This consensus study is the first to identify a range of characteristics perceived by clinical educators as indicators of an allied health student who is prepared and ready for a clinical learning opportunity. Six themes with a total of 57 characteristics were identified as being important. By conducting this study, a set of attributes relating to behaviours has been compiled and could be provided to students to aid their preparation for clinical learning. The final list of characteristics represents the consensus opinion of 161 experts in clinical education in Queensland, Australia. Of these, just over half the sample had more than five years experience as a clinical educator. In addition, we used several analytical methods (inter-quartile deviation, percentage agreement scores) to determine when consensus was reached. Cronbach’s alpha, which ranged between 0.85-0.94 for the second round, should be considered substantial and is consistent with reliability scores obtained for validated scales in clinical use [29
]. Our methodical and analytical approach, in addition to the solicitation of experienced clinical educators, ensures the developed list of attributes has content validity.
There are several interesting outcomes from this research. The first obvious finding is the large number of characteristics developed by the expert panel. However, some are not perceived to be as important as others. The three themes viewed as more important than others were ‘willingness’, ‘professionalism’ and ‘personal attributes’. For example, nine of 10 characteristics in the ‘willingness’ theme were viewed as important by over 90 per cent of participants. This contrasts to the theme ‘knowledge and understanding’ where only one of ten characteristics scored above 90 per cent. Thus, clinical educators’ views on preparedness appear based on external professional traits such as appropriate dress and appearance, along with a willingness to be involved in learning rather than a specific level of knowledge and understanding they portray commencing a placement. This may reflect the view that educators believe that knowledge takes longer to demonstrate or is developed in the context of clinical learning. Thus, it could be argued that perceptions of readiness to learn are represented by an initial phase that focuses on demonstrated external features of professional and interpersonal behaviours.
Second, the attributes developed by the expert panel were predominantly generic in nature. No attributes were raised that were profession-specific such as a particular clinical skill or assessment technique. This result is similar to that reported by Cross who identified eight constructs that were considered desirable for physiotherapy students on clinical placement: professional, abilities/persona, safety, communication, general disposition, knowledge base, approach to learning and commitment [15
]. In our study, the focus on generic attributes appeared to occur irrespective of the discipline. This finding reaffirms the focus by universities on students’ development of generic attributes and also suggests that educators believe that profession specific skills are likely to be consolidated during clinical placement.
Third, supervisors in this study appear to be focused on students’ readiness to engage in the learning environment through their personal attributes, willingness and demonstration of knowledge. The results support the status of these students as adult learners to take responsibility for their learning and demonstrate their willingness to activity engage. To build on the advantage of situated learning, educators and universities need to promote clinical learning experiences with learners as part of the clinical environment rather than being temporary adjuncts [30
]. The findings of this study promote understanding of how best to facilitate students’ transition into professional practice environments so they become more than a temporary adjunct.
A surprising outcome was the perception by our sample that it was not important for a student to demonstrate knowledge of other professions and their roles. Awareness of interprofessional practice is an important graduate skill [31
]. Our findings suggest that clinical educators may have viewed work-based learning as the location where students learn about and from other professions. Alternatively, the judgements of clinical educators are influenced by their professional competency statements that feed into the assessment tools used to evaluate students during clinical education placements [31
]. Across the professions, the assessment tools and overarching competency statements tend to encapsulate interprofessional engagement implicitly under an umbrella of descriptors such as professional communication and professional behaviour [32
]. This explanation may account for the identification by clinical educators of traits such as ‘the student is willing to work as a team with peers, colleagues and other health professionals’ and ‘the student is able to communicate professionally with members of the multidisciplinary team.’
Another interesting finding is the absence of indicators relating to knowledge and use of technology. In a health and education environment where technology in the form of communication via e-health and telehealth systems is increasing in popularity, universities are addressing the use of technology for providing efficient and effective health outcomes [35
]. A possible interpretation is that clinical educators believe that these skills are inherent in every student and that, therefore, they do not need to be stated. An alternative explanation is that educators do not consider knowledge of technology practices an important skill for clinical practice. The latter explanation disregards contemporary thought about health and education practice but further investigation and clarification with educators would shed light on this disparity.
This Delphi study had a few limitations. First, the sample of clinical educators was from one state in Australia and may not be generalisable to other states or countries. Second, while the response rates are comparable to other similar studies, our response rate of 40.6 per cent and 25.3 per cent in the first and second rounds may have led to self selection bias [10
]. This means that the non-responders may have had systematically different responses than those who elected to respond. However, our retention rate between the two rounds suggests considerable interest in the topic by the responders. Third, there is an issue of whether or not the 'learned consensus' has validity beyond demonstrating the preconceptions of educators and encouraging students to 'play the game' by meeting these. Finally, while the educators were all involved in the provision of formal clinical block placements, there is the potential that each educator may have had different conceptions of teaching that may have impacted upon the results. To some degree, this was mitigated against by the Delphi methodology that encourages participants to reassess their initial judgments about the information provided in previous iterations. This approach created a list of characteristics that could be used by students to help them prepare for placements as it benchmarks the implicit views and consensus opinion of each of the three professions in Queensland. Further research is required to understand the basis for the views of the educators and whether there are differences in the perceptions between professions.