Physiotherapy students’ perception of their clinical learning environment and clinician teaching attributes in Nigeria

Article under review

This article is currently under peer review and has not yet been accepted for publication. While it may still be referenced at this web address, please bear in mind that amendments to the article may occur as a result of the review process.

Abstract

Background: Feedback from students about their clinical learning environment and clinical instructors should be assessed regularly as they may affect the outcome of learning, readiness for professional practice, and level of satisfaction with the profession. Aim: To determine physiotherapy students’ perception of their clinical learning environment and clinicians teaching attributes. Methods: This cross-sectional study conveniently recruited 258 participants from two academic institutions which offer physiotherapy training in southeast Nigeria. A self-structured questionnaire, McGill clinical Teacher Evaluation tool and Dundee Ready Educational Environment Measure were used to collect data. Mann Whitney U test and Kruskal-Wallis test analysed the differences in the variables of interest. Results: Students’ learning environment was perceived to have more positive than negative features. Perception of learning was rated highest while social perception was rated lowest. Clinicians were rated the highest in ‘clinical interest in helping students to learn and lowest in ‘Emphasizes concept rather than factual recall. A significant difference was observed only in the clinical learning environment rating based on institution and level of study. Conclusion: There is need for a regular evaluation of clinical instructor’s attribute and the clinical learning environment so as to monitor students learning outcomes and ensure readiness for professional practice.

Reviews

Please provide a review in the form of a summary that addresses the following main themes. Note that the purpose of the review process at OpenPhysio is not to act as a gatekeeper to knowledge but to help the author present the best possible version of their ideas. Your comments below may not necessarily be used to accept or reject the article but should rather aim to identify areas where the author/s can improve their work.

1. Complete, coherent, and well-organized presentation:

The article contains all the necessary categories however formatting requires improvement. For example, in the methods section, the use of the word “questionnaire” can be removed and “Section A and B”, “Section C” etc., can all be formatted bold.

Results and discussion written well.

There are a plethora of grammar mistakes. If possible, I would suggest that the authors make use of a professional language editor.

2. Sufficient explanation of the significance of the problem:

From the article: “The clinical experience acquired by students during the clinical education phase of their programme may be influenced by the teaching attributes of the clinical instructor as well as the nature of the student’s clinical environment (Knox & Morgan, 1985)”- The authors can elaborate on how clinical education is influenced.

In addition, the authors talk about “a good clinical environment” and “optimal educational environment”- this can be unpacked as well, i.e. what constitutes these “good” and “optimal” environments.

3. Clear demonstration of the relevance to the field (beyond the case presented):

The authors research is highly relevant and the importance thereof is evident.

4. Original contribution to the topic of physiotherapy education:

A similar study was performed by Oyeyemi et al (2012) and Odele et al (2014), however the current article provides insight into whether perceptions of the clinical environment and clinicians’ teaching attributes have changed 7-9 years later. The current article also incorporates clinical instructor gender, last clinical posting unit, institution of learning and level of study into the data analysis.

5. Compelling presentation of the problem within a theoretical framework (where appropriate):

The problem is described within the theoretical framework, however, “ideal teaching attributes” and “optimal educational environment” can be unpacked, i.e. describe what these concepts entail.

6. Establishment of a relationship between the problem and other relevant literature:

The relationship between the problem and lack of literature in response to the problem is evident and well written.

7. Appropriate research design and method:

Well designed and carried out. Formatting and grammar mistakes present (see below).

8. Accurate and useful interpretation:

Interpretation executed well but formatting and grammar mistakes evident (see below).

9. Sound argument and analysis:

Well-structured argument and insightful analysis. I would only add that the authors should be explicit in their sentence writing (refer to examples below), i.e. so that the reader is not left guessing which group of students they are referring to or what type of clinical rounds they are referring to.

10. Effective conclusion about the implications for physiotherapy education, research, and/or practice:

The authors talk about the importance of the regular evaluation in order to increase the outcome of learning of students, however, this was not assessed in their study, i.e. perceptions of students were not compared to the outcome of learning of students.

Harmonised curriculum refers to harmonised locally or internationally?

Apart from the above, the rest of the implications for physiotherapy education and policy are appropriate.

If, in addition to the points above, you could provide more detailed comments and feedback below, that would also be appreciated.

Abstract:

Background: Feedback from students about regarding their clinical learning environment and clinical instructors should be assessed regularly as they  it may affect the outcome of learning, readiness for professional practice, and level of satisfaction with the profession. Aim: To determine physiotherapy students’ perception of their clinical learning environment and their clinicians’ teaching attributes. Methods: This cross-sectional study conveniently recruited 258 participants from two academic institutions, which offer physiotherapy training in southeast Nigeria. A Two self-structured questionnaires, McGill clinical Teacher Evaluation tool and Dundee Ready Educational Environment Measure were used to collect data. The Mann Whitney U test and Kruskal-Wallis test analysed was used to analyse the differences in the variables of interest (briefly describe the variables). Results: Students’ learning environment was perceived to have more positive than negative features. Perception of the students’ learning environment resulted in more positive compared to negative features.

