-driven evaluation approaches, to evaluate an intensive longitudinal program. Our aim is to elucidate how faculty development can work to support a range of outcomes among individuals and sub-systems in the academic health sciences. We conducted retrospective framework analysis of qualitative focus group data gathered from 79 program participants (5 cohorts) over a 10-year period. Additionally, we conducted follow-up interviews with 15 alumni. We represent the interactive relationships among contexts, mechanisms, and outcomes as a "mandala" of faculty development. The mandala illustrates the relationship between the immediate program context, and the broader institutional context of academic health sciences, and identifies relevant change mechanisms. Four primary mechanisms were collaborative-reflection, self-reflection and self-regulation, relationship building, and pedagogical knowledge acquisition. Individual outcomes, including changed teaching practices, are described. Perhaps most interestingly, secondary mechanisms-psychological and structural empowerment-contributed to institutional outcomes through participants' engagement in change leadership in their local contexts. Our theoretically informed evaluation approach models how faculty development, situated in appropriate institutional contexts, can trigger mechanisms that yield a range of benefits for faculty and their institutions. The adopted methods hold potential as a way to demonstrate the often difficult-to-measure outcomes of educational programs, and allow for critical examination as to how and whether faculty development programs can accomplish their espoused goals.

Analyzing international clinical education practices for Canadian rehabilitation students.

BACKGROUND: Clinical training in low-income countries has become increasingly popular among pre-licensure trainees from high-income countries. The Working Group on Ethics Guidelines for Global Health Training ("WEIGHT Guidelines") were designed to identify and inform the complex and contentious field of international clinical education. The purpose of this study was to use the WEIGHT Guidelines to evaluate an international clinical internship programme for Master's-level rehabilitation students at a Canadian university. METHODS: In-depth, semi-structured interviews were conducted with eight Canadian rehabilitation researchers, educations and/or clinicians responsible for administering international internships across three clinical training programmes. Interview questions were informed by the WEIGHT Guidelines. Directed content analysis was used to identify priorities for policy, practice and research. RESULTS: Five themes relating to strengthening international clinical education were identified: (1) from one-time internships to long-term partnerships, (2) starting a discussion about "costs", (3) a more informed approach to student selection, (4) expanding and harmonizing pre-departure training across disciplines, and (5) investing in post-internship debriefing. CONCLUSIONS: International clinical education is fraught with ethical, pedagogical and logistical issues that require recognition and ongoing management. This is the first study to use the WEIGHT Guidelines as a qualitative research tool for assessing an existing global health education programme. Results highlight new priorities for action at the Canadian "sending institution", including more explicit attention to the costs (broadly defined) borne by all parties. A crucial next step is deepened engagement with educational partners at the "receiving organizations" based in low-income countries to nurture dialogue regarding reciprocity, trust and sustainability of the partnership. Education research is also needed that evaluates models of pre-departure training and post-internship debriefing for trainees.

The Development of the Canadian Physiotherapy Assessment of Clinical Performance (ACP) 2.0 - Alignment with the 2017 Competency Profile.

Purpose: Clinical education and assessment of students' performance during clinical placements are key components of Canadian entry-to-practice physiotherapy curriculum and important in developing entry-level physiotherapy practitioners. The Canadian Physiotherapy Assessment of Clinical Performance (ACP) is the measure currently used to assess physiotherapy student performance on clinical placements in most of the entry-to-practice physiotherapy programmes across Canada. The release of the 2017 Competency Profile by the National Physiotherapy Advisory Group resulted in a revision of the existing ACP. The purpose of this study is to report the process used to develop a revised version of the ACP based on the 2017 Competency Profile, henceforth called the ACP 2.0. Method: Using a multistage process, we sought input from Canadian clinical education academics, an expert consultant panel, as well as physiotherapists across Canada using a questionnaire, meetings, and an online survey, respectively. Results: Twelve of 15 clinical education academics responded to a questionnaire. The expert consultant panel (n = 12) met three times. There were 144 physiotherapists who initiated the national, online, survey and met the inclusion criteria; 84 completed the survey. In the ACP 2.0, rating scales and comments boxes were grouped, and additional text was added to 12 items for further clarification. The ACP 2.0 came to have 18 items and 9 comment boxes in addition to summative comments, in contrast to the original ACP's 21 items and 9 comment boxes. Conclusions: In November 2020, Canadian clinical education academics reviewed the proposed draft ACP 2.0 and unanimously accepted it for implementation in Canadian physiotherapy university programmes.

Objectif: l'enseignement clinique et l'évaluation du rendement des étudiants pendant les stages cliniques sont des éléments clés du programme canadien d'entrée en pratique de la physiothérapie et sont importants pour former des praticiens de la physiothérapie prêts à entrer en pratique. L'évaluation du rendement clinique de la physiothérapie au Canada (ÉPC) est la mesure actuellement en usage pour évaluer le rendement des étudiants en physiothérapie lors de leur stage clinique dans la plupart des programmes d'entrée en pratique de la physiothérapie au Canada. La publication du Profil des compétences par le Groupe consultatif national en physiothérapie en 2017 a donné lieu à une révision de l'ÉPC. La présente étude vise à rendre compte du processus utilisé pour mettre au point une version révisée de l'ÉPC d'après le Profil des compétences de 2017, désormais appelée l'ÉPC 2.0. Méthodologie: au moyen d'un processus échelonné, les chercheurs ont demandé l'apport d'universitaires canadiens en enseignement clinique, d'un groupe d'experts consultants et de physiothérapeutes des diverses régions du Canada dans le cadre d'un questionnaire, de réunions et d'un sondage en ligne, respectivement. Résultats: au total, 12 des 15 universitaires en enseignement clinique ont répondu à un questionnaire. Le groupe d'experts consultants (n = 12) s'est réuni trois fois. Enfin, 144 physiothérapeutes qui respectaient les critères d'inclusion ont entrepris le sondage national en ligne, et 84 l'ont terminé. Dans l'ÉPC 2.0, les échelles d'évaluation et les encadrés de commentaires ont été regroupés et du texte a été ajouté à 12 des points afin de les clarifier. L'ÉPC 2.0 comporte finalement 18 points et neuf encadrés de commentaires en plus des commentaires sommatifs, par rapport aux 21 points et aux neuf encadrés de commentaires de l'ÉPC original. Conclusions: en novembre 2020, les universitaires en enseignement clinique canadiens ont révisé le projet d'ÉPC 2.0 et en ont adopté la mise en œuvre à l'unanimité au sein des programmes universitaires de physiothérapie du Canada.

