PHYSIOTHERAPY CANADA

Mori et al. Designing, Implementing, and Evaluating a Practice Tutor Internship Model during an Acute Care Clinical Internship 189 APPENDIX 2: SURVEY QUESTIONS Students https://utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Monday, February 22, 2021 8:36:50 PM - IP Address:43.246.243.82 Day 1 Midpoint Final 1. Unique identifier 1. Unique identifier 1. Unique identifier 2. I understand the role of the practice 2. I understand the role of the practice tutor 2. I understand the role of the practice tutor for this tutor for this internship. for this internship. internship. 3. I understand how the practice tutor 3. I understand how the practice tutor and CI 3. I understand how the practice tutor and CI worked and CI can work collaboratively during can work collaboratively during this internship. collaboratively during this internship. this internship. 4. I am looking forward to learning with 4. I am enjoying learning with the practice 4. I enjoyed learning with the practice tutor in this this clinical education model. tutor in this internship. internship. 5. In this upcoming internship, I am 5. In this internship, with regard to the 5. Learning with the practice tutor during this internship most looking forward to/excited about: practice tutor, I have most enjoyed/valued: met my expectations. 6. In this upcoming internship, I am 6. In this internship, with regard to the 6. I’d recommend this clinical education practice tutor least looking forward to/nervous about: practice tutor, I have least enjoyed or find learning model to my friends for future internships. these aspects less valuable: 7. Please share any additional thoughts 7. Please share any additional thoughts you 7. There were several discussion topics that were led by you have about this upcoming have about this internship model so far. the Practice Tutor. Please share your opinions on the value internship. of each of these topics. 8. Of these sessions, please indicate the ones you feel should occur in a Year 1 internship (April/May of Year 1) or Year 2 internship (fall of Year 2) or both Year 1 and Year 2. 9. Please list the strengths/benefits of this practice tutor clinical education model. 10. Please list the disadvantages of this practice tutor clinical education model. 11. If we were to use this practice tutor clinical education internship model in the future, what should we keep? 12. If we were to use this practice tutor clinical education internship model in the future, what should we change? 13. The best surprise about this practice tutor clinical education model was . . . 14. Please share any additional thoughts you have about this practice tutor clinical education internship. CI = clinical instructor

190 Physiotherapy Canada, Volume 72, Number 2 Clinical Instructors Day 1 Midpoint Final https://utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Monday, February 22, 2021 8:36:50 PM - IP Address:43.246.243.82 1. Unique identifier 1. Unique identifier 1. Unique identifier 2. I understand the role of the practice 2. I understand the role of the practice tutor 2. I understand the role of the practice tutor for this tutor for this internship. for this internship. internship. 3. I understand how the practice tutor 3. I understand how the practice tutor and CI 3. I understand how the practice tutor and CI worked and CI can work collaboratively during can work collaboratively during this collaboratively during this internship. this internship. internship. 4. I am looking forward to teaching with 4. I am enjoying teaching with the practice 4. I enjoyed teaching with the practice tutor in this this clinical education model. tutor in this internship. internship. (Clarification: You don't have to have specifically led a session with the practice tutor, but have to have 5. In this upcoming internship, I am 5. In this internship, with regard to the worked with the student who was working with the practice most looking forward to/excited about: practice tutor, I have most enjoyed/valued: tutor.) 6. In this upcoming internship, I am 6. In this internship, with regard to the 5. Teaching with the practice tutor during this internship met least looking forward to/nervous about: practice tutor, I have least enjoyed or find my expectations. these aspects less valuable: 6. Compared with the traditional internship model in the past, with the practice tutor internship model, I had more 7. Please share any additional thoughts 7. Please share any additional thoughts you time to ensure I was able to better manage my caseload and you have about this upcoming have about this internship model so far. work with the student. internship. 7. I’d recommend this clinical education practice tutor learning model to my colleagues for future internships. 8. There were several discussion topics that were led by the practice tutor. Please share your opinions on the value of each of these topics for you and/or the student. 9. Of these sessions, please indicate the ones you feel should occur in a Year 1 internship (April/May of Year 1) or Year 2 internship (fall of Year 2) or both Year 1 and Year 2. 10. Please list the strengths/benefits of this practice tutor clinical education model. 11. Please list the disadvantages of this practice tutor clinical education model. 12. If we were to use this practice tutor clinical education internship model in the future, what should we keep? 13. If we were to use this practice tutor clinical education internship model in the future, what should we change? 14. The best surprise about this practice tutor clinical education model was . . . 15. Please share any additional thoughts you have about this practice tutor clinical education internship model.