Perception of learning was rated highest while social perception was rated lowest. The highest rated category was perception of learning, while the lowest was social perception.

Clinicians were rated the highest in ‘clinical interest in helping students to learn and lowest in ‘Emphasizes concept rather than factual recall. The highest rated category for clinicians was the ‘Clinical interest in helping students to learn’, while the lowest rated was ‘Emphasizes concept rather than factual recall’.  A significant difference was observed existed only in the for ‘clinical learning environment’rating  based on amongst institution and level of study. Conclusion: There is a need for a regular evaluation of the clinical instructors’ attributes, and the clinical learning environment so as in order to monitor students’ learning outcomes and to ensure readiness for professional practice.

Introduction/background:

First paragraph:

No references in first paragraph.

I would replace “assessed” with “evaluated” in the last line.

Second paragraph:

Line 4 and 5: repetition in “clinical education” and “student training”- rework sentence to avoid repetition.

Line 6: sentence is too long- consider separating.

Line 10: “several authors” – you only reference one author.

Third paragraph:

Line 1: I am not sure that the word “however” is used appropriately here. I would remove it completely and add this paragraph to the previous one, as it continues on the various models of clinical teaching.

Line 6: remove “and” and simply continue sentence with “in which”

Line 6: I am not sure that “affiliation experiences” is the correct word to be used here- consider “clinical training”

Line 8: avoid starting a sentence with “also”.

Line 11: I would move the sentence starting with “clinical education” (and all sentences after) to a new paragraph.

Line 20: I am not sure that I understand what you mean by “and if such experience is impacted in an optimal educational environment”- perhaps rephrase. My current understanding is that this should be a new sentence and perhaps rephrase as “In addition, this clinical experience should take place in an optimal educational environment”. Then perhaps describe what an optimal educational environment entails.

Again, the authors talk about clinical educator attributes but have not described what they are.

Paragraph three:

Line 6: I would replace the word “problems” with “medical disorders” or “medical dysfunctions”, etc. I would avoid the word “problems”.

Line 6: sentence starting with “clinical learning” is too long- consider separating or adding commas.

Line 10: replace “on” with “regarding”

Line 11: add “their” before “clinical learning”

Line 12: “Several studies” – comment on the results of those studies.

Paragraph four:

Line 2: replace clinicians with clinicians’

“Oyeyemi et al carried out a study on Nigerian physiotherapy students’ perception of their clinicians’ teaching attributes (Oyeyemi et al., 2012), while Odole et al. (2014) carried out another study on physiotherapy student perception of their clinical learning environment at the University of Ibadan, Nigeria.”- I would rephrase this, for example, “Two studies were performed in Nigeria, one at the University of Ibadan (insert reference) and another at ….. (insert reference). Oyeyemi et al assessed students’ perception of their clinicians’ teaching attributes while Odele et al assessed…..” This structure reads easier.

Check entire article for correct spelling of clinicians’, and not “clinicians” or “clinician’s”.

Line 12: remove “a”

Sentence structure changed: “In addition, students opinion should be constantly evaluated to ensure alignment with  recent innovations in inpatient care.”

Check entire article for correct use of students’ and not “student’s”

Methods:

“A convenience sampling technique was utilized to select the participants.”- I would rephrase as “Convenient sampling was used to select the participants”.

Add colon after “Instrument for data collection” and continue with “section a and b” after colon. Remove “Questionnaire:”

“Section A and B was self-structured and assessed the socio-demographic characteristics of the participants and clinical instructors respectively” Rephrase to “Section A and B consisted of self-structured questions which assessed the socio-demographic characteristics of the participants and clinical instructors, respectively.”

Reference reliability score for CTE.

Remove bold font of “Section D”.

Remove bold bracket at the end of (DREEM).

Paragraph two:

Line 9: should be “5-point”

Line 11: should be “with an overall Cronbach’s of more than 0.7”

“It was also reported to have a high level of stability with a test-retest correlation coefficient of more than 0.8” –would rephrase to “ In addition, this measure has a high level of stability with a test-retest coefficient of more than 0.8”.

Procedure:

Add colon after “Procedure” and continue with “ethical approval” after colon.

Line 4: Replace “before” with “prior to”

“The data base of all the 4th and 5th year students was obtained from the various physiotherapy departments of the involved institutions. Text messages and e-mails were sent out to the students inviting them to participate.” You mention “institutions” but do not include the names of the various institutions in the methodology.

