Developing a clinical teaching quality questionnaire for use in a university osteopathic pre-registration teaching program

BMC Medical Education

Brett Vaughan¹ 

[1] Centre for Chronic Disease Prevention & Management, College of Health & Biomedicine, Victoria University, Melbourne, Australia

关键词: Osteopathic medicine;    Osteopathy;    Clinical education;    Student-run clinic;    Student-led clinic;    Exploratory factor analysis;    Evaluation;   

Others  :  1206363
DOI  :  10.1186/s12909-015-0358-6

 received in 2014-08-08, accepted in 2015-03-30,  发布年份 2015

【 摘 要 】

Background

Clinical education is an important component of many health professional training programs. There is a range of questionnaires to assess the quality of the clinical educator however none are in student-led clinic environments. The present study developed a questionnaire to assess the quality of the clinical educators in the osteopathy program at Victoria University.

Methods

A systematic search of the literature was used to identify questionnaires that evaluated the quality of clinical teaching. Eighty-three items were extracted and reviewed for their appropriateness to include in a questionnaire by students, clinical educators and academics. A fifty-six item questionnaire was then trialled with osteopathy students. A variety of statistics were used to determine the number of factors to extract. Exploratory factor analysis (EFA) was used to investigate the factor structure.

Results

The number of factors to extract was calculated to be between 3 and 6. Review of the factor structures suggested the most appropriate fit was four and five factors. The EFA of the four-factor solution collapsed into three factors. The five-factor solution demonstrated the most stable structure. Internal consistency of the five-factor solution was greater than 0.70.

Conclusions

The five factors were labelled Learning Environment (Factor 1), Reflective Practice (Factor 2), Feedback (Factor 3) and Patient Management (Factor 4) and Modelling (Factor 5). Further research is now required to continue investigating the construct validity and reliability of the questionnaire.

