Megan Craig Jenna Davidson Valerie Wallace John-Carlo Caballes

1. Scanning the landscape about 1,025 hours as the entry-to-practice clinical education standard in physiotherapy in Canada: Evidence from other countries, other professions, and scholarly literature Megan Craig Jenna Davidson Valerie Wallace John-Carlo Caballes Amanda Dawson Emily Wood Alex Mong Cassandra Schilling Kathy Davidson, Peggy Proctor, Adriana Venturini, Sandra McKeown, Kathleen E. Norman

2. Who cares about 1,025 hours?

3. Where is it specified?

4. Where is it specified? There are also notes about area of practice, context of practice and supervision.

5. Three avenues of exploration • Q1 • What is the standard for students in entry-to-practice physiotherapy programs in other countries? • Q2 • What is the standard for students in entry-to-practice programs in other professions in Canada? • Q3 • What peer-reviewed literature exists that would inform the nature, design and/or structure of clinical education in entry-to-practice physiotherapy programs in Canada? Presentation starts here

6. Scoping review of literature Sandra McKeown • databases: CINAHL, ERIC, Ovid Embase & Medline • search term examples: clinical N2 (education OR skills OR experience* OR placement* OR practice OR setting*)) preceptorship OR practicum OR internship OR fieldwork OR... entry N3 practice student simulation OR simulated environment OR... AND physical therapy OR physiotherapy OR...

7. Scoping review results Restrictions: English language Academic journals n = 2,180 items De-duplication and initial screening for true journal articles & appropriate content n = 148 items Further screening for content with more refined criteria n ≈ 31 items history, opinion/editorial systematic studies with data simulation experiences

8. Scoping review findings Megan Craig, Jenna Davidson, Valerie Wallace & John-Carlo Caballes

9. 1968 C. A. Worthingham • Description of 441 facilities and associated staff, used by 42 schools in the United States in 1965 for physiotherapy clinical education • Data about facilities’ administration, patients, equipment, and student programs • Data about staff status, clinical experience, responsibilities, and supervision of students

10. 1990 J. Gwyer • Description of the state of resources (clinical education centers, clinical faculty, and curriculum) with a growing number of students • Recommendations for changes in faculty training and curriculum to address future resource concerns

11. 1998 Clinical Education Review Working Party (CSP) • Description of Validation Guidelines: 1,000 hours of supervised clinical education required • Opinion that clinical education was hindered by placement shortage, primarily due to increasing number of students • Secondary causes included the move from acute to primary health care • Recommendations to protect clinical education viability

12. 2002 E. Mogensen et al. • New model of interdisciplinary clinical education in Sweden using Clinical Training Centres, Clinical Education Wards, and a multidisciplinary team • Goals accomplished for cooperation and collaboration of staff and students, utilization of joint resources, and self-directed learning

13. 2004 L. Chipchase et al. • Importance of evidence-based physiotherapy education, rather than 1000 hour requirement based on opinion and intuition • Clinical patient encounters are essential for competency and require evidence for structure design S. Mercer Moore • WCPT requirement for 1000 hours of clinical experience was removed in 1991 • WCPT motion in 2003 to develop international guidelines, including standards and accreditation

14. 2004 R. Grant • Description of ACOPRA accreditation requirements: quality, comprehensiveness, and depth of clinical education experience • 1000 hour requirement was not mentioned L. Chipchase et al. • Misunderstanding amongst clinicians and academics highly prevalent, despite lack of 1000 hour requirement • Recommendations to develop an educational framework based on research evidence

15. 2014 D. U. Jette et al. • Description of structures, processes, and outcomes of clinical education with emphasis on the large variation across the U.S. • Minimum 30 weeks full-time clinical education required, but varied timing and duration (8 - 68 weeks) • Recommendations for standardization of clinical education to improve quality

