DR SINEAD MCMAHON
UCD School of Public Health, Physiotherapy and Sports Science
Physiotherapy Education for the 21st Century
Dr Sinead McMahon is the Director of Clinical Education and Practice Development at the UCD School of Public Health, Physiotherapy and Sports Science.
Her primary research area examines student physiotherapist clinical work placements. She says: "my research has demonstrated that first and second year physiotherapy students have very high confidence levels, feel that they are responsible and autonomous. In contrast, the third-year students have very low average confidence levels. And by fourth year of training, their confidence rises again."
Dr McMahon thinks the Cycle of Competence model is being demonstrated within the clinical placement cycle.
This model describes the cycle of learning. Dr McMahon's research to date has found that as students begin placement as novices they are initially unconsciously incompetent - essentially they do not know what they do not know. As the learning and pressures become more intense, they are suddenly very consciously incompetent and aware that there are many things they do not know. They begin to become consciously competent as their training progresses and they eventually become unconsciously competent.
"This is where I began to see what education does, this is the cycle. This helps me guide students not to worry about the fact that they may dip or doubt their ability to complete their physiotherapy training."
Dr McMahon speaks about her work in the UCD School of Public Health, Physiotherapy and Sports Science in the video below.
Dr McMahon has also examined graduate surveys, Irish physiotherapy clinical placement sites and the core skills needed for the physiotherapy profession.
Due to the employment market, she found that a large majority of physiotherapists were working in private practice and less in the hospital sector. This did not align with the clinical placement sites at that time which were based in the acute sector. Government Policy is currently looking at Primary Care as the first point of call for health care services. She says:
"Just 5% of all placements were in primary care and 95% were in acute services. UCD were 3% of those. This presented a challenge for curriculum design."
That was the catalyst where Dr McMahon began to try and effect change. Alongside colleagues Dr Caitriona Cunningham, Dr Catherine Blake, and Dr Ulrik McCarthy Persson, she founded the UCD Physiotherapy Hub. This was initially founded as a health promotion and community exercise service. Alongside helping patients, this aimed to help fill that gap when considering Physiotherapy student placements.
Dr McMahon and colleagues are currently also considering a framework for educator and tutor credentialing such as training days and study leave. She champions for acknowledgement for people who have a natural flair for clinical education and may want to specialize in this area.
"My opinion on what makes a good educator? Their communication skills have to be brilliant. They have to be objective, self-aware and able to receive constructive feedback. They have to have this genuine motivation for teaching students. They need to have that motivation to try and guide somebody who is struggling and get them to the end, to appropriately support them throughout challenges."
Due to her work around clinical placement sites, UCD have moved from having 3% to 21% of placements in primary care. This is robustly preparing healthcare students to work in the primary care setting.
The UCD Physiotherapy Hub began with two students and they are now taking in over thirty students per year. Along with Mr Ciaran Purcell MISCP Sports Physiotherapist and Physiotherapy Hub Practice Tutor, Dr McMahon is currently conducting research around the Physiotherapy Hub one year Pilot Sports and Exercise Physiotherapy Specialisation Placement. This commenced in 2018 with 8 students who gained extensive experience in a wide variety of sports and exercise and community physiotherapy areas within UCD.
Previous student focus groups have previously compared the Physiotherapy Hub to acute settings. The Physiotherapy Hub placement seems to allow students to become more confident versus working in the acute setting. Part of Dr McMahons' current research project aims to ascertain why this is the case.
The considerations around the educational model of the Cycle of Competence have helped UCD Physiotherapy School incorporate those factors into changing the curriculum. This helps Dr McMahon guide their students not to doubt their abilities.
"Our students are so academically bright and have done so well to gain entry into the Physiotherapy education system. Suddenly they are doing something they may not like. Is this because they really dislike it, or just because this is part of the learning process?"
Dr McMahon has also added in more cultural and communication competencies to the Physiotherapy curriculum, for example, workshops with the Physiotherapy students and Irish Travellers. Along with colleagues, she has also begun to thread the idea of health promotion throughout the curriculum.
The Importance of Clinical Reasoning
The UCD Physiotherapy degree also assesses the student's ability to retrieve and use evidence using a Clinical Reasoning Form. This is unique to UCD Physiotherapy. Dr McMahon and colleagues want to ensure graduates can retrieve and understand peer-reviewed literature to implement best practice. Dr McMahon also works very closely with her colleague Ms Nessa Waters around developing Evidence-Based Practice. Ms Waters has recently developed a module which is showing promising results for the Physiotherapy and other Health and Social Care professionals curricula.
