Perceptions of physiotherapy clinical educators’ dual roles as mentors and assessors: Influence on teaching–learning relationships

Abstract

Background Central to clinical education is the teaching–learning (T-L) relationship that evolves between the clinical educator (CE) and the student. Within this T-L relationship, CEs may be expected to fulfil dual roles as mentors and assessors of students. Challenges for both parties may arise when CEs take on these different roles. Objectives The goal of this study was to ascertain how CEs perceived the influence of their dual roles as mentors and assessors on their T-L relationships with physiotherapy students. Method Individual interviews were semi-structured with nine CEs during this qualitative descriptive study at the Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University. A content analysis followed to analyse the data obtained. An iterative process, aimed to understand the phenomena under study, was conducted via an interpretive approach in context. This revealed main themes that were identified and refined. Results Clinical educators experienced challenges when their role changed from being a mentor to that of assessor. These challenges affected the learning of students, as they influenced the T-L relationship. Clinical educators experienced ambiguities regarding their dual roles and, as a result, their expectations were often not fulfilled. Conclusion Students’ learning processes were negatively affected by the changing roles of CEs, who acted as mentors and later as assessors of clinical competence during the students’ clinical rotations. The positioning theory was offered as a framework to resolve the challenges created by the dual roles and to manage expectations between CEs and students. The T-L encounters could be enhanced if students and CEs aligned themselves to a learning-centred paradigm where the focus was on learning and where the needs of the diverse students and the expectations of CEs were balanced. Further research should explore how a workshop with role play, demonstrating to CEs in practice how to reposition themselves, would impact the relationships between both parties. Clinical implications It is essential to ensure a positive T-L relationship between a CE and a student as this will improve the quality of learning in the clinical environment and, therefore, directly influence student’s patient management. Implementing faculty development programmes to address this, should be further explored. Keywords physiotherapy; clinical education; teaching–learning relationship; learning-centred; dual roles.

Performance‐based assessment during clinical placement: Cross‐sectional investigation of a training workshop for practice educators

“…Factors influencing the change in grade among participants for the borderline fail performance may include altered recall of the student's performance following group discussion, a change in understanding of the assessment standards, increased reflection time, or peer influence. The task of failing students on practice placement is recognized as challenging (Meyer et al, 2019), with "failure to fail" being frequently cited in the literature (Cross et al, 2001). Recent evidence has highlighted that physiotherapy practice educators who had awarded fail grades in high stakes performance-based assessments felt isolated in the absence of peer/university support or the opportu- assessment responsibility to be shared between practice educators, which is particularly valuable when managing an underperforming student (Trede, Mischo-Kelling, Gasser, & Pulcini, 2015;Trede & Smith, 2014).…”

“…Recent evidence has highlighted that physiotherapy practice educators who had awarded fail grades in high stakes performance-based assessments felt isolated in the absence of peer/university support or the opportu- assessment responsibility to be shared between practice educators, which is particularly valuable when managing an underperforming student (Trede, Mischo-Kelling, Gasser, & Pulcini, 2015;Trede & Smith, 2014). Although it is argued that equity and transparency in assessment practice can be improved through discussion and negotiation, it is also recognized that conflict may arise when practice educators have differing opinions, leading to further challenges in the decision-making process (Meyer et al, 2019;Trede et al, 2015). Whilst training undoubtedly should focus on a wide range of student performance levels, particular focus should be directed to the grading of poor or failing performances, as practice educators may be less assertive at this level of performance rating.…”

“…Clinical practice forms a significant component of health professional education curricula, often equating to one quarter of the overall content of these programs (CORU, 2015; WCPT, 2011). Assessment of health professional students in the workplace, also known as performance‐based assessment, evaluates the student's performance as they integrate their knowledge and skills into clinical practice (Meyer, Louw, & Ernstzen, 2019). Clinical experience developed by students during clinical placements and subsequently assessed by their practice educators, provides assurance of readiness for independent practice in many health professions thus providing a safeguard for patient care (Juntasopeepun et al, 2019).…”

“…Performance‐based assessment grades are reported to be highly variable due to the complex nature of the clinical learning environment (Boursicot et al, 2011; Yeates, O'Neill, Mann, & Eva, 2013). This is likely influenced by the dual role played by clinicians, who in many health care disciplines both supervise and grade students during clinical placements (Meyer et al, 2019; O'Connor et al, 2018). Clinicians are therefore required to combine multiple roles in their workplace, acting as teacher, mentor, and assessor.…”

“…Clinicians are therefore required to combine multiple roles in their workplace, acting as teacher, mentor, and assessor. This may impede the objectivity of their decision‐making during performance‐based assessment (Meyer et al, 2019). Other factors that may influence grading of student performance in the workplace include time available to observe student practice, assessment tools used to evaluate performance, and the level of commitment by clinicians in primarily service roles to the educational process (Cheng & Sun, 2015; Cross, Hicks, & Barwell, 2001).…”