An in-depth analysis of ethics teaching in Canadian physiotherapy and occupational therapy programs

Analysis in the ethical decision-making of dental, nurse and physiotherapist students, through case-based learning

INTRODUCTION

Training in ethical competencies is perceived with special interest among the objectives of health education. The dimensions of the person such as integrity, autonomy and dignity influence the choice of interventions, but the different specialties of the health sciences conceive these dimensions with different perspectives depending on the clinical setting. These divergences can be detected during the first years of undergraduate studies, and it is important to know the professional bias and its possible causes.

MATERIALS AND METHODS

A procedure was developed through case-based learning (CBL) to assess various characteristics of decision-making during the early stages of student training. A semi-quantitative method was designed based on the narrative responses of a case with ethical implications in the field of gender violence. The method was applied to 294 undergraduate students in nursing (95), physiotherapy (109) and dentistry (90) from the Faculty of Health Sciences of a Spanish university. A frequency analysis of the narrative responses of the students to the proposed case was carried out, using the chi-square test to determine any association between the variables studied: gender, specialty and ethical knowledge.

RESULTS

Four types of response categories were detected, as a result of combining the personal conversation, report to legal authority or require assistance of other teams. The most common option in dentists is conversation only, while physical therapists include the assistance of other teams. In nursing, a balance is observed between both possibilities. The results show that student responses differ significantly among specialties and also differ significantly according to test scores on ethical knowledge. However, no significant differences were found between the responses provided by men and women.

CONCLUSION

Most of the health sciences students highly valued their own capacity for dialogue and reflection to approach situations with complex ethical dimensions. We consider that case-based learning (CBL), in combination with narrative analysis is a valid means of evaluating the professional ethical competencies of students in health sciences careers applied to a common goal.

Physiotherapy Students' Experiences about Ethical Situations Encountered in Clinical Practices

(1) Background: It is important to explore the ethical situations that physiotherapy students encountered in their clinical practices. (2) Methods: Qualitative, explorative, descriptive study. The participants included third-year physiotherapy students. They had to write five narratives about ethical situations encountered in their clinical practices. Krippendorff’s method for qualitative content analysis was used to cluster units within the data to identify emergent themes. The study protocol was approved by the authors’ University Ethic Committee of Human Research (H1515588244257). (3) Result: 280 narratives were reported by 64 students (23.34 ± 4.20 years, 59% women). Eight categories were identified from the qualitative analysis of the data: (a) professional responsibility, (b) professional competence, (c), beneficence, (d) equality and justice, (e) autonomy, (f) confidentiality, (g) respect for privacy, and (h) sincerity. All participants were informed and provided written informed consent. (4) Conclusions: Ethical principles were frequently violated in physiotherapy. Experiences of physiotherapy students must be examined to tailor educational interventions prior to their initiation into practice. Ethics education is needed in workplaces and should be increased in basic education. Facilitating the ethical awareness of future physiotherapists is a challenge for university teachers who provide ethical competence training.

Attitudes towards learning professional ethics in undergraduate physiotherapy students: A STROBE compliant cross-sectional study

BACKGROUND

Ethics is a key competence to be acquired by physiotherapy students to ensure quality care. However, students may not be aware of the importance of ethics for the development of their clinical practice, in the same way that their attitudes towards Professional Ethics are unknown within their curriculum.

OBJECTIVES

The aim of this study was to identify the attitudes towards learning Professional Ethics among undergraduate students of Physiotherapy Degree and compare the attitude between the educational years.

DESIGN

A cross-sectional study was carried out.

SETTINGS

Physiotherapy Degree at the University of Valencia, Spain.

PARTICIPANTS

In the study 340 physiotherapy students participated.

METHODS

This was a quantitative study with a cross-sectional observational design. The students of the different years of the Physiotherapy Degree had to complete the Attitudes Questionnaire towards Professional Ethics in Physiotherapy in order to analyse the study objective.

