Towards clinical expertise: learning transitions of neuromusculoskeletal physiotherapyists

  • Nicola Petty

Student thesis: Doctoral Thesis


Postgraduate neuromusculoskeletal physiotherapy courses in the UK, accredited by the Manipulation Association of Chartered Physiotherapists (MACP), aim to promote clinical expertise. Gaining the specialist qualification has been demonstrated to enhance career progression to extended scope practitioner, clinical specialist and consultant roles within the NHS. While research has identified the attributes of expertise, there is limited understanding of how individuals learn and develop that expertise. The aim of the study was to develop an explanatory theory of the learning transitions of neuromusculoskeletal physiotherapists on completion of an MACP approved Masters programme. The methodology was a naturalistic inquiry using a single theory-seeking case study design and insider research. Twenty six semi-structured face to face or telephone, audio-taped interviews with eleven alumni who had successfully completed a MSc neuromusculoskeletal physiotherapy course participated and were selected using purposeful sampling. Alumni were interviewed between six months and five years after completion of the MSc. A further two study participants with high levels of clinical expertise, were theoretically sampled and interviewed once. Dimensional analysis of the research data was used to develop a substantive theory of the learning transition. The learning transition was from hidden, received practice knowledge with routine, therapist centred clinical practice to critical understanding of practice knowledge that enabled patient centred practice and the capability to learn in, and from, practice. This development towards clinical expertise was primarily facilitated by critical evaluation of practice knowledge through critical companionship in the practice setting. The learning transition varied between study participants and depended on their conception of clinical practice, epistemology of practice knowledge, conception of teaching and learning, achievement motivation, locus of control, perceived self efficacy in practice knowledge, professional self esteem, emotional control, learning relationships and learning style. Findings suggest that direct observation of clinical practice together with the questioning and challenging approach of critical companionship within clinical practice enhanced the clinical expertise of neuromusculoskeletal physiotherapists. Clinical expertise was characterised by critical understanding of practice knowledge, patient centred practice and a capability to learn in, and from, clinical practice. The explanatory theory of the learning transition has implications for physiotherapy clinical practice, education and research.
Date of Award1 Jan 2009
Original languageEnglish
Awarding Institution
  • University of Brighton

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