Original ArticleDefining the construct of masters level clinical practice in manipulative physiotherapy
Introduction
Recent development in healthcare knowledge and technology demands greater clinical expertise by healthcare professionals in managing more complex problems, a need that is addressed partly by masters level education. The emphasis on developing clinical expertise is evident in the recent proliferation of masters level courses, commonly taken following an initial Honours degree (Judge et al., 2005). The definition of expertise has been recognised as a difficult exercise, and has been explored across professions (Delitto et al., 1989, Coulon et al., 1996) being commonly articulated as the capacity to perform using cognitive and practical skills not employed by novices.
Differentiation of academic level has been identified as important for clinical courses in nursing and physiotherapy (Donaghy and Gosling, 1999, Gerrish et al., 2000, Whyte et al., 2000) as well as in the wider educational literature (Winter, 1994, Atkins and Redley, 1998). Some clarity regarding level has been afforded by the defined frameworks for Higher Education qualifications in the UK (QAA [Quality Assurance Agency], 2001), and the Dublin descriptors (JQI [Joint Quality Initiative], 2004) enabled through the Bologna Declaration in 1999. The emphasis within the existing frameworks is on knowledge at masters level. Findings from limited research in healthcare do however identify different areas of importance for clinical courses, for example, the application of skills to the clinical context (Davis and Burnard, 1992), improved confidence and clinical reasoning, and advanced clinical skills (Green et al., 2008). A previous study that explored the characteristics of existing masters courses in various healthcare professions (Rushton and Lindsay, 2007) supported these differences and identified a central issue as the articulation of the ‘masters levelness’ of clinical practice.
Rushton and Lindsay (2008) afforded insight into the construct of masters level clinical practice through a three round Delphi study, with participants comprising the course tutors of all masters courses aiming to develop clinical expertise for healthcare professionals in the UK in the 2002/2003 academic year. 21 behaviours indicative of the construct were prioritised. Participants demonstrated consensus for the content of the behaviours, but differences in the prioritisation of the behaviours across professions and specialities. For example, consensus across all participants identified a high level of clinical reasoning as having the greatest importance to the construct, but this ranking was different between the professions and participants reported that they would rank differently according to speciality within a profession. High expectations of students on masters courses were reflected in the high number of behaviours agreed. The characteristics of the QAA and Dublin descriptors were reflected in the agreed behaviours and this was anticipated owing to the current use of the descriptors to inform course design.
Manipulative physiotherapy is a specialist area of physiotherapy that has not been explored to date. Postgraduate development informed by international and subsequently nationally applied standards of educational practice (International Federation of Orthopaedic Manipulative Physical Therapists [IFOMPT], 2008). The identification of behaviours indicative of masters level (postgraduate) practice in manipulative physiotherapy is therefore important to inform ongoing development of educational standards.
Section snippets
Design
An exploratory case study (Robson, 1993) enabled exploration of the construct of masters level manipulative physiotherapy clinical practice in its real life context, employing multiple methods of qualitative data collection. The case study was naturalistic, holistic, and idiographic (Lincoln and Guba, 1985) with overlapping processes of design, data collection, and analysis.
Data collection for the case study was concurrent with the Delphi study previously reported (Rushton and Lindsay, 2008).
Theoretical propositions and analytic categories
The data from the interviews and observations were triangulated (Table 2) in the primary researcher's perceived order of importance (determined from the balance of time and emphasis applied to the components by the participants), illustrating good agreement for most components of the construct and order of importance. The students and clinical tutors equally emphasised the importance of knowledge and clinical reasoning (cognitive and metacognitive problem solving processes), with participant
Expertise
It is possible to delineate the theory of expertise within healthcare into two ‘generations’ of thinking that illustrate a process of evolution (Jensen et al., 2000). The emphasis on clinical reasoning in this study reflects the first generation of thinking regarding expertise (Jensen et al., 2000), that centred on the expert as an individual; highlighting the individual's reasoning strategies employed to solve problems. The emphasis on the hypothetico-deductive model using cues to develop,
Conclusions
Validation of the construct through ‘convergence’ and ‘discrimination’ (Kerlinger and Lee, 2000) is good. The converged findings from the Delphi and case study were congruent with the issues literature regarding expertise, the QAA and JQI descriptors, and the empirical work in healthcare, supporting validation, but also reliability and validity/truthfulness. This enabled articulation of the derived model as the theory behind the construct was congruent across both methods. Similarly the data
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