An exploration of factors influencing physiotherapists’ involvement in student clinical education

ABSTRACT

Background

The demand for physiotherapy student clinical placements is increasing in many countries, including Australia, and there is continued reliance on physiotherapists to assume the student clinical educator role. Exploring factors influencing physiotherapists’ decision to be involved in clinical education is essential to maintaining and building clinical education capacity for the future.

Objective

To explore factors influencing Australian physiotherapists’ decision to be involved in student clinical education.

Methods

A qualitative study using data collected from a valid and reliable online survey tool. Respondents were physiotherapists representing public and private workplaces across varied geographical settings in Australia. Data were thematically analyzed.

Results

Surveys were completed by 170 physiotherapists. Most respondents were employed in hospital (81/170, 48%) and private (53/170, 31%) settings in metropolitan locations (105/170, 62%). Six themes representing factors influencing physiotherapists’ involvement in student clinical education were identified, including perceptions of: professional duty, personal benefits or gains, suitability of workplace, support requirements, role related challenges, and readiness to be a clinical educator.

Conclusion

Many factors influence physiotherapists’ decisions to assume the clinical educator role. This study could assist clinical education stakeholders to provide practical and targeted strategies to overcome challenges, and optimize support, for physiotherapists in the clinical educator role.

KEYWORDS:

• Survey
• Physical therapists
• Clinical supervision
• Professional education

Introduction

In Australia, and internationally, physiotherapy students are required to complete a component of their entry-level education immersed in a range of workplace clinical settings (Health Workforce Australia, 2014; Rodger et al., 2008). These clinical placement experiences provide students with the opportunity to apply, integrate and expand theoretical knowledge, reasoning and practical skills in an authentic practice setting (Patton, Higgs, and Smith, 2013, 2018). Clinical placements also enable assessment of student competence for professional practice (Stoikov, Shardlow, Gooding, and Kuys, 2017). During clinical placements students are supervised by physiotherapists who are generally responsible for all aspects of the conduct of the placement, commonly referred to as a “clinical educator.” Physiotherapy clinical educators are generally employed within the healthcare setting and voluntarily assume the role or do so as a requirement of their employment (Newstead, Johnston, Nisbet, and McAllister, 2018; O’Connor, Cantillon, Parker, and McCurtin, 2019).

A clinical educators’ typical responsibilities include facilitation of student learning, assessment of student performance, assisting underperforming students, and managing challenging situations (Gibson et al., 2019). The quality of student learning in the clinical setting is impacted by the skills and capabilities of the clinical educator, and their ability to competently manage all aspects of this complex role (Gibson et al., 2019; McCallum, Reed, Bachman, and Murray, 2016). Recommendations regarding the requirements of physiotherapists to assume the clinical educator role, such as demonstrated competence in clinical and clinical education skills, are available (Recker-Hughes et al., 2014). However, these recommendations relate to specific international settings and are not necessarily requisites for the clinical educator role. In Australia, there are no uniform requirements for physiotherapists to assume the role of a clinical educator, such as additional qualifications, and their involvement may be based on goodwill, interest, or their level of clinical experience (McMeeken, 2008).

There has been an increase in the number of entry-level physiotherapy student training programs established in Australia (Reubenson and Elkins, 2022), and other international settings (Barradell, 2017; Hall, Poth, Manns, and Beaupre, 2016). Consequently, the overall demand for student clinical placements has grown (Barradell, 2017; Dean et al., 2009). Physiotherapy clinical education practices have evolved and new approaches to student clinical learning have been incorporated. Some examples of innovative approaches to clinical education include simulation, interprofessional, student-led, and peer-assisted learning experiences (Ahern and O’Donnell, 2023; Blackford, McAllister, and Alison, 2015; Sevenhuysen et al., 2015). However, despite the effectiveness of these strategies, there remains a reliance on the broader physiotherapy workforce to assume the clinical educator role and provide additional clinical placements (Johnston et al., 2017). This includes physiotherapists with a range of professional experience and those employed in diverse practice and geographical settings (Johnston et al., 2017).