Exploring the Experiences and Impacts of Research Role-Emerging Placements in Physiotherapy.

Purpose: Research role-emerging placements (RREPs) have been integrated into placement offerings in Canadian physiotherapy programmes. The purpose of the present study is to describe the experiences and impacts of RREPs completed by graduates of Canadian physiotherapy programmes. Methods: Participants were recruited by purposive sampling and completed semi-structured interviews to explore their RREP experiences. Themes were identified using thematic analysis and collaboratively analyzed using the DEPICT model. Results: Eleven participants who completed RREPs during their Canadian physiotherapy programmes (three men, eight women; aged 26.9 [SD 2.7] years) took part in this study. The participants expressed the RREP was a valuable experience. Four themes emerged from the data: (1) Motivators for selecting an RREP included interest in research or a medical injury, (2) The RREP experience involved benefits and challenges, (3) Impacts of completing an RREP, and (4) RREP participant suggestions. Conclusions: RREPs are valuable placement opportunities for learners in Canadian physiotherapy programmes facilitating the development of essential competencies in a non-traditional setting. RREPs could be considered as a placement opportunity for other allied health programmes, as the skills gained are beneficial for all health care professionals.

Objectif: les stages de recherche dans un rôle émergent (SRRÉ) sont intégrés aux offres de stage des programmes de physiothérapie canadiens. La présente étude visait à décrire les expériences et les effets des SRRÉ effectués par les diplômés des programmes de physiothérapie canadiens. Méthodologie: les chercheurs ont recruté les participants par échantillonnage dirigé et ont effectué des entrevues semi-structurées pour explorer leurs expériences de SRRÉ. Ils ont extrait les thèmes au moyen d'une analyse thématique et en ont fait une analyse coopérative à l'aide du modèle DEPICT. Résultats: onze participants qui ont effectué des SRRÉ pendant leur programme de physiothérapie au Canada (trois hommes, huit femmes; 26,9 ± 2,7 ans) ont participé à l'étude. Ils ont trouvé que leur SRRÉ avait été une expérience précieuse. Ils ont tiré quatre thèmes des données : 1) les motivations pour sélectionner un SRRÉ incluaient l'intérêt pour la recherche ou une lésion médicale, 2) l'expérience du SRRÉ comportait des avantages et des difficultés, 3) les répercussions d'avoir effectué un SRRÉ et 4) les suggestions des participants aux SRRÉ. Conclusions: les SRRÉ sont de précieuses occasions de stage pour les apprenants des programmes de physiothérapie canadiens, ce qui a facilité l'acquisition de compétences essentielles dans un milieu non traditionnel. Les SRRÉ pourraient être considérés comme des occasions de stage dans des programmes de santé connexes, car les compétences acquises sont bénéfiques pour tous les professionnels de la santé.

Virtually present: the perceived impact of remote facilitation on small group learning.

BACKGROUND: The engagement of facilitators located remotely for small group learning has received little research attention. However, this approach could increase the pool of experts for small group learning, thus addressing challenges to sustainability faced by in-person models of small group facilitation. AIM: The objective of this study was to describe the experiences and perceptions of students regarding the use of remote facilitation for small group learning in a health education setting. METHODS: This qualitative study involved three focus groups (n = 16) composed of students in the advanced neuromusculoskeletal teaching unit in the University of Toronto, Department of Physical Therapy. Focus groups were audio-taped and transcribed verbatim, and data were analyzed thematically. RESULTS: Three main influences emerged related to the experiences of students regarding the use of remote facilitation for small group learning in a health education setting: technology (including audio and visual), facilitator (including quality of facilitation and facilitator expertise), and group dynamics (including ground rules, roles and responsibilities, and learning style). Each of these influences acted independently and interdependently to shape participants' perceptions. CONCLUSION: This study prompts a widening of the concept of distance learning to also include distance teaching, which may have wide applicability to health profession programs.

Who am I? Key influences on the formation of academic identity within a faculty development program.

INTRODUCTION: Professional identity encompasses how individuals understand themselves, interpret experiences, present themselves, wish to be perceived, and are recognized by the broader professional community. For health professional and health science educators, their 'academic' professional identity is situated within their academic community and plays an integral role in their well being and productivity. This study aims to explore factors that contribute to the formation and growth of academic identity (AI) within the context of a longitudinal faculty development program. METHODS: Using a qualitative case study approach, data from three cohorts of a 2-year faculty development program were explored and analyzed for emerging issues and themes related to AI. RESULTS: Factors salient to the formation of AI were grouped into three major domains: personal (cognitive and emotional factors unique to each individual); relational (connections and interactions with others); and contextual (the program itself and external work environments). DISCUSSION: Faculty development initiatives not only aim to develop knowledge, skills, and attitudes, but also contribute to the formation of academic identities in a number of different ways. Facilitating the growth of AI has the potential to increase faculty motivation, satisfaction, and productivity. Faculty developers need to be mindful of factors within the personal, relational, and contextual domains when considering issues of program design and implementation.

Assessing the inter-rater and intra-rater reliability of the Physical Therapy Competence Assessment for Airway Suctioning (PT-CAAS).

