Evaluating Placement Quality in Allied Health: Rasch-Based Validation of the Clinical Placement Quality Survey - Student

Evaluating Placement Quality in Allied Health: Rasch-Based Validation of the Clinical Placement Quality Survey - Student | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluating Placement Quality in Allied Health: Rasch-Based Validation of the Clinical Placement Quality Survey - Student Taryn Jones, Brett Dyer, Simone Howells, Tanya Palmer, Larissa Sattler, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6019236/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The Clinical Placement Quality Survey – Student (CPQS-S) was developed to capture allied health students' perceptions of placement quality, in alignment with the Best Practice Clinical Learning Environment framework. This study aimed to validate the CPQS-S using Rasch Analysis across multiple allied health disciplines, encompassing students from Clinical Exercise Physiology, Exercise Science, Nutrition and Dietetics, Occupational Therapy, Physiotherapy, Rehabilitation Counselling, Social Work, and Speech Pathology programs. Data collected from 933 students were divided into development and validation samples. The CPQS-S was confirmed to be measuring a unidimensional construct and Rasch Analysis showed that items demonstrated strong fit statistics and separation reliability, affirming the tool’s psychometric robustness in measuring student perceptions. These findings support the CPQS-S as a reliable, data-driven instrument that consistently assesses placement experiences across diverse settings. The validated structure underscores the CPQS-S as a reliable instrument for assessing and benchmarking placement quality, providing educators with actionable data to enhance clinical learning environments. More broadly, these findings contribute to the advancement of work-integrated learning research by offering a validated tool to inform educational interventions and quality improvement initiatives in health professions education. Work Integrated Learning Student Perceptions Placement Experience Interprofessional Psychometric Validation Figures Figure 1 Figure 2 Introduction Student placements are foundational for the development of allied health professionals, facilitating the transition from theory to practical application (AHPRA Accreditation Committee, 2023 ; Penman et al., 2023 ). The term ‘placement’ is intended to be an inclusive term for experiences that may also be called work integrated learning, clinical placements, practice education, supervised practice, field education or professional practice. In Australia, allied health tertiary education programs include substantial work-integrated learning components (Penman et al., 2023 ). These experiences typically require students to demonstrate safe, effective, and ethical management of clients across diverse healthcare settings to ensure they are practice-ready upon graduation (AHPRA Accreditation Committee, 2023 ). Placement enables students to apply their skills under the supervision of professionals while being assessed on their capabilities in real-world environments. The benefits extend beyond individual student development, enhancing academic rigour for universities and providing healthcare organisations with a workforce equipped for professional practice (Hamiduzzaman et al., 2024). Through this experiential learning, students, universities, and healthcare institutions collectively contribute to the development of a capable, adaptable allied health workforce. The Australian health workforce, particularly within allied health, is facing significant challenges due to workforce shortages and growing demand for healthcare professionals (Australian Institute of Health and Welfare, 2024 ). Key factors driving this demand include population growth and an aging demographic, which are intensifying the need for allied health staff and services (Australian Institute of Health and Welfare, 2024 ). This, in turn, has led to an increasing demand for student placements, a trend expected to continue with the expansion of university health programs, larger student cohorts, and evolving workforce needs (McBride et al., 2020). For placement stakeholders, building capacity to provide sustainable placement numbers remains a persistent challenge. To ensure this rising placement demand, does not compromise the quality of learning experiences, robust mechanisms are required to ensure both adequate placement capacity and high educational standards. Placement quality is key for achieving positive outcomes for all stakeholders. For the public, including clients, the participation of allied health students in healthcare delivery can enhance access to safe, competent, and ethical services (Hams et al., 2022 ; Pigott et al., 2022 ). For students, high-quality placements foster the development of essential capabilities such as adaptability, interprofessional collaboration, and conflict resolution (Greenlees et al., 2021 ). Moreover, placements that provide a supportive learning environment promote student wellbeing (Ahern & O’Donnell, 2022 ; Bell et al., 2024 ). Universities also benefit from quality placements, as they help produce graduates who are well-prepared for the workforce and meet the expectations of regulatory bodies and public standards (Australian Government, 2021 ). Prior research has shown that placement quality is a stronger predictor of employability than factors like placement structure or duration (Smith et al., 2019 ). For healthcare providers, effective placements are a valuable tool for workforce development, contributing to the training of professionals who are ready to deliver high-quality client care upon graduation (Bell et al., 2024 ). While there are existing tools to evaluate placement quality from different stakeholder perspectives, the Clinical Placement Quality Survey – Student (CPQS-S) is specifically designed to capture allied health students' perceptions (Jones et al., 2022 ). Unlike tools created for nursing or medicine, which do not reflect the diverse clinical experiences across allied health disciplines, or instruments like the Clinical Placement Quality Survey – Educator (Hargreaves et al., 2024 ),The Maastricht Clinical Teaching Questionnaire (Stalmeijer et al., 2010 ) and Generic Supervision Assessment Tool (Hamilton et al., 2022), which focus on the placement provider’s viewpoint, the CPQS-S was developed to capture the unique aspects of placement quality from the perspective of allied health students. Key to the CPQS-S design is its foundation in the Best Practice Clinical Learning Environment (BPCLE) framework (Victorian Department of Health, 2024 ). This framework identifies five primary indicators of clinical placement quality (Victorian Department of Health, 2024 ). The CPQS-S incorporates these indicators and tailors them to assess the student perspective at the conclusion of each placement. The CPQS-S has demonstrated high internal consistency across its items, making it a useful tool for placement stakeholders to gather student feedback. The CPQS-S has 32 items with a mix of question types including binary response, Likert scale and open written responses. Allied health encompasses a diverse range of professions, each with distinct practice environments, professional competencies, educational and accreditation requirements (Penman et al., 2023 ). The initial validation of the CPQS-S by Jones et al. ( 2022 ) focused on a limited cohort of students. Whilst the tool demonstrated psychometric robustness, its generalisability to the broader allied health sector warranted further exploration. Given the evolving demands on placements and the increasing diversity in student cohorts across allied health, it was appropriate to test the CPQS-S across a broader range of disciplines and settings. A more diverse sample encompassing students from multiple allied health disciplines and across university programs would enable a more comprehensive understanding of how students perceive placement quality. Subsequent analysis could support the hypothesis that the CPQS-S is a versatile tool that reflects the unique needs and experiences of allied health students, ensuring consistent and comprehensively evaluation of placement quality across this critical sector of healthcare education. The purpose of this study was to investigate the psychometric properties of the CPQS-S using Rasch Analysis (Rasch, 1960 ), to determine if the CPQS-S is an appropriate instrument to measure student’s perception of quality of their placement experience. Methods Study Design This was a cross-sectional study using Rasch Analysis. Rasch Analysis offers a rigorous psychometric evaluation by placing items and respondents on a common scale, allowing for precise assessment of item acceptability and response consistency across groups. (Bond & Fox, 2015). Participants and instrument Data collection prospectively occurred from January to December 2023 from eight disciplines across three Australian universities. Students from Clinical Exercise Physiology, Exercise Science, Nutrition and Dietetics, Occupational Therapy, Physiotherapy, Rehabilitation Counselling, Social Work and Speech Pathology were invited to complete the CPQS-S at the end of a placement. The full CPQS-S tool including open response questions has been previous published (Jones et al., 2022). Binary and Likert responses were included for analysis in this project and are included in Table 1. A description of the program structure for each discipline is included in Appendix A. Table 1 CPQS-S Items with Binary and Likert responses Item Questions Response Options 1* How would you rate your educators’ overall performance? Excellent, Good, Adequate, Fair, Poor 2 An orientation to the facility was provided within the first week of placement? Yes No 3 Orientation to the physical environment. Yes No 4 Orientation to relevant staff. Yes No 5 Where to find relevant policies and procedures. Yes No 6 Site specific WH&S, Fire and Emergency procedures. Yes No 7^ The type of clinical presentations and clinical environment. Yes No 8 The facility was welcoming and inclusive at the commencement of the placement. Strongly Agree, Agree, Unsure, Disagree, Strongly Disagree 9^ I understood the clinical setting and was prepared to commence placement Strongly Agree, Agree, Unsure, Disagree, Strongly Disagree 10 Within the first week of the placement my educators discussed expectations of the placement with me. Yes No 11 Were the following elements discussed as part of the placement expectations? Professional conduct Yes No 12 A clear timetable of activities and responsibilities Yes No 13 Expected clinical load for each week of placement Yes No 14 Assessment and performance Yes No 15 Learning objectives Yes No 16 Overall, I was clear with regard to the expectations of the placement Strongly Agree, Agree, Unsure, Disagree, Strongly Disagree 17 I was provided adequate opportunity to actively participate in patient care. Always, Often, Sometime, Rarely, Never 18+ My educators provided opportunity where the focus of the patient contact was on learning and developing my clinical skills. Always, Often, Sometime, Rarely, Never Always, Often, Sometime, Rarely, Never 19 I was provided with effective feedback. Always, Often, Sometime, Rarely, Never Please describe why you feel you were not provided with effective feedback. Free text 20 Relating to learning environment: Adequate time was provided to reflect on and to discuss my learning experience. Always, Often, Sometime, Rarely, Never 21 My educator was consistent on their approach to supervision Always, Often, Sometime, Rarely, Never Please describe why you feel your educator was not consistence in their approach to supervision. Free text 22 My educator and I scheduled regular time for reviewing and monitoring of my placement performance Always, Often, Sometime, Rarely, Never 23 I felt respected by my educators in my role as a student Always, Often, Sometime, Rarely, Never 24 I felt I was a valued member of the clinical team. Always, Often, Sometime, Rarely, Never 25 I felt comfortable and open to ask and respond to questions with my educators. Always, Often, Sometime, Rarely, Never 26 I felt included in the team outside of direct clinical contact for example team meetings. Always, Often, Sometime, Rarely, Never 27 Were you provided with a space to complete non-clinical tasks? Yes No 28 Did the facility have resources available to support your learning? Yes No 29 I felt that my assessment was fair and transparent Yes No 30 What percentage of your care would you was related to direct to patient/client interaction care? 0-20%, 21-40%, 41-60%,61-80%, 81-100% 31 Now that you have completed this placement, how would you rate your confidence to practice independently in your first week as a as a new graduate in this clinical area? Extremely Confident, Very Confident, Confident, Confident, Not confident 32 At any stage during the clinical placement did you have contact with any members from the university directly related to your clinical placement Yes No How effective did you find the input provided by this person Excellent, Good, Adequate, Fair, Poor * Terms such as ‘supervisor’ were used in place of ‘clinical educator’ where appropriate. ^ clinical presentation and clinical environments was phrased ‘practice presentations’ and ‘practice environments’ depending on the discipline + ‘patients’, ‘clients’, ‘service users’ terminology was used interchangeably. Data management The CPQS-S responses were collected by the digital platform of choice utilised by each program. The responses were downloaded, de-identified and collated for analysis. Ethics Ethical approval for the study was granted by the Griffith University Human Research Ethics Committee (GU HREC 2022/681), Bond University Human Research Ethics Committee (2022/681) and CQUniversity Human Research Ethics Committee (0000024099). Sample Size The minimum sample size was set to 320 participants using the recommendations outlined by Linacre (2002). Sample The participant responses were divided into two samples for the development and validation of the Rasch Analysis. The outputs of both the development and validation sample are presented in the results section. Due to the volume of physiotherapy responses, both the development and validation samples were weighted to have a balanced representation between the physiotherapy respondents and the other respondents. The weighting procedure involved assigning weights based on the inverse probability of discipline membership. Physiotherapists were weighted by one divided by the probability of being a physiotherapist, while non-physiotherapists were weighted by one divided by the probability of not being a physiotherapist. A description of the demographics for each discipline is included in Appendix A. Data analysis Rasch Analysis Rasch Analysis rating scale modelling (Tennant & Conaghan, 2007) was performed in R statistical software (R Core Team, 2023) with user written packages TAM (Robitzsch et al., 2024), WrightMap (Irribarra & Freund, 2014), ErM (Mair & Hatzinger, 2007) and tidyverse (Wickham et al., 2019). Both dichotomous and polytomous items within the CPQS-S development and validation datasets were analysed simultaneously (Andrich & Maraiss, 2019; Bond & Fox, 2015; Tennant & Conaghan, 2007). Dimensionality Uni-dimensionality is a critical assumption of Rasch Analysis, meaning that items should primarily measure one underlying trait (Andrich & Maraiss, 2019). To reconfirm the dimensionality of the current data sets, principal component analysis was conducted, and a scree plot was generated to examine the number of underlying factors. Reliability and Separation Index Four statistical measures were used to assess the quality of the CPQS-S. Item Reliability indicated the consistency of the item acceptability estimates, while Person Reliability indicated the consistency of the person ability estimates. Item and Person Reliability values for these measures range from 0 to 1 where a higher value (above 0.8) indicated strong reliability (Wright & Linacre, 1994). The Separation Index reflected how well the items could be separated into different levels of agreement regarding placement quality. Person Separation Index reflected how well the participants could be separated into different levels of agreement (or different levels of their experiences of quality). A value of two, for example, would indicate that the items could be separated into different levels. Person ability (logits): Person ability (logits) evaluated data from each respondent to measure the agreement of each item. In the context of CPQS-S, a logit reflects the level of endorsement, agreement or acceptability of an item rather than difficulty. For example, a lower logit would reflect items that are more easily accepted or endorsed by the participants. A Wright Map was used as a graphical representation of item endorsement (in logits) and respondent ability on the same scale. The graphical representation assists to evaluate how well the items are aligned with the agreement of the participants. The vertical axis scale is in logits, where higher logits represent items that are more difficult to agree with and the lower logics are items that are easier to agree with. The horizontal axis represents each item in the CPQS-S. The histogram on the left panel displays the participants endorsement along the same logit scale. Item Fit Item fit evaluated the fit of each item of the CPQS-S data to the model. Two test statistics were used to evaluate the item fit for each item in the CPQS-S. It was expressed as item infit (information-weighted mean square) and outfit (outlier-sensitive mean square). Regarding the CPQS-S, item infit reflected how well an item performed when targeted to individuals of similar ability. Item outfit, on the other hand, was sensitive to unexpected responses from individuals. Unexpected item infit and outfit values were reviewed to determine if they degraded the tool (Linacre, 2012). Items that did not fit the model and degraded the development data on subsequent analysis would be removed from the validation data. Person Fit Person fit evaluated how well the observed data aligned with the expectations of the Rasch Analysis model. Two test statistics were used to evaluate the data. It was expressed as person infit (information-weighed mean square) and person outfit (outlier-sensitive mean square). Person infit reflected the consistency of responses to items that were well-targeted to a person’s acceptability of that item, while person outfit was sensitive to unexpected responses on items (Wright & Linacre, 1994). Category functioning and ordering All CPQS-S items were evaluated regarding threshold ordering and targeting. It was anticipated that items would be ordered, meaning that the more a participant agreed with this item the more likely they would select a higher category. Threshold targeting indicated how distinct the categories were from each other. A larger spread between the thresholds would indicate how distinct the categories were from each other. A graphical representation was used to visualise threshold ordering and targeting. The rating scale model assumes that the distance between thresholds is the same for each item. Results Participants A total of 933 CPQS-S survey responses were collected for analysis. The largest proportion of participants were in the 20 to 24-year age range, which represented 35% of the sample. Within this cohort, 72% identified as female, 3.8% identified as First Nations, 10% were international students, and 13% reported having a disability. The data were divided into a development (n = 466) and validation (n = 467) sample. Missing data were minimal, with less than 0.35% data points missing. Table 2 outlines CPQS-S responses received by each discipline and sample for inclusion in data analysis. Table 2: Distribution of CPQS-S Responses Across Allied Health Disciplines for Sample 1 (Development) and Sample 2 (Validation) Health Discipline CPQS-S Responses Sample 1 Development Sample 2 Validation Clinical Exercise Physiology 48 24 24 Exercise Science 18 11 7 Nutrition and Dietetics 5 3 2 Occupational Therapy 68 32 36 Physiotherapy 687 352 335 Rehabilitation Counselling 3 3 0 Social Work 34 11 23 Speech Pathology 70 30 40 Total 933 466 467 Dimensionality The single underlying construct was hypothesised to be student perceptions of placement quality. The factors from Principal Component Analysis scree plot are presented in Figure 1. The steep drop-off after the first component suggested that most of the variance in the validation dataset was explained by a single component, indicating a strong unidimensional structure. This finding supported the assumptions for Rasch Analysis. Reliability and Separation Index Four measures were used to assess the quality of the CPQS-S. Item reliability values for the development and validation samples were 0.96 and 0.97 respectively, indicating consistency of item agreement estimates. Person reliability for the development and validation samples were 0.80 and 0.82 which indicated appropriate consistency of the person ability estimates. Item Separation Index for the development and validation sample were 4.87 and 5.45 which indicated that items could be separated into different categories. The Person Separation Index for the development and validation sample was 2.03 and 2.11 which suggested that the respondents could be separated into two different levels of acceptability. Item Fit Item fit statistics are presented in Table 3 for both the development and validation sample. Analysis of the development sample indicated good overall model fit, though some items required further investigation due to infit and outfit misfit. Items 27, 29, 30, and 31, with high outfit MNSQ values, were reviewed. Item 27 pertained to non-clinical tasks, Item 29 addressed assessment fairness, Item 30 related to patient interaction, and Item 31 concerned student confidence. The Rasch Analysis was repeated for each misfitting item whereby the item was removed to assess its impact on item reliability and person separation. As shown in Table 4, item removal had minimal effect on these parameters, supporting the decision to retain these items in the CPQS-S for the validation sample analysis. However, Item 32, concerning university contact, was excluded from the development and validation sample based on prior research and the content of the question not being referenced in the BPCLE. Table 3 Item statistics from the development and validation samples including item acceptability (in logits), infit and outfit mean square. Development Sample n = 466 Validation Sample n = 467 Item Item acceptability (logits) SE Infit MNSQ Outfit MNSQ Item acceptability (logits) SE Infit MNSQ Outfit MNSQ 1 -2.421 0.077 1.029 1.723 -2.691 0.083 0.890 1.380 2 -3.910 0.375 1.007 1.219 -3.233 0.443 1.043 1.426 3 -4.018 0.394 0.952 1.124 -2.988 0.397 0.962 1.259 4 -4.406 0.472 0.963 0.494 -2.368 0.302 0.974 1.361 5 -2.687 0.224 0.970 1.667 -1.276 0.196 0.897 1.242 6 -2.559 0.213 1.099 2.105 -1.474 0.211 1.041 1.996 7 -4.393 0.469 0.927 0.372 -2.542 0.325 0.894 1.777 8 -2.956 0.091 0.810 1.498 -3.039 0.093 0.976 1.529 9 -2.395 0.077 0.871 1.740 -2.640 0.081 0.870 1.628 10 -3.091 0.263 0.881 0.722 -1.838 0.242 0.798 0.615 11 -3.165 0.272 0.920 1.238 -2.164 0.276 0.806 0.468 12 -2.395 0.202 0.985 1.735 -1.092 0.184 0.853 1.080 13 -1.933 0.172 0.920 1.237 -0.799 0.169 0.920 1.212 14 -2.320 0.196 0.913 1.161 -1.288 0.198 0.853 0.935 15 -2.083 0.200 0.857 0.788 1.103 0.087 0.483 1.271 16 -2.398 0.077 0.762 1.328 -2.447 0.077 0.708 1.480 17 -3.053 0.095 1.118 1.844 -2.883 0.088 0.958 1.463 18 -2.763 0.086 0.745 1.241 -2.717 0.083 0.716 1.173 19 -2.318 0.075 0.649 1.244 -2.398 0.075 0.701 1.364 20 -2.266 0.074 0.807 1.418 -2.349 0.074 0.784 1.353 21 -2.529 0.080 0.725 1.209 -2.609 0.081 0.843 1.349 22 -1.930 0.067 1.008 1.951 -1.889 0.066 0.996 1.840 23 -3.227 0.100 1.065 1.173 -3.029 0.093 0.883 1.008 24 -2.753 0.086 0.819 1.325 -2.715 0.083 0.825 1.335 25 -2.859 0.088 0.907 1.160 -3.017 0.092 0.927 1.100 26 -2.481 0.079 0.972 1.611 -2.549 0.079 1.282 1.976 27 -3.182 0.273 1.057 2.786 -1.687 0.228 1.057 2.791 28 -2.903 0.243 0.960 1.043 -1.777 0.237 0.969 1.618 29 -1.418 0.061 2.644 5.121 -1.509 0.060 2.688 5.169 30 -2.124 0.071 2.005 4.752 -2.116 0.070 1.683 3.549 31 -0.644 0.054 1.360 3.442 -0.782 0.054 1.389 3.533 Table 4 Impact of Item Removal on Reliability and Separation Indices for the CPQS-S Item Content of item Item Reliability* Person Separation* Interpretation Action 27 Space to complete non-clinical tasks 0.97 2.11 Changes to item reliability and person separation are negligible. From a statistical standpoint their inclusion or exclusion is negligible. Each item is a feature of the BPCLE framework. Retain in CPQSS 29 Assessment was fair and transparent 0.97 2.15 30 Direct to patient/client interaction care 0.97 2.16 31 Rate your confidence to practice 0.97 1.9 * Values relate to the subsequent Rasch Analyses where that specific item removed. Person ability (logits) Figure 2 presents the threshold and Wright item-person map for the validation sample. The CPQS-S items were generally well-targeted to the respondents, covering a broad range of acceptability. The alignment between the respondents and the items indicated that the items of the CPQS-S effectively measured the varying levels of acceptability among the validation sample. The distribution of person abilities (left axis) was skewed, with more respondents clustered towards the higher end of acceptability. The item distribution (right axis) showed items across the acceptability scale range. Most items demonstrated satisfactory category functioning, with clear and ordered thresholds across the response categories. The middle categories displayed well-ordered thresholds which suggested that respondents could reliably distinguish between levels of agreement for the items. Person Fit Most respondents (75%) had person infit distances from one that were 0.53 or less which indicated a generally good fit to the Rasch Analysis model. The typical respondent’s data aligned well with the model’s expectations, though some moderate deviations are observed. The majority of respondents (75%) had outfit distances from one that are 0.71 or less which indicated that most respondents’ data fit the Rasch model well, even when accounting for outlier responses. Discussion This study provides new evidence supporting the CPQS-S as a valid, 31-item tool that effectively measures students' perceptions of placement quality across a broad range of allied health disciplines. The CPQS-S captures a single underlying construct of student perception of placement quality and can reliably differentiate between varying levels of perceived quality. Notably, it is the first tool of its kind to be applicable across a diverse