Research focusing on health professionals from varied international settings describes the benefits associated with being a clinical educator, including enhanced professional development (Steinert and Macdonald, 2015; Waters, Lo, and Maloney, 2018). Being a clinical educator also has positive impacts on service delivery and workplace productivity (Forbes et al., 2022; Kemp et al., 2021; Nisbet et al., 2022). However, aspects of the clinical educator role have also been described as challenging and difficult, such as managing underperforming students and balancing competing role related demands (Lo, Curtis, Keating, and Bearman, 2017; Ong et al., 2019). Physiotherapists’ perceptions of the advantages and disadvantages of being a clinical educator may impact, either positively or negatively, on role related satisfaction, as well as clinical placement quality and capacity.

Information about the factors which impact on physiotherapists’ decisions to take up the clinical educator role is limited. Findings from a Canadian context suggest physiotherapists’ choices to be an educator are influenced by factors such as role related stress and perceived impacts on the workplace (Hall, Poth, Manns, and Beaupre, 2016). These findings are reflected in similar research from other allied health professions, such as Occupational Therapy (Varland, Cardell, Koski, and McFadden, 2017). In Australia, the benefits and consequences associated with being a physiotherapy clinical educator have been explored (Sevenhuysen and Haines, 2011). Authors of this research describe physiotherapists’ perceptions of the role, such as the positive and negative impacts on workplace department profile and development of the profession (Sevenhuysen and Haines, 2011). However, more research is required to investigate the factors influencing the decisions of the broader Australian physiotherapy workforce to assume the educator role. As the demand for clinical education experiences continues to grow, understanding these factors is an essential step in maintaining and building clinical education capacity for the future. The aim of this study was to explore the factors that influence Australian physiotherapists’ involvement in clinical education.

Methods

Study design

The study was a qualitative investigation based on data collected from an online cross-sectional survey of Australian physiotherapists. The study was guided by a constructivist approach, recognizing the development of knowledge through the experiences of individuals (Mann and MacLeod, 2022). Ethics approval was received from the University of Sydney Human Research Ethics Committee (approval number: 2016/445) and Hunter New England Local Health District Human Research Ethics Committee (approval number: 16/07/20/4.08).

Data were collected using a valid and reliable survey instrument purposefully developed to gather information regarding the professional profile, experience, and training requirements of physiotherapists regarding clinical education (Newstead, Johnston, Nisbet, and McAllister, 2017). The survey instrument was managed in online format via Research Electronic Data Capture (REDCap) software (Harris et al., 2009). The survey consisted of 39 questions (categorical, Likert and free text) in five sections: “participant demographic and professional characteristics”; “work type and location”; “experience and opinions regarding physiotherapy student clinical education”; “physiotherapy clinical educator experience and opportunities”; and “general comments”. Survey questions from the “experience and opinions regarding physiotherapy student education” sections of the survey were included for qualitative analysis in this study. Participant characteristics data were obtained from the “participant demographic and professional characteristics” section of the survey.

Respondents

Respondents were physiotherapists employed in public and private healthcare settings who were geographically located in one Australian state (New South Wales) and territory (Australian Capital Territory). Only physiotherapists currently registered with the Australian Health Practitioner Regulation Agency (AHPRA) were eligible to participate in the study. There were no specific exclusion criteria.

Sampling frame

Public and private healthcare settings offering a physiotherapy service and located within New South Wales (NSW) and the Australian Capital Territory (ACT) were identified via publicly available listings (Australian Government, Australian Institute of Health and Welfare, 2022) and an Australian Physiotherapy Association (APA) online search tool – “Find a physio today” (Australia Physiotherapy Association, 2023). Identified healthcare settings were stratified based on geographical location using postcodes and the Modified Monash Model (MMM) classification system (Australian Government, Department of Health and Aged Care, 2021). The MMM is a 7-tier classification system defining geographical locations in Australia as metropolitan (classification 1) through to very remote (classification 7). Using a sampling fraction, 10% of healthcare settings from each MMM stratification were selected and contact details recorded.

Physiotherapy managers at each identified healthcare setting were contacted to brief them on the research project and seek their permission to invite physiotherapists employed at their organization to participate in the online survey. If agreeable, physiotherapy managers at each healthcare setting sent an e-mail invitation including a participant information statement and hyperlink to the online survey to the physiotherapists employed at their healthcare setting and provided the research team with the number of physiotherapy employees at their workplace to enable calculation of a response rate. Two reminder e-mails were sent at two-week intervals following the initial e-mail invitation. Respondents’ consent was assumed based on completion and submission of the anonymous online survey.

