https://orcid.org/0000-0002-0079-0714
Figures
Abstract
Course leaders in rehabilitation healthcare professionals’ higher education face challenges stemming from multi-disciplinarity and the co-existence of different stakeholders. So far, the literature mainly attributed to course leaders’ managerial tasks, neglecting other fundamental transversal skills. Students represent an essential source of information for understanding the expected characteristics and roles of course leaders in rehabilitation healthcare degree programmes. This study explored students’ expected features of the course leaders in the rehabilitation healthcare professionals’ higher education. A qualitative interview study was carried out. A group of recent graduates and students of the MSc in ‘Healthcare Professionals Rehabilitation Sciences’ (University of Verona, Verona, Italy) was recruited using purposive sampling. Data were analysed using ‘Reflexive Thematic Analysis’ by Braun & Clarke. Ten healthcare professionals agreed to partake in the study (age 30 ± 9; men N = 2; women N = 8). Five themes were generated from the analysis: 1) ‘A Collaborative Manager’, as students perceived course leaders as non-authoritarian managers who involved all the stakeholders in the decision-making process addressing aspects such as curriculum adjustments, program improvements, and any challenges faced; 2) ‘A Diplomatic yet Honest Communicator’, as students needed course leaders capable of communicating transparently; 3) ‘A Flexible Mediator’, as course leaders should actively listen to all stakeholders, mitigating conflicts; 4) ‘An Empathic and Available Guide’, as students need course leaders available and ready to help; 5) ‘An Experienced Healthcare Professional’, as students felt course leaders should have a clinical background related to the course they lead. The results of this study suggested that students expect the course leaders to have a wide range of qualities and attitudes about soft (i.e., adaptation, communication, organisation skills, teamwork) and hard skills (i.e., clinical experience, evidence-based practice updated). They expect a course leader to consider all stakeholders’ needs and preferences to guarantee course harmony and satisfaction.
Citation: Giardulli B, Furri L, Testa M, Dell’Isola A, Bertoni G, Battista S (2024) Expected features of the course leader in the rehabilitation healthcare professionals’ higher education: A qualitative study on students’ perspectives. PLoS ONE 19(12): e0312943. https://doi.org/10.1371/journal.pone.0312943
Editor: Weifeng Han, Flinders University, AUSTRALIA
Received: March 17, 2024; Accepted: October 16, 2024; Published: December 17, 2024
Copyright: © 2024 Giardulli et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Course Leaders (CLs) are paramount in higher education as they are responsible for students’ education and development [1]. They design and oversee degree courses to ensure the highest educational quality [2]. Pursuing academic excellence directly impacts students’ satisfaction, a fundamental factor influencing university rankings and institutional appeal [3].
The environment in which the CLs operate within higher education programmes for rehabilitation healthcare professionals, including undergraduate and postgraduate courses, presents significant challenges. It is characterised by multi-disciplinarity and the coexistence of numerous stakeholders, including students, administrative staff, and health and rehabilitation settings. These stakeholders often have differing expectations regarding the management of the courses [4], which are only sometimes clear and shared [5]. Consequently, CLs require distinct skills and characteristics to navigate this complex reality [6].
The literature predominantly emphasises CLs’ managerial responsibilities, such as time management and institutional reporting tasks [7]. However, this perspective undervalues and under-recognises CLs’ primary role as educators. This limited managerial focus may lead institutions and curricula to overlook other essential transversal skills and characteristics, such as social and communication skills, which can significantly enhance students’ overall experience—the ultimate goal of any educational institution [7].
Therefore, it is crucial to consider students’ experiences due to their close interaction with CLs, as they can provide valuable insights into the expected characteristics that can enhance the learning experience [8–11]. Qualitative research is fundamental to exploring one’s experience [12]. Therefore, the current qualitative study aimed to investigate the expected characteristics of a CL in rehabilitation healthcare professionals’ higher education from the perspective of students’ experiences.