BACKGROUND AND PURPOSE: The Physical Therapy Competence Assessment for Airway Suctioning (PT-CAAS) is a recently developed measure to assess the clinical competence of physiotherapists who perform airway suctioning with adults. The purpose of this study was to assess the inter-rater and intra-rater reliability of the PT-CAAS. METHODS: Scoring rules were developed through expert consultation. Reliability was then assessed using nine videos of suctioning performed in a simulated learning environment. A repeated measures design was used, with two replicate sets of measurements made by each participant for all videos. Data were analyzed using a repeated measures model for the concurrent assessment of inter-rater and intra-rater reliability. Participants were physiotherapists with suctioning experience. RESULTS: Twenty physiotherapists completed initial scoring and re-scoring for all nine videos; their data were included in the analysis. Intraclass correlation coefficients (ICCs) for inter-rater reliability ranged from 0.569 [lower one-sided 95% confidence interval (CI): 0.395; standard error of measurement (SEM): 0.963] for infection control to 0.759 (lower one-sided 95% CI: 0.612; SEM: 0.722) for post-suctioning assessment and care. The inter-rater ICC for overall performance was 0.752 (lower one-sided 95% CI: 0.602; SEM: 0.660). ICCs for intra-rater reliability ranged from 0.759 (lower one-sided 95% CI: 0.197; SEM 0.721) for infection control to 0.860 (lower one-sided 95% CI: 0.544; SEM: 0.550) for post-suctioning assessment and care. The intra-rater ICC for overall performance was 0.867 (lower one-sided 95% CI: 0.559; SEM: 0.483). DISCUSSION: Evidence of moderate to good inter-rater and good intra-rater reliability was found; however, the results should be interpreted with caution given the wide CIs and relatively large SEMs. Improved assessor training and assessments of reliability using a larger sample size are recommended.

Physiotherapists' Perspectives on Professional Practice Leadership Models: Key Features to Enhance Physiotherapy Practice.

Purpose: The purpose of this study was to explore professional practice leadership models (PPLMs) within the Toronto Academic Health Science Network (TAHSN) by outlining the PPLMs currently in use, identifying elements of the PPLMs from physiotherapists' perspectives, and determining key features of PPLMs that enhance physiotherapy (PT) practice. Methods: In this qualitative, cross-sectional study, we used focus groups to explore physiotherapists' knowledge about their facility's PPLM, physiotherapists' role within the PPLM, the impact of professional practice leaders on PT practice, the impact of the PPLM on physiotherapists' job satisfaction, and the elements of an ideal PPLM. We coded transcripts using qualitative software and followed an inductive data analysis approach to develop themes. Results:We conducted eight focus groups with physiotherapists from six TAHSN facilities (four organizations). Five key features of PPLMs emerged from participants' perspectives: support network, organizational structure, professional development opportunities, influence of the leader in professional practice, and balance of workloads and accountabilities. Each key feature encompassed a group of interrelated elements - that is, components of the PPLMs that influenced PT practice. Conclusions: Our study is the first to explore elements and key features of the PPLMs used in TAHSN facilities as they relate to PT. We provide five recommendations to enhance PPLMs with respect to the PT profession.

Objectif :  explorer les modèles de leadership en pratique professionnelle (MLPP) au sein du Toronto Academic Health Science Network (TAHSN). Pour ce faire, répertorier les MLPP en usage, déterminer les éléments du MLPP du point de vue des physiothérapeutes et établir les caractéristiques clés des MLPP qui améliorent l'exercice de la physiothérapie. Méthodologie : les chercheurs de cette étude transversale qualitative ont fait appel à des groupes de travail pour explorer les connaissances des physiothérapeutes à l'égard des MLPP de leur établissement, le rôle des physiothérapeutes au sein des MLPP, les répercussions des leaders en pratique professionnelle sur l'exercice de la physiothérapie, les répercussions des MLPP sur la satisfaction au travail des physiothérapeutes et les éléments d'un MLPP idéal. Ils ont codé les transcriptions à l'aide de logiciels qualitatifs et ont utilisé une approche inductive de l'analyse de données pour dégager les thèmes. Résultats :  les chercheurs ont tenu huit groupes de travail avec des physiothérapeutes de six établissements du TAHSN (quatre organisations). Cinq caractéristiques clés des MLPP émergent des perspectives des participants : le réseau d'entraide, la structure organisationnelle, les possibilités de perfectionnement professionnel, l'influence du leader en pratique professionnelle et l'équilibre des charges de travail et des responsabilités. Chaque caractéristique clé comprenait un groupe d'éléments interreliés, soit les éléments des MLPP qui influaient sur l'exercice de la physiothérapie. Conclusions :  la présente étude est la première à explorer les éléments et les caractéristiques clés des MLPP utilisés en physiothérapie dans les établissements du TAHSN. Les chercheurs proposent cinq recommandations pour améliorer les MLPP en physiothérapie.

Physiotherapy Students' Performance in Clinical Education: An Analysis of 1 Year of Canadian Cross-Sectional Data.

Purpose: This research examines 1 year of cross-sectional, Canada-wide ratings from clinical instructors using the Canadian Physiotherapy Assessment of Clinical Performance (ACP) and analyzes the performance profiles of physiotherapy students' performance ratings over the course of their entry-to-practice clinical placements. Method: Canadian physiotherapy programmes that use the ACP were invited to submit anonymized, cross-sectional data for placements completed during 2018. Descriptive analyses and summary statistics were completed. Mixed-effects modelling was used to create typical performance profiles for each evaluation criterion in the ACP. Stepwise ordered logistic regression was also completed. Results: Ten programmes contributed data on 3,290 placements. Profiles were generated for each ACP evaluative item by means of mixed-effects modelling; three profiles are presented. In all cases, the predicted typical performance by the end of 24 months of study was approximately the rating corresponding to entry level. Subtle differences among profiles were identified, including the rate at which a student may be predicted to receive a rating of "entry level." Conclusions: This analysis identified that, in 2018, the majority of Canadian physiotherapy students were successful on clinical placements and typically achieved a rating of "entry level" on ACP items at the end of 24 months.

