Relationships matter: a qualitative study of physiotherapy students’ experiences of their first clinical placement

Abstract

Background

Students’ experiences of the clinical learning environment are crucial to learning and professional development. Earlier research using the Undergraduate Clinical Education Environment Measure shows that students’ perceptions of supervision vary significantly between undergraduate programs, with physiotherapy students scoring higher than other students.

Objectives

We explored physiotherapy students’ experiences of supervisors’ preparedness, familiarity with learning outcomes, and supervision practices during their first clinical placement.

Methods

Individual semi-structured interviews were conducted with 13 physiotherapy students. The interviews were analyzed using qualitative content analysis according to Graneheim and Lundman.

Major findings

Within the latent theme A coherent whole throughout the placement, three manifest categories were found: Establishing a relationship, Fostering active participation, and Cultivating outcome-based learning. The students valued a supervisor who was prepared for the initial meeting and wanted to establish a relationship. When the students experienced a sense of trust, they dared to ask questions. The supervisors encouraged students to move beyond the one-to-one relationship and cooperate with others in the community to develop autonomy. Self-assessment enabled the students to identify their own learning needs and enhanced the possibility of achieving intended learning outcomes. The supervisors repeatedly returned to the learning outcomes.

Conclusions

Physiotherapy students highly regarded supervisors who established a relationship and fostered active participation by being available, promoting student autonomy, and encouraging cooperation in the community. The continual use of intended learning outcomes helped students identify their learning needs and achieve the outcomes.

Keywords:

• Physiotherapy
• undergraduate education
• supervision

Introduction

In the clinical learning environment, students develop the skills and competencies necessary for future practice [1]. A challenge in health care education is to deliver consistent high-quality training in this context [2,3]. In addition, for health professional students, the relationship with their supervisors has been identified as a key factor in a clinical learning experience [4–6].

Preparedness is an important element of successful clinical learning, and students’ and supervisors’ perspectives on students’ preparedness for clinical training have been broadly studied [7–9]. A poorly prepared physiotherapy student with inadequate knowledge has been described as adding to the demanding nature of the supervisory relationship whereas a well-prepared student will maximize learning gains [10]. However, there is a paucity of studies addressing supervisors’ preparedness for students’ clinical training.

We possess limited knowledge of students’ perceptions of physiotherapy supervisors’ preparedness, but the Undergraduate Clinical Education Environment Measure (UCEEM) [11,12] provides one way to assess aspects of this matter. The UCEEM considers aspects such as whether supervisors are expecting students and whether students receive a useful introduction and sufficient supervision. Our recent study [3] using the UCEEM unexpectedly showed that students’ perceptions of supervisors’ preparedness and commitment vary significantly between undergraduate programs. Medical and nursing students gave low ratings to items related to supervisors’ preparedness while physiotherapy and speech-language pathology students rated those items highly. More specifically, the physiotherapy students highly rated items such as The supervisors were expecting me when I arrived, I had a supervisor to whom I knew I could turn, and I had sufficient access to supervision. One aspect of supervisors’ preparedness in the UCEEM is whether they are familiar with the intended learning outcomes (ILOs). In outcome-based education, the learning activities and assessments aim to support students in achieving the ILOs [13]. Pikänen et al. [14] studied, among others, physiotherapy students and found that a dialogue about ILOs positively affected the student-supervisor relationship whereas a lack of dialogue made the supervisory relationship less functional. Furthermore, Delany and Bragge [15] show that an increasing congruence between students’ and supervisors’ perceptions of ILOs may enhance the outcomes of clinical education. Despite these studies, we know little about how physiotherapy students’ supervisors use ILOs.

A theoretical framework provides researchers with a means to approach complex phenomena and focus on diverse aspects of methods and analysis [16]. Stemming from sociocultural learning theories, the theory of communities of practice (CoP) refers to groups of people who collaborate, share knowledge, and have a common interest in a specific area; such communities develop individuals both professionally and personally [17]. In this empirical work, we use CoP to frame the study in order to broaden the perspective of the findings.

A deeper understanding of undergraduate physiotherapy students’ perceptions of supervisors’ preparedness may create better conditions for clinical learning and better meet students’ learning needs. Thus, the present study aimed to explore physiotherapy students’ experiences of supervisors’ preparedness, familiarity with learning outcomes, and supervision practices during their first clinical placement.

