Telehealth E-Mentoring in Postgraduate Musculoskeletal Physiotherapy Education: A Mixed Methods Case Study to Inform Implementation for Advanced Clinical Practice

Keywords: Telehealth e-mentoring, Advanced musculoskeletal practice, Professional development Purpose: Mentored clinical practice is central to development of advanced clinical practice in musculoskeletal physiotherapy, and core within national and international educational standards. Whilst mentoring is traditionally delivered face-to-face, telehealth e-mentoring is a novel alternative, affording a unique andragogy to facilitate mentee critical reflection, deep learning and enhanced knowledge translation – all developed to optimise patient care. With COVID-19 resulting in widespread adoption of telehealth and access to specialist mentors often limited by clinic space, geography and cost, the potential value of telehealth e-mentoring is considerable. The purpose of this study was to understand the experiences and outcomes of/for multiple stakeholders (patients, student-mentees and mentors) engaged in musculoskeletal physiotherapy telehealth e-mentoring. Methods: Using case study design, sequential mixed methods explored stakeholder experiences of a 20-week telehealth e-mentoring service in a UK University as part of an advanced practice Masters programme. Quantitatively, validated outcome measures, patient participant experiences for care and empathy, patient empowerment and change in musculoskeletal health were collected at baseline and discharge. Qualitatively, semi-structured interviews exploring experiences of telehealth e-mentoring, including influence on critical thinking, clinical reasoning, communication skills, confidence, motivation, career enhancement etc. with mentee participants, and a focus group with mentor participants (topic guide informed by earlier analysis) were audio recorded and transcribed verbatim. Quantitative data were analysed using descriptive statistics (median, IQR) and qualitative data were analysed following the Framework Method. Trustworthiness was assured through reflexivity and code/recode audits with experts. Results: Data from patients (n = 90), mentees (n = 10) and mentors (n = 6) contributed to the developed analytic framework. Patients were aged median 42 years (18-73 years) presenting with a range of musculoskeletal complaints;n = 52 receiving follow up appointments. Of those followed up, improvements > MCID were clear, with MSK-HQ increasing by 11 points (MCID 6), Patient Specific Functional Scores improving by 4 points (MCID 2.7), and high scores for the Consultation and Relational Empathy and Patient Enablement Instrument. Mentors and mentees provided rich descriptions of their experiences. Main themes (sub-themes) for mentee participants’ included a) social learning (group mentorship, feedback, individualisation), b) advanced professional practice (communication, clinical reasoning, reflective practice), c) learner experience (expectation/acceptance, enjoyment/motivation) and c) limitations of telehealth (hands-on skill development, caseloads, therapeutic relationship). Mentor participants included a) preparedness (telehealth skills, relationship building, managing perceptions/expectations), b) journey of development (formative feedback, peer discussions, mimicking behaviours) and c) challenges (non-verbal communication, home environment, exercise prescription/goal-setting). Conclusion(s): Telehealth e-mentoring is an appropriate alternative to face-to-face mentored clinical practice, with improved patient outcomes and developed advanced musculoskeletal physiotherapy skills, knowledge and attributes. Planning for telehealth e-mentoring requires multi-stakeholder preparation, including setting expectations, embracing creativity in practice, and acquisition of technical skills. Impact: Adoption of telehealth e-mentoring may enhance opportunities for practice-based professional development and provide needed additional capacity to support profession specific skill development and service capability, to meet planned growth in advanced musculoskeletal physiotherapists. This study provides evidence from patients, mentees and mentors to support e-mentorship within teleheal h clinical practice. Preparation, planning and articulation of clear expectations are important to optimise the experience. Funding acknowledgements: Elsevier Research Award, MACP 2020