Osteopathic graduates perceptions of stress and competence – A longitudinal study

Abstract

Objective

The objective of this study was to explore osteopathy students' perceptions of occupational stress and clinical practice competence, and how these perceptions changed after six months of osteopathic practice.

Participants

Students who graduated in 2010 from Victoria University's osteopathy program.

Method

Participants completed one survey as final year osteopathy students in November 2010 and one survey as registered osteopaths in July 2011. The surveys were developed by drawing on previous work investigating health professional capabilities and also graduates transition to practice. Key areas of exploration were work related stressors and self-perceived clinical competence.

Results

Job related stressors experienced were different from those expected by students, however, the overall level of stress as a new practitioner was accurately anticipated by students. New graduates were found to experience high levels of stress caused by: managing tricky patients; feeling like they should know everything; medico-legal issues; time management; and, overwork. Students in their final months of the osteopathy program felt more competent than after six months in practice. However, they perceived a lack of competence in: establishing a prognosis and using appropriate outcome measures; managing risks; maintaining currency of knowledge and skills; and, maintaining current knowledge of other health practices.

Conclusion

Osteopathy graduates have similar experiences of stress and perception of competence to other health graduates in their transition to practice. New graduates in osteopathic practice perceived a lack of competence in several clinical areas. Mentorship and graduate programs are required to ensure osteopathic graduates are supported in their early professional careers.

Introduction

Osteopathic students develop their professional skills and competencies through external (with a qualified osteopath in private clinic) and internal (within the university teaching clinic) supervised clinical placements and clinical tutorials.¹ Osteopaths in Australia are eligible for registration after five years of prescribed study² then predominantly work in privately owned clinics which may be sole operator, osteopathic group or multidisciplinary in nature.³

Research suggests that when transitioning into their first year of health care practice, medical and allied health students and graduates:

• were unsure of their role and what was expected of them;4, 5, 6, 7

• identified it as a time of acquiring new skills and knowledge and accepting increased responsibilities;⁸

• felt unprepared to deal with significant increases in workload, adjusting to full time work, complex cases and decision making about patient care;4, 5, 6, 8, 9, 10, 11

• were lacking in confidence and competence to perform their job requirements adequately;6, 12

• felt that graduate programs and mentorship increase confidence and competence, make the transition from study to work less stressful, and increase job satisfaction.7, 8, 9, 13, 14

Health professional graduates perceive conflict between expectations of the clinical practice role and the reality of the work setting.4, 5, 6, 8, 15 This has been termed ‘reality shock’.¹⁶ “Reality shock occurs when a new employee's expectations, established prior to joining an organisation, differ significantly from what is experienced upon entering the organisation” (page 55).¹⁷

Unlike many other health professions, there are currently no graduate programs to support an osteopath's transition to practice in Australia. Mentoring relationships are sometimes established with the employer if the graduate is an associate in the practice but there is no formal professional structure upon which a uniform approach to mentoring is based. Some graduates may start practicing independently (their own clinic/business) and therefore have limited scope for a mentoring relationship. In either situation, from their first day in practice graduates are expected by their employers and their patients to be competent practicing osteopaths (in contrast to competent student osteopaths), with the ability to handle all situations. The expectation for graduates to immediately be competent practitioners has the potential to be a major source of stress for new graduates as evidenced in other health professions.8, 18 The present study aims to explore osteopathic graduates' perceptions of occupational stress and clinical competence.