- Email: [email protected]
Practitioners in physiotherapy
Physiotherapy 90 (2004) 139–144
National survey of Lecturer/Practitioners in physiotherapy K. Stevenson a,b,∗ , A.V. Chadwick b,c , S.M. Hunter b b
a University Hospital of North Staffordshire, Staffordshire, UK Department of Physiotherapy Studies, Keele University, Staffordshire, UK c Mid-Staffordshire General Hospitals NHS Trust, Staffordshire, UK
Abstract Purpose The purpose of this investigation was to identify variations that existed in Lecturer/Practitioner roles and the need for a national support network. Procedure Twenty-eight academic physiotherapy departments were contacted to establish whether Lecturer/Practitioners were employed. Questionnaires were sent to named individuals employed as Lecturer/Practitioners. Data were analysed using descriptive statistics and themed content analysis for open-ended responses. Main findings Twenty-four physiotherapists were identified from eight universities in England and Northern Ireland and 19 responded. Mean length of time from qualification was 12 years. Specialities within which Lecturer/Practitioners were employed varied, with the most frequent being musculoskeletal. Eleven respondents had fixed-term contracts of employment, and only six had permanent contracts. Lecturer/Practitioners identified a three-way split between clinical work, academic teaching, and research. The time for each component was not consistent. Most Lecturer/Practitioners identified that they were working in excess of their contractual hours. Whilst it was identified that this role is beneficial for career development, primary concerns around time management, the job split, difficulty keeping up to date, and lack of personal development were highlighted. Conclusion This is the first survey to examine the role of the physiotherapy Lecturer/Practitioner in some detail. It is essential for those applying for such positions and for those employing Lecturer/Practitioners to provide realistic achievable aims within the role. As a conclusion of this survey, a web-based support network has been established. © 2004 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved. Keywords: Lecturer/Practitioner; Survey; Role definition; Support network
Background/purpose The role of Lecturer/Practitioner is relatively new within the physiotherapy profession [1]. Such a role has existed in nursing since the mid 1980s and arose from the need to educate students within the clinical environment and address the perceived differences between what was being taught in the classroom and actual clinical practice, known as the ‘theory-practice gap’ [2], as well as strengthen links between academic and clinical settings and enable teachers to retain clinical expertise and credibility [3]. Although entitled “Lecturer/Practitioner”, these nursing posts were based initially in the clinical environment rather than in an academic environment but conferred educational responsibilities upon the postholder. Nurse Lecturer/Practitioners were intended to be supernumerary to ward establishment [2,3]. ∗
Corresponding author. E-mail address: [email protected] (K. Stevenson).
The purpose of this survey was to identify physiotherapists currently employed as Lecturer/Practitioners in the United Kingdom, explore definitions of and variations within the role, identify characteristics of employment (NHS or academic environments), identify how Lecturer/Practitioners maintain clinical expertise and address personal development needs, identify concerns about the role, and explore the need for a physiotherapy Lecturer/Practitioner support network. Little has been written about the role of the physiotherapy Lecturer/Practitioner which may be considered a different role from that of nursing colleagues. Certainly, the physiotherapy Lecturer/Practitioner role has evolved as a new career option for experienced clinicians who wish to combine a teaching and research role. This seems to be in contrast to the advent of the nurse Lecturer/Practitioner whose main responsibility is reported to be educating the students in the clinical environment. In the absence of a physiotherapy Lecturer/Practitioner definition, reference to the nursing
0031-9406/$ – see front matter © 2004 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.physio.2004.01.003
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K. Stevenson et al. / Physiotherapy 90 (2004) 139–144
literature provides several, highlighting the three key areas of the role: teaching, clinical expertise, and research: An individual who has authority over work organisation, the delivery of care and allocation of resources within a clinical area, who maintains her/his own practice skills, teaches practice, informs and influences current curriculum design and development. [4] Advantages of the Lecturer/Practitioner role have been summarised in the nursing literature [2,3,5] as: reducing the theory-practice gap, improving the professional profile, implementing evidence into clinical practice, and ensuring that undergraduate education reflects real life clinical practice. A significant advantage for the individual could be the unique opportunity to develop teaching and clinical skills simultaneously [1]. Challenges associated with the role of the Lecturer/ Practitioner have been identified [6,7]. These include the challenge of working within differing clinical and academic cultures, a feeling of not belonging fully to a team [1], and lack of a clear career structure, all of which potentially lead to a high risk of burnout [8]. Fairbrother and Ford [2] raise the issue of clinical and academic credibility. Whilst clinical credibility seems an aspect of the Lecturer/Practitioner role that is least likely to be challenged, concern is expressed that support for the post-holder of such a complex role must be tangible. Elcock [3] suggested that comparisons between Lecturer/Practitioner posts are extremely difficult, given that each post is multi-faceted, complex and unique. In 1999, The Chartered Society of Physiotherapy published guidelines for those considering undertaking the role of Lecturer/Practitioner, which suggest that these posts facilitate a closer partnership between the Universities and NHS Trusts, viewing this as a useful method of disseminating evidence-based practice. The role is also expected to incorporate the three key areas of teaching, clinical expertise and research whilst it is anticipated that each individual post will be unique, defined by local needs and the expertise of the individual Lecturer/Practitioner [2,3].