range of allied health professions. The CPQS-S addresses a significant gap in allied health by demonstrating its relevance across various placement settings, including hospitals, community health, aged care facilities, schools, private practices, paediatric services, mental health services, sports clinics, and research institutions. In contrast to existing tools that focus on specific disciplines, the Rasch Analysis validation of the CPQS-S encompassed a wide range of allied health disciplines, highlighting the surveys versatility and robustness. This study builds on previous work confirming that the CPQS-S predominantly measures a single dimension, hypothesised as student perception of placement quality (Jones et al., 2022 ). By evaluating CPQS-S data across themes, the tool facilitates both an overarching assessment of placement experience and a focused evaluation of elements linked to the BPCLE framework. The high item reliability values demonstrated that the CPQS-S provided consistent measurement of item agreement estimates, reflecting true differences in item acceptability rather than measurement error (Andrich & Maraiss, 2019). Similarly, the Person Separation values demonstrate the tool’s ability to differentiate between individuals with varying perceptions of placement quality. Although some uncertainty may exist in differentiating between those individuals with moderate perceptions, the CPQS-S can reliably categorised individuals into high and low strata of placement quality (Andrich & Maraiss, 2019). The Item Separation Index indicated that the CPQS-S items covered a wide range of acceptability levels and were well-distributed across the latent trait of perceived placement quality. This combined with the high item reliability, means that the items were well-targeted and diverse enough to assess the full range of a student’s perceptions of placement quality (Andrich & Maraiss, 2019). Overall, the CPQS-S Rasch Analysis demonstrated a reliable tool that could identify respondents with different perceptions of their placement quality experience. Further, there was an appropriate level of separation, indicating that the CPQS-S was capable of reliably categorising individuals into different perceptions strata. For this project, the CPQS-S was implemented across multiple health professional programs, necessitating attention to discipline-specific terminology to ensure that item wording remained applicable and meaningful. For example, terms such as ‘supervisor’ were used in place of ‘clinical educator’ where appropriate, preserving the face and content validity of each item. This interprofessional implementation raised considerations regarding the title of the tool, particularly the ‘Clinical’ element, as the tool’s utility may extend beyond traditional clinical placements to broader work-integrated learning contexts. Some CPQS-S items warranted review. Item 32 related to contact with the university and was removed from both the development and validation samples. This item was not directly linked to the BPCLE framework and did not align with any themes in the previous publication, supporting its exclusion in this study. However, all remaining items were retained due to their alignment with the BPCLE framework and their overall contribution to the tool’s validity, in such they added information rather that statistical ‘noise’ (Andrich & Maraiss, 2019). Statistical and pragmatic considerations affirm that the CPQS-S items represent key aspects of students’ perceptions of placement quality. Therefore, to ensure data integrity, all 31 items, as outlined in Table 1 , are recommended for inclusion in future applications of CPQS-S. Building on these foundational considerations, the CPQS-S holds potential to drive advancements in allied health education similar to those from discipline specific tools. The implementation and impact of The Clinical Learning Environment, Supervision, and Nurse Teacher Scale (CLES + T) may provide a roadmap for the CPQS-S. The CLES + T, which has had a significant impact on nursing education, offers insight into how the CPQS-S can inform improving clinical learning environments, educational practices, and contributing to research in allied health education (Saarikoski, 2008 ). Through rigorous psychometric testing and international application CLES + T has become a key tool for enhancing nursing pedagogy.(Ozga et al., 2020 ; Papastavrou et al., 2016). However, allied health disciplines face barriers when seeking comparable tools suitable for broad interdisciplinary application. Existing tools such as the Maastricht Clinical Teaching Questionnaire (Stalmeijer et al., 2010 ) and Generic Supervision Assessment Tool (Hamilton et al., 2022) emphasise teaching and supervision aspects of placements, rather than comprehensive quality assessment. While the Improving Quality In Practice Placements (iQIPP) framework has broader applicability it is primarily applied prior to placements rather than after the experience (Rodger et al., 2010 ). In contrast, the CPQS-S emerges as a more comprehensive solution for assessing placement quality applicable to a diverse range of allied health stakeholders, this utility and focus on overall placement experience mark the CPQS-S as an innovative tool that aligns with the complex multidisciplinary requirements of allied health education. The CPQS-S provides valuable insights for placement providers, universities, and students. Placement providers benefit by receiving feedback on site-specific strengths and areas for improvement, enabling them to enhance their placement offerings. For universities, the CPQS-S serves as a data-driven resource to evaluate and improve placement environments. It also acts as a feedback mechanism, guiding professional development efforts for educators and placement sites. For students, the CPQS-S offers a structured, standardised method to reflect on their experiences and identify the factors contributing to placement quality. While clients do not directly engage with the CPQS-S, the tool’s implementation could indirectly benefit them by enhancing the quality of student learning and supervision. Students who are well-prepared and confident in their roles contribute to better client experiences and overall care quality (Suikkala et al., 2021 ; Zhang et al., 2022 ). Additionally, positive interactions with engaged and well-supervised students can enhance the client experience (Suikkala et al., 2021 ; Wright et al., 2018 ). There are several strengths of this study. The comprehensive psychometric validation based on a substantial sample size encompassed a broad range of allied health disciplines. Employing both development and validation samples enhanced the reliability of the findings, while the application of established statistical criteria and Rasch Analysis methodology further supported the robustness of the results. Additionally, data collection occurred over a one-year period to minimise the potential impact of placement timing on perceptions. Limitations should be considered when contextualising this work. There is potential for response bias due to the self-reported nature of the CPQS-S. Whilst the disproportionate representation of the physiotherapy student cohort is present, it was addressed through weighted analyses. Finaly, the deidentified nature of data collection may have meant some students’ perspectives could be represented more frequently if they completed the CPQS-S after each placement experience. The current data set included students enrolled in health programs from Clinical Exercise Physiology, Exercise Science, Nutrition and Dietetics, Occupational Therapy, Physiotherapy, Rehabilitation Counselling, Social Work and Speech Pathology. Further to this, the researchers are aware of the CPQS-S being utilised by placement providers and university programs from the aforementioned disciplines in addition to students enrolled in Oral Health, Prosthetics and Orthotics. It suggests that the CPQS-S is widely utilised by a broad range of health disciplines. Future research could therefore focus on the stakeholders, methodology and implementation of the CPQS-S. The inclusion of a broader range of health disciplines, such as podiatry, radiography, and paramedicine could progress the implementation of the CPQS-S. Additionally, exploring the tool’s applicability in international contexts would expand its reach and relevance. There is an opportunity to explore qualitative methodologies that complement the CPQS-S psychometric properties by linking insights from the open-response questions. Longitudinal study designs could track changes in placement quality and student outcomes over time, further enhancing utility. Similarly, there may be an opportunity to triangulate information from tools such as the CPQS-E which gather the educator perspectives (Hargreaves et al., 2024 ). Finally, developing professional development resources for placement providers and university staff would facilitate the effective application of CPQS-S data to promote a comprehensive approach to quality improvement. The CPQS-S demonstrates strong psychometric properties, confirming its suitability as a standardised tool for assessing placement quality across a wide range of allied health disciplines. The current study provides new evidence that the CPQS-S captures a single underlying construct of placement quality perception, reliability differentiating level of quality across diverse placement settings. Having a validated CPQS-S tool enables data-driven approaches to enhance the quality of clinical education and prepare graduates to effectively contribute to the healthcare workforce. By supporting students, universities, placement providers, and educators, the CPQS-S promotes high-quality placement experiences that ultimately reinforce professional standards and competencies. Through consistent assessment across disciplines the CPQS-S can foster shared understanding of placement quality, supporting interprofessional collaboration and alignment with healthcare standards. This adaptability ensures that the CPQS-S remains responsive to the evolving landscape of allied health education, with potential downstream benefits for client care quality through well prepared competent healthcare graduates. Declarations Acknowledgements We would like to acknowledge the data curation from Jacqueline Broadbridge, Amanda Love and Elisa Canetti and all placement support officers. Funding details There was no funding associated with this body of work. Competing interests The authors report there are no competing interests to declare. Data Availability Statement Data may be available on request from for researchers who meet the criteria to gain access to confidential data. Author Statement Taryn Jones, Andrea Hams and Simone Howell were responsible for the conceptualisation, project administration and methodology of this work. Taryn Jones and Brett Dyer led the data curation and formal analysis. All authors were responsible for data collection and participated in the review, drafting, and final approval of the manuscript. References Ahern, C., & O’Donnell, M. (2022, 2023/05/04). Are physiotherapy student-led services a suitable model of clinical education? – perceptions & experiences of physiotherapists, students & patients, a qualitative meta-synthesis. Physiotherapy Theory and Practice, 39 (5), 963-978. https://doi.org/10.1080/09593985.2022.2031362 AHPRA Accreditation Committee. (2023). Information paper – good practice approaches to embedding clinical placements, pedagogical innovations and evidence-based technological advances in health practitioner education . Andrich, D., & Maraiss, I. (2019). A Course in Rasch Measurement Theory . Springer Nature https://doi.org/https://doi.org/10.1007/978-981-13-7496-8 Australian Government. (2021). Universities Australia report on Work Integrated Learning in Universities . https://www.education.gov.au/enabling-growth-and-innovation-program/resources/universities-australia-report-work-integrated-learning-universities Australian Institute of Health and Welfare. (2024). Health Workforce . Australian Government. Retrieved 6/11/2024 from https://www.aihw.gov.au/reports/workforce/health-workforce Bell, A., Borges Dario, A., Klinner, C., Nisbet, G., Penman, M., Storer, D., & Monrouxe, L. (2024). Improving the quality of allied health placements: student, educator and organisational preparedness. Studies in Continuing Education , 1-23. https://doi.org/10.1080/0158037x.2024.2360495 Bond, T., & Fox, C. (2015). Applying the Rasch Model: Fundamental Measurement in the Human Sciences . Routledge. https://doi.org/https://doi.org/10.4324/9781315814698 Greenlees, N. T., Pit, S. W., Ross, L. J., McCormack, J. J., Mitchell, L. J., & Williams, L. T. (2021, Jul 17). A novel blended placement model improves dietitian students' work-readiness and wellbeing and has a positive impact on rural communities: a qualitative study. BMC Med Educ, 21 (1), 387. https://doi.org/10.1186/s12909-021-02756-y Hamiduzzaman, M., Miles, S., Crook, S., Grove, L., Hewitt, J., Barraclough, F., Hawkins, P., Campbell, E., Buster, N., Thomson, K., Williams, C., & Flood, V. (2024, Jun 12). An integrative review of the impact of allied health student placements on current staff's knowledge and procedural skills in acute and primary care settings. BMC Med Educ, 24 (1), 657. https://doi.org/10.1186/s12909-024-05632-7 Hamilton, S. J., Briggs, L., Peterson, E. E., Slattery, M., & O'Donovan, A. (2022, March). Supporting