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Facilitating effective methods of physical therapy student learning during shadowing experiences Bennett, Jami; Aiers, Jen; Chicoine, Anna; Gagne, Erin; Gardiner, Susan; Bainbridge, Lesley 2012-08-10

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Facilitating effective methods of physical therapy student learning during shadow experiences INTRODUCTION & RATIONALE Shadow placements have been identified as valuable learning experiences that help students become more comfortable in the clinical setting, and subsequently more effective learners in the classroom1. Shadowing for the purpose of learning provides students with the opportunity to access and observe leadership behaviours and characteristics demonstrated by practicing therapists2. For many students this shadowing experience represents their first exposure to the clinical setting3. A highly effective and satisfying shadow placement that socializes the student to the profession, and increases comfort in the clinical environment is currently not well defined. In this study, student perspectives were evaluated using post- shadow experience surveys and focus groups to explore attitudes towards, and satisfaction with, the shadowing experience. Preceptors contributed their perspectives in a focus group addressing themes identified through student surveys, and faculty members involved in facilitating clinical practice experiences for health profession students at UBC participated in interviews. Acknowledgements The authors would like to thank Victoria Wood and Valerie Ball for project support, proposal review, and assistance with the ethics approval process. This study is part of a group student research project for the Masters of Physical Therapy program. Jennifer Aiers1, Jami Bennett1, Anna Chicoine1, Erin Gagne1, Susan Gardiner1, Lesley Bainbridge1,2 1Physical Therapy Department, Faculty of Medicine, University of British Columbia, Vancouver BC, College of Health Disciplines, Faculty of Medicine, University of British Columbia, Vancouver BC  Contact: DISCUSSION RECOMMENDATIONS  Use guided reflection around specific topics as a means of personal exploration, development, and transformative learning  Encourage students to focus on being present and to absorb information in the new environment  Direct student attention to different aspects of interprofessional practice  Use shadow placements as opportunities to increase exposure to different practice areas for physical therapists  Team up students to maximize discussion and comfort in the new environment Faculty Degree & Duration of Program Shadow Experience & Description Admissions Process Medical Genetics Counselling •  Masters •  2 years duration •  Not formal •  First days of placement considered shadow •  Letter of intent •  Volunteer experience in the profession Pharmacy •  Bachelor •  4 years duration •  Completed before classes or in first month •  4 hours Nursing •  Bachelor •  2 years duration, accelerated program •  Not formal •  First day of placement considered shadow •  Unspecific volunteer experience needed Occupational Therapy •  Masters •  2 years duration •  3 shadow placements •  One interview, one shadow, one transfer Speech Language Pathology/Audiology •  Masters •  2 years duration •  Part of admissions process •  Shadow experience must be completed prior to admissions 0 10 20 30 40 50 60 Acute/Medical Rehabilitation Outpatient Other Pe rc en t o f r es po nd en ts  0 10 20 30 40 50 60 Sc he du lin g o f o rie nta tio n Cl ea r &  U nd ers tan da ble  le ctu re Us efu lne ss  of  cl as s n ote s Re lev an ce  of  le ctu re Tim ing  re lat ive  to  pl ac em en t Us efu l d uri ng  sh ad ow  ex pe rie nc e Qu ali ty of ins tru cti on  on  as sig nm en ts Pe rc en t o f R es po nd en ts  Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied 0 10 20 30 40 50 60 70 80 90 Rotation between clinical areas Stay with same preceptor More than one student Pe rc en t o f R es po nd en ts  Yes No THEMES IDENTIFIED  Structure of the experience  Curriculum & assignments  Preceptor  Socialization  Inter-professional practice LIMITED EXPOSURE TO PATIENTS 13% HOSPITAL SETTING 9% TIMING 19% LACK OF VARIETY 23% INAPPROPRIATE PROFESSIONAL CONDUCT 2% TRAVEL DISTANCE 13% LACK OF CONTROL 2% NONE 9% ASSIGNMENT DUE DATE 2% PRECEPTOR 4% LACK OF KNOWLEDGE 4% What did you like least about your shadow placement? Experience Structure Clinical Practice Area Curriculum Delivery Figure 1. Study Design. Student participants were recruited from a pool of 79 first year students in the 2011 cohort of the MPT program at UBC. Participants received the classroom instruction about shadowing and attended 16 hours of shadowing experience. 