Practice performance and performance anxiety: Preparing osteopathic students for practice
Keywords:performance anxiety, practitioner, clinical training, osteopathy, student, professional education
Background: During clinical training, osteopathy students are required to develop skills and attitudes that challenge their capabilities and viewpoints. The aim of this project was to inform pedagogical processes that could reduce the stress associated with beginning clinical practice.
Methods: Data were collected from two sources: (1) semi-structured interviews and (2) audiovisual material prepared by students for other purposes but which also shed light on their experiences of clinical placement. With participants’ consent, data were thematically analysed using constant comparison.
Results: Osteopathic students entering clinical practice experienced high levels of performance anxiety that caused physical and psychological stress. Despite achieving objectively-measured competencies in clinical assessments, students perceived they were not ready to perform as practitioners (e.g., appear confident, overcome nervousness and manage the consultation time).
Conclusions: To reduce performance anxiety associated with the transition to beginning practitioner, professional education needs to expand to include timely opportunities to learn practice performance skills.
Abbey, H. (2008). Assessing clinical competence in osteopathic education: Analysis of outcomes of different assessment strategies at the British School of Osteopathy.
International Journal of Osteopathic Medicine, 11(4), 125.
Anderson, C. (2010). Presenting and evaluating qualitative research. American Journal of Pharmaceutical Education, 74(8), 141.
Australian Health Practitioner Regulation Agency. ( 2014). Annual report 2013/2014. Retrieved from www.ahpra.gov.au/Publications/Corporate-publications.aspx#annual
Balkissoon, R., Blossfield, K., Salud, L., Ford, D., & Pugh, C. (2009). Lost in translation: Unfolding medical students' misconceptions of how to perform a clinical digital
rectal examination. American Journal of Surgery, 197(4), 525–532.
Cavanagh, J., Burston, M., Southcombe, A., & Bartrama, T. (2015). Contributing to a graduate-centred understanding of work readiness: An exploratory study of Australian undergraduate students' perceptions of their employability. The International Journal of Management Education, 13(3), 278–288. doi:10.1016/j.ijme.2015.07.002
Chaitow, L. (2010). Palpation and assessment skills: Assessment through touch (3rd ed.). London, England: Churchill Livingstone, Elsevier.
Chila, A. G., & American Osteopathic Association. (2011). Foundations of osteopathic medicine (3rd ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Cross, V., Leach, J., Fawkes, C. A., & Moore, A. P. (2015). Patients' expectations of osteopathic care: A qualitative study. Health Expectations, 18(5), 1114–1126. doi:10.1111/hex.12084
de Weerdt, S., Bouwen, R., Corthouts, F., & Martens, H. (2006). Identity transformation as an intercontextual process. Industry & Higher Education, 2(5), 317–326.
Degenhardt, B. (2009). New horizons for research and education in osteopathic manipulative medicine. The Journal of the American Osteopathic Association [Editorial], 109(2), 76–78.
Degenhardt, B., Snider, K., Snider, E., & Johnson, J. (2005). Interobserver reliability of osteopathic palpatory diagnostic tests of the lumbar spine: Improvements from consensus training. Journal of the American Osteopathic Association, 105(10), 465–473.
Eberman, L. E., & Finn, M. E. (2010). Enhancing clinical evaluation skills: Palpation as the principal skill. Athletic Training Education Journal, 5(4), 170–175.
Ebrall, P., Draper, B., & Repka, A. (2008). Towards a 21st century paradigm of chiropractic: Stage 1, redesigning clinical learning. Journal of Chiropractic Education, 22(2), 152–160.
Fish, D., & Cole, C. (2005). Medical education: Developing a curriculum for practice. Maidenhead, UK: Open University Press.
Fryer, G. (2008). Teaching critical thinking in osteopathy: Integrating craft knowledge and evidence-informed approaches. International Journal of Osteopathic Medicine, 11(2), 56–61.
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago, IL: Aldine.
Grace, S. (2011). Enhancing students' learning of palpatory skills: A focus on language. In Teaching palpation: Proceedings of the OsEAN Open Forum 2011, Postdam, Germany.
Grace, S., & Trede, F. (2013). Developing professionalism in physiotherapy and dietetics students in professional entry courses. Studies in Higher Education, 36(8), 793–806. doi:10.1080/03075079.2011.603410
Greenhill, J., Fielke, K. R., Richards, J. N., Walker, L. J., & Walters, L. K. (2015). Towards an understanding of medical student resilience in longitudinal integrated clerkships. BMC Medical Education, 15, 137. doi:10.1186/s12909-015-0404-4
Halpin, S. N., Dillard, R. L., Idler, E., Clevenger, C., Rothschild, E., Blanton, S., . . . Flacker, J. M. (2015). The benefits of being a senior mentor: Cultivating resilience through the mentorship of health professions students. Gerontology & Geriatrics Education, 38(3). doi:10.1080/02701960.2015.1079707
Hartup, J. K., Murphy, R. A., Plowman, L. M., & Myers, R. (2010). Progression through osteopathic training in Australia: The student experience. International Journal of Osteopathic Medicine, 13(4), 160–165. doi:10.1016/j.ijosm.2010.01.003
Love, R. M., & Broduer, R. R. (1987). Inter- and intra-examiner reliability of motion palpation for the thoracolumbar spine. Journal of Manipulative Physiological Therapeutics, 10(1), 1–4.
Magolda, B. (2004). Evolution of a constructivitst-conceptualization of epistemological reflection. Educational Psychologist, 39(1), 45–56.