conscious competency: Validation of the Generic Supervision Assessment Tool (GSAT). Psychology and Psychotherapy, 95 (1), 113-136. https://doi.org/10.1111/papt.12369 Hams, A., Bell, N., & Jones, T. (2022). Evaluating the Impact of a Regional Student-Led Physiotherapy Clinic Model to Improve Self-Reported Function in Community-Dwelling Adults With Neurological Diagnoses. Journal of Neurologic Physical Therapy (1557-0584 (Electronic)). https://doi.org/10.1097/NPT.0000000000000399 Hargreaves, J., Thomas, P., & Kirwan, G. (2024). Development of the Clinical Placement Quality Survey – Educator (CPQS-E) Tool to Evaluate the Quality of Physiotherapy Clinical Placements. Australian Journal of Clinical Education, 13 , 13-34. https://doi.org/https://doi.org/10.53300/001c.94127 Irribarra, D., & Freund, R. (2014). Wright Map: IRT item-person map with ConQuest integration. In https://github.com/david-ti/wrightmap Jones, T., Kirwan, G. W., Howells, S., & Hams, A. (2022). Clinical Placement Quality Survey–Student (CPQS-S): A tool to evaluate allied health placement quality. International Journal of Work-Integrated Learning, 23 (4), 579-593 Linacre, J. M. (2002, 2002). Optimizing rating scale category effectiveness. Journal of applied measurement, 3 (1), 85-106. http://europepmc.org/abstract/MED/11997586 Linacre, J. M. (2012). A User's Guide to Winsteps Rasch-Model Computer Programs . www.winsteps.com Mair, P., & Hatzinger, R. (2007). Extended Rasch modeling: The eRm package for the application of IRT models in R. In McBride, L. J., Fitzgerald, C., Costello, C., & Perkins, K. (2020, February). Allied health pre-entry student clinical placement capacity: can it be sustained? Australian Health Review, 44 (1449-8944 (Electronic)). https://doi.org/10.1071/AH18088 Ozga, D., Gutysz-Wojnicka, A., Lewandowski, B., & Dobrowolska, B. (2020, 2020/07/06). The clinical learning environment, supervision and nurse teacher scale (CLES+T): psychometric properties measured in the context of postgraduate nursing education. BMC Nursing, 19 (1), 61. https://doi.org/10.1186/s12912-020-00455-5 Papastavrou, E., Dimitriadou, M., Tsangari, H., & Andreou, C. (2016, July). Nursing students' satisfaction of the clinical learning environment: a research study. BMC Nursing, 15 , 44. https://doi.org/10.1186/s12912-016-0164-4 Penman, M., Raymond, J., Kumar, A., Liang, R. Y. R., Sundar, K., & Thomas, Y. (2023). Allied Health Professions Accreditation Standards for Work Integrated Learning: A Document Analysis. International journal of environmental research and public health, 20 (15). Pigott, A., Patterson, F., Birch, S., Oakley, P., & Doig, E. (2022, 06/30). The health service impact of an occupational therapy practice placement model: Student-resourced service delivery of groups. Focus on Health Professional Education: A Multi-Professional Journal, 23 (2), 21-34. https://doi.org/10.11157/fohpe.v23i2.525 R Core Team. (2023). R: A Language and Environment for Statistical Computing. In R Foundation for Statistical Computing https://www.R-project.org/ Rasch, G. (1960). Studies in mathematical psychology: I. Probabilistic models for some intelligence and attainment tests . Nielsen & Lydiche. Robitzsch, A., Kiefer, T., & Wu, M. (2024). TAM: Test Analysis Modules. In (Version R package version 4.2-21.) https://CRAN.R-project.org/package=TAM Rodger, S., Fitzgerald, C., Davila, W., Millar, F., Thomas, Y., Garbutt, K., & Greber, C. (2010). The Improving Quality in Practice Placements (iQIPP) Guide (Brisbane, Queensland, The University of Queensland, Issue. Saarikoski, M. (2008). The nurse teacher in clinical practice: Developing the new sub-dimension to the clinical learning environment and supervision (CLES) scale. International journal of nursing studies, 45 (8), 1233-1237. https://doi.org/10.1016/j.ijnurstu.2007.07.009 Smith, C., Ferns, S., & Russell, L. (2019). Placement quality has a greater impact on employability than placement structure or duration. International Journal of Work-Integrated Learning, 20 (`), `5-29. Stalmeijer, R. E., Dolmans, D. H., Wolfhagen, I. H., Muijtjens, A. M., & Scherpbier, A. J. (2010, November). The Maastricht Clinical Teaching Questionnaire (MCTQ) as a valid and reliable instrument for the evaluation of clinical teachers. Academic Medicine, 85 (11), 1732-1738. https://doi.org/10.1097/ACM.0b013e3181f554d6 Suikkala, A., Timonen, L., Leino-Kilpi, H., Katajisto, J., & Strandell-Laine, C. (2021, 2021/04/22). Healthcare student-patient relationship and the quality of the clinical learning environment – a cross-sectional study. BMC Medical Education, 21 (1), 230. https://doi.org/10.1186/s12909-021-02676-x Tennant, A., & Conaghan, P. G. (2007, Dec 15). The Rasch measurement model in rheumatology: what is it and why use it? When should it be applied, and what should one look for in a Rasch paper? Arthritis Rheum, 57 (8), 1358-1362. https://doi.org/10.1002/art.23108 Victorian Department of Health. (2024). Implementation of the BPCLE Framework: Stakeholder Guidelines . https://www.health.vic.gov.au/education-and-training/best-practice-clinical-learning-environment-bpcle-framework Wickham, H., Averick, M., Bryan, J., Chang, W., McGowan, L., François, R., Grolemund, G., Hayes, A., Henry, L., Hester, J., Kuhn, M., Pedersen, T., Miller, E., Bache, S., Müller, K., Ooms, J., Robinson, D., Seidel, D., Spinu, V., Takahashi, K., Vaughan, D., Wilke, C., Woo, K., & Yutani, H. (2019). Welcome to the tidyverse. Journal of Open Source Software, 4 . https://doi.org/10.21105/joss.01686 Wright, A., Moss, P., Dennis, D. M., Harrold, M., Levy, S., Furness, A. L., & Reubenson, A. (2018, 2018/02/20). The influence of a full-time, immersive simulation-based clinical placement on physiotherapy student confidence during the transition to clinical practice. Advances in Simulation, 3 (1), 3. https://doi.org/10.1186/s41077-018-0062-9 Wright, B. D., & Linacre, J. M. (1994). Reasonable mean-square fit values. Rasch Measurement Transactions, 8 (3), 370. https://www.rasch.org/rmt/rmt83b.htm Zhang, J., Shields, L., Ma, B., Yin, Y., Wang, J., Zhang, R., & Hui, X. (2022, 2022/07/15). The clinical learning environment, supervision and future intention to work as a nurse in nursing students: a cross-sectional and descriptive study. BMC Medical Education, 22 (1), 548. https://doi.org/10.1186/s12909-022-03609-y Additional Declarations No competing interests reported. Supplementary Files AppendixA.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6019236","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":415269680,"identity":"ba9b6ca0-dc24-4998-ad48-c1ed240595cd","order_by":0,"name":"Taryn Jones","email":"data:image/png;base64,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","orcid":"","institution":"Griffith University","correspondingAuthor":true,"prefix":"","firstName":"Taryn","middleName":"","lastName":"Jones","suffix":""},{"id":415269681,"identity":"9b3a5b25-751a-4bd6-9a0d-4c69a93b0228","order_by":1,"name":"Brett Dyer","email":"","orcid":"","institution":"Griffith University","correspondingAuthor":false,"prefix":"","firstName":"Brett","middleName":"","lastName":"Dyer","suffix":""},{"id":415269682,"identity":"17cc120e-2802-4df5-aa46-ab207dad61e6","order_by":2,"name":"Simone Howells","email":"","orcid":"","institution":"Griffith University","correspondingAuthor":false,"prefix":"","firstName":"Simone","middleName":"","lastName":"Howells","suffix":""},{"id":415269683,"identity":"28e24b39-9c2d-4326-b29a-b57235397fdb","order_by":3,"name":"Tanya Palmer","email":"","orcid":"","institution":"Central Queensland University","correspondingAuthor":false,"prefix":"","firstName":"Tanya","middleName":"","lastName":"Palmer","suffix":""},{"id":415269684,"identity":"a97da8c8-c8d1-41dc-815c-b7585df0503b","order_by":4,"name":"Larissa Sattler","email":"","orcid":"","institution":"Bond University","correspondingAuthor":false,"prefix":"","firstName":"Larissa","middleName":"","lastName":"Sattler","suffix":""},{"id":415269685,"identity":"3f4c310d-927b-4a66-bf81-384e24249e7c","order_by":5,"name":"Katrina Archbald","email":"","orcid":"","institution":"Griffith University","correspondingAuthor":false,"prefix":"","firstName":"Katrina","middleName":"","lastName":"Archbald","suffix":""},{"id":415269686,"identity":"bc81f3fb-7797-4f88-ba3c-d89b5e41bb27","order_by":6,"name":"Joel Garret","email":"","orcid":"","institution":"Griffith University","correspondingAuthor":false,"prefix":"","firstName":"Joel","middleName":"","lastName":"Garret","suffix":""},{"id":415269687,"identity":"67c35680-76e4-4174-bd0b-3a9f692e20b4","order_by":7,"name":"Emily Williams","email":"","orcid":"","institution":"Griffith University","correspondingAuthor":false,"prefix":"","firstName":"Emily","middleName":"","lastName":"Williams","suffix":""},{"id":415269688,"identity":"7a182988-5af4-45cc-ad10-88f1b987f9bb","order_by":8,"name":"Christine Randall","email":"","orcid":"","institution":"Griffith University","correspondingAuthor":false,"prefix":"","firstName":"Christine","middleName":"","lastName":"Randall","suffix":""},{"id":415269689,"identity":"bc3f2c3a-ba51-47a2-aa29-0b1accbb6afd","order_by":9,"name":"Andrea Hams","email":"","orcid":"","institution":"Griffith University","correspondingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"","lastName":"Hams","suffix":""}],"badges":[],"createdAt":"2025-02-13 03:38:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6019236/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6019236/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76431433,"identity":"dff46da5-efcc-415d-9fd3-1d579ed15cb1","added_by":"auto","created_at":"2025-02-17 06:51:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":16494,"visible":true,"origin":"","legend":"\u003cp\u003eScree Plot of actual factors from Principal Component Analysis. The eigenvalues are presented on the y-axis and the factor numbers on the x-axis. Eigenvalues indicate the amount of variance in the data explained by each component or factor.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6019236/v1/1a9dfde4d615481df20d7bec.png"},{"id":76431220,"identity":"1c3d0382-ac95-4eaa-bb45-5ca3eceaeaf1","added_by":"auto","created_at":"2025-02-17 06:43:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":13328,"visible":true,"origin":"","legend":"\u003cp\u003eThe threshold and Wright item-person map for the CPQS-S validation sample.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6019236/v1/575949045e0cbe694d36bf43.png"},{"id":76942658,"identity":"cd1ce664-8b3e-4167-8921-72fcc75c95c0","added_by":"auto","created_at":"2025-02-23 00:31:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":854601,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6019236/v1/73304597-cfe0-4185-ba00-2b3c42011f38.pdf"},{"id":76431221,"identity":"9bd9cc83-de1a-455d-ba85-10d58e01b5b0","added_by":"auto","created_at":"2025-02-17 06:43:55","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15449,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixA.docx","url":"https://assets-eu.researchsquare.com/files/rs-6019236/v1/7266e9f73bbdf51dbc532271.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluating Placement Quality in Allied Health: Rasch-Based Validation of the Clinical Placement Quality Survey - Student","fulltext":[{"header":"Introduction","content":"\u003cp\u003eStudent placements are foundational for the development of allied health professionals, facilitating the transition from theory to practical application (AHPRA Accreditation Committee, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Penman et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The term \u0026lsquo;placement\u0026rsquo; is intended to be an inclusive term for experiences that may also be called work integrated learning, clinical placements, practice education, supervised practice, field education or professional practice. In Australia, allied health tertiary education programs include substantial work-integrated learning components (Penman et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). These experiences typically require students to demonstrate safe, effective, and ethical management of clients across diverse healthcare settings to ensure they are practice-ready upon graduation (AHPRA Accreditation Committee, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Placement enables students to apply their skills under the supervision of professionals while being assessed on their capabilities in real-world environments. The benefits extend beyond individual student development, enhancing academic rigour for universities and providing healthcare organisations with a workforce equipped for professional practice (Hamiduzzaman et al., 2024). Through this experiential learning, students, universities, and healthcare institutions collectively contribute to the development of a capable, adaptable allied health workforce.\u003c/p\u003e \u003cp\u003eThe Australian health workforce, particularly within allied health, is facing significant challenges due to workforce shortages and growing demand for healthcare professionals (Australian Institute of Health and Welfare, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Key factors driving this demand include population growth and an aging demographic, which are intensifying the need for allied health staff and services (Australian Institute of Health and Welfare, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This, in turn, has led to an increasing demand for student placements, a trend expected to continue with the expansion of university health programs, larger student cohorts, and evolving workforce needs (McBride et al., 2020). For placement stakeholders, building capacity to provide sustainable placement numbers remains a persistent challenge. To ensure this rising placement demand, does not compromise the quality of learning experiences, robust mechanisms are required to ensure both adequate placement capacity and high educational standards.