Materials and methods

Study design

The research adopted a qualitative approach using individual semi-structured interviews and was conducted within an interpretative paradigm that views knowledge as relative and socially constructed [18]. Rather than reflecting an objective truth, the findings aim to contribute to the understanding of a complex phenomenon and to present reasonable and generalizable interpretations [19]. We followed the Consolidated Criteria for Reporting Qualitative Research guidelines [20].

Research team and reflexivity

The multidisciplinary research team included four females and one male. Three members (MS, AH, MNB) were specialist physiotherapists with extensive experience of supervising and assessing physiotherapy students. The two other members (senior educationalist PJP; former director of the medical program RM) had extensive experience of other undergraduate programs. Four of the authors had a PhD in medicine. One author (AH) belonged to the teacher team of the two pilot interviewees while the others had no involvement with the students. AH’s position on the teacher team of the interviewees in the pilot study may have influenced their willingness to speak openly, but, with the exception of the interviewer, the researchers had access only to anonymized data. The interviewer for the two pilots and the main study (MS) was a female PhD student and trained physiotherapist with 25 years of experience of clinical teaching. MS was a teacher in the program 2 years earlier but has never been a teacher or participated in the assessments of the group that participated in the interview. This qualitative interview–based study was part of a MS’s doctoral thesis, that employed a prospective, mixed-methods case study methodology. The authors’ diverse qualitative research experience ranged from novice to experienced. Their varied disciplinary, research, and teaching experiences potentially influenced their interpretations of the data but also yielded valuable insights into health sciences education. The interviewer took notes on the participants’ comments and the researchers’ thoughts during and directly after the interviews and examined those impressions with the research group to continually revise the researcher subjectivity statement [21].

The trustworthiness of the study was enhanced by investigator triangulation; from the beginning, all the members were involved in the planning, data analysis, and writing to provide multiple perspectives in the process. To ensure dependability, the study design and data collection were described in detail. The stability of the data was ensured by reading the transcripts several times, followed by discussion until agreement. The credibility of the study was strengthened by all the members participating in the data analysis [22] and by the use of representative quotations from the transcribed text [16]. Throughout the process, and primarily due to the first author’s prior understanding of the context, constant comparisons were made between the subcategories and categories and the original data transcripts. Thus, Patton’s dual criteria of internal homogeneity and external heterogeneity were carefully considered [23].

Context

The study was conducted at a medical university, Karolinska Institutet (KI), in Stockholm, Sweden. The physiotherapy program is a three-year (six-semester; 180 European Credit Transfer System) program that leads to a professional qualification and a Bachelor of Science degree in physiotherapy. The first so-called long clinical placement of six weeks, focusing on inpatient care, is in the third semester and takes place in four teaching hospitals affiliated with KI. In the scholarly medical education literature, the terms supervisor and mentor are often used interchangeably [24,25]. Throughout this paper, supervisor refers to those providing guidance and feedback in the clinical context to enhance learning and ensure safe patient care [26]. In this case, supervisors are physiotherapist with varying levels of experience, as supervision is a requirement of the health care provider. Supervision is principally conducted on a one-to-one basis between a supervisor and a student. The supervisors assess the students’ skills formatively in the middle and at the end of the course. A teacher team of two to three specialized physiotherapists, one of whom is a university employee, is available to discuss study-related matters with supervisors and students, e.g. underperforming students at risk of failing or supervisors who do not meet the requirements. An online course in supervision is mandatory. In addition to a course syllabus, that is a legal document in Sweden, and that states the ILOs, the supervisors follow an instruction manual provided by the teacher team.

Participants

To ensure richness and variety in the data, we employed two sampling strategies: purposeful and snowball sampling [18]. We first used purposeful sampling, inviting all physiotherapy students (n = 68) in their third semester in fall 2020 to participate. An explanatory statement outlining information about the researcher (MS), the aims, method, and voluntary nature of the project was provided to the students both verbally and in writing. Next, we used snowball sampling by informing the first three interviewees that more students could be included in the study. Eleven students agreed to participate. Two female students from spring semester 2020, who did their clinical practice in fall 2020 due to the COVID-19 pandemic were asked by one of the authors (AH) to volunteer for a pilot interview [27]. The data from the pilot interviews were regarded as rich and meaningful and therefore included in the final analysis, giving a total of 13 participants (mean age 29 years; eight females).

