Abstract
Background: In a traditional South African undergraduate physiotherapy curriculum, students can be expected to evaluate and treat a non-complicated patient at a 3rd-year level. While students are expected to apply classroom knowledge in clinical settings, some struggle to transfer theoretical knowledge and skills into clinical practice. This may be because patient-specific management requires applied knowledge and skills, which are more challenging than skills in a simulated classroom environment.
Objectives: To explore the expected levels of clinical readiness by academic lecturers and clinicians exposed to 3rd-year clinical training among incoming 3rd-year physiotherapy students before their clinical work.
Method: A qualitative, exploratory descriptive design was employed, using online focus group discussions as the primary data collection method. Three focus group discussions were conducted on the Blackboard Collaborate platform. The data were analysed manually through thematic analysis.
Results: Two main themes emerged, namely skills and cognitive processes.
Conclusion: Lecturers and clinicians perceive that clinical readiness in 3rd-year students is demonstrated by their ability to apply appropriate clinical skills and sound reasoning to provide effective patient care.
Clinical implications: Clear expectations of 3rd-year physiotherapy students are beneficial for lecturers and clinicians who supervise them and for students to understand their clinical readiness. This clarity ensures that students receive the necessary guidance and are assigned patients suitable for their skill level. Additionally, the information gained from the focus groups will be used in the next phase of the umbrella study, which aims to develop a clinical readiness diagnostic assessment tool for 3rd-year physiotherapy students.
Keywords: clinical readiness; physiotherapy education; 3rd-year students; clinical training; focus group discussions.
Introduction
Globally and in South Africa, physiotherapy graduates must demonstrate clinical readiness to ensure patient safety and high-quality care. However, evidence suggests that many 3rd-year students struggle to apply theoretical knowledge in real clinical practice, which can lead to poor patient outcomes, increased supervision burdens and mental health issues among the students (Lo et al. 2017; Wijbenga, Bovend’Eerdt & Driessen 2019). Literature reflects that students have expressed that they felt prepared but often lacked the ability to apply core competencies, particularly in intervention planning and clinical reasoning, during placements (Hendricks 2021; Talberg & Scott 2014). Students frequently describe the shift from the classroom to the clinic environment as abrupt and overwhelming. The gap between clinical expectations and academic preparation causes students to experience anxiety, role confusion and feelings of inadequacy (Opoku, Khuabi & Van Niekerk 2021). Students further highlight the difficulty of transitioning into real-world patient care, where theoretical frameworks often fall short in guiding patient interactions, decision-making and adjusting to changing clinical settings (Hess et al. 2025; Opoku et al. 2021). Clinical educators also identify recurrent obstacles regarding students’ fitness to practice, highlighting concerns in clinical competence (76%), mental health (51%) and professional behaviour (47%) (Lo et al. 2017). These deficits compromise patient outcomes, increase supervision burdens and contribute to educator burnout, with 83% of clinicians noting reduced job satisfaction because of time pressures and emotional strain (Lo et al. 2017).
To maximise student engagement with learning experiences, finding ways to optimise student preparation for clinical settings is a vital step (Terry et al. 2020). To improve this engagement, we need to understand why they struggle to apply their knowledge within the clinical context. Currently, students are assessed on their ability to apply knowledge and skills with patients during clinical block tests, which are typically conducted only at the end of the block – too late for mediation. However, this practice may disadvantage students, as gaps in their knowledge and skills are only identified at the end of the block. No tools or methods are currently in place to identify these gaps or student struggles beforehand (Ribeiro, Ferla & Amorim 2019; Terry et al. 2020).