Objectif : étude transversale d'un an des évaluations canadiennes des moniteurs cliniques au moyen de l'Évaluation physiothérapique canadienne de la performance clinique (ÉPC) pour analyser les profils de performance des étudiants en physiothérapie pendant la durée de leurs stages cliniques débutants. Méthodologie : les programmes de physiothérapie canadiens qui font appel à l'ÉPC ont été invités à soumettre des données transversales anonymisées sur les stages effectués en 2018. Les chercheurs ont procédé à des analyses descriptives et des statistiques sommaires. Ils ont utilisé des modèles non linéaires à effets mixtes pour créer des profils de performance types pour chaque critère d'évaluation de l'ÉPC. Ils ont également procédé à la régression logistique séquentielle. Résultats : dix programmes ont fourni des données sur 3 290 stages. Les chercheurs ont produit des profils pour chaque point d'évaluation de l'ÉPC au moyen du modèle non linéaire à effets mixtes et en ont retenu trois. Dans tous les cas, la performance type anticipée à la fin des 24 mois d'étude correspondait environ au classement de premier échelon. Les chercheurs ont constaté des différences discrètes entre les profils, y compris la vitesse à laquelle il est possible d'anticiper qu'un étudiant recevra un classement de premier échelon. Conclusions : cette analyse a déterminé qu'en 2018, la majorité des étudiants en physiothérapie canadiens réussissaient leur stage clinique, et ils obtenaient habituellement une note de premier échelon aux points de l'ÉPC à la fin des 24 mois.

How Do I Choose a Job? Factors Influencing the Career and Employment Decisions of Physiotherapy Graduates in Canada.

Purpose: Physiotherapy is a diverse profession: there are many areas in which physiotherapists can practise. New graduates must decide in which area of physiotherapy they would like to work and with which organizations to seek employment. The purpose of this study was to describe the factors that influenced the career (area of practice, practice setting) and employment (organization) decisions of recent physiotherapy graduates. Method: Given Canada's vast expanse, we used survey methodology. We invited English-speaking physiotherapists who had completed their physiotherapy education between October 2015 and December 2017 to participate in this study. The survey was emailed to 1,442 physiotherapists in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and Nova Scotia. Results: We collected 351 responses (24%). Almost all respondents reported currently working as a physiotherapist, and the majority worked with patients with musculoskeletal conditions. Clinical education experiences were most influential in determining career decisions. Area of practice, practice setting, and mentorship were the most influential factors contributing to employment decisions. Conclusions: Clinical education experiences are influential in shaping physiotherapy students' career and employment decisions. Employers who want to recruit physiotherapy graduates may consider partnering with physiotherapy programmes to offer clinical placement experiences and develop mentorship programmes that help build novice physiotherapists' competence and confidence.

Objectif : la physiothérapie est une profession diversifiée : les physiothérapeutes peuvent exercer dans divers domaines. Les nouveaux diplômés doivent décider celui dans lequel ils désirent travailler et dans quelles organisations solliciter un emploi. La présente étude visait à décrire les facteurs qui avaient influé sur les décisions des récents diplômés en physiothérapie pour leur choix de carrière (domaine et milieu d'exercice) et d'emploi (organisations). Méthodologie : étant donné l'immensité du Canada, les chercheurs ont opté pour la méthodologie du sondage. Ils ont invité les physiothérapeutes anglophones qui avaient terminé leurs études entre octobre 2015 et décembre 2017 à participer. Ils ont posté le sondage à 1 442 physiothérapeutes de la Colombie-Britannique, de l'Alberta, de la Saskatchewan, du Manitoba, de l'Ontario et de la Nouvelle-Écosse. Résultats : les chercheurs ont colligé 351 réponses (24 %). Presque tous les répondants ont déclaré travailler comme physiothérapeutes, la majorité auprès de patients ayant des troubles musculosquelettiques. Les expériences cliniques pendant leurs études avaient été déterminantes dans leur choix de carrière. Le domaine et le milieu d'exercice et le mentorat étaient les facteurs qui avaient le plus influencé leurs décisions en matière d'emploi. Conclusions : les expériences cliniques pendant les études contribuent à orienter les décisions des étudiants en matière de carrière et d'emploi. Les employeurs qui souhaitent recruter des diplômés en physiothérapie peuvent envisager de s'associer à des programmes de physiothérapie pour offrir des expériences de stage clinique et créer des programmes de mentorat qui contribueront à accroître les compétences et la confiance des physiothérapeutes novices.

Using Expert Consensus to Develop a Tool to Assess Physical Therapists' Knowledge, Skills, and Judgement in Performing Airway Suctioning.

Purpose: The aim of this study was to develop a tool to assess physical therapists' knowledge, skills, and judgement in performing airway suctioning with intubated and non-intubated adults. Method: A modified Delphi methodology was used to develop the tool and to evaluate its sensibility (i.e., common-sense nature). Participants were experienced cardiorespiratory physical therapists who perform airway suctioning and physical therapists employed in academic positions related to cardiorespiratory physical therapy at Canadian universities. Round 1 focused on refining which items to include in the tool, Round 2 focused on finalizing the items, and Round 3 focused on evaluating a preliminary version of the tool. Results: A total of 34 individuals participated in Round 1, 30 participated in Round 2, and 25 participated in Round 3. A literature review identified 11 relevant domains and 69 supporting competencies. In Round 1, consensus was achieved for all domains; however, it was borderline for the professionalism domain. Multiple participants suggested that it was redundant because it is a global requirement for all physical therapists. Consensus was also achieved for 64 of the 69 supporting competencies; however, it was borderline for 5 of these items, and 5 achieved no consensus. In Round 2, participants rated a series of recommendations related to items requiring further consideration, as well as 9 new items suggested by the participants in Round 1. In Round 3, the preliminary tool was found to be globally sensible, but concerns were expressed about the inclusion of redundant factors and the tool's length. The tool was revised, resulting in a tool with 4 domains, 6 sub-domains and 43 supporting competencies, as well as an item rating the individual's overall performance. Conclusions: The final-round sensibility questionnaire provided preliminary evidence of the tool's face and content validity. We will investigate the tool's measurement properties in a future study.

