Good Practice in Australian Physiotherapy Education

 

PURPOSE: UK government policy to increase the number of practising physiotherapists has led to an increase in physiotherapy students. Consequently more physiotherapy staff are needed to supervise student learning within clinical settings. To date, most clinical educators are drawn from one of several grades of practising physiotherapists - the 'Senior I' grade. However, since this grade represents only one of several in which physiotherapists in the UK health sector work, a shortage of clinical educators is proving to be an increasing problem. This study, which is part of a larger investigation of different models of clinical supervision, examines evidence to test the proposition that clinical educators might additionally be drawn from a range of grades, in particular those at more junior levels.
RELEVANCE: The relationship between clinical educator and student is potentially beneficial to the educator as well as to the student, and can form part of the educator's Continuing Professional Development. Expansion of the population of potential clinical educators to include more junior-grade staff than has traditionally been the norm could have benefits for these physiotherapists' development, in addition to supporting the expansion in student numbers.
SUBJECTS: A purposive sample was provided by students who had recently completed their first clinical placement, within a variety of specialties.
METHOD: Each subject was asked to complete a questionnaire which combined a number of both closed questions to provide demographic data relating to the clinical educators, and open questions to elicit the subjects' perceptions on the quality and value of their supervision and the factors which in their perception respectively facilitated and impeded their learning.
ANALYSIS: To enhance understanding an exploratory data analysis approach was adopted and factors relating to the perceived quality of supervision were matched against the grade of clinical educators.
RESULTS: A substantial majority of subjects perceived that learning benefits could be derived from supervision by educators from a wide range of staff grades, and that the factors which they considered to facilitate or impede their learning were not grade -specific. An apparent benefit of supervision by a wider range of educators is that students can experience a variety of different attitudinal, as well as different practical and theoretical approaches to learning.
CONCLUSION: Students can derive learning benefits when supervised by staff from all grades. If this conclusion is accepted by clinical managers and potential clinical educators, this will increase the number of educators potentially available. This will both support increased student numbers, and enable more practicing physiotherapists to benefit from the experience of providing clinical supervision.

Higgs, J. (1993). "Managing clinical education: the programme." Physiotherapy. 79(4): 239-46.

 

A management framework for the design, implementation and evaluation of clinical education programmes in physiotherapy is presented. The framework has its basis in systems theory, management theory and adult learning theory. In using the CIPP (context, input, process, product) evaluation model as a starting point, the framework proposes that the evaluation of a programme's context and input should be conducted during the planning stages of the curriculum, and evaluation of the programme's process and products should be conducted both during implementation as part of programme development and after the programme for judgement and accreditation of the programme. This framework provides a relevant and comprehensive guide to clinical education programme management. This paper is a sequel to "Managing clinical education: The educator-manager and the self-directed learner" (Higgs, 1992), which discussed the application to the clinical education context of management principles.

King, J. (2003). Interdisciplinary clinical education program. The World Confederation for Physical Therapy Congress, Barcelona.

 

PURPOSE: This program introduces physiotherapy students as well as students in occupational therapy, speech therapy, audiology, nursing and medicine to interdisciplinary teamwork and provides an opportunity for them to function as a health care team in rural and remote clinical settings.
RELEVANCE: To provide the best care for patients, physiotherapists need to work within a team environment. Research evidence supports the early introduction of interdisciplinary teamwork for physiotherapy students. Unfortunately many physiotherapy educational programs due to curricular, time and financial restraints, provide limited opportunities for the students to interact and learn from other health care professionals. This program provides a practical forum to promote interdisciplinary education and teamwork.
DESCRIPTION: This model of clinical education is a partnership between multiple urban academic settings and remote community based health care delivery programs in Canada. This program is one component of a larger initiative that also deals with health care professional recruitment. Teams of health care professional students participate in tutorial groups on campus. The students are introduced to concepts of professional roles and responsibilities, scope of practice and interdisciplinary teamwork. Students maintain communication with their teammates using different types of technology used to work successfully in rural and remote areas such as computer networking and videoconferencing. In the rural setting, tutorial sessions are attended by the students and their rural preceptors. The focus is on student-centered learning ,clinical cases (problems) are developed and presented by the students based on their own experiences with patients. These are used as learning tools for further exploration of interdisciplinary issues and clinical knowledge.
OBSERVATIONS: After participating in this program, physiotherapy students report that they have gained knowledge and have an increased awareness of the health care roles and responsibilities of the various team members. The students develop an awareness of services delivery challenges and an increased preparedness for the skills needed to work as a team to overcome these challenges. The academic settings acknowledge an increased opportunity to work collaboratively with other disciplines. The rural preceptors report that the program provides an opportunity to network and improve team function in their communities.
CONCLUSIONS: Although based in Northern Ontario, Canada this very interesting and innovative way to increase team work and understanding of rural or isolated health issues for physiotherapy students could be adapted and applied in other countries.

Noronen, L. (2003). Enhancing evidence based practice in physiotherapy. The World Confederation for Physical Therapy Congress, Barcelona.