Methodology
role definition, job variations, research activity, clinical expertise and academic roles. Additional information was requested to identify a maximum of three research interests, provide an estimate of the percentage of contracted time devoted to each of the three key roles (teaching, clinical practice and research) to the nearest 5%, and offer views of the development of a Lecturer/Practitioner network and its potential format. Questionnaires were piloted by 10 academic and clinical physiotherapists including Lecturer/Practitioners, and clinical nursing colleagues to ascertain the ease of completion and any question ambiguity. Subsequent minor amendments were made to enhance the clarity of the questions. Subject recruitment Twenty-eight academic physiotherapy departments were identified through the list of recognised Physiotherapy Qualifying Programmes [1]. Individual institutions were subsequently contacted by telephone during the spring of 1998, to determine whether Lecturer/Practitioners were employed. Permission was sought and granted from each Head of Department to contact named individuals, who were each sent a questionnaire to complete and return within 4 weeks using the stamped addressed envelope provided. In addition, all subjects and managers were required to give verbal/written informed consent. Those included in the survey, therefore, were all consenting physiotherapists employed as Lecturer/Practitioners in the United Kingdom. Data analysis Closed questions provided nominal data, which were coded and summarised using descriptive statistics. Thematic content analysis [9] was used to collapse the qualitative data into themes from the open responses. Academic colleagues assisted in the analysis of the open-ended questions relating to research interests. Reliability of the themes was established through the process of investigator triangulation [10]. Differences were resolved through discussion.
Design Results A postal questionnaire was used to collect qualitative and quantitative data which included open and closed questions. Questionnaire development The questionnaire was designed following discussion with physiotherapists working in an academic environment, including three Lecturer/Practitioners. Twenty-one items were generated focusing on different aspects of the Lecturer/Practitioner role. Respondents were asked to provide information about contractual details, length of time in post,
Subjects Twenty-four physiotherapists employed as a Lecturer/Practitioner were identified from eight universities in England and Northern Ireland. A total of 19 individuals completed and returned the questionnaire, yielding a response rate of 79%. The mean length of time post qualification was 12 years. Seven subjects were employed in the musculoskeletal speciality, four in neurology, three in respiratory care and five in other specialities (Table 1).
K. Stevenson et al. / Physiotherapy 90 (2004) 139–144 Table 1 Clinical specialities of the Lecturer/Practitioners surveyed Speciality
n
Musculoskeletal Neurology Respiratory care Multiple Elderly care Rheumatology Not applicable Total
141
Table 2 Themes of research interests stated by the respondents Percent
7 4 3 2 1 1 1
37 21 16 11 5 5 5
19
100
Theme
n
Musculoskeletal issues Neurology Cardio-respiratory care Psychosocial issues Evidence-based practice and education Research methods and outcomes
18 14 6 6 5 4
Respondents could identify more than one area of research interest.
Personal development and research Employment details Six respondents were employed under a permanent contract and 11 under fixed term contracts for between 1 and 5 years (1 year n = 1; 2 years n = 2; 3 years n = 7; 5 years n = 1). Two of these held a mixed contract (permanent contract with the NHS and fixed term contract with the University). Nine subjects were employed principally by the academic institution, six by the NHS, and four jointly by both a University and NHS Trust. Time split between roles The majority of respondents (13/19) indicated that between 25–50% of their contracted time was spent in each of the academic and clinical roles. Fifteen subjects estimated that up to 25% of contracted time was allocated to research. However, four respondents estimated that 51–100% of their time was devoted to the academic role, whereas only two estimated the same time was allocated to clinical commitments. Fig. 1 highlights the percentage time allocated to each element of the Lecturer/Practitioner’s role. Thirteen subjects indicated that they regularly worked in excess of their contracted hours, with eight working up to an additional 8 h per week and four working more than an additional 8 h per week. One subject indicated that excess working hours varied.
Number of respondents
16 14 12 10
Academic Clinical Research
8 6 4 2 0 0-25
26-50
51-75
76-100
Percentage of time devoted to each activity Fig. 1. Time devoted to each of the three key aspects of the Lecturer/ Practitioner’s role.