Objectif : mettre au point un outil pour évaluer les connaissances, les compétences et le jugement des physiothérapeutes à l'égard de l'aspiration des voies respiratoires d'adultes intubés et non intubés. Méthodologie : utilisation d'une méthodologie Delphi modifiée pour mettre au point l'outil et en évaluer la sensibilité (p. ex., le gros bon sens). Les participants étaient des physiothérapeutes cardiopulmonaires expérimentés qui effectuent l'aspiration des voies respiratoires, de même que des physiothérapeutes qui occupent des postes liés à la physiothérapie cardiopulmonaire dans des universités canadiennes. La première ronde était axée sur le perfectionnement des points à inclure dans l'outil, la deuxième, sur leur peaufinage et la troisième, sur l'évaluation d'une version préliminaire de l'outil. Résultats : au total, 34 personnes ont participé à la première ronde, 30, à la deuxième et 25, à la troisième. Une analyse bibliographique a permis de relever 11 domaines pertinents et 69 compétences connexes. Pendant la première ronde, les participants sont parvenus à un consensus dans tous les domaines, même si celui du professionnalisme a failli en être exclu, car de multiples participants le trouvaient redondant puisqu'il est exigé de tous les physiothérapeutes. Ils sont également parvenus à un consensus au sujet de 64 des 69 compétences connexes, dont cinq ont failli ne pas être incluses et cinq ont été rejetées. Pendant la deuxième ronde, les participants ont classé une série de recommandations liées à des points exigeant d'être examinés plus attentivement, de même que neuf nouveaux points proposés par les participants dans la première ronde. Dans la troisième ronde, l'outil préliminaire s'est révélé globalement sensible, mais des inquiétudes ont été soulevées quant à l'inclusion de facteurs redondants et à sa longueur. L'outil a été révisé et transformé pour comporter quatre domaines, six sous-domaines et 43 compétences connexes, puis un point a été ajouté pour évaluer le rendement global de l'individu. Conclusions : le questionnaire de sensibilité de la dernière ronde a fourni des données préliminaires sur la validité apparente et la validité du contenu de l'outil. Les auteurs examineront les propriétés de mesure de l'outil dans une prochaine étude.

Designing, Implementing, and Evaluating a Practice Tutor Internship Model during an Acute Care Clinical Internship.

Purpose: The purpose of this study was to implement and evaluate a novel internship model that incorporates a practice tutor in physiotherapy clinical education during an acute care cardiorespiratory internship at a large acute tertiary care teaching hospital in Canada. Method: A prospective evaluation of this model was conducted by means of a mixed-methods approach using surveys and focus groups. The participants were students and clinical instructors (CIs) who were taking part in the internship. Results: Half of the CIs agreed that the practice tutor model gave them more time to manage their caseload and work with the student than did the traditional model, and 63% would recommend the model for future internships. In reviewing the focus group and open-ended data, we identified four themes: benefits, tensions, critical logistics, and unforeseen blind spots. There was a trend for patient attendance to increase with the practice tutor model compared with the previous year's internship session and with the 5 weeks immediately preceding the internship. Conclusions: On the basis of CIs' and students' self-reports, the piloted practice tutor model was perceived to facilitate students' clinical reasoning and collaborative learning skills. In addition, during the 5-week internship, the number of patients seen each day by the individual CIs and their students was not reduced, with a trend toward increased patient attendance. There was also a trend toward CIs having the same or more time to manage their caseload and work with the students compared with a non-practice tutor internship model. Recommendations to improve this model in future implementations are made.

Objectif : mettre en œuvre et évaluer un modèle de stage novateur qui intègre un tuteur d'entraînement à la formation clinique en physiothérapie lors d'un stage en soins cardiorespiratoires aigus dans un grand hôpital universitaire de soins tertiaires du Canada. Méthodologie : évaluation prospective de ce modèle par une méthode mixte de sondages et de groupes de travail auxquels des étudiants et des moniteurs cliniques (MI) du stage ont participé. Résultats : la moitié des MI convenaient que le modèle de tuteur d'entraînement leur donnait plus de temps pour gérer leur charge de travail et travailler avec les étudiants que le modèle classique, et 63 % le recommanderaient pour de futurs stages. Quatre thèmes ont ressorti des groupes de travail et des données ouvertes : les avantages, les tensions, l'importance de la logistique et les angles morts imprévus. Par rapport au stage de l'année précédente et aux cinq semaines précédant immédiatement les stages, il y avait une tendance à faire participer les patients pour améliorer le modèle de tuteur d'entraînement. Conclusion : selon le compte rendu des MI et des étudiants, le projet pilote de tuteurs d'entraînement était perçu comme un moyen de faciliter le raisonnement clinique et les habiletés d'apprentissage coopératif des étudiants. De plus, le nombre de patients que voyait chaque MI avec ses étudiants chaque jour ne diminuait pas, et on observait une tendance vers la fréquentation accrue des patients pendant le stage de cinq semaines. Il y avait également une tendance à ce que les MI aient le même temps ou plus de temps pour gérer leur charge de travail et travailler avec les étudiants que dans un stage sans tuteur d'entraînement. Des recommandations sont présentées pour améliorer ce modèle lors de sa mise en œuvre.

Students' Perspectives on Their Experience in Clinical Placements: Using a Modified Delphi Methodology to Engage Physiotherapy Stakeholders in Revising the National Form.

Purpose: We developed an evidence-informed Student Evaluation of the Clinical Placement form. This form gives students the opportunity to share their feedback and perceptions of their clinical placement experiences and provides meaningful data to all stakeholders. Method: We used a modified Delphi process to engage a sample of national stakeholders: physiotherapy clinical education leads of academic departments, centre coordinators of clinical education, clinical instructors, and students. An expert consultant panel, in addition to the investigators, reviewed the responses from each round and helped develop the questionnaire for the subsequent round and finalize the evaluation form. Results: The response rate was 65.3% (47 of 72) for Round 1, 76.6% (36 of 47) for Round 2, and 100% (36 of 36) for Round 3. After three rounds of questionnaires, 89% of participants thought that the evaluation form met their needs. Conclusions: We developed a revised Student Evaluation of the Clinical Placement form that is informed by the literature and meaningful to all stakeholders. This form is being implemented in physiotherapy university programmes across Canada to enable students to share their experiences at clinical sites.