Mori et al. Designing, Implementing, and Evaluating a Practice Tutor Internship Model during an Acute Care Clinical Internship 191 https://utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Monday, February 22, 2021 8:36:50 PM - IP Address:43.246.243.82 APPENDIX 3: FOCUS GROUP DISCUSSION GUIDE helpful, but would you prefer first thing in the morning or last thing in the day? Students b. Based on the survey results, it sounds like fewer ses- 1. What did you like most about this model where the sions would be better. How often do you think the practice tutor sessions should be? practice tutor worked with you in collaboration with c. What topics were of most benefit? your clinical instructor? Clinical Instructors a. How did this facilitate your learning? 1. What did you like most about this model where the 2. We heard from the survey that the group discussions practice tutor worked in collaboration with you and were helpful. the student? a. How did the group discussions facilitate your learn- a. How do you think the sessions facilitated the stu- ing? dents’ learning? 3. Tell me about your understanding of the difference 2. How do you think having a practice tutor working with between the role of the practice tutor and your clinical you and the students for the 5 weeks affected the work instructor for this internship. of hosting students for an internship? 4. Were there any things that didn’t seem to quite work 3. Were there any things that didn’t seem to quite work in this internship? in this internship? a. What aspects did not facilitate your learning? a. In the surveys, we heard that the timing of the ses- sions didn’t always work. What is your opinion on 5. Compare the sessions that you valued with ones that the ideal timing of the sessions? were less useful. b. How frequently do you think the sessions should a. What differed about the structure or content? occur? b. What contributed to your feelings that the sessions c. What topics were of most benefit? were valuable? d. What topics were of least benefit? e. How would you improve this internship model? 6. How would you improve this internship model? a. We received mixed feedback about the ideal timing of the sessions. We heard that mid-day was not

Clinician’s Commentary on Mori et al.1 https://utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Monday, February 22, 2021 8:36:50 PM - IP Address:43.246.243.82 Clinical education is an essential and required compo­ Overall, one would have expected student and CI nent of the physiotherapy (PT) curriculum, both in Can­ support for the practice tutor model to be higher, given ada and around the world. Over the past 10 years, national that those who participated initially expressed interest. PT organizations in Canada have developed more specific However, at the end of the study, only two of the six stu­ guidelines related to entry-to-practice competency mile­ dents said they would recommend this model to a PT stones and PT programme accreditation requirements classmate. One-half (four of eight) of the CIs indicated specific to clinical education (CE). This has improved that the additional practice tutor support had given them national uniformity in graduating safe and effective more time to manage their caseload. This was one of the entry-level physiotherapists while raising overall CE anticipated outcomes of implementing the model, so one standards. At present, no student can graduate from any would have expected a more positive response. The prac­ of the 15 Canadian PT programmes without completing tice tutor spent between 10 and 15 hours providing AC a minimum of 30 weeks (1,025 h) of clinical experience, education to the students, which the CIs would typically including a specified mix in certain settings (ambulatory have completed in the traditional internship model. Five care clinics, rehabilitation, acute care) and areas of prac­ of the eight CIs indicated that they would recommend tice (neurology, cardiovascular and pulmonary, musculo­ the model to a colleague. Caseloads were maintained or skeletal).2 Requirements related to areas of practice must slightly increased, a result that is consistent with other include a minimum of 100 hours in each essential area models of clinical education supervision.6 of practice (cardiovascular and respiratory, musculoskel­ etal, neurological), as described in the Clinical Education Despite its limitations, the study does give Academic Guidelines for Canadian University Programs.3 Coordinators of Clinical Education (ACCEs), CIs, and stu­ dents some preliminary insights into the potential benefits In 2014, the proportion of the Canadian PT workforce of using a practice tutor model (it fosters student critical practising in the cardiorespiratory (CR) area was relatively thinking through peer