【 授权许可】

   
2015 Vaughan; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Levy LS, Sexton P, Willeford KS, Barnum M, Guyer S, Gardner G et al.. Clinical Instructor Characteristics, Behaviors and Skills in Allied Health Care Settings: A Literature Review. Athl Train Educ J. 2009; 4(1):8-13.
• [2]Rogers J, Lautar C, Dunn L. Allied health students’ perceptions of effective clinical instruction. Health Care Manag. 2010; 29(1):63-7.
• [3]Hoffman KG, Donaldson JF. Contextual tensions of the clinical environment and their influence on teaching and learning. Med Educ. 2004; 38(4):448-54.
• [4]Stalmeijer RE, Dolmans D, Snellen-Balendong H, van Santen-Hoeufft M, Wolfhagen H, Scherpbier A. Clinical teaching based on principles of cognitive apprenticeship: views of experienced clinical teachers. Acad Med. 2013; 88(6):861-5.
• [5]Patton N, Higgs J, Smith M. Using theories of learning in workplaces to enhance physiotherapy clinical education. Physiother Theory Pract. 2013; 29(7):493-503.
• [6]Dornan T, Boshuizen H, King N, Scherpbier A. Experience‐based learning: a model linking the processes and outcomes of medical students’ workplace learning. Med Educ. 2007; 41(1):84-91.
• [7]Dornan T, Tan N, Boshuizen H, Gick R, Isba R, Mann K, et al. How and what do medical students learn in clerkships? Experience based learning (ExBL). Advances in Health Sciences Education. 2014:1–29
• [8]Vaughan B, Macfarlane C, Florentine P. Clinical education in the osteopathy program at Victoria University. Int J Osteopath Med. 2013; 17(3):199-205.
• [9]Conigliaro RL, Stratton TD. Assessing the quality of clinical teaching: a preliminary study. Med Educ. 2010; 44(4):379-86.
• [10]Parsell G, Bligh J. Recent perspectives on clinical teaching. Med Educ. 2001; 35(4):409-14.
• [11]Scheepers RA, Lombarts KM, van Aken MA, Heineman MJ, Arah OA. Personality Traits Affect Teaching Performance of Attending Physicians: Results of a Multi-Center Observational Study. PLoS One. 2014; 9(5):e98107.
• [12]Cross V. Perceptions of the ideal clinical educator in physiotherapy education. Physiotherapy. 1995; 81(9):506-13.
• [13]Jahan F, Sadaf S, Kalia S, Khan A, Hamza HB. Attributes of an effective clinical teacher: a survey on students’ and teachers’ perceptions. J Coll Physicians Surg Pak. 2008; 18(6):357.
• [14]Snell L, Tallett S, Haist S, Hays R, Norcini J, Prince K et al.. A review of the evaluation of clinical teaching: new perspectives and challenges*. Med Educ. 2000; 34(10):862-70.
• [15]Sutkin G, Wagner E, Harris I, Schiffer R. What makes a good clinical teacher in medicine? A review of the literature. Acad Med. 2008; 83(5):452-66.
• [16]Kilminster S, Jolly B. Effective supervision in clinical practice settings: a literature review. Med Educ. 2001; 34(10):827-40.
• [17]Tang F, Chou S, Chiang H. Students’ perceptions of effective and ineffective clinical instructors. Journal of Nurse Education. 2005; 44(4):187-92.
• [18]Curtis N, Helion JG, Domsohn M. Student athletic trainer perceptions of clinical supervisor behaviors: a critical incident study. J Athl Train. 1998; 33(3):249.
• [19]Dolmans D, Wolfhagen IH, Essed GG, Scherpbier AJ, van der Vleuten CP. The impacts of supervision, patient mix, and numbers of students on the effectiveness of clinical rotations. Acad Med. 2002; 77(4):332-5.
• [20]Ramani S, Leinster S. AMEE Guide no. 34: teaching in the clinical environment. Med Teach. 2008; 30(4):347-64.
• [21]Ernstzen D, Bitzer E, Grimmer-Somers K. Physiotherapy students’ and clinical teachers’ perceptions of clinical learning opportunities: a case study. Med Teach. 2009; 31(3):102-15.
• [22]Copeland HL, Hewson MG. Developing and testing an instrument to measure the effectiveness of clinical teaching in an academic medical centre. Acad Med. 2000; 75(2):161-6.
• [23]Kernan WN, Hershman W, Alper EJ, Lee MY, Viscoli CM, Perry JR et al.. Disagreement between students and preceptors regarding the value of teaching behaviors for ambulatory care settings. Teach Learn Med. 2008; 20(2):143-50.
• [24]Prideaux D, Alexander H, Bower A, Dacre J, Haist S, Jolly B et al.. Clinical teaching: maintaining an educational role for doctors in the new health care environment. Med Educ. 2000; 34(10):820-6.
• [25]Elnicki DM, Cooper A. Medical students’perceptions of the elements of effective inpatient teaching by attending physicians and housestaff. J Gen Intern Med. 2005; 20(7):635-9.
• [26]Gerzina TM, McLean T, Fairley J. Dental clinical teaching: perceptions of students and teachers. J Dent Educ. 2005; 69(12):1377-84.
• [27]Stalmeijer RE, Dolmans D, Wolfhagen H, Muijtjens AM, Scherpbier A. The Maastricht Clinical Teaching Questionnaire (MTCQ) as a valid and reliable instrument for the evaluation of clinical teachers. Acad Med. 2010; 85(11):1732-8.