Objectif : mettre à jour et élaborer un formulaire d'évaluation du stage clinique par l'étudiant à partir de données probantes. Ce formulaire permet à l'étudiant de transmettre ses commentaires et ses perceptions des expériences vécues lors de leur stage clinique et des données importantes à tous les intervenants. Méthodologie : les chercheurs ont utilisé un processus Delphi modifié pour faire participer un échantillon d'intervenants nationaux : les responsables de la formation clinique en physiothérapie des départements universitaires, les coordonnateurs de la formation clinique des centres, les moniteurs cliniques et les étudiants. En plus des chercheurs, un groupe d'experts consultants a examiné les réponses de chaque tour pour contribuer à préparer le questionnaire du tour suivant et finaliser le formulaire d'évaluation. Résultats : les chercheurs ont obtenu un taux de réponse de 65,3 % (47 sur 72) au premier tour, de 76,6 % (36 sur 47) au deuxième tour et de 100 % (36 sur 36) au troisième tour. Après trois tours, 89 % des participants trouvaient que le formulaire d'évaluation répondait à leurs besoins. Conclusion : les chercheurs ont créé un formulaire révisé de l'évaluation du stage clinique par les étudiants, éclairé par les publications scientifiques et significatif pour tous les intervenants. Ce formulaire est déployé dans les programmes de physiothérapie du Canada afin que les étudiants puissent confier leurs expériences dans les établissements cliniques.

Clinical Instructors' Experiences Working with and Assessing Students Who Perform below Expectations in Physical Therapy Clinical Internships.

Purpose: Clinical education is an integral component of the curriculum of all physical therapy (PT) entry-to-practice programmes in Canada. The literature indicates that working with and assessing students performing below expectations (SPBE) can be procedurally and emotionally difficult. Our study aimed to explore the experiences of clinical instructors (CIs) and the decision-making process involved when supervising SPBE in PT. Method: A total of 19 in-depth, semi-structured interviews were conducted with CIs, transcribed, and coded using qualitative thematic analysis. Results: Four factors appeared to be important for CIs when they were deciding how to assess SPBE: (1) features of student performance, (2) factors related to the CIs, (3) academic and clinical facility influencers, and (4) strategies and available resources. Concerns about safety and professional behaviour, a student's clinical reasoning skills, and a lack of progression were key factors that CIs considered in recommending a final grade. CIs were more likely to recommend a failing grade if there was a series of repeated incidents rather than an isolated incident. Conclusions: We make several recommendations for the student, CI, and facilities to consider to better support and facilitate the process of working with SPBE in PT clinical education.

Objectif : la formation clinique fait partie intégrante des tous les programmes d'accès à la pratique en physiothérapie au Canada. Selon les publications, il peut être difficile sur le plan technique et affectif de travailler avec des étudiants dont le rendement est inférieur aux attentes (ÉRIA) et de les évaluer. La présente étude visait à explorer les expériences des moniteurs cliniques (MC) et les processus décisionnels en cause lors de la supervision d'ÉRIA en physiothérapie. Méthodologie : Au total, les chercheurs ont procédé à 19 entrevues semi-structurées approfondies avec des MC, qu'ils ont transcrites et codées au moyen d'une analyse thématique qualitative. Résultats : quatre facteurs semblent importants pour les MC lorsqu'ils décident comment évaluer les ÉRIA : 1) caractéristiques du rendement des étudiants, 2) facteurs liés aux MC, 3) influenceurs de l'établissement universitaire et clinique et 4) stratégies et ressources disponibles. Les inquiétudes quant à la sécurité et au comportement professionnel, les capacités de raisonnement clinique de l'étudiant et le manque de progression étaient des facteurs clés pour les MC au moment de recommander une note finale. Ceux-ci étaient plus susceptibles de recommander une note d'échec devant une série d'incidents répétés que devant un incident isolé. Conclusions : les chercheurs font plusieurs recommandations pour les étudiants, les MC et les établissements afin de mieux soutenir et de faciliter le processus de travail avec les ÉRIA dans le cadre de la formation clinique en physiothérapie.

Building successful and sustainable academic health science partnerships: exploring perspectives of hospital leaders.

BACKGROUND: Clinical work-based internships form a key component of health professions education. Integral to these internships, academic health science partnerships (AHSPs) exist between universities and teaching hospitals. Our qualitative descriptive study explored the perspectives of hospital leadership on AHSPs: what they are composed of, and the facilitators and barriers to establishing and sustaining these partnerships. METHODS: Fifteen individuals in a variety of hospital leadership positions were purposively sampled to participate in face-to-face interviews, after which a thematic analysis was conducted. RESULTS: Participants reported that healthcare and hospital infrastructure shapes and constrains the implementation of clinical education. The strength of the hospitals' relationship with the medical profession facilitated the partnership, however other health professions' partnerships were viewed less favourably. Participants emphasized the value of hospital leaders prioritizing education. Further, our findings highlighted that communication, collaboration, and involvement are considered as both facilitators and barriers to active engagement. Lastly, opportunities stemming from the partnership were identified as research, current best practice, improved patient care, and career development. CONCLUSION: Our study found that AHSPs involve the drive of the university and hospitals to gain valued capital, or opportunities. Reciprocal communication, collaboration, and involvement are modifiable components that are integral to optimizing AHSPs.

Assessing the Clinical Competence of Health Care Professionals Who Perform Airway Suctioning in Adults.