Material and methods
Research design
A qualitative interview study was carried out to explore students’ expected features of a course leader in a sample of Italian students or recent graduates at the Master of Science (MSc) degree in ‘Rehabilitation Sciences of Healthcare Professions’ (University of Verona, Verona, Italy). This MSc is characterised by an interdisciplinary population of healthcare professionals working in rehabilitation (e.g., physiotherapists, speech therapists and occupational therapists). This study followed the ‘Declaration of Helsinki’ and is reported in line with the Consolidated Criteria for Reporting Qualitative Research (COREQ) [13]. Ethical approval was obtained from the Committee for the Approval of Research on Individuals of the University of Verona (Verona, Italy–date of approval: 13 October 2022, code 15.R1/2022).
Participants
A group of recent graduates and students of MSc degrees in ‘Rehabilitation Sciences of Healthcare Professions’ (University of Verona) was recruited through purposive sampling to ensure maximum variation based on the professional background (e.g., physiotherapists and speech therapists), years of experience and specific interest about the topic [14]. Potential participants were identified among those students who chose to conduct a placement in coordination or teaching during the MSc, making them the most suitable to address our research question. The snowball sampling was not adopted. To be included in the study, participants had to be healthcare professionals working in rehabilitation and either current students or recent graduates (within the past year) of the MSc in ’Rehabilitation Sciences of the Health Professions’ at the University of Verona. Finally, participants were provided with a detailed informed consent form encompassing data management practices, privacy protection measures, study-related information, and the overall aim and objectives of the research. Participants were given the written informed consent form prior to participation. Each participant read the form in the presence of the researcher, had the opportunity to ask questions, and if they provided their consent, they could participate in the study.
Data collection
For deeper exploration, we adopted a semi-structured interview guide (Table 1) created collaboratively by a researcher (SB), a course leader (LF) and a student from the MSc degrees in ‘Rehabilitation Sciences of Healthcare Professions’ at the University of Verona (NM, see acknowledgements). The interview guide was tested on two students to gain feedback. These students were chosen based on their interest in the topic and were then enrolled for the pilot interviews. Following these pilot interviews, one question was removed from the interview guide as it was repetitive, and others were made more understandable. Once the interview guide was compiled, the interviews were conducted via the Microsoft Teams Platform by a male student of the abovementioned MSc (NM) who was trained by SB in qualitative study and who successfully took the course ‘Qualitative Research’ at the University of Verona and did not have any close relationships with the interviewees. The interviews were recorded and transcribed automatically by the Microsoft Teams Platform. NM checked the clarity of the transcriptions and saved them in a OneDrive folder at the University of Verona. This folder was accessible only to the MSc student (NM) until the interview transcripts were transcribed and anonymised, as LF and SB are faculty members. Once this process was over, access to this folder was granted to the other research team members. Participants did not review transcriptions for accuracy. Participants were assigned codes based on their interview order, age, gender, and profession to make them anonymous (e.g., P4, 30y, Man, PT). No follow-up interviews were conducted.
Data analysis
Data were analysed following the six steps of the ‘Reflexive Thematic Analysis’ (RTA) as reported by Braun & Clarke [15, 16] (Table 2). The choice to use a thematic analysis was driven by the theoretical flexibility and the rich description of data provided by the tool, allowing a broad meaning of patterns and a rich picture of the participants’ experiences. The exploratory theories informing the analysis were an ‘experiential qualitative’ within a ‘realist theoretical’ framework as we intended to explore and understand the expected characteristics of the CL to reflect the perception of social reality (rehabilitation healthcare professionals), and to take the fact as voiced in the dataset. In this sense, themes are not in the data waiting but developed by exploring the intersection of the data and the researchers’ positioning, skill and interpretative work. The themes were generated by BG, a PhD student in Neurosciences and a physiotherapist, with SB constantly revising the whole process and reflecting upon the themes.
