Standing on the Precipice: Evaluating Final-Year Physiotherapy Students' Perspectives of Their Curriculum as Preparation for Primary Health Care Practice

Medical student experiences of Case-Based Learning (CBL) at a multicultural medical school

BACKGROUND

Educational research highlights active approaches to learning are more effective in knowledge retention and problem-solving. It has long been acknowledged that adapting to more active ways of learning form part of the challenge for new university students as the pedagogical distance between the didactical approach largely followed by secondary school systems the world over differs quite significantly from the often more student-led, critical approach taken by universities. University students encounter various learning challenges, particularly during the transition from secondary school to university. Poor adaptation and low performance in the first year of tertiary education can lead to higher failure rates and potential withdrawal from study programmes. Adopting active learning strategies early in this transition phase is crucial for supporting students' adaptation and success. Gaining student engagement with active learning can be a significant challenge when there is an expectation to participate in a discussion or voice an opinion. Case-based learning (CBL), with its scaffolded form of learning, is an approach that could provide the support needed to help multicultural learners adapt to their new learning environment in a non-threatening classroom-based setting. The research question in this study was: what features of CBL support active learning?

METHODS

Data was collected using Structured Group Feedback Sessions (SGFS) from 36 students from 12 different countries. Students were placed in eight Structured Group Feedback sessions, a method that facilitates structured discussions and is effect in curriculum evaluation and feedback. The Experience Based Learning model was used as the conceptual framework to guide the analysis, which was completed using the framework analysis method.

RESULTS

Themes were derived from the Experience Based Learning model: affective, pedagogical, and organisational and analysed according to the research question. We found CBL can be used to facilitate active learning with all students at a multicultural medical university. We identified six learning points to highlight features of CBL that support active learning: CBL increased contact with peers and facilitated student bonding; students need to feel psychologically safe to participate; prior learning can enhance confidence to participate; facilitators need to be aware of their role, know about psychological safety, and manage student participation including the dominant voice; some students have a lower tolerance of uncertainty and need additional clarity at the end either via the facilitator or additional notes that provide the key learning points to take away; students became more engaged when a case is aligned to a real patient case giving it authenticity.

CONCLUSIONS

This study explores how CBL can support active learning in a multicultural medical school. We identified that CBL did facilitate active learning and students engaged with it and enjoyed it. We identified six learning points to support others going forward.

Advice-giving skills in pre-registration physiotherapy training

BACKGROUND

With increased emphasis on self-management in healthcare, clinicians need outstanding skills in offering advice and empowering patients to attain an optimal outcome.

OBJECTIVES

This study explores how undergraduate physiotherapists acquire knowledge, skills, and confidence to offer advice to patients in clinical practice.

METHODS

Convenience sampling was used to recruit 50 BSc and MSc pre-registration physiotherapy students across all years of study in one university in southern England, UK. Semi-structured interviews were conducted for first year BSc students (n = 13). Six focus groups of mixed BSc and MSc students were conducted, three groups (n = 15 students) were mid-training, and three groups (n = 22 students) were in their final year.

RESULTS

Thematic analysis identified 6 themes: advice content; a patient-centered approach; delivery; acquisitions; perceptions; and uptake of advice. Students placed high value on advice-giving, drawing upon multiple learning opportunities, however they felt under-prepared to deliver this skill in practice. Furthermore, perceptions of their student status, and pressures to perform on graded placements were reported to influence the advice they offered to patients.

CONCLUSIONS

Developing high-level skills in promoting self-management is essential in physiotherapy, this study highlights the challenges for students to develop these skills. Academic and practice educators must explicitly enable and support students to develop the knowledge and skills to confidently offer high-quality advice to patients.

