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

Article accepted

This article has been accepted for publication. Peer reviews and author responses are available at the end of the article.

Abstract

Background: Feedback from students regarding their clinical learning environment and clinicians teaching attributes should be evaluated regularly to monitor students' learning experiences which can affect learning outcomes, the readiness for professional practice, and the level of satisfaction with the profession. Differences may exist in this feedback from students based on their institution, level of study, and characteristics of the clinicians. Aim: To evaluate physiotherapy students’ perception of their clinical learning environment and clinicians’ teaching attributes. Methods: This cross-sectional study utilised 258 participants from two academic institutions, which offer physiotherapy training in southeast Nigeria. A self-structured questionnaire, the McGill Clinical Teacher Evaluation tool (MCGill CTE) and the Dundee Ready Educational Environment Measure (DREEM) were used to collect the data. Descriptive statistics of mean and standard deviation were used to present the mean scores obtained on the DREEM questionnaire and McGill CTE tool. The Mann-Whitney U test was used to determine the difference in the students’ perception of their clinical learning environment and clinicians' teaching attributes based on their institution of learning and level of study. In addition, the Mann-Whitney U test also determined the difference in the students' perception of their clinicians teaching attributes based on the clinicians' gender, while the Kruskal Wallis test determined the difference in the students' perception of their clinician's teaching attributes based on their last clinical posting unit and the highest educational level of the clinicians. Results: The students perceived their learning environment to be “more positive than negative”. The highest-rated domain in the DREEM questionnaire was "perception of learning", while the lowest was "social perception". The highest-rated attribute for clinicians in the McGill CTE tool was "clinical interest in helping students to learn", while the lowest was "emphasises concept rather than factual recall". A significant difference was observed in the students rating of their clinical learning environment based on their institution and level of study. Conclusion: There is a need for regular evaluation of students' perception of their clinicians’ teaching attributes and the clinical learning environment to ensure the desired learning outcomes are attained and that students are ready for professional practice after training.

Reviews

Author: Michael Rowe
Review date: 3 February 2022
DOI: 10.14426/opj/rmr20220203
Permalink: Review - Physiotherapy students’ perception of their clinical learning environment and clinician teaching attributes in Nigeria

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 is presented well for the most part, although there are some minor grammatical errors remaining. I have made suggestions below that may help with clarifying some of the issues with presentation.

2. Sufficient explanation of the significance of the problem: There isn’t a clear link between the problem that the study purports to address (i.e. improving learning outcomes) and the findings of the study. The authors can do more to create a stronger link between student perceptions’ of clinical learning placements and clinical teachers, and improvements to the curriculum (and therefore, to learning outcomes).

3. Clear demonstration of the relevance to the field (beyond the case presented): If the authors can strengthen the link between student perceptions and improved curricula with practical suggestions, this article will have relevance for other physiotherapy educators.

4. Original contribution to the topic of physiotherapy education: While this is a local study in two Nigerian institutions, the lessons learned could be useful to other contexts.

5. Compelling presentation of the problem within a theoretical framework (where appropriate): There is room for improvement in the introduction, especially with respect to connecting the findings of the study to the practical issue of curriculum reform. The authors might consider looking for a curriculum development framework that includes ‘student perception’ as a relevant variable to consider, and then integrate it into this article.

6. Establishment of a relationship between the problem and other relevant literature: The authors can do more to link this study to the wider literature on curriculum development. Even though this isn’t made explicit in the article, the premise is that student perceptions of various parts of the programme are important for further developing the curriculum, with the aim of enhancing student learning outcomes. This connection between the existing literature and what this study sets out to achieve, can be strengthened. In addition, the use of citations to support claims made in the discussion is poor. The authors could do more to use existing research to justify some of the explanations provided for the findings of this study.

7. Appropriate research design and method: The study design is appropriate, although the analysis of data (and the meaning of the analysis outputs) could be explained more clearly.

8. Accurate and useful interpretation: For me, this was the least effective part of the article. I had difficulty connecting the findings of the study to it’s relevance to a broader community of physiotherapy educators. What is the value of reading this article, if you’re not an educator based at either of these institutions in Nigeria? The authors can do more to demonstrate the utility of these findings for a wider audience.

9. Sound argument and analysis: See my comments below for guidance on how the argument and analysis could be improved.

10. Effective conclusion about the implications for physiotherapy education, research, and/or practice: The conclusion in its current form is more like a list of recommendations. However, these recommendations don’t flow clearly from the study findings. I had little confidence in the reasons provided for the findings (because of the limited connection to existing research) and so couldn’t take the recommendations seriously. The conclusion section should be primarily a summary of the findings of this study, and recommendations could certainly be included, but only after having been thoroughly discussed in the previous section.

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

Abstract

> assessed regularly

I wonder if ‘evaluated’ would be more accurate since you’re not assessing the quality of students’ feedback but rather evaluating it. Later in the article you talk about ‘evaluation’ and not ‘assessment’.

> it

It’s not clear what you mean by ‘it’ here. Is ‘it’ the students’ feedback, or is ‘it’ the clinical learning environment and instructors? This sentence should be rephrased to make it clear how ‘it’ affects the outcomes of learning.

