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

Article: Physiotherapy students’ perception of their clinical learning environment and clinician teaching attributes in Nigeria
Article status: accepted
Author: Tammy Pretorius
Review date: 20 October 2021
DOI: to be allocated

Peer review (Tammy Pretorius) – 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

[jetpack-related-posts]

One Reply to “Peer review (Tammy Pretorius) – Physiotherapy students’ perception of their clinical learning environment and clinician teaching attributes in Nigeria”

  1. 1. Reviewer’s comments
    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.

    Authors’ corrections: All grammatical mistakes have been addressed using a professional language editor.

    2. Reviewers comments:
    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.

    Authors’ corrections: Clinical education is believed to be different from classroom education as it requires key attributes for effective learning including communication, questioning, one-to-one evaluation, and small group skills (Knox & Morgan, 1985). Students engage in supervised learning sessions in health-care settings during clinical education, giving them the opportunity to put what they’ve learned in the classroom into practice. As a result, the clinical experience acquired by students during the clinical education phase of their programme may be grossly influenced by the teaching attributes of the clinical instructor as well as the nature of the student’s clinical environment (Knox & Morgan, 1985). Therefore, student learning could be maximized if the clinical experience is impacted by clinical instructors who possess the ideal teaching attributes such as adequate clinical competence, good teaching abilities, professional ethics, substantial clinical experience and effective communication skills. In addition, an optimal educational environment which provides opportunities for learning experiences that contribute to achievement of learning objectives, professional socialization and the quality of care provided to patients during professional practice maximizes students learning.

    3. Reviewer comments:
    Clear demonstration of the relevance to the field (beyond the case presented): The authors research is highly relevant and the importance thereof is evident.

    No correction is required

    4. Reviewer comments:
    Original contribution to the topic of physiotherapy education:
    A similar study was performed by Oyeyemi et al (2012) and Odole 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.

    No correction required

    5. Reviewer comments:
    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.

    Authors corrections: This has been addressed in Number 2

    6. Reviewer comments:
    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.

    No correction required

    7. Reviewer comments:
    Appropriate research design and method:
    Well designed and carried out. Formatting and grammar mistakes present (see below).

    Authors’ corrections: All formatting and grammar mistakes that were pointed out have been addressed.

    8. Reviewer comments:
    Accurate and useful interpretation: Interpretation executed well but formatting and grammar mistakes evident (see below).

    Author corrections; All formatting and grammar mistakes that were pointed out have been addressed.

    9. Reviewer comments:
    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.
    Author corrections: This has been addressed.

    10. Reviewer comments:
    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.

    Author corrections: The focus of the study was to assess Physiotherapy students’ perception of their clinical learning environment and clinician teaching attributes in Nigeria.
    Perception of students were not compared to outcome of learning in this study.

    Introduction/background:
    Reviewer comments: First paragraph: No references in first paragraph. I would replace “assessed” with “evaluated” in the last line.

    Authors corrections:
    First paragraph: Clinical education of students is critical to our future healthcare and is an important aspect of health professions because it plays a fundamental role in shaping the students’ approach towards future professional practice (Alsiö et al., 2019; Senthilnathan et al.,2020).
    The student learning environment and clinician teaching attributes are determinants of effective clinical education and need to be regularly evaluated in any clinical setting.

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

    Author corrections: Clinical education is a core component of physiotherapy professional training, which involves the assimilation of attitudes, values, and behaviours that define a physiotherapy professional (Delany & Bragge, 2009). During this phase of student learning, direct patient care is experienced (Odole et al., 2014).

    Reviewers comments:
    Line 6: sentence is too long- consider separating.
    Authors corrections: Clinical instructors who are specialists in the different areas of physiotherapy share their knowledge and professional expertise with the students. They also give direct supervision in various areas of clinical learning using the best teaching strategies in a good learning environment.

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

    Authors corrections: Several authors agree that clinical experience is not only an essential element of the health care education programme but it is paramount for the development of good clinical reasoning and professional skills in students (Chan, 2004; Benner et al, 2008).