Airway suctioning is an important health care intervention that can be associated with serious adverse effects. Given the risks involved with suctioning, it is important to ensure the clinical competence of health care professionals who perform it. A scoping review was conducted to identify the nature and extent of research related to the assessment of airway-suctioning competence for health care professionals working with adults. This included an examination of the assessment context, the type of suctioning and health care professionals being assessed, and the methods used to assess competence. Four scientific electronic databases (MEDLINE, EMBASE, CINAHL, and the Cochrane Library) were searched from inception to March 9, 2018. A gray literature search was also performed. Two reviewers independently screened articles and resources for inclusion, and data were extracted using a form created by the authors. Seventy full text articles and resources were screened for eligibility, with 36 included in the review. Endotracheal suctioning was the most common type, and intensive or critical care units were the primary setting of interest (28 of 36, 78%). Competence or a component of competence for nurses, nursing students, nursing assistants, or nurse technicians was specifically addressed in 97% (35 of 36) of the included articles and resources; 4 of 36 (11%) also included physical therapists, 1 of 36 (3%) included respiratory therapists, and 1 of 36 (3%) was aimed toward all clinicians who perform suctioning. Nine (25%) used questionnaire-based assessments, 11 (31%) used checklists, audit forms, or other observational tools, and 16 (44%) used both. Directed content analysis revealed 3 major themes: consistency across overarching evaluation frameworks, inconsistency across detailed components, and inconsistency in the evaluation or reporting of assessment tool measurement properties. Additional gaps in the literature included limited consideration of health care professionals beyond nursing, limited consideration of settings beyond intensive and critical care, a lack of tools to assess nasotracheal and orotracheal suctioning, and limited detail regarding assessment tool development.

The feasibility of an electronic reflective practice exercise among physiotherapy students.

BACKGROUND: Reflective practice is a skill that serves as a model for continuous learning. Like any skill, reflective practice can be improved and health professional curricula should include opportunities to develop these skills. The clinical component of health professional curriculum is a natural component where reflective practice skills can be developed. Electronic means will help students and faculty stay in contact during clinical internships. AIMS: The purpose of this study was to evaluate the feasibility of an electronic reflective practice exercise during a clinical internship and explore the potential trends on students' reflective practice skills and self-directed learning readiness. METHODS: We used a prospective pre-post intervention design in a cohort of physiotherapy students to examine feasibility and explore trends. Faculty also rated the depth of reflection papers. In addition, students completed a reflective practice exercise questionnaire and the self-directed learning readiness scale (SDLRS) was completed pre- and post-internship. RESULTS: All 84 students completed the reflective practice questionnaire. Sixty-six students consented to complete the questionnaire and 17 consented to complete the SDLRS pre- and post-internship. It took an average of 7 min for faculty to review each student's reflection and there were no significant electronic difficulties encountered. Initial reflection papers were rated at a descriptive (23%), descriptive-analytical (28%) or analytical level (33%). Eighty-six percent of students rated faculty feedback as helpful and 92% rated peer feedback as helpful. Almost all students (97%) students reported that they followed through on some or all of the items on their reflective practice learning plans. The SDLRS significantly improved with the exercise (mean difference 6.8 +/- 9.9; p < 0.05). CONCLUSIONS: This electronic reflective practice exercise during the physiotherapy students' clinical internship was feasible and demonstrated trends to positively impact the learners' skills and self-directed learning readiness.

Let's Talk about the Talk: Exploring the Experience of Discussing Student Performance at the Mid- and Final Points of the Clinical Internship.

Purpose: The purpose of this study was to explore the experiences of physiotherapy students and clinical instructors (CIs) when discussing student clinical performance at the mid- and final points of clinical internships. The objectives were to identify why performance assessment discussions are valuable, explore the role of each participant throughout the discussion, identify the challenges associated with these discussions, and explore the effect of the standardized assessment tool on the discussion. Methods: This study used a qualitative descriptive design, consisting of student and CI focus groups in the Greater Toronto Area from January to June 2016. Results: All participants (N=29) recognized the importance of having face-to-face performance assessment discussions in a quiet and private space. Students and CIs agreed that the Canadian Physiotherapy Assessment of Clinical Performance helped to structure and focus the discussions. Valuable discussions occurred when students were open minded and self-reflected on their performance and when CIs were honest and used their expertise to guide learning. Other key features included mutual preparedness, two-way feedback that was constructive and tangible, and a goal-setting process. Students described the emotional component of these discussions as being challenging, and CIs found it difficult when a student took a more passive role in the discussion. Conclusions: Our findings indicate that valuable discussions can provide meaningful feedback, strengthen the student-CI relationship, and engage the learner in an ongoing and cumulative learning process that contributes to professional development.

Objectif : la présente étude visait à explorer les expériences d'étudiants en physiothérapie et de moniteurs cliniques (MC) lors des discussions sur le rendement clinique des étudiants au milieu et à la fin de leur stage clinique. Les objectifs consistaient à déterminer l'intérêt des discussions sur l'évaluation de rendement, à explorer le rôle de chaque participant à la discussion, à cerner les défis associés à ces discussions et à explorer l'effet de l'outil d'évaluation normalisé sur la discussion. Méthodologie : la présente étude faisait appel à une méthodologie descriptive qualitative, composée de groupes de travail d'étudiants et de MC du Grand Toronto entre janvier et juin 2016. Résultats : tous les participants (n=29) ont convenu de l'importance des discussions d'évaluation du rendement en tête à tête, dans un lieu calme et privé. Les étudiants et les MC conviennent également que l'évaluation de rendement clinique de l'Association canadienne de physiothérapie contribuait à structurer et à orienter les discussions. Des discussions intéressantes avaient lieu lorsque les étudiants étaient ouverts et prêts à tenir une autoréflexion sur leur rendement et lorsque les MC étaient honnêtes et utilisaient leurs compétences pour orienter l'apprentissage. Parmi les autres caractéristiques clés, soulignons une préparation mutuelle, des commentaires bidirectionnels constructifs et tangibles et un processus d'établissement d'objectifs. Les étudiants trouvaient les aspects émotifs de ces discussions exigeants, alors que les MC éprouvaient de la difficulté lorsqu'un étudiant adoptait un rôle plus passif dans la discussion. Conclusions : selon nos observations, des discussions intéressantes peuvent favoriser des commentaires significatifs, renforcer la relation entre l'étudiant et le MC et faire participer l'étudiant à un processus d'apprentissage continu et cumulatif qui contribue à son perfectionnement professionnel.

Canadian Physiotherapy Assessment of Clinical Performance: Face and Content Validity.