16. 31 articles retained for analysis 12 articles deemed “systematic” studies 3 articles about students’ perspective on clinical placement 2 articles about clinical instructors’ perspective on clinical placement 2 articles about the directors of clinical education perspective of clinical placement 2 articles related to changes in productivity and efficiency with a student 2 articles about learning contracts 1 article covered both students’ and clinical instructors’ perspectives of clinical placement

17. Value of learning contracts Documented plans for internships, including learning contracts, found to be rational and acceptable by 32 PT students and clinical instructors in developing and evaluating a clinical performance program. • Wightman & Wellock (1976) [U.S.A.] Learning contracts found useful by 41 of 64 PT students in facilitating their learning and optimizing the value of the clinical placement. • Cross (1996) [U.K.]

18. Students’ perspectives Students believe that the current assessment method is an obstacle to learning because it is conducted in a very subjective and non-transparent manner. • Tredeet al. (2015) [Italy] Predictors of overall student satisfaction on clinical placement were: student gender, life satisfaction, variety seen on placement and variables from the individuals personal, interpersonal and organizational domains. • Stithet al. (1998) [USA] Students feel that there is a need for clinical placement sites that are more representative of the current healthcare system and where new grads are likely to end up working. • Dean et al. (2009) [Australia]

19. Clinical Instructors’ perspectives Found there was a lack of agreement between academic and clinical stakeholders’ views about developing specified standards for length and breadth of clinical education across all academic PT programs • Wetherbeeet al. (2010) [USA] PT clinicians felt that assessment forms made students focus on grades rather than improving their practice. Trede et al. (2015) [Italy] DCE model  >  SR model The supposed advantages of the DCE model included an increased time to devote to clinical education, improved consistency of supervision and decreased stress levels for staff. • Stiller et al. (2004) [Australia]

20. Directors of clinical education: perspectives Less than half of respondents offer International Clinical Education (ICE) • Pechak (2012) [USA] Although clinical reasoning was explicitly integrated into programs curricula, the term was not consistently defined, taught, or assessed within or between the programs survey-resulting in significant variability in clinical reasoning education. • Christensen et al. (2017) [USA] Barriers to ICE include: expense, lack of faculty time and knowledge, and difficulty with site coordination. Benefits to ICE include: positive impact on cross-cultural competency, student personal development, and global awareness.

21. Productivity / efficiency The presence of a student did not result in an increase or decrease in productivity and efficiency at the clinical placement site; students compensate for the time a clinical instructor spends away from direct patient care. • Moore et al. (2014) [USA] The presence of a student does affect the productivity and efficiency of the clinical placement site; 5-week clinical education formats increased efficiency, and 1-day per week and 1-week formats decreased efficiency. • Graham et al. (1991) [USA] VS.

22. What is Simulation? Simulation is a technique—not a technology—to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner. Gaba (2004) Definition of simulation is broad and context-dependent.

23. Simulation – Findings • 6 studies looking at simulation 4 studies involved PT students / faculty only 2 were mixed health professional students including PT • Definitions of simulation found: Standardized patients (SP) Simulated learning environments (SLE) High fidelity simulation (HFS) Community volunteers DVD simulations

24. Simulation – Findings

25. Simulation – Findings

26. Simulation – Findings

27. Simulation - Summary  Perception of usefulness Feasibility of implementation Supplementing clinical placements

28. Clinical Training Requirements for Entry-to-Practice in Canadian Health Care Professions Cassandra Schilling & Alex Mong

29. Other Professions & Occupations Explored • Occupational Therapy (OT) • Chiropractic • Nurse Practitioner (NP) • Registered Nursing (RN) • Speech Language Pathology (SLP) • Pharmacy • Registered Massage Therapy (RMT) • Physiotherapy Assistant (PTA)