Thirteen responders were registered for a higher degree, although only seven stated that their contract required this. Eight of these were registered on M-level programmes and five on doctoral programmes. Forty-three separate areas of research interests were generated which were subsequently collapsed down into six themes (Table 2). Thirteen responders had published between one and six papers in the last 5 years, in academic/peer reviewed professional journals. Figs. 2–4 summarise the main themes identified around personal development. Attendance on courses was identified as the most common method of developing teaching skills (11/19) and support of colleagues was the most important method of developing research skills (8/19). Patient contact was the most common method of maintaining clinical expertise (11/19). Need for a Lecturer/Practitioner network A Lecturer/Practitioner network was considered to be ‘helpful’ or ‘very helpful’ (16/19). Three subjects were ‘uncertain’. Perceived benefits of a Lecturer/Practitioner network are shown in Table 3. Suggestions for the network format are shown in Table 4. Table 3 Respondents’ views on perceived benefits of having a Lecturer/Practitioner network showing the number of respondents for each benefit Perceived benefits of a Lecturer/Practitioner network
n
Peer support Exploring role definition Facilitation of research contacts Shaping the future
13 11 5 3
Table 4 Potential forms of Lecturer/Practitioner support network showing the number of respondents per form Potential forms of Lecturer/Practitioner support network
n
Special interest group National database Regular meetings Contact through e-mail Linking with other professions
10 9 6 2 1
142
K. Stevenson et al. / Physiotherapy 90 (2004) 139–144 9 8 7
Frequency
6 5 4 3 2 1 0 Colleagues
Courses
Masters/PhD
Supervision
Methods to develop research skills
Fig. 2. Factors identified by Lecturer/Practitioners in the development of research skills.
12 10
Frequency
8 6 4 2 0 Patients
Courses
ISE
SIG
Literature
Methods to maintain clinical expertise Fig. 3. Factors identified by Lecturer/Practitioners in the maintenance of clinical expertise.
12 10
Frequency
8 6 4 2 0 Courses
Experience
Peers
Methods to develop teaching skills Fig. 4. Factors identified by Lecturer/Practitioners in the development of teaching skills.
Qualification
K. Stevenson et al. / Physiotherapy 90 (2004) 139–144
Concerns about the role of the Lecturer/Practitioner The primary concerns that emerged were time management (11/19), the job split (10/19), difficulty keeping up to date (4/19) and lack of personal development (3/19): Excellent role with great opportunities but not be undertaken lightly, interestingly in my experience Lecturer/Practitioners seem to switch quickly to becoming just lecturers which is shame. (Respondent 4) Clinic work appears not to be valued by the university in the same way as it is by medicine i.e. clinical training is well rewarded within the field of medicine. It would be great to see physiotherapy clinical work equally well respected. (Respondent 7) Additional information and concerns Most of the subjects (17/19) stated that there was a lack of understanding of the role of the Lecturer/Practitioner by colleagues and it was frustrating having joint managers and multiple potentially conflicting responsibilities (16/19): There is a lack of understanding among the full time academic staff as to what these posts entail. (Respondent 17) Fall between two stools for training, i.e. each institution thinks the other one has it covered. Must have a clear understanding that you work half time in each role, not full time in both parts. (Respondent 19) The role of Lecturer/Practitioner varied between establishments (14/19): The role of Lecturer/Practitioner seams to have many and varied interpretations in different establishments. (Respondent 14) However, the overall experiences of the role were reported to be enjoyable (11/19): I thoroughly enjoy both sides of the job, which do feed into each other. (Respondent 2) I am thoroughly enjoying the job and great colleagues. (Respondent 11)
Discussion This survey of Lecturer/Practitioners in England highlights important issues for those considering entering such roles and for those who are considering employing Lecturer/Practitioners within their institution. Whilst the numbers within the study are small they represents a large cross-section of those employed at the time of the survey. There is little prior evidence examining the role or the impact of Lecturer/Practitioners within Physiotherapy.