There is a need for a diagnostic assessment tool to be developed that can identify student gaps before commencing the clinical work, facilitating effective and safe transition to managing real patients. By identifying and understanding what students struggle with before the clinical work, educators and clinicians can provide the necessary support for the students while working in the clinical setting. Before such a tool can be developed, it is important to understand lecturers’ and clinicians’ understanding of the competencies (and expected levels of performance) deemed essential to ensure effective transition to the platform. Therefore, this study aimed to explore the anticipated levels of clinical readiness (as expected by academic lecturers and clinicians involved in 3rd-year clinical training) among incoming 3rd-year physiotherapy students before the commencement of their clinical work. This part of the study forms part of Phase 1 of a bigger study, which aims to develop a clinical readiness diagnostic assessment tool for third-year physiotherapy students. Therefore, the objective of this study was to explore the expectations of the academic lecturers and clinicians regarding the clinical readiness of 3rd-year physiotherapy students before their clinical work.
Research methods and design
Design
A qualitative, exploratory descriptive design was used, where focus group discussions were conducted with academic lecturers and clinicians from South African physiotherapy departments across all eight universities.
Setting
The focus groups were held online using the Blackboard Collaborate platform. The focus group discussions consisted of a panel of physiotherapists, which included physiotherapy lecturers from universities that offer physiotherapy degrees in South Africa, as well as clinicians from hospitals involved in the clinical training of 3rd-year physiotherapy students.
Study population
A purposive sampling method was used to select academic lecturers and clinicians directly involved in 3rd-year clinical training. These participants were chosen based on their active engagement in the clinical education of 3rd-year physiotherapy students. This allowed the study to gather targeted insights reflecting firsthand experience in the training process. The participants were split into groups of six, as a focus group can comprise from six to 10 participants (Litosseliti 2003). Three focus group discussions took place on the Blackboard Collaborate online platform. The first focus group had five participants, as one participant was struggling with connectivity. Focus groups two and three had six participants each.
Inclusion criteria for focus groups
Academic lecturers and clinicians lecturing and supervising 3rd-year students from all eight universities offering a physiotherapy degree in South Africa.
Exclusion criteria for focus groups
To minimise potential confirmation bias, academic lecturers participating in other components of the overarching study, namely the modified Delphi and modified Angoff standard setting procedures, were excluded from this phase. This exclusion was implemented to prevent conceptual contamination across study phases, as their exposure to the exploratory discussions could carry over into the independent judgements they need to make in the other phases.
Data collection
A focus group discussion of three lectures was used to pilot the nine questions (Online Appendix 1). The development of the focus group questions was grounded in principles of competency-based education, drawing on frameworks such as Miller’s pyramid of clinical competence and entrustable professional activities (EPAs) framework. A moderator (the primary researcher) facilitated the focus group discussions. Before each focus group commenced, the participants were emailed information leaflets and consent forms, which included consent for recording the discussion sessions. Once the consent forms were completed, the participants were sent their participant numbers. They were all informed to log in with their unique participant number to ensure they remained anonymous throughout the process. With each focus group, the moderator gave strict instructions that participants could not use the names of people or their work locations to ensure they were not recognisable and would remain anonymous. Furthermore, the participants were requested to raise their hands so the moderator could allow them to answer. All this was done to ensure the focus group ran smoothly on the online platform. The focus groups were all scheduled for 1h. The recordings were stored on the primary researcher’s OneDrive with encrypted password protection. Three participants were given access to the recording to ensure quality control of transcripts. The transcripts are on the primary researcher’s OneDrive with encrypted password protection. The supervisor and independent reviewer were given hard copies of transcripts, which they returned once the analysis was completed. The hard copies are stored in a locked office on the university premises.
Data analysis
Once all three focus groups were concluded, the primary researcher did manual thematic analysis. Before the analysis, the researcher transcribed all three focus groups using the Microsoft Word 365 document transcribing tool. Once Word had completed the transcripts, the researcher took them to manually correct them verbatim. A few discrepancies were noted that were corrected, such as typing and spelling errors. Once the researcher had manually corrected all the transcripts, they were sent randomly to one participant from each focus group for member checking to ensure trustworthiness. Minor changes were noted and corrected before the analysis. The finalised transcripts were then used for thematic analysis.