PURPOSE: To investigate face and content validity of a draft measure to be used across Canada to assess physiotherapy students' performance in clinical education, through broad consultation with physiotherapy clinical instructors (CIs) across Canada. METHODS: An online survey was used to collect input on the draft measure. In addition to demographics, the questionnaire included questions on the preferred rating scale, the items within the measure that should have their own rating scale, and general impressions. RESULTS: Among the 259 CIs who completed the survey, a discrete rating scale with six anchors and 10 boxes or a continuous-line rating scale with six anchors was preferred. Respondents favoured using one rating scale for each key competency in the Expert role but considered a single rating scale sufficient for assessing the Scholarly Practitioner role. CIs agreed that the proposed measure would allow them to assess a student who was performing poorly or very well. The name Canadian Physiotherapy Assessment of Clinical Performance (ACP) received the most votes in the questionnaire. CONCLUSIONS: CIs' collective preferences on the design, organization, and naming of the measure they will use in evaluating students are reflected in the second draft of the ACP.

Objectif : Examiner l'apparence et la validité du contenu d'un projet de mesure qui servira dans tout le Canada pour évaluer le rendement en formation clinique des étudiants en physiothérapie, grâce à une vaste consultation auprès des enseignants cliniques à l'échelle du Canada. Méthodes : Un sondage en ligne a permis de recueillir des commentaires sur le projet de mesure. Outre les données démographiques, le questionnaire comprenait des questions sur l'échelle de cotation préférée, les éléments de la mesure qui devraient avoir leur propre échelle de cotation et les impressions générales. Résultats : Les 259 enseignants cliniques qui ont répondu au sondage préféraient généralement une échelle de cotation discrète comportant 6 ancres et 10 cases ou une échelle de cotation doublée de 6 ancres. Les répondants préféraient utiliser une échelle de cotation pour chaque compétence clé du rôle d'expert, mais considéraient qu'une seule échelle de cotation était suffisante pour évaluer le rôle d'érudit. Les enseignants cliniques étaient d'accord avec le fait que la mesure proposée leur permettrait d'évaluer les étudiants dont le rendement était mauvais ou très bon. L'appellation « évaluation du rendement clinique (ERC) de la physiothérapie au Canada ¼ a obtenu le plus de votes dans le questionnaire. Conclusions : Les préférences collectives des enseignants cliniques en matière de conception, d'organisation, et d'appellation de la mesure qu'ils utiliseront pour évaluer les étudiants sont prises en compte dans la deuxième version de l'ERC.

Evidence of Reliability, Validity, and Practicality for the Canadian Physiotherapy Assessment of Clinical Performance.

Purpose: To investigate the internal consistency, construct validity, and practicality of the Canadian Physiotherapy Assessment of Clinical Performance (ACP), a descriptive measure used by physiotherapy students and their clinical instructors (CIs) at the mid- and endpoints of an internship to describe the students' behaviours as observed in the clinical education setting relative to what might be expected of an entry-level physiotherapist. Methods: This multi-centre study piloted the ACP in 10 university physiotherapy (PT) programmes. Both CIs and students undertaking clinical internships completed the ACP and the current tool, the Physical Therapist Clinical Performance Instrument (PT-CPI; Version 1997). Results: CIs assessing PT students' performance during internships representing a variety of areas of practice completed the ACP at the midpoint (n=132) and the endpoint (n=126) of the internship. The end-of-internship sample consisted of 55 junior, 30 intermediate, and 41 senior students. The ACP demonstrated strong internal consistency: Alpha coefficients for each role ranged from 0.94 to 0.99. Aligned items on the ACP and PT-CPI were significantly correlated (r=0.51-0.84). Senior PT students performed significantly better than intermediate students, who, in turn, performed better than junior students (p<0.0001). Effect sizes for midpoint to final scores on the ACP ranged from medium to large (0.40-0.74). Participants were satisfied with the online education module that provided instruction on how to use and interpret the ACP, as indicated by satisfaction scores and qualitative comments. Conclusions: The ACP is a reliable, valid, and practical measure to assess and describe the PT students' behaviours as observed during clinical education relative to what is expected of an entry-level physiotherapist.

Objectif : Examiner la cohérence interne, la validité de construit et l'utilité pratique de l'évaluation de la performance clinique (EPC) en physiothérapie au Canada, une mesure employée par les étudiants en physiothérapie et leurs instructeurs cliniques en milieu et en fin de stage clinique pour décrire les comportements des étudiants par rapport à ce qu'il y a lieu d'être attendu d'un physiothérapeute débutant. Méthodes : Cette étude multicentrique évaluait la mise à l'essai de l'EPC dans 10 programmes universitaires. Les instructeurs cliniques et les étudiants en stage clinique ont réalisé leurs évaluations à l'aide de l'EPC et de l'outil actuel, le PT-CPI (version 1997). Résultats : Des instructeurs cliniques représentant différents champs de pratique ont complété l'ECP en milieu (n=132) et en fin (n=126) de stage. L'échantillon de fin de stage était composé de 55 étudiants débutants, 30 étudiants intermédiaires et 41 étudiants avancés. L'ECP a démontré un haut degré de cohérence interne, soit des coefficients alpha de 0,94 à 0,99 pour chaque rôle. Une corrélation significative a été observée entre les éléments correspondants de l'ECP et du PT-CPI (r=0.51­0.84). Les étudiants avancés ont obtenu des résultats significativement meilleurs que les étudiants intermédiaires qui ont à leur tour obtenu des résultats significativement meilleurs que les étudiants débutants (p<0.0001). Les différences constatées entre les notes de l'ECP en milieu et en fin de stage révèlent une taille d'effet moyenne à forte (0,40 à 0,74). Les notes de satisfaction et les commentaires qualitatifs indiquent que les participants étaient satisfaits du module de formation en ligne qui expliquait comment utiliser et interpréter l'ACP. Conclusions : L'ECP est une mesure fiable, valide et pratique pour évaluer et décrire les comportements des étudiants observés en formation clinique par rapport à ce qu'il y a lieu d'attendre d'un physiothérapeute débutant.