143
Literature that is available relates to the nursing profession and is mainly anecdotal in its nature, examining the concept of Lecturer/Practitioners rather than surveying those in post [3]. Whilst recognising that the nursing profession is unique and distinct from physiotherapy, nursing appears to be the only other profession to have embraced the role of the Lecturer/Practitioner. Identifying the roles and responsibilities of these posts have been problematic across the professions with nursing recognising that these posts work in relative isolation and it is therefore difficult to gain a true picture of the role [7]. Physiotherapists appear to gain significant clinical experience before applying for posts as Lecturer/Practitioner recognising the opportunity for greater career choice when reaching senior clinical grades. The addition of the Lecturer/Practitioner post to the career path allows physiotherapists to sample the academic environment without having to relinquish clinical skills and patient contact. The nursing literature identified clinical expertise as vital in maintaining clinical credibility among students and providing expert role models [8]. However, in nursing, Lecturer/Practitioners have been viewed as informal teachers in clinical areas [8], whereas Physiotherapy Lecturer/Practitioners are being firmly embedded within the academic framework with formal teaching and academic responsibility. Our survey has highlighted that great variations exist in the construction of individual posts. The majority of Lecturer/Practitioners work within the musculoskeletal speciality, possibly due to the relative ease of managing a clinical load on a sessional basis. This may not be so easily achieved in neurology or respiratory care. The variation in contract details reflects individual organisations establishing posts to best suit their individual needs. The high incidence of fixed term contracts suggests that employers are testing these posts and examining their success over a period of 1–5 years. The Lecturer/Practitioner post appears to be drawing together three strands of practice: teaching, clinical practice and research. Time allocated to each activity is variable, but the two main areas are teaching and clinical practice. However, to operate effectively within an academic environment and ensure that clinical practice is evidence based, it is recognised that the research element of the role is vital. Academic institutions may already have established researchers and therefore the Lecturer/Practitioner may be employed primarily for teaching up-to-date practice. Although all Lecturer/Practitioners allocated the least time to research, the scope of their research interests was diverse, including not only aspects of a clinical speciality, but also broader issues such as education, evidence-based practice; research methods and outcomes, illustrating the diversity of individual interests of Lecturer/Practitioners as well as the opportunity to broaden their research interests. Whilst having only a small amount of time for research, the majority had published work in academic and peer reviewed journals. Once in post, Lecturer/Practitioners demonstrate a strong sense of personal development with the majority registered
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for a higher degree. However, only half stated that this was a requirement of the job. Post holders utilised many different learning opportunities to enhance their skills within the new roles, to develop teaching, research and clinical skills. The Lecturer/Practitioner has to be flexible and adaptable to create learning opportunities in the separate working environments. The need for a support structure for individuals within the post was clearly demonstrated. Lecturer/Practitioner positions are still relatively new within physiotherapy and are small in number. The formation of a support structure for problem solving, peer support, research contacts and shaping the future would appear a reasonable method of giving confidence to those in post. The variety of suggestions for this network highlights that not one single method would support all Lecturer/Practitioners adequately. A support structure would have to be as flexible as each Lecturer/Practitioner in post, whilst still allowing post holders to establish support systems for themselves in their own work areas. The concerns highlighted by the Physiotherapy Lecturer/Practitioners are in keeping with evidence from the nursing profession. Issues such as time management, concerns over the job split, difficulty keeping up to date and lack of personal development have all been identified previously [4,6,11]. Within this study we identified that Lecturer/Practitioners work frequently in excess of their contractual hours. Trying to deliver in three separate areas of practice can create a feeling of overwork. Whilst the Lecturer/Practitioners appear to be able to create learning opportunities for themselves, they still need time to achieve their aims. As this role is relatively new, Lecturer/Practitioners identified the need for peer support and a clear definition of the role, which needs to be understood by both clinical and academic colleagues. This lends weight to Hollingsworth’s view [4] that the lack of understanding of the role was a concern, and that this must be clearly defined to avoid unrealistic expectations of what is possible. Both this survey and previous studies [4,6] have highlighted the fact that physiotherapy and nursing Lecturer/Practitioners are concerned about the heavy demands on time, conflicting priorities and pressures of undertaking the equivalent of ‘two jobs with two masters’ [4,11].
Conclusion This survey has highlighted the variations that exist in all aspects of the Lecturer/Practitioner role, from contractual differences, to differences in time allocated to each element
of the role. To prevent role overload or burn out it is imperative that those employing Lecturer/Practitioner have a clear understanding of the requirement of each element of the role and the time available to deliver those objectives. A strong relationship between the clinical and the university management team could ensure the appropriate division of roles and could monitor performance and need for support. This could be achieved by a collaborative university and clinical appraisal, each management base evaluating the effect of the role and contributing to the planning of future objectives. The Lecturer/Practitioners appear to be a group who can facilitate their own learning but still require a support structure. As a consequence of this survey a national database of existing Lecturer/Practitioners has been constructed, through which contact can be made with peers. This web site includes contact details, clinical specialties, research interest, Lecturer/Practitioner reference list, as well as details of related presentations at national conferences (http://www.keele.ac.uk/depts/pt/lect pract/home.htm). Future developments will include Lecturer/Practitioner discussion sites and raising the awareness of this facility and ongoing research in this area to newly appointed post holders.