Data analysis

Qualitative data were transferred to NVivo version 12 (QSR International Pty Ltd) for further analysis. Survey question responses were thematically analyzed guided by qualitative content analysis (Liamputtong and Serry, 2010). Data analysis was an iterative process conducted in multiple phases, with each phase involving at least two members of the research team. These phases included: familiarization with the data set (CN, CJ, LW, GN); generation of preliminary codes (CN, CJ); grouping codes of similar meaning into categories (CN, CJ), identification of themes (CN, CJ, LW, GN); revision of identified themes (CN, CJ, LW, GN); and labeling final themes and sub-themes (CN, CJ, LW, GN) (Liamputtong and Serry, 2010). To ensure a range of perspectives were considered, the research team met regularly during the analysis process to discuss codes, develop themes and achieve consensus on labeling the final themes. Table 1 presents an example of the coding and theming process. Quantitative survey data relating to participant characteristics were transferred to SPSS version 20.0 (IBM, Armonk, NY, USA) and analyzed descriptively using frequencies and percentages.

Table 1. Example of the data analysis process.

	Development of codes, sub-themes and themes
Theme	Do I have the right support to be a clinical educator?
Subthemes	Does my workplace support me to be a clinical educator?			Does the university support me to be a clinical educator?		My work suffers if I am not adequately supported to be a clinical educator
Codes	Staffing	Colleagues	Management	Expectations	Challenges	Service Delivery	Productivity
Example data set	“[There is] not enough support from a staffing perspective to provide education and [manage] my own caseload” “[I am] not the owner of the private practice I work at and supervising students is limited by the owner’s reservations … ”			“[There is a] lack of support from universities, particularly around what they expect to be provided” “[There is a lack of] support mechanisms from the university [regarding] managing difficult students”		“Students take time and this detracts from time spent with patients” “[Being a clinical educator] costs me lots of money in missed revenue due to time spent with students … ”

Reflexivity statement

The authors are academics working in clinical education related roles at Australian tertiary institutions. All authors have a background in allied health clinical practice, three authors are physiotherapists and one author a dietitian. Each author has previous experience in the student clinical educator role and a record of conducting health professions education research, including qualitative research designs. The authors acknowledged the potential influence of their professional backgrounds and research interests, and these were managed through regular discussions throughout the study to consider individual perceptions.

Results

Surveys were completed by 170 physiotherapists. On average, respondents were 37 years old (range 22–73 years) with 13 years of professional experience (range 0.25–46 years) as a physiotherapist. Respondents who had previous experience as a clinical educator mostly indicated that they balanced clinical educator roles and responsibilities with other clinical duties (124/140, 89%). Data relating to the demographic and professional profile of respondents is presented in Table 2.

Table 2. Respondent characteristics and professional profile.

Respondent characteristics and professional profile	n (%)
Gender
Female	111 (65)
Male	58 (34)
Missing	1 (<1)
Primary work setting
Hospital setting	81 (48)
Private setting	53 (31)
Other setting*	36 (21)
Primary work location
Metropolitan area	105 (62)
Rural area	55 (32)
Missing	10 (6)
Previous experience as a clinical educator
Yes	140 (82)
No	30 (18)
Level of clinical education experience**
“Experienced” clinical educator (>5 students total)	97 (69)
“Less experienced” clinical educator (<5 students total)	43 (31)

*Other settings include community, education or not for profit organizations; **Calculated from the 140 respondents who indicated a “Yes” response to “Previous experience as a clinical educator.”.

Six themes were identified from the analysis of the free text survey questions relating to factors influencing physiotherapists’ involvement in clinical education: 1) Being a clinical educator is my professional duty; 2) Will I benefit from being a clinical educator?; 3) Is the way I work compatible with being a clinical educator?; 4) Do I have the right support to be a clinical educator?; 5) Can I manage the challenges associated with being a clinical educator?; and; 6) Do I have the confidence and skills to be an effective clinical educator?

Theme 1: Being a clinical educator is my professional duty

This theme describes how a sense of duty to the physiotherapy profession, and to entry-level physiotherapy students, influenced decisions to take on clinical educator roles. Within this theme are two associated sub-themes: 1) professional responsibility; and 2) contribution to professional quality.

Sub theme 1: I am contributing to the future of the profession

Many respondents reported the decision to be an educator was based on a personal belief in, and recognition of, the importance of imparting their knowledge and skills through clinical education to develop the future generation of physiotherapists.