RESULTS

The four educational years' scored 3.80 or more in the questionnaire. Second-year students scored the highest (4.25 ± 0.35) and had significantly more favourable attitudes towards learning ethics in relation to the rest of the years (p = 0.007 vs. first; p < 0.001 vs. third and fourth). First-year students (4.09 ± 0.37) obtained a significantly higher score than third (3.86 ± 0.35) and fourth years (3.80 ± 0.33) with p < 0.001 vs. both third and fourth. Finally, in relation to the 3 categories of the items' questionnaire the mean scores showed significant differences between the second year and the rest of the years.

CONCLUSIONS

The attitudes towards learning Professional Ethics among students of the Physiotherapy Degree at the university is favourable, although it varies depending on the academic year, with the students in the academic year in which Ethics is taught (i.e. second year students) being the ones with better attitudes.

Continuing competency in ethical decision making: An interpretive description of occupational therapists' perspectives

BACKGROUND.

Competency in ethical decision making is a criterion for ethical practice, and it is expected to advance with ongoing professional development. However, research exploring continuing competency needs of occupational therapists regarding ethical decision making is limited.

PURPOSE.

The purpose of this study was to explore potential gaps and directions for development related to continuing competency in ethical decision making from the perspective of practicing occupational therapists.

METHOD.

Interpretive description informed secondary data analysis of professional narratives from a grounded theory study regarding ethical decision making. In-depth interviews were conducted with a purposive sample of 18 occupational therapists. Data analyses focused on identifying gaps and future directions regarding continuing competency.

FINDINGS.

Two main themes regarding gaps were identified: "I didn't have the knowledge" and "I don't have anybody." Education, tool development, and ethics mentorship were identified directions for development.

IMPLICATIONS.

Findings advance understanding of continuing competency needs of occupational therapists regarding ethical decision making.

Integration of wheelchair service provision education: current situation, facilitators and barriers for academic rehabilitation programs worldwide

Purpose: An estimated 75 million people with disabilities need wheelchairs globally, of whom 5-15% have one. Access to an appropriate wheelchair requires rehabilitation professionals trained to provide wheelchair service. One aim of the International Society of Wheelchair Professionals (ISWP) is to promote and facilitate the integration of wheelchair service provision education into academic rehabilitation programs worldwide. To inform the development of integration strategies, the purpose of this study was to develop an in-depth global portrait of the wheelchair service provision education offered in academic rehabilitation programs, the process of its integration and the associated facilitators and barriers.Method: Semi-structured qualitative interviews were conducted with a purposive sample of 14 representatives from academic rehabilitation programs (i.e., occupational therapy, physical therapy, and prosthetics and orthotics) in 11 countries, including low, middle and upper resourced settings.Findings: Thematic data analyses identified three overarching themes. The first theme, "impact of context", portrays factors related to local population needs, governance and supply chain of equipment and service delivery. The second theme, "current and planned wheelchair education", describes the content, pedagogic approach, student evaluation and feedback process. The third theme, "integration process", details five states of this process.Conclusions: This study describes in-depth the wheelchair service provision education across academic rehabilitation programs and resource settings, illustrating the context-dependent nature of its integration. This understanding may assist the global community of educators in preparing future rehabilitation professionals to better serve wheelchair users. This work has informed the development of ISWP's Seating and Mobility Academic Resource Toolkit (http://smart.wheelchairnetwork.org/).Implications for RehabilitationThe Dynamics of Context-Dependent Integration of Wheelchair Service Provision Education in Curricula model, depicting the findings of this study, may help to inform key stakeholders (i.e., academic institutions, health care providers and policy makers) about potential barriers and facilitators to the implementation of adequate wheelchair service provision education in the curricula of academic rehabilitation program.Study findings may lead to creative strategies, such as the expansion of ISWP's Seating and Mobility Academic Resource Toolkit (SMART; http://smart.wheelchairnetwork.org/), that may enable academic rehabilitation programs to be a part of the solution to strengthening rehabilitation systems worldwide, through appropriately trained rehabilitation professionals in wheelchair service provision.