discussion; it increases student small at 3% (n = 421).4 This, combined with more stringent camaraderie; 50% of CIs report an increase in downtime) graduation requirements and recent increases in PT pro­ and disadvantages (location and timing of educational gramme enrolment totaling more than 900 Canadian PTs sessions interferes with patient care; some confusion was students each year, has placed a cumulative strain on the caused by differences in clinical practice presented by ability of PT academic programmes to obtain adequate CR the CI and practice tutor; students considered the dual clinical placements. Fein outlined the limited availability ACCE–practice tutor role a conflict of interest). As Mori of CR clinical placements as early as 1996,5 indicating that and colleagues stated, 1 the goal of implementing a new acute care (AC) hospital restructuring, shorter lengths of model of clinical education support is to alleviate CIs’ stay, and increased productivity pressure on AC physio­ concerns about supervising students and by doing so therapists had led to a decrease in the amount of time encourage CIs to offer more CR clinical placements on an available to supervise students. Citing the literature, Mori ongoing, sustainable basis. However, they did not ask CIs and colleagues reported additional deterrents to place­ whether they would offer more CR clinical placements as ment offers:1 lack of physical space, PT students’ lack of a result of implementing the practice tutor model. academic preparation, and the additional clinical instruc­ tor (CI) time and resources frequently required to assist Considering the costs and benefits of the practice students who may struggle during a clinical placement. tutor model, it is useful to ask the following question: Are the benefits sufficient to warrant the cost (practice tutor Mori and colleagues should be commended for under­ time and cost in wages)? To assist with the workload in taking a research study using a practice tutor to provide Mori and colleagues’ study,1 a final-year PT student took additional supports within the traditional internship part in team meetings and helped develop the practice model of one CI supervising one PT student.1 To initiate tutor manual (15 hours). The practice tutor role requires a CE model that is novel to the AC tertiary facility, CIs a significant time commitment (30.5 h), which primarily and PT students require significant perseverance, time, facilitates students’ educational sessions and case study collaboration, resources, and education. The findings of discussions. Mori and colleagues recommended that in this study should, however, be interpreted with caution the future, the ACCE or other faculty participating in stu­ because of the small sample size. In addition, the findings dent clinical evaluation not be involved in the practice may not be adequate to support implementing a practice tutor role. Recruiting a CR physiotherapist from an AC tutor model without making certain modifications, and facility could have several benefits but could also be dif­ Mori and colleagues have suggested several. ficult given the high current AC physiotherapist workload 192

Clinician’s Commentary on Mori et al. 193 https://utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Monday, February 22, 2021 8:36:50 PM - IP Address:43.246.243.82 requirements. Each individual Canadian PT programme, clinical supervision models could also be considered. For in collaboration with its affiliated AC teaching hospi­ example, implementing a collaborative or peer-coaching tals, will need to consider whether the benefits, feasi­ clinical education model (one CI to two students) has bility, and cost of the CR practice tutor model justify its been the subject of discussion for several decades and implementation. has been shown to increase patient attendance, improve collaborative learning and critical thinking, and increase The educational sessions provided by the practice students’ time with patients.12,13 Simulation learning tutor were selected on the basis of feedback from the experiences using humans or manikins have been shown physiotherapists with the intention of reducing dupli­ to enable students to develop CR skills and clinical rea­ cation of CI teaching on common AC and CR topics that soning in an intensive care setting.7 However, these CR most CIs typically review on site with their PT students. simulation hours are not yet recognized by Physiotherapy The results indicated that the CIs found these topics and Education Accreditation Canada.2 Unfortunately, Fein’s sessions more useful than the students. However, both 1996 article “Maximizing Clinical Education Options in the students and the CIs agreed that the suctioning sim­ Cardiopulmonary Physical Therapy” sounds as