I believe it is a part of professional responsibility to pass on professional knowledge to the new generations. (P108, metropolitan, private, experienced)

I have clinical skills that I hope people would like to learn. (P37, metropolitan, hospital, experienced)

Some respondents were concerned with current clinical education experiences, and the lack of opportunities in some areas of practice. They considered it their responsibility to expose students to physiotherapy service delivery within their practice setting. This was particularly evident for those employed in rural locations, who suggested that students may otherwise lack opportunities to experience rural practice.

[I want to] provide students with an insight into rural health, which many of them may not have experienced. (P117, rural, private, less experienced)

[I am] providing students with exposure to rural settings [which has a] positive impact on potential future recruitment to rural health positions. (P106, rural, other, experienced)

Sub theme 2: I am contributing to professional quality

Respondents identified motivation to enhance the quality of learning experiences for students as a key factor influencing their decision to be involved in clinical education. This included creating a learning environment favorable to student professional development.

… students need to have a quality clinical placement where they feel safe to learn, ask questions [and] practice skills … (P3, rural, other, experienced)

[I am] providing a supportive and approachable learning environment for students. (P69, rural, hospital, experienced)

Being a clinical educator was considered an opportunity to ensure a high standard of practice for future physiotherapists. Some respondents associated this with improved quality of care for patients or clients requiring physiotherapy services.

[Clinical education is] a chance to shape future clinicians and set for them a high standard of clinical practice. (P39, metropolitan, hospital, experienced)

I want better graduates … I want better patient care. (P145, not specified, hospital, experienced)

Theme 2: Will I Benefit from Being a Clinical Educator?

This theme describes how respondents’ personal perceptions of the benefits and gains associated with being a clinical educator influenced their decision to take up the role. The clinical educator role was enjoyable for many respondents. It was seen by some as way to keep up to date with new developments in physiotherapy practice, or as a reflective process to gain greater understanding of their own practice. Within this theme are two sub-themes: 1) a sense of personal satisfaction; and 2) a sense of personal gain.

Sub theme 1: Do i gain satisfaction from the clinical educator role?

Respondents described the personal satisfaction from observing and assisting students develop the knowledge and skills required of a competent practitioner. Their motivation to be a clinical educator was also considered an opportunity to extend their own knowledge and skills.

“I enjoy teaching and having my thinking challenged by students.” (P101, rural, private experienced)

I find it very satisfying to watch the development of understanding which transforms students into good professionals. (P108, metropolitan, private, experienced)

However, not all respondents described satisfaction associated with being a clinical educator. Some indicated hesitancy to assume clinical education responsibilities due to perceived limited gain or reward. Some respondents described the role as exhausting, frustrating and stressful.

A run of difficult students [results in] more stress without adequate periods to recover and rebalance. The supervision of a troublesome student can lead to health implications for the supervisor as it is, and this needs to be addressed before taking on more troublesome students. Supervising delightful students is rewarding and uplifting. A balance is required. (P108, metropolitan, private, experienced)

[I feel] stretched between the needs of 3–4 students simultaneously, whilst having a clinical load to fulfil. I don’t handle that type of pressure well. (P18, metropolitan, hospital, experienced)

Sub theme 2: Are there other benefits for me if i take on the clinical educator role?

Respondents reported other benefits associated with involvement in student clinical education. Being a clinical educator added variety to their usual role and enhanced their own clinical knowledge, and capabilities.

I think it adds interest to clinical practice after a long career in professional isolation. (P115, rural, private, experienced)

[It] improves my knowledge [and] keeps me up to date with what students are learning. (P43, metropolitan, hospital, experienced)

Some respondents reported that being in the educator role had the potential to offer stronger professional links with tertiary institutions and contributed to better recruitment of graduates to workplace vacancies.

[It] promotes good reciprocal relationships with educational institutions. (P50, rural, hospital, experienced)

[It has] a positive impact on potential future recruitment to rural health positions. (P106, rural, other, experienced)

Theme 3: Is the way I work compatible with being a clinical educator?

This theme describes respondents’ beliefs about the suitability of their workplace for clinical education experience, and discordance related to their terms of employment. Two associated sub-themes were identified: 1) suitability of terms of employment for the delivery of clinical education; and 2) suitability of the workplace setting and caseload for the delivery of clinical Education.

Sub theme 1: Are my terms of employment suitable for clinical education?

