Determining differences between novice and expert physiotherapists in the emergency on-call environment: a vignette-based study
Emergency on-call duties have been highlighted as a key stress factor in newly qualified physiotherapists whose job performance may be affected. The concept of stress relating to on-call work, the general lack of interest or confidence in the respiratory on-call field, and subsequent difficulties with recruitment and retention, pose a difficult problem for managers of services responsible for the maintenance of a competent workforce and a high standard of service provision. Differences in novice and expert physiotherapists’ patient management and clinical reasoning strategies have been previously examined in orthopaedic, neurology, domiciliary and cardiorespiratory fields. However, no such investigations have been undertaken in the field of emergency on-call. The purpose of this study was to determine if differences existed between novice and expert physiotherapists who had by definition differing levels of context-related experience within the emergency on-call environment. This study also aimed to consider what factors may influence their physiotherapy intervention for an acute cardiorespiratory patient. A purpose-designed vignette-based postal questionnaire was administered to 26 emergency on-call providers in New Zealand. The questionnaire sought demographic data, investigated participants’ attitudes towards emergency on-call service provision and presented a vignette-based clinical scenario which asked questions throughout an evolving clinical case scenario. Analysis was performed using the computer software package for social sciences, SPSS for Windows (version 14), results were analysed using descriptive statistics, and significance testing was performed using non-parametric methods. A good response rate was achieved (78.8%; n = 56). Statistically significant differences between novices and experts were determined in scores for confidence, stress, and support required, also in the factors affecting stress levels. Novices are less confident (p = < .0001), more stressed (p = < .001) and require more support than experts (p = < .001). Factors which influenced both novice, and to a lesser extent, expert stress levels when working as emergency on-call physiotherapists, were established. A relationship was determined between confidence and level of support required (r = -.65; p = < .001); confidence and amount of stress felt (r = -.58; p = < .001); and support required and stress felt (r = .47; p = < .001). Some differences were demonstrated between novice and expert physiotherapists in their answers to a clinical case scenario. Although these were not statistically significant, a trend was noted which may reflect the different clinical reasoning strategies of these physiotherapists. There is a need for novices to gain the type of experience which includes independent problem solving and guided reflection; the use of vignette-based case studies may be one method which could be further exploited. The profession is responsible for the provision of better ways to meet the needs of our future emergency on-call workforce. If this is not achieved, other professional groups will be required to fill the gaps and physiotherapy; particularly cardiorespiratory physiotherapy will lose out.