\u003c/p\u003e \u003cp\u003ePlacement quality is key for achieving positive outcomes for all stakeholders. For the public, including clients, the participation of allied health students in healthcare delivery can enhance access to safe, competent, and ethical services (Hams et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Pigott et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). For students, high-quality placements foster the development of essential capabilities such as adaptability, interprofessional collaboration, and conflict resolution (Greenlees et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Moreover, placements that provide a supportive learning environment promote student wellbeing (Ahern \u0026amp; O\u0026rsquo;Donnell, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Bell et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Universities also benefit from quality placements, as they help produce graduates who are well-prepared for the workforce and meet the expectations of regulatory bodies and public standards (Australian Government, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Prior research has shown that placement quality is a stronger predictor of employability than factors like placement structure or duration (Smith et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). For healthcare providers, effective placements are a valuable tool for workforce development, contributing to the training of professionals who are ready to deliver high-quality client care upon graduation (Bell et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile there are existing tools to evaluate placement quality from different stakeholder perspectives, the Clinical Placement Quality Survey \u0026ndash; Student (CPQS-S) is specifically designed to capture allied health students' perceptions (Jones et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Unlike tools created for nursing or medicine, which do not reflect the diverse clinical experiences across allied health disciplines, or instruments like the Clinical Placement Quality Survey \u0026ndash; Educator (Hargreaves et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e),The Maastricht Clinical Teaching Questionnaire (Stalmeijer et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) and Generic Supervision Assessment Tool (Hamilton et al., 2022), which focus on the placement provider\u0026rsquo;s viewpoint, the CPQS-S was developed to capture the unique aspects of placement quality from the perspective of allied health students. Key to the CPQS-S design is its foundation in the Best Practice Clinical Learning Environment (BPCLE) framework (Victorian Department of Health, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This framework identifies five primary indicators of clinical placement quality (Victorian Department of Health, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The CPQS-S incorporates these indicators and tailors them to assess the student perspective at the conclusion of each placement. The CPQS-S has demonstrated high internal consistency across its items, making it a useful tool for placement stakeholders to gather student feedback. The CPQS-S has 32 items with a mix of question types including binary response, Likert scale and open written responses.\u003c/p\u003e \u003cp\u003eAllied health encompasses a diverse range of professions, each with distinct practice environments, professional competencies, educational and accreditation requirements (Penman et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The initial validation of the CPQS-S by Jones et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) focused on a limited cohort of students. Whilst the tool demonstrated psychometric robustness, its generalisability to the broader allied health sector warranted further exploration. Given the evolving demands on placements and the increasing diversity in student cohorts across allied health, it was appropriate to test the CPQS-S across a broader range of disciplines and settings. A more diverse sample encompassing students from multiple allied health disciplines and across university programs would enable a more comprehensive understanding of how students perceive placement quality. Subsequent analysis could support the hypothesis that the CPQS-S is a versatile tool that reflects the unique needs and experiences of allied health students, ensuring consistent and comprehensively evaluation of placement quality across this critical sector of healthcare education. The purpose of this study was to investigate the psychometric properties of the CPQS-S using Rasch Analysis (Rasch, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e1960\u003c/span\u003e), to determine if the CPQS-S is an appropriate instrument to measure student\u0026rsquo;s perception of quality of their placement experience.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a cross-sectional study using Rasch Analysis. Rasch Analysis offers a rigorous psychometric evaluation by placing items and respondents on a common scale, allowing for precise assessment of item acceptability and response consistency across groups. (Bond \u0026amp; Fox, 2015).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and instrument\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData collection prospectively occurred from January to December 2023 from eight disciplines across three Australian universities. Students from Clinical Exercise Physiology, Exercise Science, Nutrition and Dietetics, Occupational Therapy, Physiotherapy, Rehabilitation Counselling, Social Work and Speech Pathology were invited to complete the CPQS-S at the end of a placement. The full CPQS-S tool including open response questions has been previous published (Jones et al., 2022). Binary and Likert responses were included for analysis in this project and are included in Table 1. A description of the program structure for each discipline is included in Appendix A.\u003c/p\u003e\n\u003cp\u003eTable 1 CPQS-S Items with Binary and Likert responses\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"718\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponse Options\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e1*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eHow would you rate your educators\u0026rsquo; overall performance?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eExcellent, Good, Adequate, Fair, Poor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eAn orientation to the facility was provided within the first week of placement?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eOrientation to the physical environment.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eOrientation to relevant staff.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eWhere to find relevant policies and procedures.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eSite specific WH\u0026amp;S, Fire and Emergency procedures.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e7^\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eThe type of clinical presentations and clinical environment.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eThe facility was welcoming and inclusive at the commencement of the placement.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eStrongly Agree, Agree, Unsure, Disagree, Strongly Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e9^\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eI understood the clinical setting and was prepared to commence placement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eStrongly Agree, Agree, Unsure, Disagree, Strongly Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eWithin the first week of the placement my educators discussed expectations of the placement with me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eWere the following elements discussed as part of the placement expectations?\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eProfessional conduct\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eA clear timetable of activities and responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eExpected clinical load for each week of placement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eAssessment and performance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eLearning objectives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eOverall, I was clear with regard to the expectations of the placement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eStrongly Agree, Agree, Unsure, Disagree, Strongly Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eI was provided adequate opportunity to actively participate in patient care.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eAlways, Often, Sometime, Rarely, Never\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e18+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eMy educators provided opportunity where the focus of the patient contact was on learning and developing my clinical skills.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eAlways, Often, Sometime, Rarely, Never\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAlways, Often, Sometime, Rarely, Never\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eI was provided with effective feedback.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eAlways, Often, Sometime, Rarely, Never\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 393px;\"\u003e\n \u003cp\u003ePlease describe why you feel you were not provided with effective feedback.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eFree text\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eRelating to learning environment: Adequate time was provided to reflect on and to discuss my learning experience.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eAlways, Often, Sometime, Rarely, Never\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eMy educator was consistent on their approach to supervision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eAlways, Often, Sometime, Rarely, Never\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 393px;\"\u003e\n \u003cp\u003ePlease describe why you feel your educator was not consistence in their approach to supervision.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eFree text\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 393px;\"\u003e\n \u003cp\u003eMy educator and I scheduled regular time for reviewing and monitoring of my placement performance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eAlways, Often, Sometime, Rarely, Never\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eI felt respected by my educators in my role as a student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eAlways, Often, Sometime, Rarely, Never\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eI felt I was a valued member of the clinical team.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eAlways, Often, Sometime, Rarely, Never\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eI felt comfortable and open to ask and respond to questions with my educators.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eAlways, Often, Sometime, Rarely, Never\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eI felt included in the team outside of direct clinical contact for example team meetings.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eAlways, Often, Sometime, Rarely, Never\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eWere you provided with a space to complete non-clinical tasks?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eDid the facility have resources available to support your learning?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eI felt that my assessment was fair and transparent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eWhat percentage of your care would you was related to direct to patient/client interaction care?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003e0-20%, 21-40%, 41-60%,61-80%, 81-100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eNow that you have completed this placement, how would you rate your confidence to practice independently in your first week as a as a new graduate in this clinical area?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eExtremely Confident, Very Confident, Confident, Confident, Not confident\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eAt any stage during the clinical placement did you have contact with any members from the university directly related to your clinical placement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes No\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eHow effective did you find the input provided by this person\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eExcellent, Good, Adequate, Fair, Poor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e* Terms such as \u0026lsquo;supervisor\u0026rsquo; were used in place of \u0026lsquo;clinical educator\u0026rsquo; where appropriate.