Mann, J., Protty, M. B., Duffy, J., Mohammed, M., & Wiskin, C. (2014). Near-peer teaching and exam results: The acceptability, impact, and assessment outcomes of a novel biological sciences revision programme taught by senior medical students. Journal of Biomedical Education, 2014, 9. doi:10.1155/2014/367493
Manninen, K., Henriksson, E. W., Scheja, M., & Silen, C. (2013). Authenticity in learning: Nursing students' experiences at a clinical education ward. Health Education, 113(2), 132–143.
Mootz, R. D., Keating, J. C., Kontz, H. P., Milus, T. B., & Jacobs, G. E. (1989). Intra- and inter-observer reliability of passive motion palpation of the lumbar spine. Journal of Manipulative Physiological Therapeutics, 12(6), 440–445.
O'Keeffe, M., Cullinane, P., Hurley, J., Leahy, I., Bunzli, S., O'Sullivan, P., & O'Sullivan, K. (2015). What influences patient–therapist interactions in musculoskeletal physical therapy? Qualitative systematic review and meta-synthesis. Physical Therapy, 96(5), 609–622. doi:10.2522/ptj.20150240
Orrell, J. (2011). Good practice report: Work integrated learning. Sydney, Australia:Australian Learning and Teaching Council.
Palmgren, P. J., & Chandratilake, M. (2011). Perception of educational environment among undergraduate students in a chiropractic training institution. Journal of Chiropractic Education, 25(2), 151–163.
Panzer, D. M. (1992). The reliability of lumbar motion palpation. Journal of Manipulative Physiological Therapeutics, 15(8), 518–524.
Patrick, C., Peach, D., Pocknee, C., Webb, F., Fletcher, M., & Pretto, G. (2008). The WIL report: A national scoping study (Australian Learning and Teaching Council Final Report). Retrieved from http://www.altc.edu.au/resource-wil-work-integratedlearning-griffith-2009
Performance anxiety. (n.d.). In The free dictionary. Retrieved from http://medicaldictionary. thefreedictionary.com/performance+anxiety
Rajendran, D., & Gallagher, D. (2011). The assessment of pelvic landmarks using palpation: A reliability study of undergraduate students. International Journal of Osteopathic Medicine, 14(2), 57–60.
Ramklass, S. (2013). The clinical education experience of student-physiotherapists within a transformed model of healthcare. Internet Journal of Allied Health Sciences & Practice, 11(2), 9.
Roland, D. (1997). The confident performer. London, England: Nick Hern Books. Roskell, C. (2009). Patient-centred practice in physiotherapy: Linking professional identity and learning. Interational Journal of Therapy & Rehabilitation, 16(5), 246–247.
Shaban, I. A., Khateremail, W. A., & Akhu-Zaheya, L. M. (2012). Undergraduate nursing students’ stress sources and coping behaviours during their initial period of clinical training: A Jordanian perspective. Nurse Education in Practice, 12(4), 204–209.
Sommerfeld, P. (2008). Whose values are we teaching? Deconstructing responsibilities and duties of teachers of osteopathy. International Journal of Osteopathic Medicine,
Sommerfeld, P., Kaider, A., & Klein, P. (2004). Inter- and intraexaminer reliability in palpation of the “primary respiratory mechanism” within the “cranial concept”. Manual Therapy, 9(1), 22–29.
Stovall, B. A., Bae, S., & Kumar, S. (2010). Anterior superior iliac spine asymmetry assessment on a novel pelvic model: An investigation of accuracy and reliability. Journal of Manipulative and Physiological Therapeutics, 33(5), 378–385.
Streckfuss, J. (2011). Unlocking the language of palpatory experience. In Teaching palpation: Proceedings of the OsEAN Open Forum 2011, Potsdam, Germany.
ten Cate, O., van de Vorst, I., & van den Broek, S. (2012). Academic achievement of students tutored by near-peers. International Journal of Medical Education, 3, 6–13. doi:10.5116/ijme.4f0c.9ed2
Trede, F., Macklin, R., & Bridges, D. (2012). Professional identity development: A review of the higher education literature. Studies in Higher Education, 37(3), 365–384.
Vaughan, B., Carter, A., Macfarlane, C., & Morrison, T. (2014). The DREEM, part 1: Measurement of the educational environment in an osteopathy teaching program. BMC Medical Education, 14, 99. doi:10.1186/1472-6920-1114-1199.
Vivian, D., & Wilk, V. (2000). The inter-observer reliability and validity of craniosacral palpation. Australasian Musculoskeletal Medicine, 5(2), 6–9.
Walker, A., Yong, M., Pang, L., Fullarton, C., Costa, B., & Dunning, T. (2013). Work readiness of graduate health professionals. Nurse Education Today, 33(2), 116–122. doi:10.1016/j.nedt.2012.01.007
Wallace, S. S. (2008). Criticality, research, scholarship and teaching: Osteopaths as educators. What makes a good teacher? International Journal of Osteopathic Medicine, 11(2), 52–55. doi:10.1016/j.ijosm.2008.02.001
Walshe, K., & Rundall, T. G. (2001). Evidence-based management: From theory to practice in health care. Milbank Quarterly: A Multidisciplinary Journal of Population Health and Health Policy, 79(3), 429–457.
Zegarra-Parodi, R. (2011). The need for standardized, evidence-based terminology in palpation teaching. In Teaching palpation: Proceedings of the OsEAN Open Forum 2011, Potsdam, Germany.
Zegarra-Parodi, R., Rickards, L. D., & Renard, E. (2009). Cranial palpation pressures used by osteopathy students: Effects of standardized protocol training. JAOA, 109(2), 79–85.
How to Cite
On acceptance for publication in FoHPE the copyright of the manuscript is signed over to ANZAHPE, the publisher of FoHPE.
Any reproduction of material published in FoHPE must have the express permission of the publisher.
Articles published in Focus on Health Professional Education (FoHPE) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0).