RTA does not follow the (post)positivist paradigm characterised by minimising bias, coding accuracy and the use of different strategies (e.g., data saturation and member checking) to increase data trustworthiness [17]. We used an inductive approach as we did not adopt any predefined framework (i.e. the codebook of the deductive approach). The coding process was conducted on a semantic level of meaning, analysing the explicit or the surface meanings of the data. However, we tried to go beyond these descriptive levels of the data when possible. Different strategies were adopted to ensure study rigour and trustworthiness, such as audit trail of code generation, peer debriefing, and records of all data field notes. During and after each interview, the researcher took field notes–“Memos” and diary—to promote reflexivity, intended as personal reflections relevant to producing knowledge. These memos were shared during research meetings for reflexive thoughts. Moreover, the research team met frequently to refine the themes and subthemes until a consensus on the final themes was achieved. Finally, an audit trail containing meeting notes, analysis discussions, and research decisions was continuously reorganised by the four authors who analysed the interviews to stress the dependability and confirmability of the study [14].
Research team
BG is a physiotherapist and PhD student in Neurosciences. LF is a physiotherapist and the course leader of the MSc in ‘Rehabilitation Sciences of Healthcare Professions’. MT is a physiotherapist, PhD in Rehabilitation Sciences and associate professor. AD is a physiotherapist with a PhD in Musculoskeletal Diseases and associate professor. SB is a physiotherapist with a joint PhD in Neurosciences and Medical Science and a research fellow. BG, MT, AD, and SB identify themselves as men; LF identifies as women. BG and SB are experts in conducting qualitative studies.
Results
Ten Italian students or recent graduates at the University of Verona agreed to partake in the study (Age (mean and deviation standard): 30 ± 9; 20% Men, N = 2; 80% Women, N = 8; all white Italian). Among the participants, four were physiotherapists (40%), four were speech therapists (40%) and two were psychiatric rehabilitation technicians (20%) (Table 3). From the analysis of the interviews, five themes were developed: 1) ‘A Collaborative Manager’, 2) ‘A Diplomatic yet Honest Communicator’, 3) ‘A Flexible Mediator’, 4) ‘An Empathic and Available Guide’, 5) ‘An Experienced Healthcare Professional’. Quotations and codes that led us to generate the themes are reported in Tables 4–8.
Theme 1: ‘A Collaborative Manager’
By exploring students’ experiences, a necessary reported characteristic of CLs was the ability to manage and direct the degree course with a broad vision and a clear educational mission based on shared decision-making, gathering insights from the stakeholders, and assessing alternative resolutions. Hence, we generated the first theme: ‘A Collaborative Manager’ (Table 4). This theme underscored the importance of participative and non-authoritarian leadership, valorising and involving all relevant stakeholders, especially students and lecturers, in the organisational dynamics of the degree programme. Moreover, students perceived managing a degree programme as demanding and very time-consuming. Therefore, an essential perceived managerial skill of the CL was delegating minor tasks to others and coordinating them to prevent work overload. Finally, as a manager, the CL must maintain clear objectives and a broad vision. In other words, the CL must understand which goals should be prioritised strategically.
Theme 2: ‘A Diplomatic yet Honest Communicator’
Every task or facet of the course should be purposefully chosen following a specific rationale. However, to interact effectively with stakeholders and a team, good communication skills are essential to favour the transmission of the correct messages. Hence, we generated the second theme: ‘A Diplomatic yet Honest Communicator’ (Table 5). The interviewees emphasised the importance of having a CL with good communication skills, the ability to convey messages, and the ability to adapt their language to the audience. Another pivotal factor was that the CLs needed to safeguard their integrity, which meant that CLs were required to be honest and transparent. Moreover, CL needed to recognise their limits and admit when they had no answer to a question.
Theme 3: ‘A Flexible Mediator’
Being able to mediate among different stakeholders, coupled with active listening and receptivity to criticism, was perceived as a crucial characteristic by students, leading us to generate the third theme: ‘A Flexible Mediator’ (Table 6). Mediating among all the stakeholders around the degree course programme was considered crucial for students, especially concerning conflicts. For instance, the CL could have mitigated uncomfortable situations among students and lecturers. Hence, active listening was a prerequisite to guarantee a suitable mediation between stakeholders, as it allowed CLs to grasp the involved parties’ needs and work towards collaborative solutions. Moreover, CLs sometimes had to listen to constructive criticism and try to question themselves. Such flexibility and openness to criticism were perceived as paramount by students.