• [28]Laurent T, Weidner TG. Clinical instructors’ and student athletic trainers’ perceptions of helpful clinical instructor characteristics. J Athl Train. 2001; 36(1):58-61.
• [29]Hewson MB, Jensen N. An inventory to improve clinical teaching in the general internal medicine clinic. Med Educ. 1990; 24:518-27.
• [30]Boor K, Scheele F, Van Der Vleuten CP, Teunissen PW, Den Breejen EM, Scherpbier AJ. How undergraduate clinical learning climates differ: a multi‐method case study. Med Educ. 2008; 42(10):1029-36.
• [31]Dolmans D, Wolfhagen I, Heineman E, Scherpbier A. Factors adversely affecting student learning in the clinical learning environment: A student perspective. Education for Health. 2008; 20(3):e1-10.
• [32]Abey S, Lea S, Callaghan L, Cotton D, Shaw S. The development of a scale to assess practitioner capacity to engage in clinical education. Journal of Further and Higher Education. 2015; 39(2):22-240.
• [33]Beckman TJ, Ghosh AK, Cook DA, Erwin PJ, Mandrekar JN. How reliable are assessments of clinical teaching? J Gen Intern Med. 2004; 19(9):971-7.
• [34]Irby DM. Teaching and learning in ambulatory care settings: a thematic review of the literature. Acad Med. 1995; 70(10):898-931.
• [35]Fluit CR. Assessing the quality of clinical teachers. J Gen Intern Med. 2010; 25(12):1337-45.
• [36]van der Leeuw R, Lombarts K, Heineman MJ, Arah O. Systematic evaluation of the teaching qualities of obstetrics and gynecology faculty: reliability and validity of the SETO tools. PLoS One. 2011; 6(5):e19142.
• [37]Currens JB, Bithell CP. The 2: 1 clinical placement model: perceptions of clinical educators and students. Physiotherapy. 2003; 89(4):204-18.
• [38]Moore A, Morris J, Crouch V, Martin M. Evaluation of physiotherapy clinical educational models: comparing 1: 1, 2: 1 and 3: 1 placements. Physiotherapy. 2003; 89(8):489-501.
• [39]Martin M, Morris J, Moore A, Sadlo G, Crouch V. Evaluating practice education models in occupational therapy: Comparing 1: 1, 2: 1 and 3: 1 placements. The British Journal of Occupational Therapy. 2004; 67(5):192-200.
• [40]Beckman TJ, Cook DA, Mandrekar JN. Factor instability of clinical teaching assessment scores among general internists and cardiologists. Med Educ. 2006; 40(12):1209-16.
• [41]Kane MT. Current concerns in validity theory. J Educ Meas. 2001; 38(4):319-42.
• [42]Kane MT. Validation. In: Educational measurement. 4th ed. Brennan R, editor. Praeger Publishers, Westport, USA; 2006: p.17-64.
• [43]Cook DA. When I, say… validity. Med Educ. 2014; 48(10):948-9.
• [44]Roff S, McAleer S, Skinner A. Development and validation of an instrument to measure the postgraduate clinical learning and teaching environment for hospital-based junior doctors in the UK. Med Teach. 2005; 27(4):326-31.
• [45]Hudak PL, Wright JG. The Characteristics of Patient Satisfaction Measures. Spine. 2000; 25(24):3167-77.
• [46]Lozano LM, García-Cueto E, Muñiz J. Effect of the number of response categories on the reliability and validity of rating scales. Methodology. 2008; 4(2):73-9.
• [47]Oppenheim AN. Questionnaire design, interviewing and attitude measurement: Continuum International Publishing Group. 2000.
• [48]Gaskin CJ, Happell B. On exploratory factor analysis: A review of recent evidence, an assessment of current practice, and recommendations for future use. Int J Nurs Stud. 2014; 51:511-21.
• [49]Schmitt TA. Current methodological considerations in exploratory and confirmatory factor analysis. J Psychoeduc Assess. 2011; 29(4):304-21.
• [50]Baglin J. Improving your exploratory factor analysis for ordinal data: a demonstration using FACTOR. Practical Assessment, Research & Evaluation. 2014; 19(5):2.
• [51]Holgado–Tello FP, Chacón–Moscoso S, Barbero–García I, Vila–Abad E. Polychoric versus Pearson correlations in exploratory and confirmatory factor analysis of ordinal variables. Qual Quant. 2010; 44(1):153-66.
• [52]Basto M, Pereira JM. An SPSS R-Menu for ordinal factor analysis. J Stat Softw. 2012; 46(4):1-29.
• [53]Ruscio J, Roche B. Determining the number of factors to retain in an exploratory factor analysis using comparison data of known factorial structure. Psychol Assess. 2012; 24(2):282.
• [54]Garrido LE, Abad FJ, Ponsoda V. A new look at Horn’s parallel analysis with ordinal variables. Psychol Methods. 2013; 18(4):454.
• [55]Velicer WF. Determining the number of components from the matrix of partial correlations. Psychometrika. 1976; 41(3):321-7.
• [56]Zwick WR, Velicer WF. Comparison of five rules for determining the number of components to retain. Psychol Bull. 1986; 99(3):432.