\u003c/p\u003e\n\u003cp\u003e^ clinical presentation and clinical environments was phrased \u0026lsquo;practice presentations\u0026rsquo; and \u0026lsquo;practice environments\u0026rsquo; depending on the discipline\u003c/p\u003e\n\u003cp\u003e+ \u0026lsquo;patients\u0026rsquo;, \u0026lsquo;clients\u0026rsquo;, \u0026lsquo;service users\u0026rsquo; terminology was used interchangeably.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData management\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe CPQS-S responses were collected by the digital platform of choice utilised by each program. The responses were downloaded, de-identified and collated for analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was granted by the Griffith University Human Research Ethics Committee (GU HREC 2022/681), Bond University Human Research Ethics Committee (2022/681) and CQUniversity Human Research Ethics Committee (0000024099).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe minimum sample size was set to 320 participants using the recommendations outlined by Linacre (2002).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participant responses were divided into two samples for the development and validation of the Rasch Analysis. The outputs of both the development and validation sample are presented in the results section. Due to the volume of physiotherapy responses, both the development and validation samples were weighted to have a balanced representation between the physiotherapy respondents and the other respondents. The weighting procedure involved assigning weights based on the inverse probability of discipline membership. Physiotherapists were weighted by one divided by the probability of being a physiotherapist, while non-physiotherapists were weighted by one divided by the probability of not being a physiotherapist. A description of the demographics for each discipline is included in Appendix A.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRasch Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eRasch Analysis rating scale modelling (Tennant \u0026amp; Conaghan, 2007) was performed in R statistical software (R Core Team, 2023) with user written packages TAM (Robitzsch et al., 2024), WrightMap (Irribarra \u0026amp; Freund, 2014), ErM (Mair \u0026amp; Hatzinger, 2007) and tidyverse (Wickham et al., 2019). Both dichotomous and polytomous items within the CPQS-S development and validation datasets were analysed simultaneously (Andrich \u0026amp; Maraiss, 2019; Bond \u0026amp; Fox, 2015; Tennant \u0026amp; Conaghan, 2007).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDimensionality\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eUni-dimensionality is a critical assumption of Rasch Analysis, meaning that items should primarily measure one underlying trait (Andrich \u0026amp; Maraiss, 2019). To reconfirm the dimensionality of the current data sets, principal component analysis was conducted, and a scree plot was generated to examine the number of underlying factors.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eReliability and Separation Index\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFour statistical measures were used to assess the quality of the CPQS-S. Item Reliability indicated the consistency of the item acceptability estimates, while Person Reliability indicated the consistency of the person ability estimates. Item and Person Reliability values for these measures range from 0 to 1 where a higher value (above 0.8) indicated strong reliability (Wright \u0026amp; Linacre, 1994). The Separation Index reflected how well the items could be separated into different levels of agreement regarding placement quality. Person Separation Index reflected how well the participants could be separated into different levels of agreement (or different levels of their experiences of quality). A value of two, for example, would indicate that the items could be separated into different levels.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePerson ability (logits):\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePerson ability (logits) evaluated data from each respondent to measure the agreement of each item. In the context of CPQS-S, a logit reflects the level of endorsement, agreement or acceptability of an item rather than difficulty. For example, a lower logit would reflect items that are more easily accepted or endorsed by the participants. A Wright Map was used as a graphical representation of item endorsement (in logits) and respondent ability on the same scale. The graphical representation assists to evaluate how well the items are aligned with the agreement of the participants. The vertical axis scale is in logits, where higher logits represent items that are more difficult to agree with and the lower logics are items that are easier to agree with. The horizontal axis represents each item in the CPQS-S. The histogram on the left panel displays the participants endorsement along the same logit scale.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eItem Fit\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eItem fit evaluated the fit of each item of the CPQS-S data to the model. Two test statistics were used to evaluate the item fit for each item in the CPQS-S. It was expressed as item infit (information-weighted mean square) and outfit (outlier-sensitive mean square). Regarding the CPQS-S, item infit reflected how well an item performed when targeted to individuals of similar ability. Item outfit, on the other hand, was sensitive to unexpected responses from individuals. Unexpected item infit and outfit values were reviewed to determine if they degraded the tool (Linacre, 2012). Items that did not fit the model and degraded the development data on subsequent analysis would be removed from the validation data.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePerson Fit\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePerson fit evaluated how well the observed data aligned with the expectations of the Rasch Analysis model. Two test statistics were used to evaluate the data. It was expressed as person infit (information-weighed mean square) and person outfit (outlier-sensitive mean square). Person infit reflected the consistency of responses to items that were well-targeted to a person\u0026rsquo;s acceptability of that item, while person outfit was sensitive to unexpected responses on items (Wright \u0026amp; Linacre, 1994).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCategory functioning and ordering\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll CPQS-S items were evaluated regarding threshold ordering and targeting. It was anticipated that items would be ordered, meaning that the more a participant agreed with this item the more likely they would select a higher category. Threshold targeting indicated how distinct the categories were from each other. A larger spread between the thresholds would indicate how distinct the categories were from each other. A graphical representation was used to visualise threshold ordering and targeting. The rating scale model assumes that the distance between thresholds is the same for each item.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 933 CPQS-S survey responses were collected for analysis. The largest proportion of participants were in the 20 to 24-year age range, which represented 35% of the sample. Within this cohort, 72% identified as female, 3.8% identified as First Nations, 10% were international students, and 13% reported having a disability. The data were divided into a development (n = 466) and validation (n = 467) sample. Missing data were minimal, with less than 0.35% data points missing. Table 2 outlines CPQS-S responses received by each discipline and sample for inclusion in data analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: Distribution of CPQS-S Responses Across Allied Health Disciplines for Sample 1 (Development) and Sample 2 (Validation)\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"559\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eHealth Discipline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eCPQS-S Responses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eSample 1\u0026nbsp;\u003cbr\u003e\u0026nbsp;Development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eSample 2\u0026nbsp;\u003cbr\u003e\u0026nbsp;Validation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eClinical Exercise Physiology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eExercise Science\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eNutrition and Dietetics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eOccupational Therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003ePhysiotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e335\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRehabilitation Counselling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eSocial Work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eSpeech Pathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e933\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e467\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eDimensionality \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe single underlying construct was hypothesised to be student perceptions of placement quality. The factors from Principal Component Analysis scree plot are presented in Figure 1. The steep drop-off after the first component suggested that most of the variance in the validation dataset was explained by a single component, indicating a strong unidimensional structure. This finding supported the assumptions for Rasch Analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReliability and Separation Index\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFour measures were used to assess the quality of the CPQS-S. Item reliability values for the development and validation samples were 0.96 and 0.97 respectively, indicating consistency of item agreement estimates. Person reliability for the development and validation samples were 0.80 and 0.82 which indicated appropriate consistency of the person ability estimates. Item Separation Index for the development and validation sample were 4.87 and 5.45 which indicated that items could be separated into different categories. The Person Separation Index for the development and validation sample was 2.03 and 2.11 which suggested that the respondents could be separated into two different levels of acceptability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eItem Fit \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eItem fit statistics are presented in Table 3 for both the development and validation sample. Analysis of the development sample indicated good overall model fit, though some items required further investigation due to infit and outfit misfit. Items 27, 29, 30, and 31, with high outfit MNSQ values, were reviewed. Item 27 pertained to non-clinical tasks, Item 29 addressed assessment fairness, Item 30 related to patient interaction, and Item 31 concerned student confidence. The Rasch Analysis was repeated for each misfitting item whereby the item was removed to assess its impact on item reliability and person separation. As shown in Table 4, item removal had minimal effect on these parameters, supporting the decision to retain these items in the CPQS-S for the validation sample analysis. However, Item 32, concerning university contact, was excluded from the development and validation sample based on prior research and the content of the question not being referenced in the BPCLE.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3 Item statistics from the development and validation samples including item acceptability (in logits), infit and outfit mean square.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 37.268%;\"\u003e\n \u003cp\u003eDevelopment Sample n = 466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 41.5381%;\"\u003e\n \u003cp\u003eValidation Sample n = 467\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5.3473%;\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.702%;\"\u003e\n \u003cp\u003eItem acceptability (logits)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003eInfit\u0026nbsp;\u003cbr\u003e\u0026nbsp;MNSQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003eOutfit\u0026nbsp;\u003cbr\u003e\u0026nbsp;MNSQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.9284%;\"\u003e\n \u003cp\u003eItem acceptability (logits)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003eInfit\u0026nbsp;\u003cbr\u003e\u0026nbsp;MNSQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003eOutfit\u0026nbsp;\u003cbr\u003e\u0026nbsp;MNSQ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5.3473%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.702%;\"\u003e\n \u003cp\u003e-2.421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.723\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.9284%;\"\u003e\n \u003cp\u003e-2.691\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.380\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5.3473%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.702%;\"\u003e\n \u003cp\u003e-3.910\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.9284%;\"\u003e\n \u003cp\u003e-3.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.426\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5.3473%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.702%;\"\u003e\n \u003cp\u003e-4.