Improving the Evidence-Based Practice Skills of Entry-Level Physiotherapy Students through Educational Interventions: A Scoping Review of Literature

Evidence-based practice (EBP) is an essential approach in healthcare, attracting growing interest among both practitioners and researchers. This scoping review aims to (1) systematically investigate the effectiveness of pedagogical methods used to facilitate learning of the EBP approach, and (2) explore the perceptions, experiences, and issues related to these learning methods. The overarching purpose is to identify the state of the art in pedagogical methods, instruments, influences, and barriers in teaching and learning EBP within entry-level physiotherapy education programs. This scoping review was conducted following PRISMA guidelines, with PubMed and Eric databases being searched for peer-reviewed original research articles using a combination of keywords. Excluding non-pertinent articles from the initial 465 identified, 12 were eligible for final inclusion (5 quantitative, 3 qualitative, and 4 mixed-methodology studies). A range of pedagogical methods and instruments for teaching EBP in physiotherapy education were detected, all of which having the capability to positively affect physiotherapy outcomes. Findings from this study support the significant influence that EBP exerts on the improving of the quality of teaching, together with the necessities that the involvement of EBP in physiotherapy education programs provide. Several barriers were identified, which should be taken into consideration when designing population-specific EBP strategies tailored to these particular needs.

Evaluation of a blended learning approach on stratified care for physiotherapy bachelor students

BACKGROUND

Stratified models of care are valuable for addressing psychosocial factors which influence the outcome of patients with musculoskeletal disorders. Introducing such models in undergraduate training has the potential to propagate this knowledge with evidence and foster its implementation. The objective of this paper is to explore the perception and changes in the fear-avoidance beliefs of physiotherapy students participating in a developed blended learning course on stratified care.

METHODOLOGY

A mixed-methods with a convenient sample of two consecutive cohorts were given a blended learning course on stratified care for patients with low back pain. The blended learning course comprised scientific rudiments and application of stratified care in clinical practice conceptualised using the KERN' 6-step approach. The exam scores, perceptions, performance on self-reflection-tests and pre- and post-scores on The Tampa Scale for Kinesiophobia for Physiotherapists' (TSK-PT) were obtained. After gaining clinical experience, participants were invited to discuss their clinical experiences and perceptions in workshops. The quantitative data was analysed explorative-descriptively. The qualitative data was analysed following an inductive coding system with constant comparisons.

RESULTS

Ninety-one participants consented to the evaluation (mean age = 22.9 ± 1.6 years), 66% were female. Exam scores correlated with time spent in training (r = 0.30) and scores on self-reflection-tests 1 and 2 (r = 0.40 and r = 0.41). Participants in both cohorts described the learning resources as promoting their interest in the subject (72% and 94%), up-to-date (91% and 93%) and helpful (91% and 97%). The fear-avoidance scores for participants decreased from 53.5 (± 9.96) to 40.1 (± 12.4) with a large effect size (d = 1.18). The regression model [F (2, 49) = 1151.2, p < 0.001] suggests that pre-TSK-PT and the interest of participants in the training predicted post-TSK-PT. The workshop participants (n = 62) all worked in clinical practice. Emerging from the analysis were 4 categories (evolving to maturity in practice, perceiving determinants of stratified care, strategising for implementation and adopting an outlook for future practice).

CONCLUSION

The quality of engagement in learning, training strategy and interest in the subject contributes immensely to learning outcomes. This blended learning course was successful in reducing kinesiophobia and influencing the participants' attitude towards care with the potential of being translated into long-term practice.

The Impact of the COVID-19 Lockdown on Physical Therapy Undergraduates and Their Families. A Qualitative Study from the United Arab Emirates

Background

The COVID-19 pandemic closed most establishments in the United Arab Emirates except health care and other essential services from 8 March 2020 until 24 June. By 22 March, most citizens were working online, including physical therapy students, and a no-movement policy restricted exercise to homes. The lockdown ended partially in August 2021 and almost complete by January 2022.

Objective

We aimed (1) to explore the physical activities of advanced undergraduate physical therapy students and their families during the lockdown, (2) to discuss how participants helped promote and maintain their own and their family’s physical health, and (3) to identify what knowledge and skills gained in their physical therapy study students utilized during the lockdown.

Methods

We took a qualitative approach; a one-to-one semi-structured interviews were conducted by Year 4 physical students who at the time were registered for a module covering qualitative research methods. The students interviewed other physical therapy students from year 4 and 5 who were recruited using convenience sampling from a health sciences educational institution. Interviews were conducted and recorded on the Zoom platform and transcribed verbatim. Thematic analysis was utilised to analyse the data.