Data collection

An interview guide (see the Supplemental Online Material) was prepared from the outcomes of our previous UCEEM study to explore the topic and elicit detailed information on supervision [3]. The pilot interviews revealed no need to modify the interview process or the interview guide content. All the interviews, carried out by the first author (MS), were conducted face to face and were audio- and video-recorded using the Zoom platform, the informants were allowed to choose the place for the interview at their own convenience. It was unknown if someone else was present in the room. Before starting, the interviewer made sure that the interview process was clear and that no technical problems existed [28]. The interviews lasted 45 min on average (range 35–60) and comprised 140 pages of text.

Data analysis

The data were analyzed by inductive qualitative content analysis [29], which uses an iterative constant comparison coding technique to explore the data. The audio recordings were transcribed verbatim and anonymized by MS. To obtain a sense of the whole and ensure accuracy, the transcripts were read through several times by all five authors and then entered into the NVivo software package [30]. All the coauthors continually discussed the transcripts’ content and meaning units (the latter identified and labeled with descriptive codes by MS) until reaching consensus on the initial coding [23, 29, 31]. Codes with the same or similar meanings were combined and grouped into subcategories and categories describing the manifest content of the data and were iteratively discussed by the authors. Thus, codes, subcategories, and categories were developed from the text without a predetermined coding scheme. Finally, we went beyond the explicit manifest content to interpret the data’s underlying latent content [32].

Findings

The analysis resulted in one latent overarching theme—A coherent whole throughout the placement—and three categories: Establishing a relationship, Fostering active participation, and Cultivating outcome-based learning (Table 1). The categories were based on seven subcategories and are described below with illustrative quotations.

Table 1. Overview of the identified subcategories, categories, and the theme.

Theme	Categories	Subcategories
A coherent whole throughout the placement	Establishing a relationship	A well-organized initial encounter
		Creating a sense of trust
	Fostering active participation	Proximity of the supervisor
		Promoting student autonomy
		Encouraging cooperation in the community
	Enculturating outcome-based learning	Intended learning outcomes used recurrently
		Facilitating self-assessment

A coherent whole throughout the placement

The students described experiencing a coherent whole throughout the placement. Their descriptions of how the supervisors aligned learning activities chronologically, from introduction to assessment, revealed that the supervisors seemed to have a plan for the students’ learning from the beginning. On the first day, the ILOs were introduced and discussed. On the following days, simple learning activities were gradually supplemented with more complex situations. The early introduction of the ILOs showed the students that the supervisors knew what the students should achieve and had a plan to implement an outcome-based approach to learning. The appointed clinical supervisors’ colleagues and other staff also supported student learning by being available and open to questions and inviting them to participate in clinical activities. The students conveyed that the organization showed a genuine interest in supporting future colleagues’ education.

Establishing a relationship

This category was based on two subcategories: A well-organized initial encounter and Creating a sense of trust.

A well-organized initial encounter

The students described the beginning of the clinical practice as entering a new world, abundant with new impressions and novel information. Their anxiety about possibly arriving late was alleviated by the supervisors’ prearranging clear, easily found meeting places, such as a reception area, or a café at the hospital.

It was easy to know where we should gather, as it was always the same place, which was easy to find. (Student 3)

The students noted that a well-organized initial meeting laid a foundation for the supervisor-student relationship. Most supervisors booked fewer patients for the first day and prioritized a scheduled personal meeting with their students. Furthermore, they provided the students with information about the ward, routines, and types of patient on the ward, which better prepared the students for their practice. The supervisors also presented the ILOs, assessments, and other information provided by the university. In addition, the supervisors and students discussed expectations, their prior experiences of health care, and whether they had any worries.

We talked a lot, went through expectations and fears and what I wanted to do, plans I have for myself. That was great, as I got the opportunity to discuss what I felt was a bit difficult at that time. (Student 3)

The students expressed that the supervisors warmly welcomed and cared about them. Being addressed as a future colleague was gratifying and illuminated the supervisors’ intentions.

I was very well received; my supervisor said that she considered me as a future colleague and that she hoped to have that kind of relationship with me during the placement. (Student 2)

Creating a sense of trust

The students reflected on the relationship with their supervisors in terms of a sense of trust. In the beginning, the students were nervous about asking questions. After the supervisors clarified that they had time to listen and discuss, the students felt less worried and could better focus on their learning activities. The supervisors encouraged them to pose questions and emphasized the importance of airing potential uncertainties. Furthermore, the supervisors created trust and facilitated getting to know each other by asking clarifying questions.

She was a new person; we did not know each other. I appreciated that she posed questions, such as, “Do you know why I did this? Otherwise, I can explain to you.” (Student 10)

The students mentioned being afraid of making mistakes that could harm the patients, but the interviews revealed that the supervisors assured them that they would not have to handle excessively complicated patients and that the supervisors would take over if something seemed to go wrong. In these circumstances, the students experienced a sense of security that enabled them to trust in themselves.