References [1] Chartered Society of Physiotherapy. Guidelines for members considering a post as a Lecturer/Practitioner and for higher education institutions considering employment of a Lecturer-Practitioner. Information paper CPD 20. London: Chartered Society of Physiotherapy; 1999. [2] Fairbrother P, Ford S. Lecturer practitioners: a literature review. J Adv Nurs 1998;27:274–9. [3] Elcock K. Lecturer practitioner: a concept analysis. J Adv Nurs 1998;28(5):1092–8. [4] McGee P. An evaluation of the lecturer-practitioner role in the independent health care sector. J Clin Nurs 1998;7(3):251–6. [5] Lathlean J. The implementation and development of lecturer practitioner roles in nursing. Oxford: Ashdale Press; 1995. [6] Willis J. Lecturer-practitioners: serving two masters for a common cause. Nurs Times Learn Curve 1998;1(12):6–7. [7] Woodrow P. Role of the Lecturer Practitioner. 2. Br J Nurs 1994;3(12):611–4. [8] Bowling A. Research methods in health—investigating health and health services. Buckingham: Open University Press; 1997. [9] Sim J, Wright C. Research in healthcare—concepts, designs and methods. Cheltenham: Stanley Thornes Publishers Ltd.; 2000. [10] Burke LM. The future of the specialist nurse teacher: two different models explored. Nurs Educ Today 1993;13:40–6. [11] Hollingworth S. Lecturer-Practitioner roles in England. A report prepared for the chief nursing officer/director of nursing. Leeds: NHS Executive; 1997.
National survey of Lecturer/Practitioners in physiotherapy K. Stevenson a,b,∗ , A.V. Chadwick b,c , S.M. Hunter b b
a University Hospital of North Staffordshire, Staffordshire, UK Department of Physiotherapy Studies, Keele University, Staffordshire, UK c Mid-Staffordshire General Hospitals NHS Trust, Staffordshire, UK
Abstract Purpose The purpose of this investigation was to identify variations that existed in Lecturer/Practitioner roles and the need for a national support network. Procedure Twenty-eight academic physiotherapy departments were contacted to establish whether Lecturer/Practitioners were employed. Questionnaires were sent to named individuals employed as Lecturer/Practitioners. Data were analysed using descriptive statistics and themed content analysis for open-ended responses. Main findings Twenty-four physiotherapists were identified from eight universities in England and Northern Ireland and 19 responded. Mean length of time from qualification was 12 years. Specialities within which Lecturer/Practitioners were employed varied, with the most frequent being musculoskeletal. Eleven respondents had fixed-term contracts of employment, and only six had permanent contracts. Lecturer/Practitioners identified a three-way split between clinical work, academic teaching, and research. The time for each component was not consistent. Most Lecturer/Practitioners identified that they were working in excess of their contractual hours. Whilst it was identified that this role is beneficial for career development, primary concerns around time management, the job split, difficulty keeping up to date, and lack of personal development were highlighted. Conclusion This is the first survey to examine the role of the physiotherapy Lecturer/Practitioner in some detail. It is essential for those applying for such positions and for those employing Lecturer/Practitioners to provide realistic achievable aims within the role. As a conclusion of this survey, a web-based support network has been established. © 2004 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved. Keywords: Lecturer/Practitioner; Survey; Role definition; Support network
Background/purpose The role of Lecturer/Practitioner is relatively new within the physiotherapy profession [1]. Such a role has existed in nursing since the mid 1980s and arose from the need to educate students within the clinical environment and address the perceived differences between what was being taught in the classroom and actual clinical practice, known as the ‘theory-practice gap’ [2], as well as strengthen links between academic and clinical settings and enable teachers to retain clinical expertise and credibility [3]. Although entitled “Lecturer/Practitioner”, these nursing posts were based initially in the clinical environment rather than in an academic environment but conferred educational responsibilities upon the postholder. Nurse Lecturer/Practitioners were intended to be supernumerary to ward establishment [2,3]. ∗
Corresponding author. E-mail address: [email protected] (K. Stevenson).
The purpose of this survey was to identify physiotherapists currently employed as Lecturer/Practitioners in the United Kingdom, explore definitions of and variations within the role, identify characteristics of employment (NHS or academic environments), identify how Lecturer/Practitioners maintain clinical expertise and address personal development needs, identify concerns about the role, and explore the need for a physiotherapy Lecturer/Practitioner support network. Little has been written about the role of the physiotherapy Lecturer/Practitioner which may be considered a different role from that of nursing colleagues. Certainly, the physiotherapy Lecturer/Practitioner role has evolved as a new career option for experienced clinicians who wish to combine a teaching and research role. This seems to be in contrast to the advent of the nurse Lecturer/Practitioner whose main responsibility is reported to be educating the students in the clinical environment. In the absence of a physiotherapy Lecturer/Practitioner definition, reference to the nursing
0031-9406/$ – see front matter © 2004 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.physio.2004.01.003
140
K. Stevenson et al. / Physiotherapy 90 (2004) 139–144
literature provides several, highlighting the three key areas of the role: teaching, clinical expertise, and research: An individual who has authority over work organisation, the delivery of care and allocation of resources within a clinical area, who maintains her/his own practice skills, teaches practice, informs and influences current curriculum design and development. [4] Advantages of the Lecturer/Practitioner role have been summarised in the nursing literature [2,3,5] as: reducing the theory-practice gap, improving the professional profile, implementing evidence into clinical practice, and ensuring that undergraduate education reflects real life clinical practice. A significant advantage for the individual could be the unique opportunity to develop teaching and clinical skills simultaneously [1]. Challenges associated with the role of the Lecturer/ Practitioner have been identified [6,7]. These include the challenge of working within differing clinical and academic cultures, a feeling of not belonging fully to a team [1], and lack of a clear career structure, all of which potentially lead to a high risk of burnout [8]. Fairbrother and Ford [2] raise the issue of clinical and academic credibility. Whilst clinical credibility seems an aspect of the Lecturer/Practitioner role that is least likely to be challenged, concern is expressed that support for the post-holder of such a complex role must be tangible. Elcock [3] suggested that comparisons between Lecturer/Practitioner posts are extremely difficult, given that each post is multi-faceted, complex and unique. In 1999, The Chartered Society of Physiotherapy published guidelines for those considering undertaking the role of Lecturer/Practitioner, which suggest that these posts facilitate a closer partnership between the Universities and NHS Trusts, viewing this as a useful method of disseminating evidence-based practice. The role is also expected to incorporate the three key areas of teaching, clinical expertise and research whilst it is anticipated that each individual post will be unique, defined by local needs and the expertise of the individual Lecturer/Practitioner [2,3].
