Review (Yngve Roe) Bridging the gap between educational institutions and private practice

In general, the manuscript focus on an interesting topic within physiotherapy education, that is how we can implement clinical placement into the education, which is relevant for the later working-life for students. This may be dependent of new models of cooperation between universities and clinical settings. I think this is a general challenge across countries. When it comes to financing of primary care physiotherapy, the authors should be aware that there may be huge differences between countries; for example in the Scandinavian countries the public financing of primary care physiotherapy, is probably much higher than in Germany(?). Thus, I think it would improve the manuscript to put most emphasize on the principal problems, which again I think are the same, independent of financing. Did the informants from the private clinics also see benefits of cooperating? For example, rising standards as a consequence of having students who were recently taught in evidence-based physiotherapy? This is obviously a two-way relationship where also clinics have to change.

Several places in the manuscript, statements from informants are cited. For example  “….as private practice owners attribute a bridging function to the school (I 1, line 486, I 3, lines 445-446)”. Thes reference to lines should be removed. In addition, I would recommend that such citations are kept to a minimum, and are only used in cases were a statement inform the themes analysed. .

The manuscript is too long and will profit on being shortened, I think this would be easier with a new, and tighter structure. Lastly, the ethical issues commented on, needs to be addressed.

Thank you for giving me the opportunity to review the manuscript – this is a really important and interesting topic!


Specific comments


The abstract generally reads well and provides an overview of the study. However, in the methods section it should be more clearly stated whether the interviews were individual and how the informants were recruited. The conclusion only to a little extent answer the aim of the study, which was to identify new models of cooperation.



First paragraph is generally well written and explains the discrepancy between where physiotherapists work and where they have their clinical placements. However, the authors do not explain the reason for why physiotherapists currently, to a lesser extent work in acute hospitals. I find the claim that “there is a clear need for a clinical education which prepares physical therapists for work in private practice settings”, a bit difficult and probably dependent on country and health care system. Instead, one could argue that the is a need for education preparing physiotherapists for primary care settings – independent of whether it is public or private.

Second paragraph starts with “the main barrier….”, I will suggest to start with one or two sentences explaining why private practice clinics in Germany could offer a valuable contribution to the education. Thereafter, you could write about the potential benefits with respect to increased cooperation, such as recruitment of future staff, improved standards among staff? etc. Finally would could address some of the barriers, leading up to the aim.

“The overall goal of the study is to improve cooperation between learning locations”. Research studies seldom have goals but rather aims or objectives. This “goal” should be rephrased. I would suggest something pointing to the exploratory nature of the study, such as to identify possibilities, challenges and barriers for….. If you agree to this, the results section should be structured accordingly. This would greatly improve readability!

A more general question to the authors I whether some additional literature on similar challenges in bridging education and practice within health education, could have been added. I should admit, though, that I am not deeply into the literature within this field.



There is no such thing as “methodological aim”, this is only confusing.

The recruitment process is in many aspects well described, however, were the informants randomly chosen based on the criteria, or was it rather a strategic sample?

Sentence that reads: “The participating practice owners were both female, 37 and 46 years old, had no experience in supervising students and had been working as practice owners for 5 and 10 years” Due to ethical reasons, I would strongly suggest that you do not provide this combination of details, which easily make it possible to identify the informants. In addition, you have already described, in which region of Germany the research takes place. Tables 1 and 2 provide too much detail, instead present as text in less detail.

“The interviews were conducted by the first author”. Here you should add some information of the background of the first author, i.e. past experiences with interviewing and doing similar analyses.

“The interviews were audiotaped and between 35 and105 minutes”. Were the interviews also transcribed by the first author? Add a sentence about this.

The analyses is really comprehensive and explained in great detail. I wonder whether some of the information presented, such as the bits with citations, are rather part of the result section. Please consider this.

There is no information about ethical considerations in the manuscript, except from the informed consent. Did the study receive any institutional approvals? Or any data protection approval (GDPR)? If not, it should be explicitly stated why not. This type of data cannot and should not be considered anonymous.



This section is really comprehensive and should be restructured and also shortened (see comment earlier about the aim). This again, has major consequences for how the discussion is structured.



What were the 3-5 most important findings? Discuss them one by one, accordingly. The discussion section should also address important methodological issues, such as limitations with respect to analyses etc. The number of informants Is low, what could have been the results with a higher number of informants, or if the informants were recruited in other regions? Could it have been an alternative to perform focus-group interviews in this case. Why, or why not?



“The current gap between practical training and professional reality can only be bridged by an increased involvement of private practices in practical training”. This is a claim that is beyond the “goal” and which may not be justified by the empirical findings. The conclusion points back to the aim, thus it needs to be rephrased accordingly.


Practical implications

I would suggest to remove this section, because I do not think there are any. The scope of this type of study is to increase knowledge about a problem and thus to guide decision-making and further research.

One thought on “Review (Yngve Roe) 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.

    For the recruitment of the participants the anticipated proximity to the problem subject was decisive. All participants were contacted via e-mail or telephone.
    The result section was adapted to the new research question. Accordingly, the main results are briefly outlined in terms of barriers, advantages and potentials.

    In the introduction section we added definitions on terms related to private practice. Furthermore, we restructured the introduction part, so that we started with general introductions on clinical education (considering barriers and advantages as described in the literature) and ended with transferring this to the situation of the German education system.
    We base our argumentation on literature referring to clinical education in physiotherapy and not to other health professions. Given the amount of literature on that topic and focusing on the transferability to the German system, we have decided to concentrate on the available literature from the field of physiotherapy.

    We added information on the sampling process and left out some details about the participants due to your valuable comment.
    Furthermore, we shortened the method section as we focused on a more general description of the thematic analysis process.
    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 more a social science project focusing on professional issues, the supervisors consented on this project.

    The results section was adapted to the new research question and was restructured.
    Barriers, advantages and potentials of collaboration between the learning sites are the main structuring points of the results section. The items have subcategories which have been reduced in size compared to the first manuscript. Further conditions for success were excluded, which would result from the modification of external framework structures.

    The discussion part was restructured. Now, it bases on the three main criteria barriers, advantages and potentials for collaboration between learning sites. The main findings, such as the early acquisition of employees or the modification of legal guidelines, are critically discussed from an educational point of view. The focus was also on discussing different views of the interviewees which was primarily expressed under the point of the modification of legal guidelines. Based on the results, conclusions could be drawn regarding the comparison between German physiotherapy training and international physiotherapy training.
    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.

    Practical implication
    We removed this section.

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

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