I felt that there was room for me, that I could trust in my ability; since I understood that she trusted me, I was able to trust myself. (Student 4)

One student mentioned that an authoritarian supervisor reduced the likelihood of building a relationship and getting to know each other. This kind of supervision did not encourage the student to participate in dialogue or the planning of their learning activities for the day.

She did not want to do anything together with me. For me, it is easier to observe first and then to act myself. What I missed was a short meeting in the morning and a summary at the end of the day. (Student 11)

Fostering active participation

This category comprised three subcategories: Proximity of the supervisor, Promoting student autonomy, and Encouraging cooperation in the community.

Proximity of the supervisor

The students indicated that their supervisors were available when needed. At the beginning of the placement, the students met the patients together with the supervisor. Later, the supervisor was in or just outside the room when the students met the patient on their own. Finally, when the students were more independent, they still perceived that the supervisors (or other staff notified by the supervisors) were in the proximity, and they knew how to contact them if necessary.

We talked about what needed to be done before I entered the room to meet the patient. My supervisor stayed outside in the corridor in case I would need help. (Student 7)

Promoting student autonomy

This subcategory illustrates how supervisors evolved their supervision to support the development of students’ autonomy by gradually increasing the complexity of the tasks. Initially, the students were given simple tasks, but, as they developed, they were gradually allowed to handle more complex patient situations and to collaborate with others. As a consequence, the students could experience uncertainty in the subsequent, more challenging situations. The students described getting used to these variations in their self-perceived independence and said that they recognized their own development.

We took one step at a time, and, after about one and a half weeks, we achieved a level at which we felt that we did fine. But the next patient we met was really challenging, and we felt that it was really difficult. In the weeks that followed, such a patient became a routine patient—I was constantly developing. (Student 5)

The supervisors encouraged the students to engage with others than their appointed supervisors to develop autonomy. In the beginning, this might be a close colleague of the supervisor who was introduced to the student. Gradually, such engagement was extended to include more peripheral staff. The students described their need for a supervisor who, under safe circumstances, encouraged them to become more independent, make decisions, and take responsibility. In these situations, the students felt that the supervisors challenged them to a reasonable degree but nevertheless supported them.

My supervisor told me, “If you want to get the best out of this period, it is best to start now.” It was a bit like being thrown into the deep end of the pool, but the supervisor was there and told me that I would not drown; I just had to swim. (Student 2)

In one case, a supervisor did not let the student handle a patient encounter but took over the situation without being asked, so the student felt sidestepped and lost an opportunity to develop autonomy.

If I took a pause to think, he continued the dialogue with the patient without including me. I never got the chance to achieve the feeling that I could handle situations myself. (Student 4)

Encouraging cooperation in the community

According to the students, the supervisors introduced them to the whole staff on the ward. Consequently, not only the appointed supervisors but also the whole staff took responsibility for the students’ learning and invited them to participate in various clinical activities. This enabled the students to learn from and take advantage of the experiences of professionals other than the appointed supervisor.

It was like the whole department took a joint responsibility for the students. It was not like, “You are supposed to be supervised by someone else; stick with your supervisor.” I could ask anyone if there was something interesting for me to observe or be a part of. (Student 2)

When the staff (e.g. physiotherapists, occupational therapists, nurses, and medical doctors) expressed that the students were welcome to ask anyone for help, the students experienced the potential to learn. They felt that the whole community welcomed them and was willing to support their learning.

Everyone made it clear that I could ask if I had any concerns. They would all help me. It was a really good “Ask and we will help” approach. (Student 10)

Several students in the same medical unit further strengthened their own feelings of being members of a team. The students knew or were introduced to one another, could discuss and reflect together, and came to know one another’s supervisors. Students without such relationships felt lonely and lacked a sense of belonging and context.

I was alone, in a completely different place. All the other students were in another building. They ate lunch together and had a nice time. I felt very isolated. (Student 11)

Cultivating outcome-based learning

This category was constructed from the following subcategories: Intended learning outcomes used recurrently and Facilitating self-assessment.

Intended learning outcomes used recurrently

The students indicated that the supervisors were familiar with the ILOs, which were integrated and aligned with day-to-day activities from the first day and throughout the placements. The supervisors’ familiarity with the ILOs supported and empowered the students to achieve those outcomes. Furthermore, the supervisors returned to the outcomes repeatedly during the course; they were directly discussed in conjunction with the students’ patient encounters and at the evaluations in the middle and at the end of the course. This approach enabled a continuous dialogue about the students’ learning and established a sense of coherence for the students.