Thematic analysis
Thematic analysis was conducted by the researcher using the six steps outlined by Braun and Clarke (2006). A hybrid approach to thematic analysis combined the deductive and the inductive approaches. The deductive approach was primarily based on pre-established themes and subthemes derived from Miller’s pyramid of clinical competence, which acknowledges that student competencies in clinical education are supposed to be approached at teaching levels that cascade from basic knowledge to performance of certain skills (Witheridge, Ferns & Scott-Smith 2019). Co-jointly, the EPA framework, which outlines tasks that students should be able to do in clinical settings (Rizk et al. 2025), was used to inform the inductive approach of identifying additional uniform themes and subthemes as they emerged from the data.
The researchers read and re-read the data for familiarisation to gain more insight into the content. The transcripts were then used to generate the initial codes. The main researcher and supervisor first independently generated codes, which were later discussed at length until consensus was reached. The latent approach was used, where the researchers read the subtext and assumptions underlying the data. This involved attending to tone, emphasis and contextual cues that signalled deeper beliefs about competence. Once the data were coded, themes emerged through an iterative process of pattern identification and conceptual clustering. The primary researcher and the supervisor conducted the initial identification of themes separately. Subsequently, three consensus meetings were held to review, refine and finalise the themes collaboratively. Disagreements were resolved through discussion and a return to raw data until consensus was reached. During the consensus meetings, the researchers systematically discussed each identified theme in detail, carefully reviewing relevant data extracts and collaboratively addressing any discrepancies in interpretation while remaining consistent in aligning with the frameworks used. Prior to finalising the codes and themes, peer debriefing was employed, where qualitative experts were engaged to review interpretations and provide input. During the final consensus meeting, all themes and codes were visually mapped on a whiteboard (Online Appendix 1) to assess internal homogeneity (consistency within themes) and external heterogeneity (distinctiveness between themes), as defined by Patton (2014). This visual clustering facilitated final refinements to theme names and boundaries, ensuring clarity, coherence and theoretical alignment.
Quality control
To enhance the trustworthiness of the thematic analysis, an independent coder conducted a parallel thematic analysis of the transcripts for an independent review. The independent coder was chosen because they have more than 20 years of lecturing experience, supervise 3rd-year students and have a special interest in qualitative research. Additionally, the supervisor independently reviewed and coded the data. A collaborative review was conducted by the primary researcher, supervisor and independent coder, which yielded comparable interpretations that enhanced the credibility of the analysis.
The primary researcher is a lecturer with experience in clinical training of undergraduate physiotherapy students. Therefore, a reflexive stance was taken to mitigate potential biases arising from prior assumptions or familiarity with the topic.
Ethical considerations
Ethical approval was received on 10 October 2023 from the Faculty of Health Sciences Research Ethics Committee (ethics number 477/2023) of the University of Pretoria. The participants were given an information leaflet on the details of the study. All participants signed written informed consent documents emailed to the primary researcher before the focus group interviews. The participants were notified that they can withdraw from the study at any point if they feel uncomfortable.
Results
The demographic details of the participants are depicted in Table 1. Each focus group had a combination of academic lectures and clinicians. The results of the three focus group interviews addressed the question of what clinical readiness at a 3rd-year level should be when clinical block work commences. Two main themes were highlighted, namely skills and cognitive processes. The themes are displayed in Table 2.
| TABLE 1: Participants’ demographics (N = 17). |
| TABLE 2: Factors identified concerning 3rd-year clinical readiness. |
Theme 1: Skills
The theme ‘skills’ refers to the ability that a student has to perform an assigned role in a clinical setting (Timmerberg et al. 2019). Three subthemes emerged from the ‘Skills’ theme: evidence-based knowledge integration into clinical skills, professional competence skills and communication.
