The construction of supervision and physiotherapy expertise : a qualitative study of physiotherapy students' learning sessions in clinical education

Abstract

Clinical education is asserted to be an important period in professional education, being an environment where deep conceptual understanding together with practical experience can develop. The supervisional interaction between clinical educators and students in clinical education is regarded as the strongest element in developing students’ expertise, and in forming professional identity. This study examined the natural learning sessions in physiotherapy students’ clinical education. The purpose was to analyse what kinds of meanings related to supervision, physiotherapy practice, client, and students’ learning experiences were constructed in the learning sessions, and also, how these meanings were constructed. The study assumed according to socio-constructivistic approach that the student, the clinical educator and the patient / client construct the meanings together in interacting with each other. Furthermore, the study presumed that learning does not just occur in one’s head but through active engagement with individuals. Thus, the physiotherapy student constructs the professional learning and comprehension of the physiotherapy expertise by participating in the professional community and by accomplishing professional tasks in clinical education. A total of 13 practical learning sessions and 10 supervision conferences were video-recorded, transcribed verbatim, and analysed using an adaptation of the method of discourse analysis. Discourse analysis as a methodological frame of reference in this study focused on the language. Language, in this case, was understood to cover all kinds of interactional acts, verbal talk and non-verbal acts.The study indicated that the practical learning sessions are complicated and multidimensional interactional entities. Therefore, it might be difficult for the clinical educator to accomplish patient-centred and student-centred supervision during a natural physiotherapy encounter. Accordingly, the results of this study showed that clinical educators play a directing role in constructing the interaction in practical learning sessions. In this role, they have a possibility to direct student attention to the essential elements of the physiotherapy profession. Together with the professional-centred practice, the study revealed episodes where client was constructed in a client-centred way. This two-dimensional observation challenges physiotherapists to be aware of the interactional elements that support or reject client participation during the physiotherapy encounters functioning as practical learning sessions for physiotherapy students. Although a traditional and a technical and a mechanistic orientation to physiotherapy practice emerged in the supervision discussions of this study, learning sessions with elements of evidence-based practice and elements of enhancing students' reflective skills were also noted. However, this study showed no initiations of transferring the students’ learning experiences to other circumstances and vague initiations where the students' experiences were tried to transfer to more abstract level and interact with theoretical knowledge. Furthermore, the study revealed that even though self-assessment skills have been mentioned among the core skills for future professionals, only some elements of this kind of discussion were observed.Considering the methodological limitations and the fact that this study focused only on the undergraduate level of physiotherapy education, it can be concluded that it gave a fresh insight into the opportunities to construct and widen the understanding of the role of clinical education in enhancing the professional development of physiotherapy students, in promoting evidence-based practice, and in developing the next generation of physiotherapists. Furthermore, the study increased the understanding of both the interactional and the discursive practices employed in the learning sessions during clinical education.