49 students participated in the survey, and 8 students participated in the focus group. Preceptors at sites throughout Vancouver were invited to participate in a focus group to provide their perceptions of the themes identified in the student survey. Invitations were distributed by a 3rd party email to clinical practice leaders; 1 clinical site responded and 4 preceptors participated in a focus group. Faculty coordinators of clinical experiences in Faculty of Medicine programs at UBC were invited by a 3rd party email to participate in interviews during the spring of 2012. Interviews with faculty members who oversee clinical education in 5 other healthcare disciplines at UBC focused on the structure of their programs and explored the themes identified in the student survey. Participant invitation, in the College of Health Disciplines at UBC. Names of participants and clinical sites are confidential to the co-investigators. PURPOSE The purpose of this study was to identify essential characteristics of effective shadow placements  from students, preceptors, and faculty members at the University of British Columbia, in order to develop recommendations to optimize this educational opportunity for all stakeholders. This study was approved by the Institutional Review Board at the University of British Columbia (UBC) in Vancouver, British Columbia. All participants signed an informed consent prior to involvement. FINDINGS Figure 2. Student Survey  Simple, random, convenience sampling was used in the survey portion of this study. All MPT1 students were emailed a link to the online survey for completion, which included a consent form in the introduction, if they chose to participate. The 18-item survey administered using SurveyMonkey™ Students completed the survey anywhere from one to three months following their shadow experience. We used a 5-point Likert scale to obtain quantitative data for 11 closed-ended survey questions; 4 yes-no questions, 1 numerical question, 1 categorical question, and 8 open ended questions were also included. Survey data were downloaded onto a secure, password-protected database within the College of Health Disciplines. Questions were developed for both student and preceptor focus groups based on the responses from the surveys. Figure 3. Faculty Interviews. Summary of Shadow Experiences as represented by interviews with UBC health professional program faculty who facilitate clinical curriculum delivery.  Goals of shadow experiences have been described as exposure to clinical practice, communication styles and roles, socialization to the profession, and interprofessional learning 2,4,5  Observation and reflection are low risk ways to be exposed to the clinical setting and reinforce skills like interviewing, clinical reasoning and communication 4,5,6,7  Enabling all students to have a similar experience is difficult, as the learning occurs in a variable and uncontrolled clinical environment  In an attempt to standardize the experience, structure is created through site selection, duration, assignments and debriefing approaches  There is a critically important role for the assignment or debriefing approach in the learning process which directs both the level of cognitive challenge and amount of personal reflection for the learner  Shadowing experience structure must necessarily reflect the goals of all stakeholders (students, preceptors and faculty) and enable completion of assignments to facilitate success 1 Hoellein, A. R., et al. "Student Involvement on Teaching Rounds." Academic medicine : journal of the Association of American Medical Colleges 82.10 Suppl (2007): S19-21. Print. 2 Eades, J., K. Hill, and J. Craig. "The Shadowing Experience for Nursing Students." Nursing standard (Royal College of Nursing (Great Britain) : 1987) 20.12 (2005): 48-51. Print. 3 Eddy, M.E., and Schermer, J. “Shadowing: A Strategy to Strengthen the Negotiating Style of Baccalaureate Nursing Students.” Journal of Nursing Education 38.8 (1999): 364 - 367. Print. 4 Alford CL, Currie DM. Introducing first-year medical students to clinical practice by having them "shadow" third-year clerks. Teach Learn Med. 2004;16(3):260-3. Print. 5 Bates T, Cohan M, Bragg DS, and Bedinghaus J. The Medical College of Wisconsin Senior Mentor Program: Experience of a Lifetime. (2006) Gerontology & Geriatrics Education, Vol. 27(2):93-103. Print. 6 Cole, B., and J. Wessel. "How Clinical Instructors can Enhance the Learning Experience of Physical Therapy Students in an Introductory Clinical Placement." Advances in health sciences education : theory and practice 13.2 (2008): 163-79. Print. 7 Skøien AK, gstøl UV, and Raaheim R. Learning physiotherapy in clinical practice: Student interaction in a professional context. (2009) Physiotherapy Theory and Practice, 25(4):268–278. Print. SELECTED REFERENCES Shadow Experiences Student surveys Student Focus Group Faculty Interviews Preceptor Interviews Medical Genetics Pharmacy Nursing OT SLP Themes Conclusions


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