When we met with the patients, we brought up the paper again to see which learning activities we had just carried out. It was clear that the supervisor tried to refer to them [ILOs] and to what we had done. There was a clear central thread, so to say. (Student 12)

The midpoint evaluation was considered as important and enlightening. Some students were surprised that they did worse than expected while others acknowledged that they already knew they had fulfilled the criteria for acceptable performance.

At the midpoint evaluation, it became clear what my strengths and weaknesses were. And then we put an effort on the weaknesses in the last period and came back to those every day. (Student 8)

Facilitating self-assessment

The students said that the supervisors encouraged them to reflect on their learning and that the supervisors continually involved them in taking responsibility for their learning through self-assessment.

Before the final assessment, my supervisor asked me to look at the learning outcomes at home and asked, “At which level are you? Do you think you will pass or not?” (Student 8)

Recurrent dialog about the ILOs helped the students visualize their learning needs and achievements in relation to them. When the students became aware of their learning needs and described their knowledge gaps, the supervisors supported them by arranging occasions in which the unmet outcomes could be practiced. Thus, the supervisors organized the upcoming learning situations based on students’ self-assessments and invited them to take part in planning the learning activities.

It was not like I arrived at the ward and there was already a plan for me, just to tick off. It was a dynamic relationship between me and my supervisor. “What would you need to do to achieve the learning outcomes?” So, we scheduled meetings when we sat down and discussed my achievements. (Student 2)

Discussion

This study explored physiotherapy students’ experiences of supervision practices and, more specifically, supervisors’ preparedness for students’ clinical practice. Rather than assessing a clinical course summatively, which is done through close-ended quantitative questions, we posed open-ended questions in post-placement interviews, enabling us to study in depth students’ experiences of their first longer clinical placement. Our findings suggest that the students valued a supervisor who was prepared and who reserved time at the beginning to establish a relationship (Table 1). They also appreciated supervisors who fostered active participation by being available, by steadily increasing the complexity of tasks, and by making the students a part of the working community. The continual use of ILOs helped students identify their learning needs and achieve the intended outcomes.

The relationship that develops between a student and a clinical supervisor has drawn limited attention in the scholarly literature. In the early 1990s, Jarski et al. [33] found that physiotherapy students deemed it important to their learning that supervisors facilitated positive interpersonal relationships, but a supervisor’s clinical skills were considered less important. Moreover, Delany and Bragge [15] reported that undergraduate physiotherapy students relationships with supervisors influenced students’ confidence and interest in engaging in the learning process. A helpful strategy was when the supervisor provided time for reflection and was approachable. These findings are supported by Vågstöl et al. [34], who noted that physiotherapy students valued supervisors who established personal relationships with students by showing a genuine interest in them and a willingness to understand their perspective. Our conclusions are in line with these findings. Supervisors who made efforts to establish a relationship eased students’ introduction to the clinical environment. Moreover, supervisors created a welcoming environment by recognizing that it was the students’ first clinical placement and by paying attention to their feelings, thoughts, and circumstances. Taken together, these findings suggest that it is crucial to cultivate a positive beginning of clinical placements. Supervisors need to prepare for the student’s arrival and prioritize establishing a safe, positive relationship.

The current study was informed by CoP theory, which views learning as a social process in which collaboration is crucial and students learn by participating in activities [35]. Newcomers evolve from legitimate peripheral participation toward full participation in the CoP when they are given more complicated tasks as they gain experience [35]. Consequently, students can use the broader workplace environment as a source of guidance to facilitate learning [36]. A noteworthy finding of our study is that the students were invited to enter into a community through relevant, tailored activities appropriate to their educational level under the guidance of the supervisor or other members of the community. Being included in both their discipline-specific team and the general ward organization indicated that the whole staff took responsibility for student learning. A supervisor’s encouragement to move beyond the one-to-one relationship and engage with others in an independent manner supported the students’ development of autonomy. This finding is in line with those of Delany and Bragge [15], who studied third-year physiotherapy students and found that they reached higher levels of self-confidence and satisfaction in their learning encounters when they were involved in the departmental team and when other health professionals offered their perspectives. Thus, we believe that cultivating pedagogical environments that reflect the tenets of CoP is important in broadening students’ learning and developing their autonomy; this demonstrates how a whole organization can contribute to students’ professional development.