Teaching professionalism: some features in Canadian physiotherapy programs

The role of "professionalism" is core to many health professions including Physical Therapy (PT), and the development of competence in professionalism is a key requirement of entry-to-practice PT programs. However, the actual curriculum, teaching methodologies, and evaluation methods currently used to develop professional competence during PT training programs in Canada are unclear. This study explored current teaching practices, evaluation and curricular content related to professionalism in Canadian entry-to-practice PT programs. Results showed that teaching practices related to professionalism were not necessarily congruent with methods promulgated by educational theory and relied heavily on lecture, while more appropriate strategies such as simulation and role play were under-utilized. The numbers of different teaching methods utilized for specific aspects of professionalism were variable. Emphasis on different curricular areas related to professionalism also varied: communication was given the most emphasis while change management was under-represented. It is posited that teaching methods related to professionalism could be improved and curricular content and emphasis should also be reconsidered.

Ethics and sexual health: Exploration of the ethical code of conduct for physiotherapists concerning sexual health in clinical practice

Physiotherapists have an important role in sexual health, but there are specific ethical considerations regarding sexuality and the practice of physiotherapy which require serious consideration. This article aims to illustrate how the professional ethical code of physiotherapy can serve as a tool for ethical clinical reasoning regarding sexual health in clinical physiotherapy practice. We analyse the ethical codes for physical therapy, in relation to a definition of sexual health and the declaration of sexual rights. The analysis outlines several ethical considerations crucial in dealing with sexual health, while also acknowledging the critical role of cultural context in any ethical analysis. We conclude that physiotherapists need to practise ethical reasoning and that the ethical code of physiotherapy can act as a point of departure for reflection on thought-provoking ethical dilemmas to improve the practice of physiotherapy and support clients' overall health.

Supporting ethics educators in Canadian occupational therapy and physical therapy programs: A national interprofessional knowledge exchange project

Ethics education is the cornerstone of professional practice, fostering knowledge and respect for core ethical values among healthcare professionals. Ethics is also a subject well-suited for interprofessional education and collaboration. However, there are few initiatives to gather experiences and share resources among ethics educators in rehabilitation. We thus undertook a knowledge exchange project to: 1) share knowledge about ethics training across Canadian occupational and physical therapy programs, and 2) build a community of educators dedicated to improving ethics education. The objectives of this paper are to describe this interprofessional knowledge exchange project involving ethics educators (with a diversity of professional and disciplinary backgrounds) from Canadian occupational and physical therapy programs as well as analyze its outcomes based on participants' experiences/perceptions. Two knowledge exchange strategies were employed: an interactive one-day workshop and a wiki platform. An immediate post-workshop questionnaire evaluated the degree to which participants' expectations were met. Structured telephone interviews 9-10 months after the workshop collected participants' perceptions on whether (and if so, how) the project influenced their teaching or led to further interprofessional collaborations. Open-ended questions from the post-workshop questionnaires and individual interviews were analyzed using qualitative methods. Of 40 ethics educators contacted, 23 participated in the workshop and 17 in the follow-up interview. Only 6 participants logged into the wiki from its launch to the end of data collection. Five themes emerged from the qualitative analysis: 1) belonging and networking; 2) sharing and collaborating; 3) changing (or not) ways of teaching ethics; 4) sustaining the network; and 5) envisioning the future of ethics education. The project attained many of its goals, despite encountering some challenges. While the wiki platform proved to be of limited benefit in advancing the project goals, the interactive format and collaborative nature of the one-day workshop were described as rewarding and effective in bringing together occupational therapy and physical therapy educators to meet, network, and share knowledge.

Low Back Pain: Investigation of Biases in Outpatient Canadian Physical Therapy

BACKGROUND

Previous research suggested that physical therapy services can be influenced by patient characteristics (age, sex, socioeconomic status) or insurance status rather than their clinical need.