Subtheme 1: Evidence-based knowledge integration into clinical skills
The subtheme ‘Evidence-based knowledge integration into clinical skills’ in this study refers to students’ ability to integrate their knowledge with evidence-based practice. Three codes were derived from this subtheme. The most favoured code was ‘Application of theory into clinical setting’, which had the most responses from 10 participants across the three focus groups. One participant said:
‘Theoretical knowledge that will be needed to apply the practical knowledge.’ (Focus group 1, participant 2, clinician)
Another participant stated:
‘The ability to apply the knowledge and the skills that the students learned in a classroom setting. They should be able to apply that in a real clinical setting.’ (Focus group 3, participant 1, lecturer)
The code with the second most responses was ‘Integration of theory and practical knowledge’, with three responses from across the three focus groups. The following quotes supported this:
‘… record keeping standards, so understanding how to do your SOAP [Subjective, Objective, Assessment, Plan] notes format once you have now put your theory in place, done it in a practical setting.’ (Focus group 1, participant 3, clinician)
‘Integrating your theoretical knowledge with your practical application.’ (Focus group 3, participant 6, clinician)
The code with the least responses was ‘Skill development (Evidence-based learning)’, which had one response, namely:
‘Clinical readiness will be measured by a student being able to show a skill in evidence-based. Evidence-based reasoning, when presented with the clinical case.’ (Focus group 1, participant 6, clinician)
Subtheme 2: Professional practice competencies
The subtheme ‘Professional Practice Competencies’ in this study refers to the essential abilities for a student to succeed in a clinical setting, including physiotherapy practice skills and professionalism. Four codes were derived from this subtheme.
The code with the most responses was ‘Cognitive skills’, with four responses, which include applying theory to practice, prioritising information, critical thinking and formulating a diagnosis. One participant said:
‘The skill set to be able to interpret an X-ray, be it your cardio patients, your MSK [musculoskeletal] patients, surface anatomy, and the ability to implement your neurodynamic tests, the use of outcome measures.’ (Focus group 1, participant 3, clinician)
Another participant said:
‘Able to assess, diagnose and do almost everything.’ (Focus group 3, participant 2, clinician)
The second code was ‘Curiosity-driven’ with three responses, which include the ability to inquire to learn more. Responses include:
‘Proactive to learn more and also want to learn beyond what the clinician is able to give them.’ (Focus group 1, participant 5, clinician)
‘Students to be proactive. To have that skill to know, OK, if you don’t know something and you’re not very knowledgeable about this condition, have the ability to say, I don’t know this, please, can you help me work this out or go and redo your own research.’ (Focus group 2, participant 5, clinician)
The third code with two responses was ‘Time management skills’. One participant said:
‘[T]ime management.’ (Focus group 2, participant 3, clinician)
While another said:
‘And the other important thing is time management as well, because if you have a certain number of patients that you need to see, you must be able to plan your time wisely so that you can be able to see all the patients that are allocated to you within the said time.’ (Focus group 3, participant 4, clinician)
The fourth code was ‘Interpersonal skills’, with one response, namely:
‘What I have learned later equipped a lot with the technical skills, the hard skills. However, it seems as if we are still slightly behind, or we do not emphasise the soft skills a lot in our day-to-day, and then you will find out that you need many sorts of soft skills for people management. You know, it’s not just the patient, how do I interact with the patient that is in pain that really does not want to talk to me, does not want to do the things because they’re uncomfortable. The knowledge of their self-emotional intelligence.’ (Focus group 2, participant 2, clinician)
Subtheme 3: Communication
The subtheme ‘Communication’ in this study refers to the ability of students to communicate with patients and the multidisciplinary team. Three codes were derived from this subtheme.
