Exploring the lived experience of osteopathy students making the transition from working in student clinic (8 hours per week) to working full-time (40 hours per week) during the summer holiday break

Abstract

INTRODUCTION: The transition made from being a novice to having greater expertise has been discussed since the late 20th century in the field of nursing. However, recently the focus of research has widened to study transitions in all forms of healthcare. Osteopathy, a form of manual healthcare, has limited research into its techniques and philosophies, and the transitions made by students when studying and practicing osteopathy. In New Zealand, Unitec and the ARA Institute of Technology are the providers of education in osteopathy, with students completing an undergraduate degree and Master of Osteopathy (MOst) Postgraduate Diploma of Osteopathy, respectively. This research project investigates the lived experiences of student osteopaths as they make the transition from full-time students and part-time practitioners to full-time practitioners in a supervised work environment at Unitec. During the MOst programme at Unitec, students complete eight hours of clinical work experience per week during the semester. During the summer break of the first year, the students are immersed in a clinical experience where they complete 40 clinical work hours per week for one month.

METHODOLOGY: An exploration of the transition that students make during this immersive experience was conducted through focus group interviews. To analyse the data, a descriptive phenomenological research method was used. This method allows the researcher to analyse the data, extract the essence of the discussion and create a fundamental structure of the phenomenon (making the transition). Preconceptions and biases held by the researcher are recorded and acknowledged to mitigate external influences acting on the data. Colaizzi’s (1979) method was used to analyse the data. In this method, the information gathered is read and reread and clustered into themes before the essence and fundamental structure of the phenomenon is recorded and checked by the participants.

RESULTS/FINDINGS: The themes and subthemes that presented themselves were: 1.“Confidence from Validation” with subthemes including the effects of validation on i. clinical skills; ii. professional identity; and iii. comparison with others.

2. “Immersion and groundedness” (which is described by the participants as being mentally present and able to adapt their own style of osteopathy for each patient) with subthemes including the changes to i. sense of self and confidence; ii. New patient management; and iii. environmental effects: tutors, chores and reception.

3. “Stress from clinical and extra-curricular commitments”, with subthemes i. financial burden; ii. positive and negative reactions to stress; and iii. rewards from immersion.

CONCLUSION: The students felt nervous and unsure going into the month, expecting very difficult clinical scenarios to come up throughout the month. The clinical tutors played a large part in building the students’ confidence during the experience. As there is no objective measure of improvement, the students sought validation of their clinical skills from the tutors and compared their skills to those of other students. After being immersed in the experience the students built a sense of self confidence and groundedness. The environment that the students worked in, from the tutors and receptionists to the chores and clinical maintenance, had a large effect on their experience of this transition. Stresses such as financial strains and relationship burdens added to the pressure on the students, as the month of clinical work is unpaid, leaving students without income for a month during a time where they could have equivalent, paid employment (the summer break period). Some students felt that the stresses improved their clinical confidence and competence as they learnt to manage themselves and their time effectively. By comparison, other students felt that these stresses took away from the experience. There was consensus that the month-long immersion was essential for helping the novice osteopath find their own style of osteopathy that they hope to employ in the future and helping in the transition that is entailed in acquiring greater expertise.