30. Findings – The Minimum Requirements

31. Findings – Occupational Therapy Regulatory Body/National Credentialing Organization

32. Findings – Chiropractic Regulatory Body/National Credentialing Organization

33. Findings – Nurse Practitioner Regulatory Body/National Credentialing Organization Regulated at a provincial level

34. Findings – Registered Nursing Regulatory Body/National Credentialing Organization Regulated at a provincial level

35. Findings – Speech Language Pathology Regulatory Body/National Credentialing Organization Regulated at a provincial level

36. Findings – Pharmacy Regulatory Body/National Credentialing Organization

37. Findings – Registered Massage Therapy Regulatory Body/National Credentialing Organization

38. Findings – Physiotherapy Assistant Regulatory Body/National Credentialing Organization

39. Discussion • Lack of clear, standardized require- ments in some healthcare professions • Areas of scope missing from practicum requirements e.g.: no requirements for SLP students to work with both developmental and acquired speech disorders • Best interest of public vs. feasibility of placements Fee-for-service Hospital policies Class size

40. Discussion • Self-regulating professions • Student’s exposure to certain conditions at the mercy of supervisor’s caseload Very difficult/near impossible to experience entire breadth of profession Two students who have same placement will not see exact same caseload/conditions • Important to be reflective and only practise in areas in which you have acquired competence, and continue to maintain competence

41. Discussion • Reliance on Competency Examinations • In some professions, Board exams used to determine competence and do not have many regulations about the schools’ curricula. e.g.: Registered nursing is a profession in which the minimum number of practical hours varies from no minimum number of hours to 1,664 hour minimums

42. Clinical Training Requirements for Entry-to-Practice in Physiotherapy around the World Amanda Dawson & Emily Wood

43. Methods • World Confederation for Physical Therapy (WCPT) “Members” • Google search • Emails • Inclusion entry to practice physiotherapy program at any specified degree level and have clinical education duration specifications • Exclusion No available evidence of clinical education requirements and/or did not respond to email query within 3 months

44. Results • We initiated communications via email or online investigations with a total of 74 separate programs and jurisdictions in 28 countries. • We were able to find adequate information for 20 countries/jurisdictions

46. For the countries in this bracket: Duration: Ranged from 1600 hours to 2 years Supervisor Requirements: Were not stated for any of the included countries Setting Requirements: 3 out of 6 stated some stipulation, only one stated specific practice areas such as “hospital, community and rural” settings The other 2 used less specific terms such as “Compulsory Training” and, “Abroad”

47. The Netherlands: 1610 hours Source: Amsterdam University of Applied Sciences (Individual University) Supervision: Not stated Setting: 2 internships must be abroad - only one can be within The Netherlands Nigeria: 2 years Source: The Medical Rehabilitation Therapists (Registration) Board of Nigeria Supervision: Not stated Setting: “Hospital, community and rural”

49. For the countries in this bracket: Duration: Ranged from 1000 to 1500 hours Supervisor Requirements: Ranged in specificity from • Not Stated (2 countries) • “The clinical instructor is required to have at least 1 year of experience in the field, and be an effective role model for the student” (Canada) Setting Requirements: 2 out of 11 were not stated, all other stated requirements ranged in specificity

50. Ethiopia: 1020 hours Source: Individual university   Supervision: Always includes a physiotherapist, some secondary supervision as well from other disciplines Setting: ≥ 1 rotation through each of 5 hospital services: (i) outpatient (mix of cases); (ii) inpatient medical (includes neurology); (iii) inpatient paediatrics; (iv) inpatient surgical (includes chest and cardiac surgery; also amputations); (v) inpatient orthopaedics (includes non-surgical and surgical cases) United States + Puerto Rico: 1030 hours Source: CAPTE Supervision: “The clinical instructor is required to have at least 1 year of experience in the field, and be an effective role model for the student” Setting: “Practice in settings representative of those in which physical therapy is commonly practiced” New Zealand: 1000 hours Source: Board of Physiotherapists of New Zealand Supervision: “Under the supervision of a registered physiotherapist” Setting: “Must demonstrate competency in the areas of cardiopulmonary, musculoskeletal and neurological physiotherapy”