Many respondents indicated they were willing to assume the clinical educator role but felt inhibited by their terms of employment, such as contracted work hours and level of appointment. Respondents employed in junior roles, such as new graduates, perceived themselves as ineligible to be involved in providing clinical education.

I have less than 12 months of clinical physiotherapy experience. I understand that after 12 months I may be required to provide supervision to entry-level students on observational placements … (P154, rural, hospital, less experienced)

Irrespective of their level of experience, other respondents felt the terms of their employment, such as part-time work status were a barrier to undertaking the clinical educator role.

I only work part-time at a private practice – most student placements require full-time availability. (P113, metropolitan, private, experienced)

[I am] only working 12 hours per week and this does not fit with the allocation of students. This is undertaken by other full-time members of staff currently. (P87, rural, hospital, experienced)

Sub Theme 2: Is my workplace setting suitable for clinical education?

Perceptions regarding workplace setting and caseload suitability also impacted on decisions to be a clinical educator. Respondents based in private practice questioned their ability to support student learning experiences in their workplace and felt restricted when involving students in the provision of services for paying clients.

[I have] difficulty with students in [the] private practice setting regarding fees and private health rebates. (P127, rural, private, experienced)

[I am limited by the] restrictions of private practice setting. [There is] less opportunity for hands-on experience/teaching. (P75, metropolitan, private, experienced)

Across practice settings, respondents also considered their caseload to be unsuitable for student learning, mainly in clinical settings with specialized and complex clientele.

[I am limited] by the types of patients we have at our practice – mine is largely women’s health and our general musc [musculoskeletal] clients are often too complex. (P135, metropolitan, private, less experienced)

[I have a] complex patient group with lots of social issues, requiring a holistic approach and great interpersonal skills. (P36, metropolitan, hospital, less experienced)

Theme 4: Do I have the right support to be a clinical educator?

This theme relates to respondents’ perceptions of how the availability and type of support influenced their decision to assume the clinical educator role. Respondents had demanding workloads and indicated that a lack of support in the clinical educator role negatively impacted on service delivery and student learning. Three sub-themes were identified: 1) support from the workplace; 2) support from the university; and 3) the impact of levels of support on service delivery and productivity.

Sub-Theme 1: Does my workplace support me to be a clinical educator?

A lack of support from within the workplace made respondents reluctant to assume the clinical educator role. It was noted that adequate workplace staffing was required to allow them to fulfil clinical educator responsibilities without adversely impacting on other work-related duties.

[There is] not enough support from a staffing perspective to provide education and [manage] my own caseload. (P59, metropolitan, hospital, experienced)

[I need] support from the department to reduce clinical caseload to focus on students. (P49, rural, hospital, less experienced)

Workplace sentiment regarding clinical education was also reported to be a factor influencing decisions to assume the clinical educator role. A lack of willingness to provide clinical education from workplace colleagues negatively impacted on their own motivation to assume the educator role.

The clinical setting in which I work does not have entry-level physiotherapy students due to other staff not being willing to supervise. (P111, metropolitan, private, experienced)

For some, the manager of their workplace was a major influence on their ability to assume the clinical educator role, particularly in private practice settings. Respondents felt constrained by the level of managerial support to dedicate time to facilitating student learning in their workplace.

[I am] not the owner of the private practice I work at and supervising students is limited by the owner’s reservations … (P113, metropolitan, private, experienced)

[I require] a supportive workplace. One workplace restricted my students to observation only and they weren’t allowed to touch or engage with the patients, so I stopped taking students … (P108, metropolitan, private, experienced)

Sub theme 2: Does the university support me to be a clinical educator?

Support from universities for student clinical education experiences was identified as an influence on respondents’ decision to be a clinical educator. A lack of clarity regarding university expectations for student learning discouraged them from engaging in student clinical education.

[There is a] lack of support from universities, particularly around what they expect to be provided. (P13, metropolitan, hospital, experienced)

Some respondents felt unsupported by the university to address challenges and difficulties arising during clinical placements, particularly relating to student underperformance.

[There is a lack of] support mechanisms from the university [regarding] managing difficult students. (P60, rural, hospital, experienced)

… I find it very hard to contact the uni if there is a problem and receive very limited support in managing challenging students. (P45, metropolitan, hospital, experienced)

Sub theme 3: My work suffers if i am not adequately supported in the clinical educator role

Without support, respondents reported that the clinical educator role could have a negative impact on service delivery and efficiency, reducing time available to dedicate to patients or clients and decreasing financial productivity.