The Health and Social Care regulatory body CORU have recently examined the UCD Physiotherapy curriculum to assess physiotherapy core competencies. Many of Dr McMahon's modules are driving the Physiotherapy curriculum in UCD. Due to Dr McMahon’s work around Physiotherapy education, she was asked to collaborate in writing a Health Service Executive policy document around musculoskeletal services in Primary Care. This document will potentially influence a shift in physiotherapy practice in Ireland.
The contributors are recommending primary care physiotherapy as the first point of contact for certain illnesses and injuries which will reduce the burden on the acute hospital sector. Dr McMahon also notes that the previous policymakers were not physiotherapists and there was nothing in the previous version about physiotherapists role in health promotion.
Health promotion is a key area as it is considering prevention rather than cure and physiotherapists are ideally placed to provide this information. Dr McMahon aims to clarify this within her role in contributing to the revised document. She has also recently made contact with the HSE Workplace Planning and Intelligence Department about involving the Higher Education Institutes in workforce planning. Through doing this she hopes to influence employment rates going forward.
She thinks graduates who can work in any context and well-rounded learning experience is key to continue to create impactful change going forward. Regarding core competencies for tutors and educators, Dr McMahon plans to do this research and present her findings to the HSE to create a national framework going forward.
The crux of Dr McMahon's work is the common thread of an education component.
"Somebody will always need training, whether that is students, staff, tutors or educators. So that is my real area of interest-education."
About the researcher
Dr Sinead McMahon MISCP PhD BSc MISCP PGDip is the Director of Clinical Education and Practice Development in the UCD School for Public Health, Physiotherapy and Sports Science.
Dr McMahon's programme of research centres around education, curriculum design and curriculum development. Her PhD looked at preparing graduates to work in primary care centres rather than acute care hospitals. She is interested in looking at physiotherapy practice skills and the teaching and learning methods used to achieve these.
Currently, she is involved in a research project in Ethiopia with Dr Cliona O’Sullivan. This is looking at the healthcare professional skills needed to work within health rehabilitation in low and middle-income countries. It is part of the Building Resilience through Education (BRTE) Horizon 2020 project. UCD are leaders in practice education and the Physiotherapy team have developed innovative models for practice such as the UCD Physiotherapy Hub. This initiative provides experiential learning environments for students in health promotion, sports physiotherapy and community-based exercise.
Dr McMahon is also leading a Health Service Executive funded project, exploring ways and means of incentivisation for those individuals who could provide student placements and looking at a credentialing system for physiotherapy educators. She is also collaborating with colleagues from NUIG, UCC and UL to develop a National Quality Practice Education framework for Health and Social Care professionals. The most important aspect of Dr McMahon's research is that it is immediately translated into practice, it informs her teaching and it helps to make a better learning experience for students through their programme in UCD Physiotherapy.
Associated References
Coote, S., Alpine, L., Cassidy, C., Loughnane, M., McMahon, S., Meldrum, D., O'Connor, A. and O'Mahoney, M. (2007)(opens in a new window)(opens in a new window)The development and evaluation of a common assessment form for physiotherapy practice education in Ireland.
McMahon, S., Waters, N., Cusack, T. and O'Donoghue, G. (2014)(opens in a new window)(opens in a new window)A profile of physiotherapy practice education settings in Ireland 2009–2012. Physiotherapy Practice and Research, 35(2), pp.95-100.
McMahon, S., O'Donoghue, G., Doody, C., O'Neill, G., Barrett, T. and Cusack, T. (2016) (opens in a new window)(opens in a new window)Standing on the Precipice: Evaluating Final-Year Physiotherapy Students' Perspectives of Their Curriculum as Preparation for Primary Health Care Practice.Physiotherapy Canada, 68(2), pp.188-196.
McMahon, S., O’Donoghue, G., Doody, C., O’Neill, G. and Cusack, T. (2016) (opens in a new window)(opens in a new window)Expert opinion regarding the preparation of entry-level physiotherapists for primary healthcare practice, examined using Biggs 3P’s model of teaching-learning.Education for Primary Care, 27(3), pp.196-204.
O’Neill, G. and McMahon, S. (2012) (opens in a new window)(opens in a new window)Giving student groups a stronger voice: using participatory research and action (PRA) to initiate change to a curriculum.Innovations in Education and Teaching International, 49(2), pp.161-171.