 

PURPOSE: The purpose of this study was to find out how physiotherapists and physiotherapy students viewed evidence based physiotherapy and its applicability in clinical practice. This paper examines the facilitating factors and problem areas in the implementation of evidence based physiotherapy. It will be argued that evidence based practice has not become an integral part of everyday physiotherapy because physiotherapists lack the prerequisites for implementation.
RELEVANCE: Physiotherapy units should pay more attention towards evidence-based practice in order to be able to show the effectiveness and outcomes of their services. According to recent studies, there seems to be lack of knowledge, skills and attitudes among clinicians.
SUBJECTS: All physiotherapy units (n= 23) in an administrative hospital district and two groups of last year PT students from two schools in Finland were chosen for this study. The sample size was approximately 170 physiotherapists and 36 last year physiotherapy students.
METHODS AND MATERIALS: The data was gathered by a questionnaire, modified from a previous study (Eriksson, Myllymäki & Nordman 2000), and it consisted of both closed and open questions. The questionnaires were filled in by 67 physiotherapists and 29 physiotherapy students.
ANALYSIS: The facilitating factors and problem areas in adapting the EBP approach were analysed statistically using an SPSS package. The open questions were analysed by qualitative content analysis.
RESULTS: According to both groups the absence of research culture was the greatest barrier to realising evidence based practice. The physiotherapists perceived as a second barrier the lack of high quality research appropriate for clinical application, whereas the second choice of the students was that physiotherapists do not understand the research findings. The factors facilitating evidence based physiotherapy in clinical settings would be multiprofessional collaboration, education in all levels, positive attitude and support from colleagues and the employer.
CONCLUSIONS: The results support the idea of conscious and systematic development of research culture in physiotherapy. The enhancement of adopting evidence based physiotherapy in clinical settings would benefit from collaboration between clinicians, educators and researchers.

Oldmeadow, L. (1996). "Developing clinical competence: a mastery pathway." Australian Journal of Physiotherapy. 42(1): 37-44.

 

Developing clinical competence in physiotherapy students is a particularly challenging task due to the complexities and uncertainties of the clinical task and the clinical environment. Supervisors experience difficulty with the rival demands of patient service and student education as well as the assessment of competence. Students demand supportive supervision with regular, constructive feedback. In 1993, when The University of Melbourne School of Physiotherapy first allocated students into clinical placements, a pathway was developed to guide practice and assessment of clinical competency. The pathway follows the principles of progressive mastery, individual pacing and part-to-whole sequencing. It encourages collaborative learning and provides a grid for visually representing progressive development. This article reports the rationale, reliability, validity and evaluation of this pathway.

Stiller, K., E. Lynch, A. C. Phillips and P. Lambert (2004). "Clinical education of physiotherapy students in Australia: perceptions of current models." Australian Journal of Physiotherapy 50(4): 243-7.

 

The aim of this study was to seek opinions regarding the perceived advantages and disadvantages of the two main models of clinical education used in Australia. A questionnaire was designed specifically for this study and distributed to physiotherapists involved in clinical education at health units throughout Australia. There were 343 respondents (giving an approximate response rate of 74.5%). In most health units (78.4%) the model of clinical education currently used involves a number of physiotherapists sharing responsibility for the clinical education of students (SR model). Only a minority reported employing a designated clinical educator (DCE) to provide clinical education. Overall, respondents preferred the DCE model to the SR model. The perceived advantages of the DCE model included an increased time to devote to clinical education, improved consistency of supervision and decreased stress levels for staff.

CURRICULUM DESIGN

 

Broberg, C., M. (2003) A conceptual framework for curriculum design in physiotherapy education - an international perspective. The World Confederation for Physical Therapy Congress, Barcelona.

 

PURPOSE: The main aim of this work was to develop and describe a conceptual framework for physiotherapy curriculum design and, in doing so, to stimulate international debate on physiotherapy education.
RELEVANCE: Globalisation is having a significant impact on health care and physiotherapy. Education, among other sectors, can benefit from this trend.
DESCRIPTION: The framework was developed through an international curriculum development collaboration between five European universities and university colleges. The framework was tried out in the participating schools during three years in order to refine it further.
OBSERVATIONS: The current framework consists of three elements to be taken into account in physiotherapy curriculum design: (1) The content aspect or the knowledge base of physiotherapy, (2) the learning aspect or the student's learning process, and (3) the socio-cultural context aspect, which concerns the way in which physiotherapy is experienced and practiced. The content aspect includes a description of core concepts of physiotherapy: body, movement and interaction and acknowledges that physiotherapy should be science- and evidence-based. The learning aspect and the socio-cultural context aspect form separate parts of the framework. Nonetheless, all aspects are intertwined and reflect theory-practice integration.
CONCLUSIONS: This framework is offered for critical reflection and as basis for a debate on the development and evaluation of physiotherapy programmes world-wide. A stronger emphasis on the theoretical underpinnings of physiotherapy is advocated in order to develop academic physiotherapy education and research. Further work is needed in testing the relevance of this framework for curriculum design in different countries and settings.

Broberg, C., M. Aars, et al. (2003). "A conceptual framework for curriculum design in physiotherapy education -- an international perspective." Advances in Physiotherapy 5(4): 161-8.