current as ulation session and the breath sounds tree were very if it had been written in 2019.5 valuable. This feedback demonstrates the effectiveness of simulation in the clinical education environment, a Ann MacPhail, BSc, MSc, PT finding that has been noted by other authors.7 All the stu­ Academic Coordinator of Clinical Education (retired), dents rated the case study presentations and discussions School of Physical Therapy, Faculty of Health Sciences, as very valuable, and this result agrees with the previously Western University, London, Ont.; [email protected]. reported value of case-based learning.8 REFERENCES Rather than conducting face-to-face educational ses­ sions, academic PT programmes could consider develop­ 1. Mori B, Coleman J, Knott K, et al. Designing, implementing, and ing e-learning CR modules to offer a more flexible model evaluating a practice tutor internship model during an acute care of education delivery, available at the learner’s conve­ clinical internship. Physiother Can. 2020;72(2):177–91. https://doi. nience, that would have the potential to interfere less org/10.3138/ptc-2018-0055. with hands-on patient care during a clinical placement. E-learning has been shown to produce changes in knowl­ 2. Physiotherapy Education Accreditation Canada (PEAC). PEAC edge, skills, attitude, and satisfaction9 and to be effective accreditation standards [Internet]. London (ON): PEAC; 2012 [2019 in PT students’ skills acquisition.10 Several e-learning Nov 25]. Available from: https://peac-aepc.ca/english/accreditation/ modules have been developed by teaching hospitals to accreditation-standards.php. meet provincial health and safety requirements, and many health care students are required to complete 3. Canadian Council of Physiotherapy University Programs (CCPUP), these online modules before beginning an AC clinical National Association for Clinical Education in Physiotherapy, Canadian placement. Several key topics, such as fall prevention, Physiotherapy Association, et al. Entry-to-practice physiotherapy electronic patient records, privacy and confidentiality, curriculum: a companion document: clinical education guidelines breathe easier, chain of transmission, hand hygiene, and for Canadian education programs [Internet]. CCPUP; 2011 [2019 infection control are currently available online.11 Addi­ Nov 25]. Available from: http://www.physiotherapyeducation.ca/ tional online CR modules could be developed to cover Resources/Clin_Ed_Guidelines_FINAL_%202011.pdf. chest assessment, arterial blood gases and lab values, PT AC discharge planning, and chest X-rays. 4. Conference Board of Canada. The role of physiotherapy in Canada: contributing to a stronger health care system [Internet]. Ottawa: The In addition, PT programmes could collaborate with the Board; 2014 [2019 Nov 25]. Available from: https://physiotherapy.ca/ Canadian Physiotherapy Association’s Cardiorespiratory sites/default/files/8648_role-of-physiotherapy_rpt.pdf. Division to develop these key online CR resources, with the CR Division providing e-learning instructional design 5. Fein BD. Maximizing clinical education options in cardiopulmonary support. Although these online modules are often labour physical therapy. Cardiopulm Phys Ther J. 1996;7(3):3–8. https://doi. intensive to develop, once created they could be used org/10.1097/01823246-199607030-00002. in PT CR academic and clinical education programmes across Canada as well as by practising PTs requiring a CR 6. Pabian PS, Dyson J, Levine C. Physical therapist productivity using a refresher. collaborative clinical education model within an acute care setting: a longitudinal study. J Phys Ther Educ. 2017; 31(2):11–17. https://doi. Looking ahead, academic PT programmes must con­ org/10.1097/00001416-201731020-00003. tinue to actively engage and collaborate with their AC hospitals and physiotherapists to develop CE strategies 7. Mori B, Carnahan H, Herold J. Use of simulation learning experiences and models that best meet their individual AC environ­ in physical therapy entry-to-practice curricula: a systematic review. ment and clinical practice culture, which can vary greatly Physiother Can. 2015;67(2):194–202. https://doi.org/10.3138/ from hospital to hospital. Promoting and adopting other ptc.2014-40e. Medline:25931672. 8. McLean SF. Case-based learning and its application in medical and health-care fields: a review of worldwide literature. J Med Educ Curric Dev. 2016;3:39–49. https://doi.org/10.4137/jmecd.s20377. Medline:29349306. 9. George PP, Papachristou N, Belisario JM, et al. Online eLearning for undergraduates in health professions: a systematic review of the impact on knowledge, skills, attitudes and satisfaction. J Glob Health. 2014;4(1): 1–17. https://doi.org/10.7189/jogh.04.010406. Medline:24976965.