Students take time and this detracts from time spent with patients. (P23, metropolitan, hospital, less experienced)

In private practice [clinical education] is not deemed to be viable for financial reasons and potential quality of services being provided to paying clients. (P143, not specified, private, less experienced)

Theme 5: Can I manage the challenges associated with being a clinical educator?

This theme describes the impact of perceived challenges associated with clinical placements on physiotherapists’ decision to assume the educator role. Within this theme were two sub-themes outlining the main challenges: 1) those relating to students undertaking placements; and 2) those relating to placement model and delivery.

Sub theme 1: Can I manage student performance issues?

Respondents frequently indicated that having to manage challenges associated with students was a key factor discouraging them from assuming the educator role. The challenges mainly reported centered on a lack of student preparedness for clinical practice with respect to knowledge, skills, and attitude. The perception was that managing such challenges created a burden for clinicians on top of an already busy workload.

Students [are] not sufficiently prepared… e.g. unaware of time constraints, often poor communication skills. (P111, metropolitan, private, experienced)

[I find it difficult to manage] critical students who don’t appreciate the extra work their Placements Cause. (P13, Metropolitan, Hospital, Experienced)

Sub Theme 2: Can I work within the current clinical placement structure and models?

Respondents also described challenges relating to physiotherapy clinical placement models and felt restricted by inflexibility relating to clinical placement planning, scheduling, and student ratios.

[Clinical placements] are too long for me. I couldn’t perform [the] student supervision role plus fulfil my clinical role and all my delegated departmental tasks. Impossible. Compromises too much. (P18, metropolitan, hospital, experienced)

[I would like] more flexible timing of placement blocks. (P34, metropolitan, hospital, experienced)

Respondents felt that models of supervision requiring back-to-back placements and/or multiple students to be supervised at one time were difficult and stressful.

[There is] exhaustion of back-to-back units and having to repeat yourself every five weeks. (P38, metropolitan, private, experienced)

[I don’t enjoy] having to educate more than two students. (P20, metropolitan, hospital, experienced)

Respondents reported being burdened by an increase in tasks relating to placement administration, organization, feedback, and assessment. Comments suggest these extra duties negatively impacted on their willingness to be a clinical educator.

In the past I have been responsible for organisation and communicating with universities for organisation of placements. The time taken at this end of organising a placement was a barrier. (P102, rural, private, experienced)

[I do not enjoy] assessing and giving feedback - needing to constantly check why they’re [students] doing what they’re doing and asking them if they’ve thought of other options and how can they do it better … I [have] other work I’d rather be doing. (P144, not specified, hospital, experienced)

Respondents suggested greater consideration for effectively matching students to clinical experiences. Some respondents indicated they would like more input into the selection of students for clinical placement experiences at their workplace.

[There is] an unwillingness of the university to allow us to select our own students based on appropriateness and enthusiasm. (P139, metropolitan, private, experienced)

[I would like the university to be] more interested in individual students and promoting their best interests. It is disheartening feeling as if the uni’s objectives are just to secure a clinical placement and do not care if this is not in the student’s best interests. (P45, metropolitan, private, experienced)

Theme 6: Do I have the confidence and skills to be an effective clinical educator?

Decisions about whether to be a clinical educator were influenced by respondents’ opinions regarding their readiness to assume the role. Respondents were reluctant to engage in the clinical educator role if they didn’t feel equipped with the necessary skills to facilitate student learning, assess performance, and manage challenging situations. Some also suggested that they needed to be better prepared with respect to their own physiotherapy clinical knowledge and skills.

[I have] a lack of clinical education knowledge e.g. how to assess the students correctly [and] how to provide appropriate and relevant education. (P78, rural, hospital, less experienced)

My own knowledge and skill base is not at a level that I think is sufficient to be able to educate students. (P117, rural, private, less experienced)

Respondents suggested optimizing their preparedness and confidence in clinical education would potentially enhance their involvement in role. For many this included being able to access additional professional development opportunities, and support from more experienced peers.