‘Interpersonal communication’ was the most popular, with four responses, some of which include:
‘Be really good theoretically, but unable to communicate with a patient because of a language barrier. So, I think that these soft skills are also an important aspect to consider when we think of clinical readiness and the engagement of students.’ (Focus group 3, participant 5, lecturer)
‘Professionalism is also important to me. For instance, in the hospital setting, you must understand if you enter a ward that you need to make sure that the ward unit manager knows who you are and why you are there. In order to also be respectful to everyone in the team and then also obviously the ethical considerations when you work with patients, what is expected of you and that you, the patient must understand that they can stop the treatment at any time.’ (Focus group 2, participant 6, lecturer)
‘At training institution we are really equipped a lot with the technical skills, the hard skills. However, it seems as if we are still slightly behind, or we do not emphasise the soft skills a lot in our day-to-day and then you will find out that you need a lot of soft skills that the people management, you know, it’s not just the patient, how do I interact with the patient.’ (Focus group 2, participant 2, clinician)
The code with the second fewest responses was ‘Information extraction’, with two responses, namely:
‘Ability to gather information.’ (Focus group 2, participant 2, clinician)
‘Extract information from what the patient has told them.’ (Focus group 3, participant 4, clinician)
The code with the fewest responses was ‘Writing skills’, with one response, namely:
‘The ability to record good clinical notes.’ (Focus group 1, participant 6, clinician)
Theme 2: Cognitive processes
The theme ‘cognitive processes’ refers to a multifaceted approach that a student should follow when treating a patient (Yazdani & Hoseini Abardeh 2019). Three subthemes emerged from the ‘cognitive processes’ theme: clinical preparedness, clinical reasoning and scientific (evidence-based) and clinical inquiry skills.
Subtheme 1: Clinical preparedness
The subtheme ‘Clinical preparedness’ in this study refers to a student’s preparedness to interact with patients in a clinical setting. From this subtheme, two codes were derived. The ability to treat patients had the most common response, with eight responses. The responses ranged from treating patients with a qualified physiotherapist or supervisor, in pairs with their peers and observing clinicians treat patients. Some quotes are mentioned below:
‘See one patient in conjunction with maybe the on-site supervisor.’ (Focus group 1, participant 3, clinician)
‘To assess and treat a patient, but with some assistance either from a clinician or from a classmate.’ (Focus group 3, participant 1, lecturer)
There were six responses regarding the code ‘Knowledge of conditions’. One participant said:
‘Know most frequently which conditions they should expect to be seeing.’ (Focus group 1, participant 5, clinician, clinician)
While another participant said:
‘To go and research the condition.’ (Focus group 2, participant 5, clinician)
It was further expressed in a subcode for knowledge of conditions that 3rd-year students should treat non-complicated patients based on the university guidelines. Some responses include:
‘Straight cut conditions.’ (Focus group 1, participant 3, clinician)
‘Uncomplicated conditions.’ (Focus group 2, participant 5, clinician)
‘Only one system involvement and not complex patients.’ (Focus group 3, participant 1, lecturer)
One participant also acknowledged that students should be able to progress to more complex conditions towards the end of their rotation, namely:
‘We start giving them the more complicated patients, like maybe the polytraumas that include a pelvic fracture, towards the end of the block.’ (Focus group 2, participant 4, clinician)
Subtheme 2: Clinical reasoning
Clinical reasoning generated four codes. The code with the most responses was ‘Integration of theory into a practical skill’, with 12 responses. To name a few:
‘Why they are doing what they are doing. Knowing why you are doing what you’re doing to the patient.’ (Focus group 1, participant 1, clinician)
‘Understanding why you are treating the patient.’ (Focus group 2, participant 3, clinician)
‘The thinking process behind how you gather information from various sources.’ (Focus group 3, participant 1, lecturer)
‘Understanding what to assess from what they told you in the subjective and knowing how to plan to treat effectively what is the actual issue.’ (Focus group 2, participant 4, clinician)
‘It means integrating your theoretical base and the practical component, integrating it, using an evidence-based approach.’ (Focus group 3, participant 6, clinician)
The code with the second most responses was ‘Patient-specific application’, with four responses. One participant said:
‘What treatment is needed as per your assessment, changes in treatment to adapt to patients’ presentation.’ (Focus group 2, participant 3, clinician)
While another said:
‘Evaluate and manage the patient’s problem based on the clinical presentation.’ (Focus group 1, participant 6, clinician)
Diagnosis was the third code, which had two responses, namely:
‘Be able to plan and come up with the diagnosis.’ (Focus group 3, participant 4, clinician)
‘And come up with a diagnosis.’ (Focus group 3, participant 2, clinician)
Reflection had one response, namely:
‘To critically then review the treatment.’ (Focus group 2, participant 6, lecturer)
Subtheme 3: Scientific (evidence-based) and clinical inquiry skills
Scientific (evidence-based) and clinical inquiry skills generated three codes, two being the most popular with four responses each, namely sound baseline knowledge and hypothesis formulation.