Findings

Forty-six students agreed to participate, and data saturation was achieved with interviews of 24 students. During the COVID-19 Stay Home—Stay Safe initiative, students of physical therapy were found to be physically active and to have designed home exercise programs for themselves and their families. Adherence to regular exercise was high among the students but low among family members. Three overarching themes, each with three subthemes, emerged through synthesis, coding, and categorizing.

Conclusion

Undergraduate students can effectively promote their own and their family’s health. Energy imbalance and increasing neck, shoulder, and back pain among youth and lack of exercise among adults, midlife, and older, raise health concerns.

Clients and conditions encountered by final year physiotherapy students in private practice. A retrospective analysis

Currently little is known about the clients and conditions final-year physiotherapy students are exposed to in private practice settings. The aim of this study is to describe the clients and conditions encountered by final-year physiotherapy students during a six-week full-time private practice clinical placement. Client data of conditions were collected over 11 years (2008-2018) from final year physiotherapy students' client reports in a university clinic, Christchurch, New Zealand. Data for anatomical site and pathology were categorized using the Orchards Sports Injury Classification System 10 and descriptive analyses completed. Students saw a mean of 22 (SD 5) unique clients. The anatomical sites most encountered were the shoulder (97.4% of students), lumbar spine (96.3%), knee (95.8%) and ankle (91.2%). The pathologies most encountered were joint sprain (100%), muscle injury (90%), and tendon injury (88.4%). While final year physiotherapy students are exposed to a substantial number of clients encompassing major regions and condition types, this exposure is limited in scope. The findings offer a basis for discussion about what clinical exposure to clients and conditions might best support the transition from physiotherapy student to new graduate in private practice settings.

Navigating diagnostic uncertainty in musculoskeletal practice: The perspectives and experiences of new graduate physiotherapists

BACKGROUND

Diagnostic uncertainty in musculoskeletal pain presents as a frequent and challenging dilemma encountered by health professionals. Current literature indicates that diagnostic uncertainty impacts the clinical decision making of experienced physiotherapists. Despite this, the experiences and navigational strategies of new graduate physiotherapists, pertaining to this dilemma, are widely unknown.

OBJECTIVES

The aim of this study was to explore how new graduate physiotherapists experience and navigate diagnostic uncertainty when managing individuals with musculoskeletal pain.

METHODS

A qualitative study using a thematic analytical research approach was undertaken. A randomized sample of new graduate physiotherapists, working in musculoskeletal settings (n = 17), participated in semi-structured telephone interviews. Interview data was subsequently subject to thematic analysis.

RESULTS

Four key themes emerged from the data: 1) diagnostic uncertainty is fraught with challenges; 2) diagnosis is not the end game; 3) intrinsic strategies and extrinsic actions and 4) the imperative role of clinical practice.

CONCLUSION

New graduate physiotherapists frequently experience diagnostic uncertainty within musculoskeletal practice and are commonly challenged by this dilemma. Despite this, new graduates utilize several strategies to mitigate challenges including focusing on patient-centered care, maintaining transparency and relying on senior colleagues. Most strategies are directly attributed to clinical experiences. This study further outlines implications for physiotherapy curricula and workplace support.

Development of real world learning opportunities in community exercise prescription for healthcare professional programmes - 'Physio Hub'

BACKGROUND

Given the challenge of chronic lifestyle diseases, the shift in healthcare focus to primary care and recognised importance of a preventive approach to health, including exercise prescription, the embedding of related learning in healthcare professional programmes is critical.

METHODS

In response to these contemporary demands, a complex curriculum development project was undertaken at University College Dublin, employing a four dimensional curriculum framework for the development of health professional curricula, that focused on (1) future orientation of healthcare practices (the why?), (2) defining capabilities of graduates (the what?), (3) teaching, learning and assessment (the how?) and (4) organisation/institution delivery (the where)? The process was informed by latest exercise, health promotion, educational and health policy literature, alongside engagement with multiple internal university and external community stakeholders.