[I need] better support/training/education on how to ‘teach’ and how to manage challenging situations. (P67, rural, other, experienced)

[Less experienced educators need] a mentor (senior clinical educator) to support and guide you during your first intake of students. (P78, rural, hospital, less experienced)

Discussion

The aim of this study was to explore the factors that influence Australian physiotherapists’ involvement in clinical education. Several factors guiding physiotherapists’ decisions to be involved in student clinical education were identified. These included: a sense of professional duty, perceptions regarding personal benefits, suitability of workplace, level of support, associated challenges, and readiness to assume the role. These factors reflect the opinions and attitudes of physiotherapists from a range of practice contexts, geographical locations, and with varying levels of experience in providing clinical education. Our results are similar to other research projects in a range of contexts spanning the last few decades (Currens and Bithell, 2000; Hall, Poth, Manns, and Beaupre, 2016; Sevenhuysen and Haines, 2011). The lack of change in physiotherapists’ perceptions toward the clinical educator role is noteworthy and warrants further attention. A possible reason for this lack of change may be due to the complex nature of the factors which impact on physiotherapists’ willingness to assume the educator role. Consequently, it may be difficult to develop and implement targeted solutions to address these ongoing issues. In particular, physiotherapists’ ongoing requests to be more effectively supported in the clinical educator role implies that practical support mechanisms are lacking.

The results of this study indicate physiotherapists are motivated to be clinical educators by a sense of responsibility. They perceive being a clinical educator contributes to the quality of student clinical education and enhances the physiotherapy profession. This finding is similar to another study exploring physiotherapists’ perceptions of the clinical educator role (Sevenhuysen and Haines, 2011), and reflects physiotherapists’ acknowledgment of the importance of clinical education in preparing the future workforce (Recker-Hughes et al., 2014). As the demand for physiotherapy student clinical placements continues to grow in Australia, and abroad (Barradell, 2017; Hall, Poth, Manns, and Beaupre, 2016; Reubenson and Elkins, 2022), we suggest there should be greater efforts to affirm and recognize the importance of the clinical educator role in developing the profession. Our recommendation is congruous with a body of international research indicating the need to enhance recognition for health professionals who contribute to student clinical education (Tassoni, Kent, Simpson, and Farlie, 2023).

Our study has highlighted that physiotherapists’ perceptions of benefits, or a lack of benefits, associated with being a clinical educator impacts on their decision to assume the role. The motivation to be a clinical educator was positively influenced by the prospect of developing their own professional capabilities. However, some physiotherapists were disinclined to be clinical educators due to a seeming lack of tangible benefits. Similar sentiments have been reported by authors from other countries (Currens and Bithell, 2000), and may have negative consequences for clinical placement capacity in the future. Consistent with the recommendations of other authors, our findings indicate the need to promote the benefits of being involved in student clinical education, such as enhanced service delivery (Nisbet et al., 2022). More could also be done to ensure physiotherapists assuming the clinical educator role feel rewarded with respect to their personal sense of satisfaction, perceptions of professional growth, and development of role related skills. Increased awareness of the value of clinical education for health professionals, and workplaces, may enhance overall clinical placement capacity (Kemp et al., 2021).

This study has identified several operational factors negatively impacting physiotherapists choices about participation in clinical educator roles. These include perceptions of role related challenges, such as managing difficult situations associated with students, time pressures, and placement structure. This finding is unsurprising as the complexities associated with the clinical educator role have been well described (Bourne, Short, Kenny, and McAllister, 2022; Davies, Hanna, and Cott, 2011). The clinical educator role is considered by some health professionals to be a burden in addition to usual role related duties, often resulting in stress (Nisbet et al., 2022). Methods of mitigating clinical educator stress have been described across professions, including identification of contributing factors (Bourne, Short, Kenny, and McAllister, 2022) and developing strategies to manage underperforming students (Bearman, Molloy, Ajjawi, and Keating, 2013). However, more research is required to understand how physiotherapists are supported in their role, and if these methods are effective.

The critical importance of having adequate support was consistently highlighted in the findings of our study. This includes support relating to placement organization and planning, balancing competing workload demands, and managing challenging situations. Findings from this study suggest a dual approach, where there is enhanced collaboration between universities and clinical placement sites regarding placement planning, expectations, and managing challenging situations to best support physiotherapists to be clinical educators. This reflects the recommendations from a recent scoping review outlining the need for support options to alleviate clinical education related pressures and improve educator capabilities across professions and geographical settings (Tassoni, Kent, Simpson, and Farlie, 2023). Without adequate support for clinical educators, there may be negative implications for individual clinicians and future clinical placement capacity.