> determine

This is different to saying that you’re ‘assessing’ (or evaluating) student feedback. I suggest changing to “To evaluate physiotherapy students’…”

> based on clinical instructors’ gender

This is very specific and should be justified earlier in the abstract. Why do you think it’s important to determine differences in student perceptions of clinical instructors’ teaching attributes based on their (the instructors’) gender?

> Perception of the students’ learning environment resulted in more positive compared to negative features.

This sentence isn’t clear.

> perception of learning

You should try to differentiate the names of your categories from the rest of the sentence. You could do this by using italics for the category names, or capitalising them, or placing them in single quotes.

> ‘Clinical interest in helping students to learn’

Here you’ve used capitalisation and single quotes to name the category. I suggest using only one of these options, and ensuring that you’re consistent in how you do this throughout the article.

> Emphasizes

Use UK/English spelling throughout the article. In this case, you should use “Emphasises” i.e. “s”, not “z”.

> regular evaluation of the clinical instructors’ attributes

Your study didn’t evaluate the actual attributes; you evaluated student perceptions of the attributes. Please make sure that you are clear in terms of what you actually did and what you say you did.

> in order to monitor students’ learning outcomes and to ensure readiness for professional practice

I think it’s a stretch to say that this is something that your study can say anything about. You didn’t formally establish a link from student perceptions of various concepts to the monitoring of outcomes and readiness for practice.

Introduction/background

> emphasized

UK spelling should be used throughout the article.

> practice

I’m not sure that this first paragraph adds much value to the article. The second paragraph could also serve as a suitable opening for the article.

> Clinical education is a core component of physiotherapy professional training

You don’t have to argue for why clinical training is important; everyone reading this article already accepts the value of clinical placement and education in that environment. I suggest that this introduction should try to focus on the core concepts of the study i.e. student perceptions, clinical learning environments, and clinical teachers. What is the minimum amount of information you need to provide to ensure that the reader is comfortable with the concepts you’re going to explore in the article?

> Benner et al,

Please review the APA guidelines for citation formatting and ensure that your usage is consistent throughout the article.

> Generally

It feels like this paragraph is a distraction and doesn’t add much to the overall article. I get that it’s providing a basic overview of different approaches to clinical training but the reader doesn’t need to know the other systems in order to understand this article. Maybe a single sentence describing how Nigerian clinical supervision takes place would be enough?

> with medical dysfunctions

Unnecessary to include.

> Clinical learning is therefore an important part of physiotherapy education as it is a key determinant of curriculum and a silent index of both students’ and teachers’ behaviour (Demiroren et al., 2008)

You’ve made this point several times in the article already. I’m not sure you need to keep repeating it.

> Medical Students’ Perception of the Clinical Learning Environment

Shouldn’t be capitalised.

> Different Phases of Medical Education

Don’t capitalise.

> Ghana

Would it be worthwhile summarising the key findings of these studies? Without knowing what the authors found, there’s little value in including this list of papers. Perhaps you could summarise the main outcome of the studies collectively, rather than simply listing the authors and titles.

> Nigerian Universities

Is this the name of an institution? It’s not clear. If not, consider rephrasing.

> Oyeyemi et al

Review APA for correct formatting of in-text citations.

> have been reported to have an enormous impact on the outcome of learning

Who made this claim and what is the nature of this impact? Considering the pivotal role that the claim plays in the article, it should be clearly cited and explained in some detail earlier in the introduction.

> In addition, students’ opinion on their clinicians’ teaching attributes and the clinical learning environment needs to be constantly evaluated to ensure it’s in line with the recent innovations in patient care.

I don’t recall seeing any evidence for this claim earlier in the introduction. Please justify it with some form of evidence because it’s a strong claim to make and is central to your main argument.

> Nigeria

I think that the introduction section is too long and could be shortened to 2-3 paragraphs that describe only what is essential for the reader to understand this study.

Methods

> cross-sectional research design

It’s often useful to explain briefly what this is and why you chose this design.

> Section A and B

Of what? A self-designed questionnaire? It’s not clear what these sections are referring to.

> self-structured questions

What is a ‘self-structured question’?

> assessed

“…was used to collect sociodemographic characteristics…”

> contained

“…included…” may be more suitable.

> physical therapy

Be consistent in how you name the profession. You can use either “physical therapy” or “physiotherapy” but not both.

> is rated on

“…uses a 5 point…”

> assessed

“…evaluated…”

> It consists of five sub-domains with a total of 48 questions. Students’ perception of learning contains 11 questions, students’ academic self-perception contains 8 questions, students’ perception of teachers contains 10 questions, students’ perception of the atmosphere contains 12 questions and students’ self-perception contains 7 questions. The DREEM is rated on a 5-point scale as follows: Strongly agree = 4, Agree = 3, Unsure= 2, Disagree=1, Very Strongly Disagree= 0. Environmental perception of students as determined by DREEM is classified as “very poor” for scores between 0 and 50, “plenty of problems” for scores between 51 and 100, “more positive than negative” for scores between 101 and 150, and “excellent” for scores between 151 and 200 (Askari et al., 2018).

