Relationships between physiotherapy coursework assessments and student performance in clinical practice settings.

Student thesis: Doctoral Thesis


Clinical placements are an essential component of the education of physiotherapy students and involve many stakeholders. As the demand for clinical placements continues to grow, it is important that students are adequately prepared to be successful in a clinical placement. If students who are less likely to succeed on a clinical placement could be identified prior to the commencement of a clinical placement, targeted guidance and support could be implemented with the aim of optimising their performance.

There is a wealth of literature based in the medical profession focused on the education and assessment of students. A smaller body of literature is focused on the physiotherapy profession. There is a tendency to translate research from medical education to physiotherapy student education. Evidence from the medical profession suggests that student performance on written examinations and Objective Structured Clinical Examinations (OSCEs) is related to their future performance in clinical practice. However, there are differences between the graduate standards expected of the two professions, and this suggests that research from medicine should be replicated in the physiotherapy profession.

This thesis investigated four cohorts of entry-level postgraduate physiotherapy students to determine the relationships between potential predictive measures and their future performance in clinical practice, as measured by the Assessment of Physiotherapy Practice (APP). The APP is a standardised instrument used by all physiotherapy education programs in Australia and New Zealand, as well as in Qatar and Iceland. Undergraduate GPA (UGPA) was identified to be the most utilised admission criterion into postgraduate physiotherapy programs in Australia. Analysis identified no significant relationship between UGPA and students’ future performance in clinical practice.

Analysis of the relationships between students mean scores on summative assessments used in four pre-clinical coursework subjects identified significant relationships between future clinical performance and oral presentations, written examinations and OSCEs. Of these, the OSCE demonstrated the strongest relationship. The OSCE was then further investigated to explore differences in relationship strength between clinical performance and individual OSCEs used in six pre-clinical coursework subjects. This highlighted that not all OSCEs demonstrate predictive validity and suggested that intrinsic properties of the OSCE influence their validity.

A content analysis of two OSCEs, one with a moderate predictive relationship with students’ future clinical performance and one with no significant relationship, was conducted. This analysis identified differences between the two OSCEs and supports current recommendations for OSCE design from literature within the medical profession: mark-sheet items should be clear, unambiguous and be accompanied by an expected standard of performance; OSCE’s content should focus on skills that cannot be included elsewhere in a program of assessment; and global rating scales should be considered for use with items or stations assessing holistic constructs such as communication and education.

Findings from this thesis question the use of UGPA as the sole eligibility criterion or selection measure for entry-level postgraduate physiotherapy education. This thesis provides support for the use of a range of assessment methods within physiotherapy entry-level education programs and supports the use of OSCEs to identify students at risk of poor performance in clinical practice. Practical recommendations are made to guide educators in the design of OSCEs with appropriate construct validity.
Date of Award16 Feb 2023
Original languageEnglish
SupervisorWayne Hing (Supervisor), Rob Orr (Supervisor) & Nikki Milne (Supervisor)

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