    Reviewers comments:
    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.

    Authors corrections: Generally, there are three variations of physiotherapy clinical education organisations. The first is the internal version which is no longer in existence in which the same institution provides both the foundational/clinical sciences theory and the student’s clinical experience. There is also an external version which is very common in the United States of America in which students’ clinical training takes place in free-standing hospitals, clinics, and centers.

    Common in British Commonwealth countries, including Nigeria, is the bridge version in which students gain their clinical experience in a teaching hospital specifically affiliated with the University
    (This has been moved to a new paragraph)

    Reviewers comments:
    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.

    Authors corrections:
    Clinical education is believed to be different from classroom education as it requires key attributes for effective learning including communication, questioning, one-to-one evaluation, and small group skills (Knox & Morgan, 1985). Students engage in supervised learning sessions in health-care settings during clinical education, giving them the opportunity to put what they’ve learned in the classroom into practice. As a result, the clinical experience acquired by students during the clinical education phase of their programme may be grossly influenced by the teaching attributes of the clinical instructor as well as the nature of the student’s clinical environment (Knox & Morgan, 1985). Therefore, student learning could be maximized if the clinical experience is impacted by clinical instructors who possess the ideal teaching attributes such as adequate clinical competence, good teaching abilities, professional ethics, substantial clinical experience and effective communication skills. In addition, an optimal educational environment which provides opportunities for learning experiences that contribute to achievement of learning objectives, professional socialization and the quality of care provided to patients during professional practice maximizes students learning.

    Reviewers comments:
    Line 6: I would replace the word “problems” with “medical disorders” or “medical dysfunctions”, etc. I would avoid the word “problems
    Authors corrections: Students, therefore, have to combine and integrate knowledge, skills, values, and philosophies of the profession that they have learned in the classroom and apply these to the real patient, with medical dysfunctions.

    Reviewers comments
    Line 6: sentence starting with “clinical learning” is too long- consider separating or adding commas.
    Authors corrections: 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). However, obtaining feedback from students regarding their clinician’s teaching attributes and their clinical learning environment is an important element of health care as it provides a useful basis for modifying and improving the quality of teaching and learning.

    Reviewers comments:
    Line 10: replace “on” with “regarding”
    Authors correction:
    However, obtaining feedback from students regarding their clinician’s teaching attributes and their clinical learning environment is an important element of health care as it provides a useful basis for modifying and improving the quality of teaching and learning.

    Reviewers comments:
    Line 11: add “their” before “clinical learning”
    Authors corrections: However, obtaining feedback from students regarding their clinician’s teaching attributes and their clinical learning environment is an important element of health care as it provides a useful basis for modifying and improving the quality of teaching and learning.

    Reviewers comments:
    Line 12: “Several studies” – comment on the results of those studies.
    Authors corrections: Thus, clinical learning experience provides a context for the application of prior knowledge and the integration of new learning. Students, therefore, have to combine and integrate knowledge, skills, values, and philosophies of the profession that they have learned in the classroom and apply these to the real patient, with medical dysfunctions (Demiroren et al., 2008). 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). However, obtaining feedback from students regarding their clinician’s teaching attributes and their clinical learning environment is an important element of health care as it provides a useful basis for modifying and improving the quality of teaching and learning. Several studies have been conducted in various health professions to evaluate clinical students’ perceptions of their learning environment and clinician’s teaching attributes.Arzuman, et al. (2010), Salminen et al. (2016) and Shar et al. (2019) carried out a study on Medical Students’ Perception of the Clinical Learning Environment. Demiroren et al. (2008) conducted a study on the perceptions of students in Different Phases of Medical Education of their educational environment. Alammar et al. (2020) studied nursing students’ perception of the Clinical Learning Environment. Wilsom et al. (2021) conducted a study on nursing Students’ perceived effective clinical teacher behaviours. Nyante et al. (2020) studied physiotherapy students satisfaction on clinical Learning Environment and supervision at University of Ghana.