A requirement for effective clinical placement is that the teaching and learning focus on the ILOs. Our students’ description of the learning outcomes being integrated into day-to-day activities throughout the placement aligns well with the description of outcome-based education, in which the supervisor’s role is to support the student in achieving the ILOs [13]. In addition, encouraging students to reflect on their learning enhanced their awareness of the learning needs and their engagement in planning the learning activities. Cole and Wessel [37] studied physiotherapy students participating in their introductory clinical placement and found that the supervisors who challenged students by questioning them and who provided time for reflection enriched the students’ clinical experience. Our students also indicated that they appreciated a dialog about the ILOs, which contributed to a sense of coherence during the placement. This type of supervision also developed the students’ capacity for self-assessment. Other authors have advised that more congruence is needed between supervisors’ and students’ perceptions of achieving the ILOs [15], so a positive finding of our study is that the supervisors arranged upcoming learning activities on the basis of the formative assessments. Discussions of learning outcomes between supervisors and students importantly contribute to making the most of learning in a clinical environment.

The major strengths of this study are the richness of the data and the thick descriptions, which support its trustworthiness. The credibility may be questioned, as our data were derived from individual interviews, which may be interpreted in various ways. The participants may not have been representative, but they revealed both positive and negative aspects, indicating that they felt comfortable enough to express their true opinions [22]. In addition, while in-depth recollections of single institutions are limited, common themes can emerge from a range of solitary studies and lead to the development of generalizations. Despite potential disadvantages, such as the technical and interactional problems described in the literature, using an online platform to collect data was a prerequisite for the safe completion of the study due to the COVID-19 pandemic [38]. We experienced no technical difficulties, and the students were accustomed to using Zoom due to the pandemic. The advantages included reduced travel and the possibility for the students to choose their own interview environment.

Some gaps should be addressed in future studies. This study could be repeated among students in later courses in the program as well as among students in other programs to identify possible differences in their early need to establish a relationship with the supervisor, as the students’ perspectives and preferences may change from year to year. Furthermore, different programs have varying organizational structures, e.g. for supervision, which certainly might affect the results. A broader investigation of supervision practices could illuminate how to support students’ attainment of learning outcomes, thus underpinning theory and optimizing supervisors’ preparedness for clinical placements to benefit student learning.

Conclusions

The physiotherapy students highly regarded supervisors who established a relationship and fostered active participation. Furthermore, they appreciated supervisors who were available, promoted student autonomy, and encouraged cooperation in the community during clinical placements. The continual use of ILOs helped students identify their learning needs and achieve the outcomes.

Ethical aspects

The study was approved by the Regional Ethical Review Board in Stockholm (2017/38-31/4). The participants provided informed consent at the time of the interview, and they were reassured that their anonymity would be protected.

Acknowledgements

The authors wish to thank the students at Karolinska Institutet who devoted their time to participate in the study.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [MS], upon reasonable request.

Disclosure statement

The authors declare that they have no competing interests.

Additional information

Funding

This work was supported by grants provided by Region Stockholm (ALF project). The funding body did not participate in the study design, data collection, analysis, interpretation of data, or in the writing of the manuscript.

Notes on contributors

Malin Sellberg

Malin S. Sellberg, PT, MSc, is a physical therapist and a PhD student at the Department of Clinical Science, Intervention and Technology at the Karolinska Institutet. Her research focuses on learning and supervision in the clinic.

Alexandra Halvarsson

Alexandra Halvarsson, PT and associate professor at the Department of neurobiology, care science and society at the Karolinska Institutet. Dr. Halvarsson studies different methodological considerations and has a focus of digitalization of evidence base training. Furthermore, Dr Halvarsson has an interest in clinical learning environments and supervision.

Malin Nygren-Bonnier

Malin Nygren-Bonnier, PT, and associate professor at Department of Neurobiology, Care Sciences and Society, Karolinska Institutet. Her focus is on function and health in respiratory and cardiovascular conditions as well as pedagogical research.

Per J. Palmgren

Per J. Palmgren, DC, MMedEd, PhD, is associate professor in Medical Education and mixed-method educational scientist at the Department of Learning, Informatics, Management and Ethics, Karolinska Institutet. His research addresses the environment in which students learn and teachers work.

Riitta Möller

Riitta Möller, MD, PhD, MMe., is an otolaryngologist and associate professor at the Department of Medical epidemiology and biostatistics at Karolinska Institutet. Dr Möller studies focus om students’ scientific development and learning environment.