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.394\u003c/p\u003e\n \u003c/td\u003e\n 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style=\"width: 5.3473%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.702%;\"\u003e\n \u003cp\u003e-2.529\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.725\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.9284%;\"\u003e\n \u003cp\u003e-2.609\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.843\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.349\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5.3473%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.702%;\"\u003e\n \u003cp\u003e-1.930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.951\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.9284%;\"\u003e\n \u003cp\u003e-1.889\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.840\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5.3473%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.702%;\"\u003e\n \u003cp\u003e-3.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.9284%;\"\u003e\n \u003cp\u003e-3.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5.3473%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.702%;\"\u003e\n \u003cp\u003e-2.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.9284%;\"\u003e\n \u003cp\u003e-2.715\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.825\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.335\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5.3473%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.702%;\"\u003e\n \u003cp\u003e-2.859\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.9284%;\"\u003e\n \u003cp\u003e-3.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.927\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5.3473%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.702%;\"\u003e\n \u003cp\u003e-2.481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.972\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.611\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.9284%;\"\u003e\n \u003cp\u003e-2.549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.976\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5.3473%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.702%;\"\u003e\n \u003cp\u003e-3.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e2.786\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.9284%;\"\u003e\n \u003cp\u003e-1.687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e2.791\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5.3473%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.702%;\"\u003e\n \u003cp\u003e-2.903\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.960\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.9284%;\"\u003e\n \u003cp\u003e-1.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.969\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.618\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5.3473%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.702%;\"\u003e\n \u003cp\u003e-1.418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e2.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e5.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.9284%;\"\u003e\n \u003cp\u003e-1.509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e2.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e5.169\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5.3473%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.702%;\"\u003e\n \u003cp\u003e-2.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e2.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e4.752\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.9284%;\"\u003e\n \u003cp\u003e-2.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.683\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e3.549\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5.3473%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.702%;\"\u003e\n \u003cp\u003e-0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e3.442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.9284%;\"\u003e\n \u003cp\u003e-0.782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e1.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.307%;\"\u003e\n \u003cp\u003e3.533\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 Impact of Item Removal on Reliability and Separation Indices for the CPQS-S\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eContent of item\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003eItem Reliability*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003ePerson Separation*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eInterpretation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003eAction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eSpace to complete non-clinical tasks\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e2.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 180px;\"\u003e\n \u003cp\u003eChanges to item reliability and person separation are negligible. From a statistical standpoint their inclusion or exclusion is negligible. Each item is a feature of the BPCLE framework.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 56px;\"\u003e\n \u003cp\u003eRetain in CPQSS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eAssessment was fair and transparent\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eDirect to patient/client interaction care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e2.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eRate your confidence to practice\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Values relate to the subsequent Rasch Analyses where that specific item removed. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerson ability (logits)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 2 presents the threshold and Wright item-person map for the validation sample. The CPQS-S items were generally well-targeted to the respondents, covering a broad range of acceptability. The alignment between the respondents and the items indicated that the items of the CPQS-S effectively measured the varying levels of acceptability among the validation sample. The distribution of person abilities (left axis) was skewed, with more respondents clustered towards the higher end of acceptability. The item distribution (right axis) showed items across the acceptability scale range.\u0026nbsp;Most items demonstrated satisfactory category functioning, with clear and ordered thresholds across the response categories. The middle categories displayed well-ordered thresholds which suggested that respondents could reliably distinguish between levels of agreement for the items.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerson Fit \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost respondents (75%) had person infit distances from one that were 0.53 or less which indicated a generally good fit to the Rasch Analysis model. The typical respondent\u0026rsquo;s data aligned well with the model\u0026rsquo;s expectations, though some moderate deviations are observed. The majority of respondents (75%) had outfit distances from one that are 0.71 or less which indicated that most respondents\u0026rsquo; data fit the Rasch model well, even when accounting for outlier responses. \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides new evidence supporting the CPQS-S as a valid, 31-item tool that effectively measures students' perceptions of placement quality across a broad range of allied health disciplines. The CPQS-S captures a single underlying construct of student perception of placement quality and can reliably differentiate between varying levels of perceived quality. Notably, it is the first tool of its kind to be applicable across a diverse range of allied health professions. The CPQS-S addresses a significant gap in allied health by demonstrating its relevance across various placement settings, including hospitals, community health, aged care facilities, schools, private practices, paediatric services, mental health services, sports clinics, and research institutions. In contrast to existing tools that focus on specific disciplines, the Rasch Analysis validation of the CPQS-S encompassed a wide range of allied health disciplines, highlighting the surveys versatility and robustness.\u003c/p\u003e \u003cp\u003eThis study builds on previous work confirming that the CPQS-S predominantly measures a single dimension, hypothesised as student perception of placement quality (Jones et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). By evaluating CPQS-S data across themes, the tool facilitates both an overarching assessment of placement experience and a focused evaluation of elements linked to the BPCLE framework. The high item reliability values demonstrated that the CPQS-S provided consistent measurement of item agreement estimates, reflecting true differences in item acceptability rather than measurement error (Andrich \u0026amp; Maraiss, 2019). Similarly, the Person Separation values demonstrate the tool\u0026rsquo;s ability to differentiate between individuals with varying perceptions of placement quality. Although some uncertainty may exist in differentiating between those individuals with moderate perceptions, the CPQS-S can reliably categorised individuals into high and low strata of placement quality (Andrich \u0026amp; Maraiss, 2019). The Item Separation Index indicated that the CPQS-S items covered a wide range of acceptability levels and were well-distributed across the latent trait of perceived placement quality. This combined with the high item reliability, means that the items were well-targeted and diverse enough to assess the full range of a student\u0026rsquo;s perceptions of placement quality (Andrich \u0026amp; Maraiss, 2019). Overall, the CPQS-S Rasch Analysis demonstrated a reliable tool that could identify respondents with different perceptions of their placement quality experience. Further, there was an appropriate level of separation, indicating that the CPQS-S was capable of reliably categorising individuals into different perceptions strata.\u003c/p\u003e \u003cp\u003eFor this project, the CPQS-S was implemented across multiple health professional programs, necessitating attention to discipline-specific terminology to ensure that item wording remained applicable and meaningful. For example, terms such as \u0026lsquo;supervisor\u0026rsquo; were used in place of \u0026lsquo;clinical educator\u0026rsquo; where appropriate, preserving the face and content validity of each item. This interprofessional implementation raised considerations regarding the title of the tool, particularly the \u0026lsquo;Clinical\u0026rsquo; element, as the tool\u0026rsquo;s utility may extend beyond traditional clinical placements to broader work-integrated learning contexts.\u003c/p\u003e \u003cp\u003eSome CPQS-S items warranted review. Item 32 related to contact with the university and was removed from both the development and validation samples. This item was not directly linked to the BPCLE framework and did not align with any themes in the previous publication, supporting its exclusion in this study. However, all remaining items were retained due to their alignment with the BPCLE framework and their overall contribution to the tool\u0026rsquo;s validity, in such they added information rather that statistical \u0026lsquo;noise\u0026rsquo; (Andrich \u0026amp; Maraiss, 2019). Statistical and pragmatic considerations affirm that the CPQS-S items represent key aspects of students\u0026rsquo; perceptions of placement quality. Therefore, to ensure data integrity, all 31 items, as outlined in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, are recommended for inclusion in future applications of CPQS-S. Building on these foundational considerations, the CPQS-S holds potential to drive advancements in allied health education similar to those from discipline specific tools.\u003c/p\u003e \u003cp\u003eThe implementation and impact of The Clinical Learning Environment, Supervision, and Nurse Teacher Scale (CLES\u0026thinsp;+\u0026thinsp;T) may provide a roadmap for the CPQS-S. The CLES\u0026thinsp;+\u0026thinsp;T, which has had a significant impact on nursing education, offers insight into how the CPQS-S can inform improving clinical learning environments, educational practices, and contributing to research in allied health education (Saarikoski, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Through rigorous psychometric testing and international application CLES\u0026thinsp;+\u0026thinsp;T has become a key tool for enhancing nursing pedagogy.(Ozga et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Papastavrou et al., 2016). However, allied health disciplines face barriers when seeking comparable tools suitable for broad interdisciplinary application. Existing tools such as the Maastricht Clinical Teaching Questionnaire (Stalmeijer et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) and Generic Supervision Assessment Tool (Hamilton et al., 2022) emphasise teaching and supervision aspects of placements, rather than comprehensive quality assessment. While the Improving Quality In Practice Placements (iQIPP) framework has broader applicability it is primarily applied prior to placements rather than after the experience (Rodger et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). In contrast, the CPQS-S emerges as a more comprehensive solution for assessing placement quality applicable to a diverse range of allied health stakeholders, this utility and focus on overall placement experience mark the CPQS-S as an innovative tool that aligns with the complex multidisciplinary requirements of allied health education.