Methodology
role definition, job variations, research activity, clinical expertise and academic roles. Additional information was requested to identify a maximum of three research interests, provide an estimate of the percentage of contracted time devoted to each of the three key roles (teaching, clinical practice and research) to the nearest 5%, and offer views of the development of a Lecturer/Practitioner network and its potential format. Questionnaires were piloted by 10 academic and clinical physiotherapists including Lecturer/Practitioners, and clinical nursing colleagues to ascertain the ease of completion and any question ambiguity. Subsequent minor amendments were made to enhance the clarity of the questions. Subject recruitment Twenty-eight academic physiotherapy departments were identified through the list of recognised Physiotherapy Qualifying Programmes [1]. Individual institutions were subsequently contacted by telephone during the spring of 1998, to determine whether Lecturer/Practitioners were employed. Permission was sought and granted from each Head of Department to contact named individuals, who were each sent a questionnaire to complete and return within 4 weeks using the stamped addressed envelope provided. In addition, all subjects and managers were required to give verbal/written informed consent. Those included in the survey, therefore, were all consenting physiotherapists employed as Lecturer/Practitioners in the United Kingdom. Data analysis Closed questions provided nominal data, which were coded and summarised using descriptive statistics. Thematic content analysis [9] was used to collapse the qualitative data into themes from the open responses. Academic colleagues assisted in the analysis of the open-ended questions relating to research interests. Reliability of the themes was established through the process of investigator triangulation [10]. Differences were resolved through discussion.
Design Results A postal questionnaire was used to collect qualitative and quantitative data which included open and closed questions. Questionnaire development The questionnaire was designed following discussion with physiotherapists working in an academic environment, including three Lecturer/Practitioners. Twenty-one items were generated focusing on different aspects of the Lecturer/Practitioner role. Respondents were asked to provide information about contractual details, length of time in post,
Subjects Twenty-four physiotherapists employed as a Lecturer/Practitioner were identified from eight universities in England and Northern Ireland. A total of 19 individuals completed and returned the questionnaire, yielding a response rate of 79%. The mean length of time post qualification was 12 years. Seven subjects were employed in the musculoskeletal speciality, four in neurology, three in respiratory care and five in other specialities (Table 1).
K. Stevenson et al. / Physiotherapy 90 (2004) 139–144 Table 1 Clinical specialities of the Lecturer/Practitioners surveyed Speciality
n
Musculoskeletal Neurology Respiratory care Multiple Elderly care Rheumatology Not applicable Total
141
Table 2 Themes of research interests stated by the respondents Percent
7 4 3 2 1 1 1
37 21 16 11 5 5 5
19
100
Theme
n
Musculoskeletal issues Neurology Cardio-respiratory care Psychosocial issues Evidence-based practice and education Research methods and outcomes
18 14 6 6 5 4
Respondents could identify more than one area of research interest.
Personal development and research Employment details Six respondents were employed under a permanent contract and 11 under fixed term contracts for between 1 and 5 years (1 year n = 1; 2 years n = 2; 3 years n = 7; 5 years n = 1). Two of these held a mixed contract (permanent contract with the NHS and fixed term contract with the University). Nine subjects were employed principally by the academic institution, six by the NHS, and four jointly by both a University and NHS Trust. Time split between roles The majority of respondents (13/19) indicated that between 25–50% of their contracted time was spent in each of the academic and clinical roles. Fifteen subjects estimated that up to 25% of contracted time was allocated to research. However, four respondents estimated that 51–100% of their time was devoted to the academic role, whereas only two estimated the same time was allocated to clinical commitments. Fig. 1 highlights the percentage time allocated to each element of the Lecturer/Practitioner’s role. Thirteen subjects indicated that they regularly worked in excess of their contracted hours, with eight working up to an additional 8 h per week and four working more than an additional 8 h per week. One subject indicated that excess working hours varied.
