Developing clinical expertise in musculoskeletal physiotherapy; Using observed practice to create a valued practice-based collaborative learning cycle

Background
Observed clinical practice is a commonly used approach to develop clinical expertise in the musculoskeletal (MSK) physiotherapy workforce. The value of this approach is not known.

Objectives
To understand how regular observed clinical practice is considered to support the development of MSK physiotherapy clinical expertise in one UK organisation who adopts this approach to practice-based education.

Design
A qualitative, constructivist grounded theory study.

Method
Eight initial individual interviews were undertaken with MSK physiotherapists engaged in this approach to practice-based education. Secondary interviews were completed with two participants. A focus group concluded data generation. Data were analysed using a three-stage constant comparative process.

Findings
Regular observed clinical practice was found to facilitate the development of clinical expertise by enabling a valued practice-based collaborative learning cycle. Three essential elements were identified:

Precursory requirements
Mentors are required to reflect on their own successful experiences of clinical development and consider their professional moral responsibility to develop the future workforce.

Learning activity
Observed clinical practice situated in the workplace can successfully facilitate clinical expertise development. Whole-team involvement adds further value.

Subsequent requirements
Successful learning outcomes are achieved when mentor and learner engage in collaborative reflection and analysis soon after the observed practice. Developing an ‘educational alliance’, sharing fallibilities, adopting a developmental approach and placing the learner as the ‘judge’ of the learning experience are important considerations to achieve successful learning outcomes.

Conclusion
These findings offer a framework to consider when using observed clinical practice to develop the clinical expertise of a MSK physiotherapy workforce.