Sound baseline knowledge had quotes that include:
‘Sound knowledge of anatomy and pathology.’ (Focus group 3, participant 1, lecturer)
‘Understanding the condition to begin with. Having a good baseline knowledge.’ (Focus group 2, participant 1, clinician)
Hypothesis formulation had quotes that include:
‘You hypothesise what could be the issues and then you diagnose, you plan, and you treat, and then you reevaluate.’ (Focus group 1, participant 2, lecturer)
‘Ability to gather information to process it into meaningful data.’ (Focus group 2, participant 2, clinician)
Ability to inquire (know what I know or not know) had one response, namely:
‘Theoretical knowledge of the case presented and how they can manage it using the evidence-based practices.’ (Focus group 1, participant 6, clinician)
Discussion
This study explored the expected levels of clinical readiness (as anticipated by academic lecturers and clinicians directly involved in 3rd-year clinical training) among incoming 3rd-year physiotherapy students before their clinical work. The main findings of this study highlight that students need both skills and the ability to cognitively process theoretical knowledge and the practical application of the knowledge to treat patients in a clinical setting effectively. These findings were systematically derived and guided by two complementary theoretical frameworks, Miller’s pyramid of clinical competence and EPA. These frameworks informed the development of the interview guide and shaped the thematic analysis.
Miller’s pyramid was primarily developed to assess clinical competencies of students in healthcare settings, focusing on the progression of students from gaining theoretical knowledge (‘knows’) to real-world performance in a clinical setting (‘does’) (Witheridge et al. 2019). In this study, the interview guide was designed to probe the performance-based tiers of the pyramid, which outlined the clinical skills required by 3rd-year physiotherapy students to manage patients in clinical settings. This focus ensured that the data collected reflected the performance-based expectations of 3rd-year students as they transitioned into clinical practice.
The EPA, on the other hand, provides a task-based lens for evaluating student competence, focusing on specific clinical activities that students should be able to perform initially under supervision and gradually with less supervision (Hennus et al. 2022). The framework was used to identify and define the core clinical tasks expected of 3rd-year physiotherapy students, such as assessing and treating non-complicated patients under supervision. These expectations were embedded into the interview guide and directly informed the coding, ensuring the analysis remained anchored in observable, assessable clinical behaviours.
This study offers a theoretically grounded understanding of clinical readiness by aligning the development of the interview guide and the thematic analysis with Miller’s pyramid and EPA. It highlights the importance of performance-based assessment and task-specific competence in preparing 3rd-year physiotherapy students for supervised clinical practice.
Students need evidence-based knowledge and theoretical, technical and cognitive (reasoning) skills. Evidence-based knowledge is an important focus in healthcare, as it is important to provide patients with the best practice. Implementing evidence-based knowledge in clinical settings leads to high-quality care, including better patient outcomes, lower costs and enhanced job satisfaction (Landsverk, Olsen & Brovold 2023). On the contrary, insufficient evidence-based knowledge and practice can be dangerous to a patient (Dizon, Grimmer-Somers & Kumar 2014; Larsen et al. 2019). In the focus group interviews, evidence-based practice was a leading factor of what students needed to be considered clinically ready. It was further noted that it is not just evidence-based knowledge and practice that is important. Students must show professional competency skills, including the softer skills needed to interact with patients. These skills include communication skills with patients and clinical staff, time management skills and the student’s personal skills to be proactive. These findings are supported by the literature, which states that soft skills are becoming increasingly important in the healthcare industry and should be developed in addition to professional skills (Dolev, Naamati-Schneider & Meirovich 2021).