RESULTS

Having sufficient clinical education opportunity for translating exercise theory into practice was identified as a key need (the Why?). Development of strategies for health promotion and design and delivery of evidence based exercise programmes with inter-professional and inter-sectoral network building were some of the graduate capabilities identified as being critically important. (the what?) The resultant UCD Physio Hub model of clinical education combines 'on campus' and 'community outreach' activity to facilitate inter-sectoral 'real world' experiential student learning in health promotion and exercise prescription for both healthy and clinical populations. Underpinned by social constructivist educational theory, students are encouraged to be creative and to collaborate in responding to identified health needs of specific community groups by designing and delivering community services. (the how?) In developing new student learning opportunities to enhance curriculum, a supportive organisational culture and context was critical with UCD having excellent exercise infrastructure and the Physio Hub project aligning with a community engagement ethos articulated in the university's strategy. (the where?) CONCLUSION: This paper provides an overview of Physio Hub, its services, educational practices and translational research ethos, all of which are combined to deliver a rich exercise and health promotion learning experience. Although developed for physiotherapy in this instance, the curriculum process and resultant education model could be applied across medical and other health professional programmes and to facilitate interdisciplinary learning.

The professional development and career journey into musculoskeletal first contact physiotherapy: a telephone interview study

(a)Background: Musculoskeletal (MSK) first contact physiotherapy (FCP) is being rolled out in the National Health Service, but limited research exists on career pathways into MSK FCP, or on pre-and-post-registration educational preparation for the knowledge and skills that are required for musculoskeletal first contact physiotherapy. (b) Objectives: From the perspectives of existing MSK FCPs, the study sought to understand the pre-and-post-registration professional developmental journey into musculoskeletal first contact physiotherapy. (c) Methods: Semi-structured interviews over the telephone were conducted with a self-selected and snowball sample of 15 MSK FCPs from across Britain. Framework analysis was used to analyze the interview transcripts. (d) Results: Four overarching themes were identified: (1) Decision to choose a career path as a MSK FCP; (2) Relevancy of pre-registration physiotherapy (PT) education for MSK FCP; (3) Relevancy of post-registration continuing professional development for MSK FCP, and; (4) Improving pre-registration PT education for the foundational knowledge and skills required to work in musculoskeletal first contact physiotherapy. Each overarching theme generated several subthemes. (e)Conclusion: The research contributes to understanding the career pathway into the MSK FCP role and showed what relevant knowledge and skills were acquired for this role at pre-and-post registration levels. Findings will inform guidance for pre-registration PT curriculum development.

Challenges and Learning Opportunities of Pre-Registration Physiotherapy Placements in First Contact Settings: The Perspectives of Musculoskeletal First Contact Physiotherapists

OBJECTIVES

As musculoskeletal first contact physiotherapy is rolled out into primary healthcare in Britain, this could offer up new practice-based educational opportunities for pre-registration physiotherapy students. Thus, the present study sought to explore the perceived challenges and learning opportunities of pre-registration physiotherapy placements in musculoskeletal first contact physiotherapy settings from first contact physiotherapists' perspectives.

METHODS

Using a qualitative strategy, 15 musculoskeletal first contact physiotherapists from different geographical locations in Britain, participated in telephone mediated semi-structured interviews. Participants were self-selected through a Chartered Society of Physiotherapy fortnightly bulletin and online forum for first contact physiotherapists, or recruited via snowball sampling. Interview transcripts were analysed according to framework analysis - and the findings were member-checked by proxy.

RESULTS

Three core themes emerged: operational challenges, challenges for pre-registration physiotherapy students and learning opportunities for pre-registration physiotherapy students. Operational challenges included: ensuring sufficient support from first contact physiotherapy practice educators; financial cost implications of placements, and; lack of capacity within the existing first contact physiotherapy workforce to provide placements. Challenges for physiotherapy students involved: time pressures and stressors of a first contact physiotherapy placement; identifying red flags, and; complexity of patient presentations. Identified learning opportunities for physiotherapy students were: experience of a specialised physiotherapy role in a primary healthcare setting; bringing awareness of first contact physiotherapy as a potential career pathway, and; experience multidisciplinary team working in primary care.

