Clinical

Developing clinical expertise for healthcare professionals through masters courses Alison Rushton, Geoff Lindsay

This paper identifies a gap in the existing literature surrounding the role of masters postgraduate courses in developing clinical expertise, and through use of survey methodology describes the characteristics of existing courses. Quantitative and qualitative data were combined through the use of a questionnaire to a total population sample (n=171) of course tutors of masters courses in healthcare. A very good response rate (n=148, 86.5%) found 89% (n=132) of courses aiming to develop clinical expertise. As a means of developing expertise, greatest emphasis was placed on the theoretical components of a course (90%, n=120), with a similar emphasis on clinical placement (38.6%, n=51) and mentorship (46.2%, n=61). Approaches were similar across professions except for the use of placements where a significant difference existed (x2 [132,2] = 25.173, P1 means.

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advance warning of the questionnaire was provided, explaining the selection of the participant. Confidentiality and anonymity were assured. The appearance and length of the questionnaire was professional and succinct, and return envelopes were provided (Oppenheim, 1992). Reminders were sent after three and 6 weeks. All participants were informed that their answers were confidential, with only the researchers having access to identifying information. The questionnaires were coded, but the participants were assured that this was purely for the purposes of following up non-respondents, and that the coding system would be subsequently destroyed. Having agreed to participate, participants still had the right to withdraw from the study after receiving the questionnaire. Their informed consent was assumed through their decision to complete and return the questionnaire. For open questions, a framework was derived from the data to organize the responses by grouping similar statements together and defining themes based upon their common features. Deriving the framework from the data ensured that the researcher’s interests did not influence the data and that all responses were included (Munn and Drever, 1990). The reliability and validity of the coding system was evaluated by using another researcher also to code the data independently, with a discussion between the two researchers resolving any differences. The process of coding employed in this study was essentially descriptive in nature. Quantitative data were analysed using a combination of descriptive statistics exploring frequency distributions, and the use of inferential analysis to explore associations between variables. Data of a nominal or ordinal level were analysed using the chi-squared statistic. To facilitate interferential analysis when low numbers of cases were present (Cochran, 1952), courses were grouped according to the nature of their background into allied health professionals (AHPs), nursing and interprofessional; categories reflecting a distinction that exists in practice.

RESULTS Response rate A response rate of 86.5% (n=148) was achieved. The reason for non-response was explored a by follow up letter or email requesting the reason for nonresponse only, with seven out of 23 non-respondents then responding. All reasons supplied were unrelated to the nature of the questionnaire. Some courses were interprofessional in nature, encompassing at least two professions. The response rate for the different backgrounds of course ranged from 80–100%.

International Journal of Therapy and Rehabilitation, April 2007, Vol 14, No 4

Courses developing expertise One hundred and thirty two courses (89%) aimed to develop clinical expertise (Table 1). For those courses not aiming to, reasons included: does not include practical skills (n=4), university based (n=1), focus is on independent skills (n=1), emphasis is on the exploration of the profession (n=3). However, several participants recognized that there was an indirect enhancement of expertise, in particular to decision-making skills (n=2). Five participants did not elaborate on their reasons. Use of theoretical components The most common means of developing expertise was by the theoretical course components (n=120, 90%), and this is illustrated by professional focus of the course in Table 2. There was no statistically significant difference between nursing, AHP and interprofessional courses (X2 [132,2]=0.286, P>0.05). Descriptive coding of the qualitative data identified the following themes: ■ Philosophy of teaching and learning ■ Teaching and learning strategies ■ Desired outcomes of the course. ‘Philosophy’ centred on issues of delivery of teaching and learning, for example, problem-based learning and assessment recognizing that clinical practice underpins all assessments. This theme is illustrated by the following quotations from participants: ‘Students explore theoretical models of advanced and expert practice and critically apply them to their own practice.’ (participant 34) ‘Students are assessed on their ability to produce work at the theory-practice interface.’ (participant 2)

Teaching and learning strategies encompassed strategies employed including role play and assessment strategies, for example, practical assessment. This theme is illustrated by the following quotations: ‘Reflective practice enables them to evaluate their effectiveness and clinical expertise, particularly decision making.’ (participant 67) ‘The practice portfolio…. Provides evidence of teaching in practice and college and demonstrates synthesis.’ (participant 120)

Comments linked to the desired outcomes of the course overall include: ‘Developing evidence-based practitioners who can explain the rationale behind treatment choice.’ (participant 87)

Use of mentorship Courses from a radiography background placed great emphasis on mentorship (Table 2). Physiotherapy, SLT, podiatry and interprofessional courses placed some emphasis, but no OT courses used mentorship. However, there was no statistically significant difference between nursing, AHP and interprofessional courses (X2 [132,2]=1.634, P>0.05) in the use of mentorship. Descriptive coding of the qualitative data identified the following themes: ■ Characteristics of mentorship ■ The mentor ■ Assessment ■ The process of mentorship. Most attention was received by the theme of ‘characteristics’, and was reflected by comments such as: ‘Student has control over what experience they have and the skills gained.’ (participant 13) ‘To provide support and guidance in the clinical setting.’ (participant 68) ‘Mentor in the workplace monitors clinical progress.’ (participant 102)

Use of clinical placements Courses from a radiography background place great emphasis on placements (Table 2), with Physiotherapy courses equally using and not using them. However, no OT, SLT or podiatry courses used placements, with nursing and interprofessional courses only occasionally using them. There was a statistically significant difference between the nursing, AHP and interprofessional courses (X2 [132,2]=25.173, P