    Reviewers comments:
    Line 2: replace clinicians with clinicians’
    Authors corrections: However, there is paucity of literature on physiotherapy students’ perception of their clinical learning environment and clinicians’ teaching attributes in Nigeria.

    Reviewers comments:
    “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.
    Authors corrections: Two studies were performed in Nigeria, one at the University of Ibadan (Odole et al., 2014) and another in some Nigerian Universities (Oyeyemi et al., 2012). Oyeyemi et al assessed physiotherapy students’ perception of their clinicians’ teaching attributes while Odole et al assessed physiotherapy clinical students’ perception of their learning environment.
    Sentence structure changed: “In addition, students opinion should be constantly evaluated to ensure alignment with recent innovations in inpatient care.”

    Reviewers comments:
    In addition, student’s 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. “change sentence structure”

    Authors corrections: In addition, students opinion should be constantly evaluated to ensure alignment with recent innovations in inpatient care.

    Reviewers comments:
    Check entire article for correct spelling of clinicians’, and not “clinicians” or “clinician’s
    Authors corrections: This has been addressed

    Reviewers comments:
    Check entire article for correct use of students’ and not “student’s”
    Authors corrections: This has been addressed

    Reviewers comments:
    Line 12: remove “a”
    Authors corrections: However, there is still dearth of knowledge on the perception of clinical learning environment and clinicians’ teaching attributes by physiotherapy students in Nigeria,

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

    Reviewers comments:
    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.”
    Authors corrections:
    Instruments for data collection: Section A and B consisted of self-structured questions which assessed the socio-demographic characteristics of the participants and clinical instructors, respectively.

    Reviewers comments:
    Reference reliability score for CTE.

    Authors corrections: It has been assessed for reliability among Nigerian physiotherapy students in a pilot study and a reliability coefficient of 0.73 was obtained (Oyeyemi et al., 2012).

    Reviewers comments:
    Line 9: should be “5-point”
    Authors corrections: this have been adressed.

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

    Authors corrections: with the overall Cronbach’s alpha of more than 0.7

    Reviewers comments:
    “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”.

    Authors correction: In addition, this measure has a high level of stability with a test-retest coefficient of more than 0.8.

    Reviewers comments:
    Procedure:
    Add colon after “Procedure” and continue with “ethical approval” after colon.
    Line 4: Replace “before” with “prior to” participants before data prior to collection.
    Authors correction: This has been addressed.

    Reviewers comments:
    “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.
    Authors correction: The database of all 4th and 5th year students was obtained from the physiotherapy departments of the University of Nigeria, Enugu campus, Enugu state, Nigeria and Nnamdi Azikiwe University, Awka, Anambra state, Nigeria.

    Reviewers comments:
    Line 8: replace “also” with “in addition
    Authors corrections: In addition, further notification was given to the students through their class representatives.
    Reviewers comments:
    “confidentially”- should this not be “confidentiality was assured”?
    All the procedures were explained to the participants and confidentially assured.
    Authors corrections:
    All procedures were explained to the participants and confidentiality was assured.

    Reviewers comments:
    “They were asked to fill in the appropriate responses.”- I would rephrase as “The students were asked to complete all the questions honestly”.
    Authors corrections: The students were asked to complete all the questions honestly.

    Reviewers comments:
    Replace “class room” with “classrooms”
    Authors corrections: The questionnaires were distributed and collected in the classrooms of the participants.

    Reviewers comments:
    Line 1: consider rephrasing to “descriptive statistics consisting of the mean, standard deviation and…”
    Authors corrections: Descriptive statistics consisting of the mean, standard deviation and…”

    Reviewers comments:
    Should be “The Mann-Whitney”
    Authors correction: The Mann Whitney U test

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

    Authors corrections: The Mann Whitney U test was used to determine the difference in the students perception of their clinical learning environment and clinicians teaching attributes amongst the institution of learning as well as the level of study.

    Reviewers comments:
    Line 5: replace “and” with as well as the”
    Authors corrections: The Mann Whitney U test was used to determine the difference in the students perception of their clinical learning environment and clinicians teaching attributes amongst the institution of learning as well as the level of study.