CONCLUSIONS

By seeking the perspectives of first contact physiotherapists, this study provides the first step for the development of placements in an emerging practice area.

Leveraging Interdisciplinary Education Toward Securing the Future of Connected Health Research in Europe: Qualitative Study

BACKGROUND

Connected health (CH) technologies have resulted in a paradigm shift, moving health care steadily toward a more patient-centered delivery approach. CH requires a broad range of disciplinary expertise from across the spectrum to work in a cohesive and productive way. Building this interdisciplinary relationship at an earlier stage of career development may nurture and accelerate the CH developments and innovations required for future health care.

OBJECTIVE

This study aimed to explore the perceptions of interdisciplinary CH researchers regarding the design and delivery of an interdisciplinary education (IDE) module for disciplines currently engaged in CH research (engineers, computer scientists, health care practitioners, and policy makers). This study also investigated whether this module should be delivered as a taught component of an undergraduate, master's, or doctoral program to facilitate the development of interdisciplinary learning.

METHODS

A qualitative, cross-institutional, multistage research approach was adopted, which involved a background study of fundamental concepts, individual interviews with CH researchers in Greece (n=9), and two structured group feedback sessions with CH researchers in Ireland (n=10/16). Thematic analysis was used to identify the themes emerging from the interviews and structured group feedback sessions.

RESULTS

A total of two sets of findings emerged from the data. In the first instance, challenges to interdisciplinary work were identified, including communication challenges, divergent awareness of state-of-the-art CH technologies across disciplines, and cultural resistance to interdisciplinarity. The second set of findings were related to the design for interdisciplinarity. In this regard, the need to link research and education with real-world practice emerged as a key design concern. Positioning within the program context was also considered to be important with a need to balance early intervention to embed integration with later repeat interventions that maximize opportunities to share skills and experiences.

CONCLUSIONS

The authors raise and address challenges to interdisciplinary program design for CH based on an abductive approach combining interdisciplinary and interprofessional education literature and the collection of qualitative data. This recipe approach for interdisciplinary design offers guidelines for policy makers, educators, and innovators in the CH space. Gaining insight from CH researchers regarding the development of an IDE module has offered the designers a novel insight regarding the curriculum, timing, delivery, and potential challenges that may be encountered.

Addressing complex societal challenges in health education – A physiotherapy-led initiative embedding inclusion health in an undergraduate curriculum

Socially marginalised groups suffer vastly poorer health outcomes compared to the general population. Inclusion health seeks to directly address the health inequities experienced by groups such as homeless people and refugees. Despite the unique healthcare needs experienced by these vulnerable groups, inclusion health features very little in health education curricula. This letter has been written by a group of clinicians, academics, clinical education specialists and students with a common interest in inclusion health. In the absence of established guidance on how best to incorporate the broad topic of inclusion health in undergraduate education, we have developed a two-pronged approach within physiotherapy. We are writing to highlight the following initiatives; firstly, the provision of a dedicated undergraduate clinical placement devoted to the area of inclusion health. Secondly, we have also initiated a step-wise process of introducing the topic of inclusion health into the formal undergraduate curriculum. This letter demonstrates the need to implement strategies to incorporate inclusion health into the curriculum and the approaches described are applicable to diverse health professions and settings.

"The more you did, the more it made sense": Problem-based learning to improve early evidence-based practice in an undergraduate physiotherapy professional programme

BACKGROUND AND PURPOSE

Evidence-based practice (EBP), which integrates clinical reasoning skills, research evidence, and patient preference, has become standard in curricula for health care professional programs. Students however perceive EBP as difficult and often irrelevant to clinical practice.

METHODS

A problem-based learning (PBL) approach is trialled in an early stage module where EBP knowledge and skills are stated learning outcomes. Prior to this, the content-based approach to EBP teaching and learning received negative student feedback. The impact of delivering EBP through PBL is evaluated by comparing 5 standard Likert feedback scales and open-ended question responses relating to the EBP instruction in the module before and after a PBL approach was implemented. The impact of a PBL approach on EBP profiles is further examined under domains (relevance, sympathy, terminology, practice, and confidence) of the validated Evidence-based Practice Profile Questionnaire.