Theme 4: ‘An Empathic and Available Guide’
Embodying a CL also meant investing time to foster unity among students. A guide capable of empathising with their students was regarded as an exemplary role model, a figure whom students highly appreciated. Hence, we generated the theme ‘An Empathic and Available Guide’ (Table 7). In their experience, CLs had to bond within the class, offering motivation and helping when needed. In this perspective, CLs were perceived as guides who needed to stay close and present to their students. In addition, CLs, as guides, are also required to spend some time and create activities with the class to create cohesion and mutual knowledge exchange among them. Teamwork and team building were viewed as fundamental activities to which the CL needed to respond actively.
Theme 5: ‘An Experienced Healthcare Professional’
Among the different roles and characteristics gained through students’ experiences, CLs must also possess a good reputation and a robust background as healthcare professionals. Students emphasised the crucial need for CLs to maintain a strong clinical background related to the course they lead, meaning they must have a lot of clinical experience and a good reputation among their colleagues, leading to the generation of the theme ‘An Experienced Healthcare Professional’ (Table 8). This aspect was relevant for students as they considered CLs a helpful guide for their clinical training journey. The interviews also highlighted the need for CLs to update their knowledge and continuously showcase resourcefulness. Students felt that CLs need to be a reliable reference point for discussing the latest evidence available in the literature, demonstrating a proactive approach to staying informed and changing the training clinical practices into the most cutting-edge treatments. However, students also emphasised how being an excellent healthcare professional or lecturer should not be a solid and harsh requirement. The primary expectation was that CLs fulfilled their role, recognising that success in any one of these domains did not necessarily guarantee proficiency in the others.
Discussions
The current study explored the experiences of a group of Italian healthcare professionals attending an MSc degree to understand the expected characteristics of CLs in rehabilitation healthcare professionals’ higher education. In students’ experiences, the CLs need to know how to manage and direct the degree course based on a shared-decision making with different stakeholders (‘A Collaborative Manager’), to possess good diplomatic and communication skills (‘A Diplomatic yet Honest Communicator’), to listen actively to and mediate different stakeholders (‘A Flexible Mediator’), to embody an empathetic and present guide for students (‘An Empathic and Available Guide’), and finally to have a robust and updated background as healthcare professionals (‘An Experienced Healthcare Professional’).
Embodying the skills and capabilities of a manager and carefully planning the team’s tasks and time efficiently are characteristics already present in the literature. Parkin’s assertion that a good CL uses “the logic of goals, sequencing and priorities to map what should happen, when and where, and who should be involved” [18] underscored the importance of avoiding time wastage and adhering to a well-structured agenda. This piece of evidence resonated with the views of our interviewees, who emphasised the significance of CLs possessing clear priorities and well-defined goals. Moreover, delegation was necessary for our interviewees, which was in line with another study [19].
Communication skills represented another relevant characteristic, with students attributing value to CLs capable of effectively conveying messages and adapting their language to their audience. Muteswa’s work supported this perspective, emphasising the importance of communication skills [20]. Not less important was the honesty and transparency during communication, including the ability to admit limitations, as our students and other authors highlighted as paramount characteristics [18, 21].
Moving beyond managerial and communicative roles, students perceived the CLs as mediators who foster connections among different stakeholders [18], which can help solve conflicts, as reported elsewhere [21, 22]. Active listening, receptivity to criticism, and ability to put themselves in discussion are fundamental characteristics of a mediator from our students’ perspectives. These characteristics resonate with the concepts of “Embodied Leadership” and “Enabling Leadership” [18, 23]. The first is characterised by being non-judgmental, listening actively and embracing uncertainty and reflective practice [23]. The second is characterised by considering ideas and strategies suggested by top-down and bottom-up approaches, looking to work with people in teams to pursue innovation and develop a sense of energy and collective commitment [18]. Hence, CLs need to adhere to both leadership styles.