Consistent with other research, physiotherapists in our study felt that their perceived readiness was an important influence on their decision to be a clinical educator. Physiotherapists with less clinical expertise, and less experience, described feeling unqualified and unprepared for the clinical educator role. This finding is likely to reflect the historical perception that those with greater clinical expertise are more capable of assuming the role responsibilities of a clinical educator (Rodger et al., 2008). However, authors of previous research describe many qualities that junior physiotherapists may offer as a clinical educator, such as enthusiasm for teaching, approachability, creating a positive learning environment, and reflecting on their own recent clinical experiences (Bennett, 2003; Greenfield et al., 2014). We suggest greater consideration should be given to strategies to introduce physiotherapists to being a clinical educator early in their career. This may include commencing with a small number of students from earlier years of study, or more formal clinical educator mentoring programs or communities of practice. However, our findings suggest more could also be done to prepare physiotherapy students for the clinical educator role during their entry-level training. Preparing current students to be clinical educators could have a positive impact on physiotherapists’ readiness to assume the role, as well as the capacity and quality of clinical education experiences.

Physiotherapists who are less experienced as clinical educators often describe feeling anxious and unconfident in aspect of the role, such as providing feedback, assessment processes, and managing unforeseen challenges (Newstead, Johnston, Nisbet, and McAllister, 2018). Although research from the United States suggests health professionals may develop skills and confidence as a clinical educator with experience and reflection (Buccieri, Pivko, and Olzenak, 2011), our findings indicate a need to enhance the support for those commencing in the role. This finding is consistent with those of other authors describing the need for health professionals to be adequately trained to be a clinical educator (Coleman-Ferreira, Tovin, Rone-Adams, and Rindflesch, 2019). More research is required focusing on the training needs of physiotherapists in Australia, including content and mode of delivery. However, physiotherapists in our study suggest skills-based training relating to delivering feedback, facilitating learning, and supporting underperforming students may be a priority. This is supported by other research findings identifying the learning needs of clinical educators across health professions (Bearman et al., 2018). Although training relating to clinical education is available for health professionals, there is a need to consider innovative and evidence-based approaches to delivering this form of continuous professional development (Steinert et al., 2016). This may include the use of experiential learning methods, such as simulated teaching activities, involving repeat practice, self-reflection, and performance feedback to enhance the confidence and capabilities of physiotherapists in the clinical educator role.

Strengths and limitations

This research was conducted using a survey instrument purposefully developed for the aims of the study and tested for face and content validity (Newstead, Johnston, Nisbet, and McAllister, 2017) ensuring the reliability of response data collected. In addition, a rigorous sampling frame was implemented when identifying potential participants to ensure responses were received from a population representative of the physiotherapy workforce. The main limitation to this study is the inclusion of participants from one Australian state and territory, and the associated risk of a response bias. However, responses were received from participants with varying professional profiles and is comparative to the Australian national physiotherapy workforce with respect to many demographics, including age and workplace factors. As such, the findings are likely to be representative of the physiotherapy workforce in many aspects. It is also possible that respondents in this study were more likely to be those who had encountered challenges in previous experiences as a clinical educator. Whilst this may have influenced responses, it may represent real life experiences and is valuable in identifying challenges which negatively influence physiotherapists’ decision to assume the educator role. In addition, respondent data may have been constrained by the written response format. Future research could explore the factors influencing Australian physiotherapists’ decision to be a clinical educator in more depth via focus group or interview methods.

Conclusion

This study explored the factors acting to influence physiotherapists’ decision to assume the role of a clinical educator, either positively or negatively. Several factors were identified as impacting on their decision to be a clinical educator, including their sense of duty and perceptions regarding role associated benefits. This study also highlighted the need for physiotherapists to be well supported to ensure they are prepared to manage the responsibilities associated with being a clinical educator, along with any challenges arising. Although the research was conducted in an Australian context, and focusing on physiotherapists, aspect of clinical education, including the associated challenges, are common across many health professions globally. Our findings should encourage researchers to explore the best methods of supporting health professionals to be clinical educators. Findings may also be used to inform the development and implementation of targeted support and training methods to overcome barriers for physiotherapists’ involvement in clinical education in a range of settings. Doing so is essential to meet the ongoing demand for physiotherapy student placement experiences in preparing the future workforce.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.