RESULTS

All mean Likert scores relating to subject understanding, relevance of assessments, achievement of learning outcomes, teaching, and overall module satisfaction improved when the PBL approach was compared with the lecture-based format (p < 0.05). Student comment post-PBL continued to identify EBP as a difficult concept, but now comments on the teaching and assessment approach were mainly positive, addressing the collaborative nature of PBL, identifying EBP, communication and team-working skills acquired, praising the real life, practical application of EBP taken, and commenting on improvement in EBP self-efficacy. Within group change in the Evidence-based Practice Profile Questionnaire following a PBL approach identified significant improvement in EBP domains of terminology (mean change 3.38; p < 0.001); practice (mean change 16.5; p < 0.001), and confidence (mean change 10.1; p = 0.008). Conceptual links, based on constructivist underpinnings of PBL and EBP, are developed in the paper.

CONCLUSIONS

Using mixed methods evaluation, PBL is effective at promoting early EBP. Students identified with the interactive, collaborative, and experiential nature of PBL to EBP instruction.

Knowledge, Attitudes, and the Practice of Health Promotion among Physiotherapists in Nigeria

Purpose: In spite of the growing epidemic of non-communicable diseases in Nigeria and the compelling need for the active participation of physiotherapists in health promotion activities around the world, there is no evidence that physiotherapists in Nigeria are engaged in health promotion activities. This study aimed to investigate the knowledge of, attitudes toward, and practice of health promotion among physiotherapists practising in Nigeria. Method: This was a cross-sectional study. We contacted members of the Nigeria Society of Physiotherapy (n = 368) by email; the message contained a link to an online questionnaire. Results: A total of 229 (62%) physiotherapists responded. Most demonstrated a good knowledge of health promotion (approximately 70%) and indicated that they often incorporated aspects of health promotion into their patients' treatment (63%). However, fewer than one-fifth strongly agreed that health promotion was taught in their entry-level programme and had equipped them with the necessary health promotion skills. Conclusions: The majority of the physiotherapists surveyed demonstrated good knowledge and often incorporated health promotion into their routine daily practice. Nevertheless, the respondents stated that their entry-level physiotherapy education had not sufficiently equipped them for health promotion practice. These findings provide a baseline reference that can be used to track capacity building for health promotion practices. The results also highlight important gaps in the physiotherapy entry-level curriculum and the health promotion training needs of physiotherapists in Nigeria.

Student-led community placement in physiotherapy

BACKGROUND

Service provision and the education of health professionals has diversified with the shift in health care focus to primary care. Current evidence, particularly in physiotherapy education, has identified shortfalls in practical experience and education provided in health promotion. To address this, practice placements in non-traditional settings have been recommended; however, limited evidence exists to guide this innovation. This study aimed to address this gap by exploring the challenges and facilitators of a community-based, student-led placement involving physiotherapy undergraduate students and community-based groups.

METHODS

A qualitative descriptive approach was employed. Students (n = 7) and the service users and community facilitators (n = 12) who had engaged in this placement model were invited to participate in focus groups and semi-structured interviews. Interviews were recorded, transcribed and analysed using thematic analysis.

RESULTS

Two themes were identified: collaborative learning and embracing change. The acquisition of professional skills, such as leadership, teamwork and adaptability, was perceived to be greater than on traditional placements. Students, service users and community facilitators experienced mutual learning benefits, but also identified challenges with the placement model. These insights informed opinion regarding the sustainability of the model.

DISCUSSION

Student-led community-based placements appear to impact positively on the well-being of community service users. Mutual benefits were acknowledged by all stakeholders. This evaluation highlighted issues related to sustainability, and the need for a balanced representation of student and service user needs. Areas for development were identified, providing an optimistic outlook for the feasibility of this model and its transferability to other health professions. Health professional services have diversified, in both social and health contexts, with a shift in focus from the treatment of ill health to health promotion.