Line 8: replace “also” with “in addition”.

“confidentially”- should this not be “confidentiality was assured”?

“They were asked to fill in the appropriate responses.”- I would rephrase as “The students were asked to complete all the questions honestly”. (How do you define ‘appropriate’ in this instance? What is most important is that the students answered honestly without fear of any repercussions).

Replace “class room” with “classrooms”

Data analysis:

Add colon after “Data collection” and continue with “descriptive statistics” after colon.

Line 1: consider rephrasing to “descriptive statistics consisting of the mean, standard deviation and…”

Should be “The Mann-Whitney”

Line 4: replace “based” with “amongst”. In same line, replace “on” with “the”.

Line 5: replace “and” with as well as the”

Should be “In addition, the Mann-Whitney U test was used to determine the difference in the students’ perception of their clinicians’ teaching attributes based on the clinical instructors gender.”

Should be “The Kruskal Wallis”.

Line 8: I would use the word “compare” instead of “difference”.

Line 9: I would replace “based on” with “on the basis of”.

Line 10: Insert “the” prior to “highest”

Line 11: Insert “the” prior to “data”. Insert “aspects” after “data”. Insert “the” prior to “statistical”.

Results:

Paragraph one:

“Out of this, 258 were returned giving a return rate of 87%.”- Rephrase “An 87% return rate resulted in 258 questionnaires completed and returned.”

Should be “Table 2”, not “table 2”.

Insert “the” prior to clinical instructors.

Clinical learning environment:

Paragraph one:

Numbers in the text should be written as N=189 and should be in brackets, i.e. (N=189; 73.2%)

Is “plenty of problems” an aspect of the DREEM? As I don’t seem to see it on the questionnaire- if it isn’t, then this should be written in academic terms, alternatively, if it is an aspect of the questionnaire, then place it in apostrophes.

Line 6: Should be ‘21 students’.

“Others are: students’ academic self-perception (23.86±5.45), students’ perception of teachers (26.21±6.30), students’ perception of atmosphere (24.02±10.38).” – I would rewrite this as “The remaining domains’ mean scores included/consisted of….”

Insert p-value in brackets after ‘institution’ and ‘level’.

Clinicians teaching attributes

Grammar: students’; instructors’; clinicians’

I would rephrase: ‘clinical instructors who worked/supervised” in exercise immunology.

Avoid starting sentences with “also”.

This is the first time using MSc etc., so you should write it out in full and then place the abbreviation in brackets.

Insert comma before ‘while clinicians with PHD’

Discussion

Clinical learning environment:

“This could be attributed to the recurrent advances in the health sector which makes every department faced with the struggle of meeting up with the required standard to ensure that the clinical learning environment is conducive for the students.”- Academic writing requires improvement in this sentence, for example, ‘meeting up with’. This sentence also needs a reference.

“Students in NAU rated their clinical environment higher than students in UNN.” -I think you need to elaborate what “higher” entails.

“The 4th year students rated their clinical environment higher than the 5th year students.” -Again, I think you need to elaborate what “higher” entails.

“This was consistent with a similar study which reported that students’ year of study influenced the perception of their learning environment (Riquelme et al., 2009).” –Following this statement, the authors describe the reasons for this result- my suggestion is to be more explicit in the explanation, i.e. which year level are you referring to in each sentence- it allows for an easier read.

“cliical” should be “clinical”

“For students in their fifth year, this was of less concern, probably because before transitioning to the fifth year they must have learned the means to access support when they need it.” –Grammar needs improvement.

Clinicians’ teaching attribute

Insert comma after ‘tool’

Replace ‘they’ with ‘the authors reported that’

Replace ‘by’ with ‘amongst physiotherapy students’

“This may have resulted from a wide range of contact with different clinicians who have different specialties during their SIWES programme.”- be clear in your writing and mention that this refers to the NAU students.

‘This may be attributed to the level of exposure and contact the 5th year have gained within their rounds in different clinical posting units compared to the fourth year.’- Grammar mistakes. Repetition present as well. Be consistent with the use of 5th or fifth etc. (while following APA guidelines). In addition, describe the clinical rounds that the fourth years are exposed to, in order to highlight the difference between the two groups of students.

Should be written as: ‘exercise-immunology-instructors’

‘This could be attributed to the style of teaching adopted in these clinical posting units which involve mostly practical teaching sessions.’ –This sentence requires a reference.

‘The students also had a higher rating of male instructors compared to females even though no significant difference in the rating of clinical instructors’ attributes based on gender was recorded.’- “even though” not academic writing. Sentence also reads difficulty as it is too long.

Conclusion:

“boost” – not academically appropriate

I would replace “of students” with “by students”.

“Spelling out”- not academically appropriate

Conflict of interest statement

The authors declare that there is no conflict of interest.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.