Number of respondents
16 14 12 10
Academic Clinical Research
8 6 4 2 0 0-25
26-50
51-75
76-100
Percentage of time devoted to each activity Fig. 1. Time devoted to each of the three key aspects of the Lecturer/ Practitioner’s role.
Thirteen responders were registered for a higher degree, although only seven stated that their contract required this. Eight of these were registered on M-level programmes and five on doctoral programmes. Forty-three separate areas of research interests were generated which were subsequently collapsed down into six themes (Table 2). Thirteen responders had published between one and six papers in the last 5 years, in academic/peer reviewed professional journals. Figs. 2–4 summarise the main themes identified around personal development. Attendance on courses was identified as the most common method of developing teaching skills (11/19) and support of colleagues was the most important method of developing research skills (8/19). Patient contact was the most common method of maintaining clinical expertise (11/19). Need for a Lecturer/Practitioner network A Lecturer/Practitioner network was considered to be ‘helpful’ or ‘very helpful’ (16/19). Three subjects were ‘uncertain’. Perceived benefits of a Lecturer/Practitioner network are shown in Table 3. Suggestions for the network format are shown in Table 4. Table 3 Respondents’ views on perceived benefits of having a Lecturer/Practitioner network showing the number of respondents for each benefit Perceived benefits of a Lecturer/Practitioner network
n
Peer support Exploring role definition Facilitation of research contacts Shaping the future
13 11 5 3
Table 4 Potential forms of Lecturer/Practitioner support network showing the number of respondents per form Potential forms of Lecturer/Practitioner support network
n
Special interest group National database Regular meetings Contact through e-mail Linking with other professions
10 9 6 2 1
142
K. Stevenson et al. / Physiotherapy 90 (2004) 139–144 9 8 7
Frequency
6 5 4 3 2 1 0 Colleagues
Courses
Masters/PhD
Supervision
Methods to develop research skills
Fig. 2. Factors identified by Lecturer/Practitioners in the development of research skills.
12 10
Frequency
8 6 4 2 0 Patients
Courses
ISE
SIG
Literature
Methods to maintain clinical expertise Fig. 3. Factors identified by Lecturer/Practitioners in the maintenance of clinical expertise.
12 10
Frequency
8 6 4 2 0 Courses
Experience
Peers
Methods to develop teaching skills Fig. 4. Factors identified by Lecturer/Practitioners in the development of teaching skills.
Qualification
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Concerns about the role of the Lecturer/Practitioner The primary concerns that emerged were time management (11/19), the job split (10/19), difficulty keeping up to date (4/19) and lack of personal development (3/19): Excellent role with great opportunities but not be undertaken lightly, interestingly in my experience Lecturer/Practitioners seem to switch quickly to becoming just lecturers which is shame. (Respondent 4) Clinic work appears not to be valued by the university in the same way as it is by medicine i.e. clinical training is well rewarded within the field of medicine. It would be great to see physiotherapy clinical work equally well respected. (Respondent 7) Additional information and concerns Most of the subjects (17/19) stated that there was a lack of understanding of the role of the Lecturer/Practitioner by colleagues and it was frustrating having joint managers and multiple potentially conflicting responsibilities (16/19): There is a lack of understanding among the full time academic staff as to what these posts entail. (Respondent 17) Fall between two stools for training, i.e. each institution thinks the other one has it covered. Must have a clear understanding that you work half time in each role, not full time in both parts. (Respondent 19) The role of Lecturer/Practitioner varied between establishments (14/19): The role of Lecturer/Practitioner seams to have many and varied interpretations in different establishments. (Respondent 14) However, the overall experiences of the role were reported to be enjoyable (11/19): I thoroughly enjoy both sides of the job, which do feed into each other. (Respondent 2) I am thoroughly enjoying the job and great colleagues. (Respondent 11)
Discussion This survey of Lecturer/Practitioners in England highlights important issues for those considering entering such roles and for those who are considering employing Lecturer/Practitioners within their institution. Whilst the numbers within the study are small they represents a large cross-section of those employed at the time of the survey. There is little prior evidence examining the role or the impact of Lecturer/Practitioners within Physiotherapy.