The role of CLs as empathetic guides, capable of investing their time to foster unity among students, was central from students’ perspectives, emphasising the need for someone to rely on to solve problems in the degree course [19]. This attitude encompasses the characteristics of “Emotional Intelligence”, defined as the ‘form of social intelligence that involves the ability to monitor one’s own and others’ feelings and emotions, to discriminate among them, and to use this information to guide one’s thinking and action’ [24]. On the other hand, empathy is another fundamental characteristic of the guide role, as it helps mediate between stakeholders and reduce interpersonal conflicts. In this regard, Olga et al. have highlighted how empathy helps to build neutral relations between parties in the educational environment [22]. Moreover, interviewees also felt that the CLs were responsible for team building and class cohesion, which aligns with the results of another study [19].
Finally, the CLs needed to be experienced and updated healthcare professionals with credible reputations. From students’ perspectives, this concept meant having " credible " CLs as they were perceived closer to their professional identity. In this way, the students had an example to shape themselves and could lead the education of their academic course. In line with this, the students appreciated when the CLs were updated on the latest evidence-based practice techniques. Also, having a reputation among colleagues was considered an essential element. A study exploring the competencies for effective leadership in higher education highlighted how ‘academic credibility’ involved reputation and respect [19]. In the same study, ‘experience of being an academic’ or ‘experience in a university setting’ were also reported as essential prerequisites [19]. However, it must be noted that the academic and clinical roles should not overshadow or detract time from the primary duties of the course leader role [19].
The insights gained from this study may represent a valuable resource for faculty and policymakers within higher education, especially in the training and development of CL in rehabilitation healthcare fields. Higher education institutions could design targeted training programmes to develop the skills highlighted in our themes for current and aspiring CLs. Future research could explore if these CL characteristics are common among students across different universities, disciplines, and geographical areas and if CLs perceive these characteristics as necessary.
Some limitations of the study need to be addressed. First, only a few rehabilitation healthcare professionals (i.e., physiotherapists, speech therapists, and psychiatric rehabilitation technicians) were represented in our sample. Consequently, the results may not be applied to all the other rehabilitation healthcare professionals. Second, most of the participants were women. Finally, all participants were taken from the same university (University of Verona), so it is impossible to conclude whether our results might transfer to other universities in different geographical areas. Moreover, most of the participants were white women. This consideration is crucial since meanings attached to education might be influenced by gender, ethnicity and place of living [25]. Nevertheless, this study has significantly contributed by providing rich insights into CLs’ multifaceted roles and characteristics in the rehabilitation healthcare professionals’ higher education. Moreover, the study was designed and conducted with a course leader and a student to increase its relevance. This exploration addresses a topic that has received limited attention in the existing literature, enhancing our understanding of this crucial aspect of academic leadership.
Conclusions
The results of this study highlighted that students expect the CLs in the rehabilitation healthcare professionals’ higher education to have advanced soft skills (adaptability, communication, organisation, teamwork) and hard skills (i.e., clinical experience, evidence-based practice updated). A huge emphasis was placed on interpersonal and organisational capabilities, underscoring the importance of effective mentorship for CL training. Additionally, students expected CLs to consider the different needs of all stakeholders, indicating an approach that ensures course quality and satisfaction. These insights contribute valuable perspectives to the literature on academic leadership in the rehabilitation healthcare professionals’ higher education.
Acknowledgments
The authors would like to thank Nicolò Magistrelli for helping to conduct the interviews.
References
- 1. Lawrence J, Morón-García S, Senior R. Supporting Course and Programme Leaders in Higher Education: Practical Wisdom for Leaders, Educational Developers and Programme Leaders. Supporting Course and Programme Leaders in Higher Education: Practical Wisdom for Leaders, Educational Developers and Programme Leaders. 2022; 1–209.
- 2. Stensaker B, Frølich N, Aamodt PO. Policy, Perceptions, and Practice: A Study of Educational Leadership and Their Balancing of Expectations and Interests at Micro-level. Higher Education Policy. 2020;33: 735–752.
- 3. Onditi EO, Wechuli TW. Service Quality and Student Satisfaction in Higher Education Institutions: A Review of Literature. 2017.
- 4. Cinaroglu S. Complexity in healthcare management: Why does Drucker describe healthcare organizations as a double-headed monster? Int J Healthc Manag. 2016;9: 11–17.
- 5. Murphy M, Curtis W. The micro-politics of micro-leadership: Exploring the role of programme leader in English universities. Journal of Higher Education Policy and Management. 2013;35: 34–44.