    Reviewers comments:
    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.”
    Authors corrections: 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.

    Reviewers comments:
    The Kruskal Wallis test
    Authors corrections: This has been addressed.

    Reviewers comments:
    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”.

    Authors corrections: this has been addressed.

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

    Reviewers comments:
    Should be “Table 2”, not “table 2”.
    Insert “the” prior to clinical instructors.
    Paragraph one: Numbers in the text should be written as N=189 and should be in brackets, i.e. (N=189; 73.2%)

    Authors corrections: This has been addressed.

    Reviewers comments:
    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
    Authors corrections: This is an aspect of the DREEM questionnaire and has been explained under the instruments for data collection.

    Reviewers comments:
    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….”
    Author corrections: The remaining domains’ mean scores consisted of: students’ academic self-perception (23.86±5.45), students’ perception of teachers (26.21±6.30), students’ perception………..

    Reviewers comments:
    Insert p-value in brackets after ‘institution’ and ‘level’.
    Authors corrections: There was a significant difference in the rating of students’ perception of learning environment based on institution (p = 0.037) and the level of study (p = 0.031).

    Reviewers comments:
    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 Ph.D’
    Authors corrections: This has been addressed
    Clinicians with a Master of Science (M.Sc) degree were rated higher (mean rank: 130.48) than clinicians with Bachelor of Science (B.Sc) degree (mean rank: 116.56), while clinicians with a Doctor of Philosophy (Ph.D) had the lowest rating (mean rank: 114.36).
    Reviewers comments:
    “Students in NAU rated their clinical environment higher than students in UNN.” -I think you need to elaborate what “higher” entails.
    Authors corrections; Students in NAU had higher mean scores than students in UNN in the rating of their clinical environment.

    Reviewers comments:
    “The 4th year students rated their clinical environment higher than the 5th year students.” -Again, I think you need to elaborate what “higher” entails.
    Authors corrections: The 4th year students had higher mean scores in the rating of their clinical environment than the 5th year students.

    Reviewers comments:
    “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.

    Authors corrections: This supports the findings of a study carried out by Riquelme et al. (2009) to assess students’ perceptions of their educational environment. Their study reported that 5th year students’ had lower scores in the sub-scales of the DREEM questionnaire compared to students in other levels of study. 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 preclinical to clinical phase of training. Furthermore, students who have recently moved from preclinical to clinical training may be unfamiliar with the system.

    Reviewers comments:
    “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.

    Authors corrections: On the other hand, this finding contradicts the study by Till et al. (2004) in which 4th year students rated their clinical environment lower than their final years. They reported that students in their fourth year required more assistance in transiting from their preclinical to clinical year of study but had inadequate support from their institution.

    Reviewers comments:
    They reported that students in their fourth year required more assistance in transiting from their preclinical to clinical year of study but had inadequate support from their institution. They Authors corrections: The authors reported that students in their fourth year required more assistance in transiting from their preclinical to clinical year of study but had inadequate support from their institution.

    Reviewers comments:
    They reported that the ‘clinicians interest in helping students learn’ had the highest mean score amongst physiotherapy students in Nigeria
    AAuthors corrections: They reported that the ‘clinicians interest in helping students learn’ had the highest mean score amongst physiotherapy students in Nigeria

    Reviewers comments: is 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.
    Authors corrections: 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.

    Reviewers comments:
    ‘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.’- sGrammar 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.

    Authors corrections: This may be attributed to their increased number of contact with their clinical instructors as well as a higher level of clinical exposure in several clinical posting units compared to the fourth year students.

    Reviewers comments:
    “boost” – not academically appropriate
    Authors corrections: Regular evaluation of clinical instructors and students’ clinical learning environments should be advocated so as to improve student learning outcomes and ensure readiness for professional practice after training.

    Reviewers comments:
    “Spelling out”- not academically appropriate
    Authors corrections: There should be a revised harmonised curriculum for the clinical posting experience of students outlining the basic minimum standards of clinical exposure a student should have during clinical education.

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