Review (Marianne Unger) Bridging the gap between educational institutions and private practice

Thank you for the invitation to review. Given that many of our graduates end up in the private sector, it seems logical that physiotherapy training programs should include this setting within undergraduate curricula. What concerns me though is the obvious perception that it is acceptable to allow students to learn and ‘practice’ on patients within the public health care domain, but that it is not alright to do so in the private sector. Bar the possible financial constraints on the private practices, the multiple benefits for all stakeholders are seldom further investigated.

Given my statement above, it was disappointing to find that this study has not really added to the current body of knowledge/evidence concerning the challenges of having undergraduate PT students train in private practice. The study suggests that it aimed to find ‘solutions’ yet still excessively focuses on existing barriers. The study concluded that change is necessary – but then does not elaborate on this.

A further concern is the very small sample size given that Germany has 36 or more training institutions for physiotherapy. How were these participants identified and recruited? Similarly only two practitioners working in private were invited to participate, one of whom works in both sectors – did this not lead to bias? It is unlikely that their responses are similar to the rest of the population and this study therefore lacks generalisability.

Do you have ethical clearance and or was the proposal externally reviewed?

In general the manuscript is too long, and although the transparency concerning the qualitative methods you have used, are unnecessary and has lead to a lot of repetition. To the reader this then becomes boring.

My recommendations for improving this manuscript are thus:

  • consider changing the title – you have not developed a framework nor any model/s for cooperation to facilitate the inclusion of the private sector into the undergraduate (UG) clinical training program and as my co-reviewer pointed out, the local setting and challenges vary significantly between countries and perhaps elaborating on the German context will add value.
  • ‘Tighten up’ the methodology as well as the results sections and try to keep your focus on the information/data that can assist in ‘bridging the gap’ or rather fostering cooperation between the schools and the private sector
  • Why did you select heads of schools and not the undergraduate program coordinator or clinical training coordinators? And why share their qualifications, funding model etc. – this seems irrelevant to the topic and makes them identifiable.
  • What measures did you put in place to ensure trustworthiness?
  • ‘contentual’ learning – do you not mean contextual learning?
  • Discussion – begin with what the major findings were and then proceed to discussing each one. Again – keep focused on what is needed to foster better cooperation and propose how this could be done in line with recommendations from the literature e.g. remuneration seems a key consideration – what about proposing other models for remuneration? Continuous professional development, a university accredited practice etc.
  • What are this study’s limitations? Discuss the implications of the purposive  sampling and small sample size? Any suggestions for further research?
  • Practical implications – this section I would rewrite to summarise clearly the issues and some of the ‘solutions’ to the issues


One thought on “Review (Marianne Unger) Bridging the gap between educational institutions and private practice

  1. In the following, we would like to comment on changes made, based on your advice.

    General comments
    We restructured the article to follow the idea, that we state barriers as well as the options of collaboration seen by the interview partners. As we conducted our research in the German Health Care System, we specified that within our title.

    In the German education system, we have around 35 higher education institutions and more than 200 schools of physiotherapy on the vocational level. Therefore, we are totally aware of the limited generalisability of the research. Nevertheless, we included the view of typical and somehow contrary positions.
    We don´t agree that we have a bias with our interview partner who is both, educational program director as well as private practice practitioner. The interview partner understands both perspectives. This enriches the results from our point of view.
    The ethical consideration is a sensitive aspect of our research. As our institution does not have an ethic committee, every student research project is reviewed by the two supervisors of the project. No research on patients or other vulnerable groups will be conducted in this manner. As this project is a more social science project focusing on professional issues, the supervisors consented on this project. The coordination of clinical training in Germany is usually undertaken by the program director. The program director coordinates the practical training and the theoretical education. In the paper the term “program director” was chosen instead of the term head of school.
    The qualifications of the interview participants and the funding model of the school were taken out of the method section as they do not affect the results, as initially assumed.

    The results section highlights three possibilities for cooperation. The analysis, however, takes a step backwards by first presenting the advantages and disadvantages of cooperation.

    Discussion and conclusion
    Methodological limitations were included in the discussion section. To give an example, the federal structure of Germany is listed, which reduces the transferability of the results. In addition, further inclusion criteria could have been formulated that relate to the institutional context.
    In order to concentrate on the possibilities of cooperation, it was necessary to discuss advantages and barriers of collaboration first. Thus, the discussion part was restructured in barriers, advantages and potentials.
    Regarding potentials for collaboration between learning sites, the three main themes are presented and critically discussed.
    In the discussion it becomes clear that the advantages of cooperation, such as continuous professional development of the employees, provide increased incentives for cooperation. However, a financial structure must be established as a necessary condition for cooperation
    There will be no university accreditations in Germany, as this requires that physiotherapy training is linked to the university context. This is not yet the case in Germany.
    In the conclusion section suggestions for further research were included.

    Thank you very much for reviewing our manuscript and giving us valuable feedback to improve our manuscript!

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