- 6. Krause K-LD, Bath D, Lizzio A, Albert L, Clark J-A, Campbell S, et al. Degree Programme Leader roles and identities in changing times. 2010.
- 7. Wilder-Davis K. Creating Cultures of Enhancement: Programme Leader or Programme Manager. QAA Collaborative Cluster. 2020 [cited 21 Dec 2023]. Available: https://www.academia.edu/45576554/Creating_Cultures_of_Enhancement_Programme_Leader_or_Programme_Manager
- 8. Cahill J, Bowyer J, Rendell C, Hammond A, Korek S. An exploration of how programme leaders in higher education can be prepared and supported to discharge their roles and responsibilities effectively. Educational Research. 2015;57: 272–286.
- 9. Crevani L, Lindgren M, Packendorff J. Leadership, not leaders: On the study of leadership as practices and interactions. Scandinavian Journal of Management. 2010;26: 77–86.
- 10. Cunliffe AL, Eriksen M. Relational leadership. 2011;64: 1425–1449.
- 11. Milburn PC. The role of programme directors as academic leaders. Active Learning in Higher Education. 2010;11: 87–95.
- 12. Morse JM, M . J. Qualitative health research: creating a new discipline. Qualitative health research: Creating a new discipline. 2012; 176. Available: http://mendeley.csuc.cat/fitxers/43246b4f8d2e61df8fe6875830e710dc
- 13. Booth A, Hannes K, Harden A, Noyes J, Harris J, Tong A. COREQ (Consolidated Criteria for Reporting Qualitative Studies). Guidelines for Reporting Health Research: A User’s Manual. 2014; 214–226.
- 14. Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. Eur J Gen Pract. 2018;24: 9–18. pmid:29199486
- 15. Braun V, Clarke V. Conceptual and Design Thinking for Thematic Analysis. Qualitative Psychology. 2021;9: 3–26.
- 16. Braun V, Clarke V. Thematic analysis. APA handbook of research methods in psychology, Vol 2: Research designs: Quantitative, qualitative, neuropsychological, and biological. 2012; 57–71.
- 17.
Braun Virginia; Clarke V. Thematic Analysis: A Practical Guide. SAGE Publishing, editor. 2021. Available: https://uk.sagepub.com/en-gb/eur/thematic-analysis/book248481
- 18. Doug Parkin. Leading Learning and Teaching in Higher Education: the key guide to designing and delivering courses. 2016; 285. Available: https://www.perlego.com/book/1610086/leading-learning-and-teaching-in-higher-education-the-key-guide-to-designing-and-delivering-courses-pdf
- 19. Spendlove M. Competencies for effective leadership in higher education. International Journal of Educational Management. 2007;21: 407–417.
- 20. Muteswa RPT. Qualities of a Good Leader and the Benefits of Good Leadership to an Organization: A Conceptual Study. European Journal of Business and Management www.iiste.org ISSN. 2016;8. Available: www.iiste.org
- 21. Baba MM, Makhdoomi UM, Siddiqi MA. Emotional Intelligence and Transformational Leadership Among Academic Leaders in Institutions of Higher Learning. Global Business Review. 2021;22: 1070–1096.
- 22. Smolyaninova OG, Posokhova ST, Izotova MK. The possibilities of empathy in preventing interpersonal conflicts in the educational environmentof a higher education institution. Journal of Siberian Federal University—Humanities and Social Sciences. 2021;13: 219–233.
- 23. Koya K, Anderson J, Sice P. The embodied nurse: Interdisciplinary knowledge exchange between compassionate nursing and recent developments in embodied leadership studies. J Adv Nurs. 2017;73: 3028–3040. pmid:28620966
- 24. Salovey P, Mayer JD. Emotional intelligence. Imagin Cogn Pers. 1990;9: 185–211.
- 25. Battista S, Furri L, Pellegrini V, Giardulli B, Coppola I, Testa M, et al. Which lecturers’ characteristics facilitate the learning process? A qualitative study on students’ perceptions in the rehabilitation sciences. BMC Medical Education 2023 23:1. 2023;23: 1–10. pmid:37308863