• [57]Revelle W, Rocklin T. Very simple structure: An alternative procedure for estimating the optimal number of interpretable factors. Multivariate Behav Res. 1979; 14(4):403-14.
• [58]Raîche G, Walls TA, Magis D, Riopel M, Blais J-G. Non-graphical solutions for Cattell’s scree test. Methodology. 2013; 9(1):23.
• [59]Courtney R, Gordon M. Determining the Number of Factors to Retain in EFA: Using the SPSS R-Menu v2. 0 to Make More Judicious Estimations. Practical Assessment, Research & Evaluation. 2013;18(8).
• [60]R Core Team. R: A language and environment for statistical computing Vienna, Austria2014. Available from: http://www.R-project.org/.
• [61]Revelle W. psych; Procedures for Personality and Psychological Research Evanston, Illinois, USA: Northwestern University; 2014. 1.4.5: Available from: http://CRAN.R-project.org/package=psych.
• [62]Bernaards CA, Jennrich RI. Gradient projection algorithms and software for arbitrary rotation criteria in factor analysis. Educ Psychol Meas. 2005; 65(5):676-96.
• [63]Fox J. Polycor: polychoric and polyserial correlations. 2007.
• [64]Raiche G, Magis D. nFactors: Parallel analysis and non graphical solutions to the Cattell Scree Test 2010 [cited 2 2]. 60]. Available from: http://CRAN.R-project.org/package=nFactors.
• [65]Sass DA, Schmitt TA. A comparative investigation of rotation criteria within exploratory factor analysis. Multivariate Behav Res. 2010; 45(1):73-103.
• [66]Schmitt TA, Sass DA. Rotation criteria and hypothesis testing for exploratory factor analysis: Implications for factor pattern loadings and interfactor correlations. Educ Psychol Meas. 2011; 71(1):95-113.
• [67]Hair JF, Anderson RE, Tatham RL, William C. Multivariate data analysis. London, UK, Prentice Hall; 1998.
• [68]Tabachnick BG, Fidell LS. Using multivariate statistics. 5th ed. Allyn and Bacon, Boston; 2007.
• [69]MacCallum RC, Widaman KF, Zhang S, Hong S. Sample size in factor analysis. Psychol Methods. 1999; 4(1):84.
• [70]Zumbo BD, Gadermann AM, Zeisser C. Ordinal versions of coefficients alpha and theta for Likert rating scales. J Mod Appl Stat Methods. 2007; 6(1):4.
• [71]Gadermann AM, Guhn M, Zumbo BD. Estimating ordinal reliability for Likert-type and ordinal item response data: A conceptual, empirical, and practical guide. Practical Assessment, Research & Evaluation. 2012; 17(3):1-13.
• [72]Boerboom TB, Mainhard T, Dolmans DH, Scherpbier AJ, Van Beukelen P, Jaarsma AC. Evaluating clinical teachers with the Maastricht clinical teaching questionnaire: How much’teacher’is in student ratings? Med Teach. 2012; 34(4):320-6.
• [73]Rethans JJ, Norcini J, Barón-Maldonado M, Blackmore D, Jolly BC, LaDuca T et al.. The relationship between competence and performance: implications for assessing practice performance. Med Educ. 2002; 36:901-19.
• [74]Griffith CH, Georgeson JC, Wilson JF. Six-year documentation of the association between excellent clinical teaching and improved students’ examination performances. Acad Med. 2000; 75(10):S62-4.
• [75]Bates J, Konkin J, Suddards C, Dobson S, Pratt D. Student perceptions of assessment and feedback in longitudinal integrated clerkships. Med Educ. 2013; 47(4):362-74.
• [76]Litzelman DK, Stratos G, Marriott D, Skeff K. Factorial validation of a widely disseminated educational framework for evaluating clinical teachers. Acad Med. 1998; 73(6):688-95.
• [77]Kikukawa M, Nabeta H, Ono M, Emura S, Oda Y, Koizumi S et al.. The characteristics of a good clinical teacher as perceived by resident physicians in Japan: a qualitative study. BMC Med Educ. 2013; 13(1):100. BioMed Central Full Text
• [78]Kelly C. Student’s perceptions of effective clinical teaching revisited. Nurse Educ Today. 2007; 27(8):885-92.
• [79]Van de Ridder J, Stokking KM, McGaghie WC, Ten Cate OTJ. What is feedback in clinical education? Med Educ. 2008; 42(2):189-97.
• [80]Bennett D, Kelly M, O’Flynn S. Framework for feedback: the peer mini‐clinical examination as a formative assessment tool. Med Educ. 2012; 46(5):512.
• [81]Pelgrim E, Kramer A, Mokkink H, Van der Vleuten C. Quality of written narrative feedback and reflection in a modified mini-clinical evaluation exercise: an observational study. BMC Med Educ. 2012; 12(1):97. BioMed Central Full Text
• [82]Schweitzer PJ, Rice TR. The student-run clinic: a new opportunity for psychiatric education. Acad Psychiatry. 2012; 36(3):233-6.
• [83]Fryer G. Muscle energy technique: An evidence-informed approach. Int J Osteopath Med. 2011; 14(1):3-9.
• [84]Fryer G. Teaching critical thinking in osteopathy–Integrating craft knowledge and evidence-informed approaches. Int J Osteopath Med. 2008; 11(2):56-61.
• [85]Peterson R. A meta-analysis of Cronbach’s coefficient alpha. J Consum Res. 1994; 21:381-91.