It’s reasonable to direct the reader to the relevant source for more detailed information, especially for a commonly used tool like the DREEM. It’s not a problem for this detail to be included here but it does take up more space than necessary, and the reader can easily find this information on their own.

> that

“…who…”

> The students were asked to complete all the questions honestly.

We can safely assume that students were expected to answer honestly. This sentence could be removed.

> was also used to determine the difference in the student’s perception of their clinician’s teaching attributes based on clinical instructors’ gender.

Why do you emphasise this component? There is nothing in your introduction to indicate that this variable (i.e. gender) is relevant for your study question. I think it would be useful for you to explain why this particular variable is important to investigate.

Results

> Table 1 shows the socio-demographic characteristics of the students while Table 2 presents the profile of the clinical instructors.

At this point I’m wondering where you’re presenting cross-tabulated data e.g. participants with variable X were more likely to respond in this way to question Y.

> plenty of problems

Do you have any sense of what these problems might be? Simply knowing that almost 20% of the students perceive there to be “plenty of problems” isn’t very useful, without knowing what they are.

> domains of DREEM

I see some of them listed below but it may be difficult for the reader to understand what you mean when you say that the highest mean on a certain domain is X.

> least

“…lowest…”

Discussion

> to have more positive than negative features

Is it relevant that there are “more” or “less” positive/negative features? What we really need to know are how important the relative value of each feature is. For example, a negative feature might be that there isn’t enough space to properly learn. While a positive feature might be that there is parking space for students. These are not equivalent and one is way more important for learning than the other. A simple tally of “how many” doesn’t tell the reader the important part of the story. Is it possible to add any of this detail?

> This is not surprising given that students in their third and fourth years of study have a greater desire to learn and explore new ground as they transition from the preclinical to the clinical phase of training.

This would benefit from a citation in support of the claim.

> may be unfamiliar with the system

Which system?

> They reported that the ‘clinicians interest in helping students learn’ had the highest mean score amongst physiotherapy students in Nigeria

Your discussion would benefit from some description of what this all means for the reader or interested physiotherapy educator. How can the reader use the results of your study to make changes in their own programme?

> This may have been noted in NAU students because of a wide range of contact with different clinicians who have different specialties during their SIWES programme.

It would really strengthen your article if you provided citations in support of the rationales you provide for your findings. Yes, it may be because of what you suggest. But it also may not. A citation in support would give the reader more confidence that your explanation is valid.

> This may be attributed to their increased number of contact with their clinical instructors

Same here. It may be because of what you describe but it may also be something else entirely. Without a citation to support your claim, the reader can’t have much confidence in your explanation.

> This could be attributed to the style of teaching adopted in these clinical posting units which involve majorly practical teaching sessions

Again, a citation would be great here.

> These hospitals had more male instructors compared to female instructors.

How does this explain the fact that participants rated male teachers more positively?

> The majority of these clinical instructors head clinical posting units and may not always be available to students.

Citation needed.

Conclusion

> so as to improve student learning outcomes and ensure readiness for professional practice after training

What you’ve presented in the results and discussion doesn’t actually provide any guidance around how knowing this information can improve learning outcomes. If you want to make this claim in your conclusion, you really should discuss how your findings can be used in this way. What, in practical terms, can the reader do with your findings in order to improve learning outcomes?

> There should be a revised harmonised curriculum for the clinical posting experience of students outlining the minimum standards of clinical exposure a student should have during clinical education.

Again, it’s not clear to me how your findings lead you to this conclusion. And, what do you mean when you say “harmonised curriculum”?

> Seminars and workshops on clinical skill acquisition should be regularly organised for clinical instructors in the health sector to improve their teaching abilities.

Your conclusion doesn’t actually discuss the findings of this study. You seem to be making recommendations in the conclusion that don’t clearly stem from your results and discussion. This paragraph should only present the conclusions from this study. And recommendations should be supported in the discussion through appropriate citation.

> Poor compliance on the part of some students.

This isn’t a limitation. If students chose not to complete your survey, there are many other reasons for why that might be true. For example, the survey may have been confusing, or distributed at a busy time of year, or the rationale for completing it may not have been explained. My point is, you can’t blame your participants when things don’t work out as you had hoped.

Table layout and presentation

> UNN

Write these out in full.

> Less

“Younger…”

> 15.0

Remove the decimal place when the first number after the point is 0.

> Greater

“Older…”

> Marital status

Why present this information if you’re not going to link responses to these variables. For example, It might be interesting to know if married participants perceptions of feedback based on the gender of the clinical teacher is different to the perceptions of unmarried participants. The same question can be asked of the gender of participants. There’s little value in including sociodemographic information that isn’t tied to some other variable.

> Key: N= Number of participants, UNN= University of Nigeria, NAU= Nnamdi Azikiwe University.

Not necessary to include. All readers will know what the “N” stands for. And there’s enough space in the table to write the institution names in full.

Author: Tammy Pretorius
Review date: 20 October 2021
DOI: 10.14426/opj/rtp20211020
Permalink: Review - Physiotherapy students’ perception of their clinical learning environment and clinician teaching attributes in Nigeria

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.

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