‘Cognitive processes’ is the second theme derived from the results of this study. As previously mentioned, ‘cognitive processes’ is a multifaceted approach that a student should follow when treating a patient (Yazdani & Hoseini Abardeh 2019). In this study, these processes include clinical preparedness, clinical reasoning, scientific (evidence-based) and clinical inquiry skills. The participants in the focus groups noted that it is important to integrate all the theory learnt, including paper patient management, into patient-specific management in a clinical setting. It was further stated that the theory provided a good baseline knowledge. This baseline knowledge included the knowledge of patient conditions that students need to be able to treat. Participants clearly expressed that students at a 3rd-year level should only treat simple, straightforward conditions. There is a consensus among South African institutions that, at an entry level typically reached in the 3rd year, a physiotherapy student should be able to independently evaluate and treat a patient with uncomplicated pathology under supervision. This expectation aligns with the competencies outlined in the National Qualifications Framework (NQF) level seven.
The NQF level seven subdomain of problem solving requires the student to identify and solve problems, where a student can demonstrate their ability to analyse, evaluate, critically reflect on and apply evidence-based solutions to complex problems (South African Qualifications Authority 2008). At an NQF level seven, a student must be able to work independently. In the context of healthcare students, they need to be able to work independently with supervision. This was expressed well in the clinical preparedness code, where the responses ranged from treating patients with a qualified physiotherapist or supervisor, in pairs with their peers and observing clinicians treat patients. To work independently, a student needs integrated knowledge and skills. This means the findings of this study align with national standards.
It is important to note that two participants expected students to be able to diagnose. These are outliers and should be noted that at an NQF level seven, 3rd-year students are not expected to diagnose. These outlier responses suggest inconsistent expectations across individual educators regarding the scope of student competence at this stage. This highlights a potential misalignment between curriculum standards and workplace expectations, particularly in clinical settings where supervisors may conflate diagnostic reasoning with assessment or treatment planning. This discrepancy emphasises the need for more transparent communication and calibration between academic programmes and clinical educators to ensure that entrustable tasks appropriately match students’ developmental stage.
Miller’s pyramid of clinical competence provides a structure for students to develop clinical competencies. To support this, academic assessments must reflect the same performance-based learning approach. The EPA framework complements this by focusing on observable units of professional practice, which are essential for evaluating readiness in real-world clinical settings. It is therefore important for academic programmes to have systems in place that ensure students receive targeted formative feedback before entering clinical practice, in an attempt to improve student clinical competencies and throughput. A key gap identified in current physiotherapy education is the absence of a tool to assess students’ embedded prior knowledge and clinical reasoning before they commence their clinical modules. The development of such a tool is essential to evaluate baseline competence and provide tailored feedback that supports students’ transition into supervised clinical work.
Strengths and limitations
The strength of this study is that the focus groups included participants from across South Africa who were involved in physiotherapy education. The online platform was advantageous as it allowed participants from across the country to be represented in one sitting. This ensured that the feedback received was not concentrated in one area or institution but a good representation of South African university physiotherapy departments.
The limitations noted are that the focus group interviews took place online, and one participant encountered technical difficulties. It also meant that the moderator needed to probe participants more to contribute to the interview. It is recommended that focus groups of this nature be held in person.
Conclusion
The findings of this study reveal a shared expectation among academic lecturers and clinicians that 3rd-year physiotherapy students should enter clinical practice with a foundational level of competence that enables them to assess and treat non-complicated patients under supervision. However, the study also uncovered a minor expectation variability, particularly regarding the depth of hypothesis formulation expected at this stage. This inconsistency highlights a need for more precise alignment between academic curricula and clinical training environments.
Acknowledgements
The authors would like to acknowledge Prof Mshunqane for assisting with independent coding of the data.
Competing interests
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
Authors’ contributions
M.A.K., E.K. and R.N.P. were responsible for conceptualisation of the study. M.A.K. and E.K. were responsible for data collection, analysis of data, drafting and editing of article. R.N.P. was responsible for reviewing analysed data, drafting and critical editing of the article.
Funding information
This study received funding from the University of Pretoria University Capacity Development Program (UCDP) grant.
Data availability
The data supporting the findings of this study will be made available on reasonable request.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. The article does not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The authors are responsible for this article’s results, findings, and content.
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