OBJECTIVE

The aim of this study was to determine whether patient-related factors (age, sex, SES) and the source of reimbursement for physical therapy services (insurance status) influence wait time for, frequency of, and duration of physical therapy for low back pain.

DESIGN

This study was an empirical cross-sectional online survey of Canadian physical therapy professionals (defined as including physical therapists and physical rehabilitation specialists).

METHODS

A total of 846 physical therapy professionals received 1 of 24 different (and randomly selected) clinical vignettes (ie, patient case scenarios) and completed a 40-item questionnaire about how they would treat the fictional patient in the vignette as well as their professional clinical practice. Each vignette described a patient with low back pain but with variations in patient characteristics (age, sex, socioeconomic status) and insurance status (no insurance, private insurance, Workers' Compensation Board insurance).

RESULTS

The age, sex, and socioeconomic status of the fictional vignette patients did not affect how participants would provide service. However, vignette patients with Workers' Compensation Board insurance would be seen more frequently than those with private insurance or no insurance. When asked explicitly, study participants stated that insurance status, age, and chronicity of the condition were not factors associated with wait time for, frequency of, or duration of treatment.

LIMITATIONS

This study used a standardized vignette patient and may not accurately represent physical therapy professionals' actual clinical practice.

CONCLUSIONS

There appears to be an implicit professional bias in relation to patients' insurance status; the resulting inequity in service provision highlights the need for further research as a basis for national guidelines to promote equity in access to and provision of quality physical therapy services.

Ethics teaching in rehabilitation: results of a pan-Canadian workshop with occupational and physical therapy educators

PURPOSE

Ethical practice is an essential competency for occupational and physical therapists. However, rehabilitation educators have few points of reference for choosing appropriate pedagogical and evaluation methods related to ethics. The objectives of this study were to: (1) identify priority content to cover in ethics teaching in occupational therapy (OT) and physical therapy (PT) programmes and (2) explore useful and innovative teaching and evaluation methods.

METHOD

Data for this qualitative descriptive study were collected during a 1-d knowledge exchange workshop focused on ethics teaching in rehabilitation.

RESULTS

Twenty-three educators from 11 OT and 11 PT Canadian programmes participated in the workshop. They highlighted the importance of teaching foundational theoretical/philosophical approaches and grounding this teaching in concrete examples drawn from rehabilitation practice. A wide range of teaching methods was identified, such as videos, blogs, game-based simulations and role-play. For evaluation, participants used written assignments, exams, objective structured clinical examinations and reflective journals. The inclusion of opportunities for student self-evaluation was viewed as important.

CONCLUSION

The CREW Day provided ethics educators the opportunity to share knowledge and begin creating a community of practice. This space for dialogue could be expanded to international rehabilitation ethics educators, to facilitate a broader network for sharing of tacit and experiential knowledge. Implications for Rehabilitation According to the study participants, rehabilitation ethics education should include learning about foundational knowledge related to ethical theory; be grounded in examples and cases drawn from clinical rehabilitation practice; and contribute to building professional competencies such as self-knowledge and critical thinking in students. Regardless of the methods used by occupational therapy (OT) and physical therapy (PT) educators for teaching and evaluation, the value of creating spaces that support open discussion for students (e.g. protected discussion time in class, peer-discussions with the help of a facilitator, use of a web discussion forum) was consistently identified as an important facet. Educators from OT and PT programmes should work with various professionals involved in OT and PT student training across the curricula (e.g. clinical preceptors, other educators) to extend discussions of how ethics can be better integrated into the curriculum outside of sessions specifically focused on ethics. The CREW Day workshop was the first opportunity for Canadian rehabilitation ethics educators to meet and discuss their approaches to teaching and evaluating ethics for OT and PT students. Including international rehabilitation ethics educators in this dialogue could positively expand on this initial dialogue by facilitating the sharing of tacit and experiential knowledge amongst a larger and more diverse group of ethics educators.