\u003c/p\u003e \u003cp\u003eThe CPQS-S provides valuable insights for placement providers, universities, and students. Placement providers benefit by receiving feedback on site-specific strengths and areas for improvement, enabling them to enhance their placement offerings. For universities, the CPQS-S serves as a data-driven resource to evaluate and improve placement environments. It also acts as a feedback mechanism, guiding professional development efforts for educators and placement sites. For students, the CPQS-S offers a structured, standardised method to reflect on their experiences and identify the factors contributing to placement quality. While clients do not directly engage with the CPQS-S, the tool\u0026rsquo;s implementation could indirectly benefit them by enhancing the quality of student learning and supervision. Students who are well-prepared and confident in their roles contribute to better client experiences and overall care quality (Suikkala et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Zhang et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Additionally, positive interactions with engaged and well-supervised students can enhance the client experience (Suikkala et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Wright et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere are several strengths of this study. The comprehensive psychometric validation based on a substantial sample size encompassed a broad range of allied health disciplines. Employing both development and validation samples enhanced the reliability of the findings, while the application of established statistical criteria and Rasch Analysis methodology further supported the robustness of the results. Additionally, data collection occurred over a one-year period to minimise the potential impact of placement timing on perceptions. Limitations should be considered when contextualising this work. There is potential for response bias due to the self-reported nature of the CPQS-S. Whilst the disproportionate representation of the physiotherapy student cohort is present, it was addressed through weighted analyses. Finaly, the deidentified nature of data collection may have meant some students\u0026rsquo; perspectives could be represented more frequently if they completed the CPQS-S after each placement experience.\u003c/p\u003e \u003cp\u003eThe current data set included students enrolled in health programs from Clinical Exercise Physiology, Exercise Science, Nutrition and Dietetics, Occupational Therapy, Physiotherapy, Rehabilitation Counselling, Social Work and Speech Pathology. Further to this, the researchers are aware of the CPQS-S being utilised by placement providers and university programs from the aforementioned disciplines in addition to students enrolled in Oral Health, Prosthetics and Orthotics. It suggests that the CPQS-S is widely utilised by a broad range of health disciplines.\u003c/p\u003e \u003cp\u003eFuture research could therefore focus on the stakeholders, methodology and implementation of the CPQS-S. The inclusion of a broader range of health disciplines, such as podiatry, radiography, and paramedicine could progress the implementation of the CPQS-S. Additionally, exploring the tool\u0026rsquo;s applicability in international contexts would expand its reach and relevance. There is an opportunity to explore qualitative methodologies that complement the CPQS-S psychometric properties by linking insights from the open-response questions. Longitudinal study designs could track changes in placement quality and student outcomes over time, further enhancing utility. Similarly, there may be an opportunity to triangulate information from tools such as the CPQS-E which gather the educator perspectives (Hargreaves et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Finally, developing professional development resources for placement providers and university staff would facilitate the effective application of CPQS-S data to promote a comprehensive approach to quality improvement.\u003c/p\u003e \u003cp\u003eThe CPQS-S demonstrates strong psychometric properties, confirming its suitability as a standardised tool for assessing placement quality across a wide range of allied health disciplines. The current study provides new evidence that the CPQS-S captures a single underlying construct of placement quality perception, reliability differentiating level of quality across diverse placement settings. Having a validated CPQS-S tool enables data-driven approaches to enhance the quality of clinical education and prepare graduates to effectively contribute to the healthcare workforce. By supporting students, universities, placement providers, and educators, the CPQS-S promotes high-quality placement experiences that ultimately reinforce professional standards and competencies. Through consistent assessment across disciplines the CPQS-S can foster shared understanding of placement quality, supporting interprofessional collaboration and alignment with healthcare standards. This adaptability ensures that the CPQS-S remains responsive to the evolving landscape of allied health education, with potential downstream benefits for client care quality through well prepared competent healthcare graduates.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eAcknowledgements \u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge the data curation from Jacqueline Broadbridge, Amanda Love and Elisa Canetti and all placement support officers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eFunding details\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThere was no funding associated with this body of work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report there are no competing interests to declare.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData may be available on request from for researchers who meet the criteria to gain access to confidential data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Statement \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTaryn Jones, Andrea Hams and Simone Howell were responsible for the conceptualisation, project administration and methodology of this work. Taryn Jones and Brett Dyer led the data curation and formal analysis. All authors were responsible for data collection and participated in the review, drafting, and final approval of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAhern, C., \u0026amp; O\u0026rsquo;Donnell, M. (2022, 2023/05/04). Are physiotherapy student-led services a suitable model of clinical education? \u0026ndash; perceptions \u0026amp; experiences of physiotherapists, students \u0026amp; patients, a qualitative meta-synthesis. \u003cem\u003ePhysiotherapy Theory and Practice, 39\u003c/em\u003e(5), 963-978. https://doi.org/10.1080/09593985.2022.2031362\u003c/li\u003e\n \u003cli\u003eAHPRA Accreditation Committee. (2023). \u003cem\u003eInformation paper \u0026ndash; good practice approaches to embedding clinical placements, pedagogical innovations and evidence-based technological advances in health practitioner education\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eAndrich, D., \u0026amp; Maraiss, I. (2019). \u003cem\u003eA Course in Rasch Measurement Theory\u003c/em\u003e. Springer Nature https://doi.org/https://doi.org/10.1007/978-981-13-7496-8\u003c/li\u003e\n \u003cli\u003eAustralian Government. (2021). \u003cem\u003eUniversities Australia report on Work Integrated Learning in Universities\u003c/em\u003e. https://www.education.gov.au/enabling-growth-and-innovation-program/resources/universities-australia-report-work-integrated-learning-universities\u003c/li\u003e\n \u003cli\u003eAustralian Institute of Health and Welfare. (2024). \u003cem\u003eHealth Workforce\u003c/em\u003e. Australian Government. 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The clinical learning environment, supervision and nurse teacher scale (CLES+T): psychometric properties measured in the context of postgraduate nursing education. \u003cem\u003eBMC Nursing, 19\u003c/em\u003e(1), 61. https://doi.org/10.1186/s12912-020-00455-5\u003c/li\u003e\n \u003cli\u003ePapastavrou, E., Dimitriadou, M., Tsangari, H., \u0026amp; Andreou, C. (2016, July). Nursing students\u0026apos; satisfaction of the clinical learning environment: a research study. \u003cem\u003eBMC Nursing, 15\u003c/em\u003e, 44. https://doi.org/10.1186/s12912-016-0164-4\u003c/li\u003e\n \u003cli\u003ePenman, M., Raymond, J., Kumar, A., Liang, R. Y. R., Sundar, K., \u0026amp; Thomas, Y. (2023). Allied Health Professions Accreditation Standards for Work Integrated Learning: A Document Analysis. \u003cem\u003eInternational journal of environmental research and public health, 20\u003c/em\u003e(15).\u003c/li\u003e\n \u003cli\u003ePigott, A., Patterson, F., Birch, S., Oakley, P., \u0026amp; Doig, E. 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(2024). \u003cem\u003eImplementation of the BPCLE Framework: Stakeholder Guidelines\u003c/em\u003e. https://www.health.vic.gov.au/education-and-training/best-practice-clinical-learning-environment-bpcle-framework\u003c/li\u003e\n \u003cli\u003eWickham, H., Averick, M., Bryan, J., Chang, W., McGowan, L., Fran\u0026ccedil;ois, R., Grolemund, G., Hayes, A., Henry, L., Hester, J., Kuhn, M., Pedersen, T., Miller, E., Bache, S., M\u0026uuml;ller, K., Ooms, J., Robinson, D., Seidel, D., Spinu, V., Takahashi, K., Vaughan, D., Wilke, C., Woo, K., \u0026amp; Yutani, H. (2019). Welcome to the tidyverse. \u003cem\u003eJournal of Open Source Software, 4\u003c/em\u003e. https://doi.org/10.21105/joss.01686\u003c/li\u003e\n \u003cli\u003eWright, A., Moss, P., Dennis, D. M., Harrold, M., Levy, S., Furness, A. L., \u0026amp; Reubenson, A. (2018, 2018/02/20). The influence of a full-time, immersive simulation-based clinical placement on physiotherapy student confidence during the transition to clinical practice. \u003cem\u003eAdvances in Simulation, 3\u003c/em\u003e(1), 3. https://doi.org/10.1186/s41077-018-0062-9\u003c/li\u003e\n \u003cli\u003eWright, B. D., \u0026amp; Linacre, J. M. (1994). Reasonable mean-square fit values. \u003cem\u003eRasch Measurement Transactions, 8\u003c/em\u003e(3), 370. https://www.rasch.org/rmt/rmt83b.htm\u003c/li\u003e\n \u003cli\u003eZhang, J., Shields, L., Ma, B., Yin, Y., Wang, J., Zhang, R., \u0026amp; Hui, X. (2022, 2022/07/15). The clinical learning environment, supervision and future intention to work as a nurse in nursing students: a cross-sectional and descriptive study. \u003cem\u003eBMC Medical Education, 22\u003c/em\u003e(1), 548. https://doi.org/10.1186/s12909-022-03609-y\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Work Integrated Learning, Student Perceptions, Placement Experience, Interprofessional, Psychometric Validation","lastPublishedDoi":"10.21203/rs.3.rs-6019236/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6019236/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe Clinical Placement Quality Survey \u0026ndash; Student (CPQS-S) was developed to capture allied health students' perceptions of placement quality, in alignment with the Best Practice Clinical Learning Environment framework. This study aimed to validate the CPQS-S using Rasch Analysis across multiple allied health disciplines, encompassing students from Clinical Exercise Physiology, Exercise Science, Nutrition and Dietetics, Occupational Therapy, Physiotherapy, Rehabilitation Counselling, Social Work, and Speech Pathology programs. Data collected from 933 students were divided into development and validation samples. The CPQS-S was confirmed to be measuring a unidimensional construct and Rasch Analysis showed that items demonstrated strong fit statistics and separation reliability, affirming the tool\u0026rsquo;s psychometric robustness in measuring student perceptions. These findings support the CPQS-S as a reliable, data-driven instrument that consistently assesses placement experiences across diverse settings. The validated structure underscores the CPQS-S as a reliable instrument for assessing and benchmarking placement quality, providing educators with actionable data to enhance clinical learning environments. More broadly, these findings contribute to the advancement of work-integrated learning research by offering a validated tool to inform educational interventions and quality improvement initiatives in health professions education.\u003c/p\u003e","manuscriptTitle":"Evaluating Placement Quality in Allied Health: Rasch-Based Validation of the Clinical Placement Quality Survey - Student","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-17 06:43:50","doi":"10.21203/rs.3.rs-6019236/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4993fbbb-c5a3-46cc-b7e3-4f39393345a5","owner":[],"postedDate":"February 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-23T00:23:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-17 06:43:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6019236","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6019236","identity":"rs-6019236","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}