Vaughan, Brett ORCID: 0000-0002-8623-4558 (2020) Evaluating the quality of clinical teaching in osteopathy. PhD thesis, Victoria University.

Abstract

Clinical education is a core component of all pre-professional health professions courses. This experiential learning allows the student to utilise the skills and knowledge developed in the classroom, workshop and simulated learning environments, in patient care. Supervision of patient care is undertaken by qualified health professionals with their role being the facilitation of the students’ learning to prepare them for clinical practice. This approach to teaching and learning contrasts with academic teaching whereby clinical teaching is embedded in the patient care environment rather than a classroom or simulated care environment. In osteopathy, this patient care and clinical education is undertaken in student-led clinics. Student- led clinics are broadly defined as an education and clinical environment where the student leads patient care under supervision of a qualified health professional. Clinical teaching and supervision in the student-led context relates to supervision of patient care by the student, and the demonstration of patient care skills, knowledge and attitudes by the clinical educator. As part of the quality assurance for this education, students are asked to provide feedback about the quality of clinical teaching and supervision they receive. Most often, this feedback is in the form a questionnaire. Questionnaires in the literature have been developed for the hospital and tertiary care contexts. However, there is no such questionnaire for the student-led clinical environment. This Thesis by Publication presents the development and testing of a questionnaire to allow students to evaluate the quality of clinical teaching they receive. The conceptual framework was adopted for this thesis was Kane’s approach to validity – developing a validity argument for the score derived from the questionnaire. To develop evidence for the validity argument, four studies were undertaken. Study one reviewed the clinical teaching evaluation and quality literature and developed an initial questionnaire item bank. An initial bank of 83 items was reviewed by stakeholders and refined to 56 items. The 56 items were then tested with osteopathy students. The resultant exploratory factor analysis identified a 5-factor, 30 item measure. Study two utilised item response theory (Rasch analysis) to refine the 30-item questionnaire and provide additional evidence for the measurement properties. This study resulted in the development of a 12-item measure of clinical teaching quality that demonstrated fir to the Rasch measurement model and the properties of measurement invariance. Study three explored the reliability of the questionnaire, including the application of generalisability analysis to determine the number of questionnaires needed for a single educator to draw reliable inferences from the data. This study identified that eight ratings of a clinical educator by individual students would be reliable. Study four evaluated the relationship between student perceptions of clinical teaching and clinical educator self-efficacy and self- evaluation of their clinical teaching quality. This final study demonstrated that those clinical educators with high self-efficacy were rated lower by students than those clinical educators who reported low self-efficacy with respect to clinical teaching. This research developed a 12-item questionnaire that is feasible, reliable and provides evidence for the validity of the score derived from the questionnaire. The questionnaire is designed to be incorporated into a suite of quality assurance evaluation tools to ensure that patients receive high-quality care and students receive the best possible educational experience to prepare them for their life as a health professional.

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