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Literature that is available relates to the nursing profession and is mainly anecdotal in its nature, examining the concept of Lecturer/Practitioners rather than surveying those in post [3]. Whilst recognising that the nursing profession is unique and distinct from physiotherapy, nursing appears to be the only other profession to have embraced the role of the Lecturer/Practitioner. Identifying the roles and responsibilities of these posts have been problematic across the professions with nursing recognising that these posts work in relative isolation and it is therefore difficult to gain a true picture of the role [7]. Physiotherapists appear to gain significant clinical experience before applying for posts as Lecturer/Practitioner recognising the opportunity for greater career choice when reaching senior clinical grades. The addition of the Lecturer/Practitioner post to the career path allows physiotherapists to sample the academic environment without having to relinquish clinical skills and patient contact. The nursing literature identified clinical expertise as vital in maintaining clinical credibility among students and providing expert role models [8]. However, in nursing, Lecturer/Practitioners have been viewed as informal teachers in clinical areas [8], whereas Physiotherapy Lecturer/Practitioners are being firmly embedded within the academic framework with formal teaching and academic responsibility. Our survey has highlighted that great variations exist in the construction of individual posts. The majority of Lecturer/Practitioners work within the musculoskeletal speciality, possibly due to the relative ease of managing a clinical load on a sessional basis. This may not be so easily achieved in neurology or respiratory care. The variation in contract details reflects individual organisations establishing posts to best suit their individual needs. The high incidence of fixed term contracts suggests that employers are testing these posts and examining their success over a period of 1–5 years. The Lecturer/Practitioner post appears to be drawing together three strands of practice: teaching, clinical practice and research. Time allocated to each activity is variable, but the two main areas are teaching and clinical practice. However, to operate effectively within an academic environment and ensure that clinical practice is evidence based, it is recognised that the research element of the role is vital. Academic institutions may already have established researchers and therefore the Lecturer/Practitioner may be employed primarily for teaching up-to-date practice. Although all Lecturer/Practitioners allocated the least time to research, the scope of their research interests was diverse, including not only aspects of a clinical speciality, but also broader issues such as education, evidence-based practice; research methods and outcomes, illustrating the diversity of individual interests of Lecturer/Practitioners as well as the opportunity to broaden their research interests. Whilst having only a small amount of time for research, the majority had published work in academic and peer reviewed journals. Once in post, Lecturer/Practitioners demonstrate a strong sense of personal development with the majority registered
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for a higher degree. However, only half stated that this was a requirement of the job. Post holders utilised many different learning opportunities to enhance their skills within the new roles, to develop teaching, research and clinical skills. The Lecturer/Practitioner has to be flexible and adaptable to create learning opportunities in the separate working environments. The need for a support structure for individuals within the post was clearly demonstrated. Lecturer/Practitioner positions are still relatively new within physiotherapy and are small in number. The formation of a support structure for problem solving, peer support, research contacts and shaping the future would appear a reasonable method of giving confidence to those in post. The variety of suggestions for this network highlights that not one single method would support all Lecturer/Practitioners adequately. A support structure would have to be as flexible as each Lecturer/Practitioner in post, whilst still allowing post holders to establish support systems for themselves in their own work areas. The concerns highlighted by the Physiotherapy Lecturer/Practitioners are in keeping with evidence from the nursing profession. Issues such as time management, concerns over the job split, difficulty keeping up to date and lack of personal development have all been identified previously [4,6,11]. Within this study we identified that Lecturer/Practitioners work frequently in excess of their contractual hours. Trying to deliver in three separate areas of practice can create a feeling of overwork. Whilst the Lecturer/Practitioners appear to be able to create learning opportunities for themselves, they still need time to achieve their aims. As this role is relatively new, Lecturer/Practitioners identified the need for peer support and a clear definition of the role, which needs to be understood by both clinical and academic colleagues. This lends weight to Hollingsworth’s view [4] that the lack of understanding of the role was a concern, and that this must be clearly defined to avoid unrealistic expectations of what is possible. Both this survey and previous studies [4,6] have highlighted the fact that physiotherapy and nursing Lecturer/Practitioners are concerned about the heavy demands on time, conflicting priorities and pressures of undertaking the equivalent of ‘two jobs with two masters’ [4,11].
Conclusion This survey has highlighted the variations that exist in all aspects of the Lecturer/Practitioner role, from contractual differences, to differences in time allocated to each element
of the role. To prevent role overload or burn out it is imperative that those employing Lecturer/Practitioner have a clear understanding of the requirement of each element of the role and the time available to deliver those objectives. A strong relationship between the clinical and the university management team could ensure the appropriate division of roles and could monitor performance and need for support. This could be achieved by a collaborative university and clinical appraisal, each management base evaluating the effect of the role and contributing to the planning of future objectives. The Lecturer/Practitioners appear to be a group who can facilitate their own learning but still require a support structure. As a consequence of this survey a national database of existing Lecturer/Practitioners has been constructed, through which contact can be made with peers. This web site includes contact details, clinical specialties, research interest, Lecturer/Practitioner reference list, as well as details of related presentations at national conferences (http://www.keele.ac.uk/depts/pt/lect pract/home.htm). Future developments will include Lecturer/Practitioner discussion sites and raising the awareness of this facility and ongoing research in this area to newly appointed post holders.
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