A placement scheme allowing student physios to gain research skills
Hannah Young and Heather MacKinnon believe strongly in the importance of basing clinical practice on thorough, well-researched evidence. It’s something they exemplify in their roles as clinical academic physiotherapists in renal rehabilitation at Leicester General Hospital.
As part of that integrated approach, they have set up what may be the first clinical research placement for undergraduate physios in the UK.
The five-week stint, equivalent to the normal clinical placement, was established in partnership with Leicester University and the University Hospitals of Leicester (UHL) Trust, and is intended to give students an experience of all parts of the research cycle within a clinical setting.
The first student to complete the placement was Athena Yeung, from Coventry University (see case study). Plans are well advanced for another student to do it later this year, and Heather and Hannah hope to be able to offer the experience on a regular basis.
The idea emerged when they noticed that some medical students at UHL were able to take a year out of medical training to focus on research. ‘We thought, why don’t we do that for physiotherapy students?’ recalls Hannah. ‘It would be a great opportunity for physios to learn hands-on research skills.’
Emphasis on inspiration
It became clear that setting up a similar scheme for physios was impractical, but out of that grew the idea of the clinical research placement. When Leicester University and the UHL therapy department showed interest, Heather and Hannah were only too happy to take on the challenge.
‘I think it’s essential in this climate that we put resources into things we know are effective and patient-centred,’ says Hannah. ‘But it’s so tricky to break into research – to get funding you need previous experience and that can be difficult to find.
‘One of the things we hope will come out of this placement is that it will inspire. Maybe it can give students that little bit of clinical research experience that can act as a springboard for other opportunities.’
The placement is designed around a small-scale project – in Athena’s case, centring on part of Hannah’s PhD study looking at exercise interventions for frail, haemodialysis patients at risk of falls – which enables students to gain practical experience in a range of research skills, including collecting and analysing data and disseminating those findings.
Students receive guidance and support during each task and are given a resource pack with further information. Time is set aside to discuss progress and challenges, and provide detailed feedback. Students are also encouraged to do self-directed reading and learning.
The placement took around three years to get off the ground. Painstaking negotiations were conducted to ensure it would meet all the academic requirements. There were detailed discussions with therapy colleagues at UHL. Heather and Hannah have also had to shoehorn the demands of designing and running such a complex project into their day jobs.
Despite this, Hannah is puzzled about why so few – if any – other departments have gone down this road. ‘I’ve never understood why they’re not more available,’ she says. ‘Even if you don’t want a career in research, understanding how to critically appraise and apply this to practice is important for everyone.’
But the two colleagues have no doubt their effort has been worthwhile. The placement has clearly benefited Athena Yeung, but Hannah says she has also learned a lot from the process.
In particular, it has helped her think more holistically about patients’ pain. In setting up her exercise intervention for haemodialysis patients, she had focused on their experience around falls and long-term musculoskeletal issues. But Athena’s project looked at wider aspects of pain, including psychological issues, and this has changed her thinking.
And because she sat in on a number of Hannah’s interviews with patients, Athena could give invaluable feedback on her interview technique. ‘She noticed I did a lot of nodding when I was listening to patients which isn’t good practice, so now I try to be more neutral.’
Heather also relished the experience: ‘I think Athena’s preconception was that research was for other people. So it was really nice to see her passion and enthusiasm by the end. It also amazes me, whenever I have a student, to realise how much I know about a subject.
‘It has made me reflect and question in some cases why I do things in a particular way – and that’s good for me.’
Heather and Hannah hope the placements will become a regular part of the UHL’s partnership with local universities. They are also discussing their timing within a three-year course and how they might be able to tailor future placements more to the student’s interests. Hannah also wonders whether similar but longer placements might be possible for masters students as, well as junior physios at UHL.
Local universities, Coventry and Leicester, have expressed interest in sending undergraduate physios on similar placements in the future. But challenges still lurk – not least that neither Heather nor Hannah knows what they will be doing or where they will be once their projects are complete.
Charlotte Carter-Lang, Leicester University’s clinical placement lead for allied health professionals, was closely involved in developing the placement. She believes combined research and clinical placements could be an even bigger attraction.
‘Practice is changing and we are pushing for physios to be involved in research processes and being at the heart of that change. Getting our students involved in that gives them another avenue.’ She hopes Leicester will be able to roll out the first of such placements in the coming year.
Athena Yeung has just completed the first clinical research placement at UHL and is full of praise for the scheme. But she admits she fell into it rather by accident.
As a third-year student at Coventry University, she had been preparing for a placement on an oncology ward. When that fell through she was told about this opportunity and decided that learning more about research would be useful – and might hone
her writing skills.
She was initially nervous but, once there, she was reassured by the clear timetable and structure, as well as the comprehensive resource pack that Heather and Hannah provided – ‘that made me feel a lot more secure.’
Athena’s project involved analysing a number of qualitative studies of frail haemodialysis patients’ experience of pain, identifying
themes and observing and taking part in interviews with patients.
The experience has helped her develop a more critical and questioning approach to research evidence. The interviews also gave her a new insight into the patient experience. ‘Doing qualitative research you have to be very open-minded because there are so many new perspectives from patients.
‘This has changed how I communicate with a patient and what to look out for when talking to them.’
Athena also attended the three-day British Renal Society conference in Harrogate halfway through her placement. It had a big impact.
‘There were so many talks and so many professionals there – I learned so much, including some presentational skills,’ she recalls.
That came in useful when she faced a ‘nerve-wracking’ assessment interview with Hannah, Heather and Charlotte in the final week of the placement and then had to present a summary of what she had learned over the five weeks to fellow physios in the department.
Athena will graduate this November and plans to return to Hong Kong, where she was born, to practise. She wants to do hospital work to begin with and doesn’t yet know whether she will move into research.
But she has no doubt it will inform her practice and has given her greater empathy for her patients. ‘It has really helped me to develop my skills in doing evidence-based practice.
I see how important it is to keep up to date and how I can apply that evidence to practice.’
Author: Andrew Cole, freelance health journalist
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