 

Globalization is having a significant impact on healthcare and physiotherapy education, among other sectors, can benefit from this trend. The main aim of this work was to develop and describe a conceptual framework for physiotherapy curriculum design and, in doing so, to stimulate international debate on physiotherapy education. The framework was developed through an international collaboration and was tried out in the participating schools in order to refine it further. The current framework consists of three elements to be taken into account in physiotherapy curriculum design: (1) The content aspect or the knowledge base of physiotherapy; (2) the learning aspect or the student's learning process; and (3) the socio-cultural context aspect, which concerns the way in which physiotherapy is experienced and practised. The content aspect includes a description of core concepts of physiotherapy: body, movement and interaction, and acknowledges that physiotherapy should be science-based. The learning aspect and the socio-cultural context aspect form separate parts of the framework. Nonetheless, all aspects are intertwined and reflect theory-practice integration. This framework is offered for critical reflection and as the basis for a debate on the development and evaluation of physiotherapy programmes. Further work is needed in testing the relevance of this framework for curriculum design in different countries and settings.

Krause, M. W., M. J. Viljoen, et al. (1999). "Educational perspective. An introductory article on the concept of programme development in physiotherapy training." South African Journal of Physiotherapy 55(4): 20-3.

 

The move to an outcomes-based education and training system in South Africa presents higher education and training institutions with a challenge to review their curricula and to adapt to changes brought about by the new education and health care dispensations. Key aspects of the move to outcomes-based education and training as contained in the South African Qualifications Authority (SAQA) Act, information regarding the National Qualifications Framework (NQF) and other matters informing curriculum review are addressed. The Department Of Physiotherapy of the University of the Orange Free State has just completed the first phase of restructuring its education and training programme in order to submit the qualification for registration on the NQE The rationale behind the shift to an outcomes-based, student-centred curriculum and the key features of the programme are briefly discussed, as this is the first step towards the registration of unit standards/qualifications, a process which all education and training institutions will have to embark upon soon.

CURRICULUM REVIEW

Amosun, S. L., R. Shabodien, et al. (1997). "AIDS and sexuality education in the physiotherapy curriculum." South African Journal of Physiotherapy. 53(2): 11-4.

 

The need for physiotherapy in the multidisciplinary management of patients with AIDS is generally acknowledged. Physiotherapists should understand the disease, and develop appropriate attitudes towards individuals with AIDS. Data obtained from questionnaires completed at the University of the Western Cape by prospective physiotherapy students between 1991 and 1993, on knowledge of and attitudes about AIDS, were analysed, The some questionnaire was re-administered to a group of physiotherapy students completing their fourth-year of study. Although most of the students indicated accurate know edge about AIDS, their attitudes were uncertain. Students expressed anxiety about contact with persons with AIDS. The findings suggest the need for the inclusion of AIDS education in the physiotherapy education curriculum at the University of the Western Cape.

Boucaut, R. (1998). "Health education activities conducted by physiotherapy students on field trips to rural areas: a case study." Australian Journal of Rural Health. 6(4): 208-11.

 

Field trips to country communities have formed part of the final year physiotherapy undergraduate curriculum at the University of South Australia since 1995. These trips have aimed to give students an experience in primary health care. This paper evaluates these activities within the framework of the health promotion model from the perspective of those involved and evaluates feedback from these people. The activities met four of the five criteria of the health promotion model to some degree. Evaluation from all those participating has been mainly positive, with some aspects of organisation of the field trips requiring improvement. All involved felt they had gained benefits from the field trips; however, further work is needed to align the activities with local health promotion infrastructure.

Cook, C. E. and H. H. Merrifield (2003). "Distance learning outcomes for Texas Tech University's physical therapy program." Journal of Physical Therapy Education 17(1): 74-7.

 

BACKGROUND AND PURPOSE: The most significant driving force behind distance education in the physical therapy curriculum may be the ability to overcome barriers of distance and costs. In 1994, the Texas Tech University Health Sciences Center physical therapy program expanded to a 3-campus system, opening quasi-distance education at campuses in Amarillo and Odessa, Tex. Expansion occurred in order to meet the needs and desires as the primary provider of health care within the geographically vast West Texas region. The campuses of Amarillo and Odessa are linked into the (main) Lubbock campus by an interactive 2-way video called HealthNet. HealthNet is asynchronous learning environment, which allows all 3 campuses to interact through video and audio technology. Regional faculty were hired not only to teach to other campuses by virtue of HealthNet, but also to provide laboratory education and facilitate interaction in conjunction with the didactic format.
SUBJECTS: This study investigated the grade point averages (GPAs) and dropout rates of master's-level physical therapist students between the Lubbock and regional campuses in successive graduation years (1998-2002).
METHODS: For the GPA differences, an unpaired t test was selected and a chi square analysis was done to determine whether a difference in dropout rates existed between the Lubbock and regional campuses.
RESULTS: <!--=.95, critical t-test value = 0.061) or dropout rates (P
The study showed no statistically significant differences in GPAs (P

DISCUSSION AND CONCLUSION: This study supports the program hypothesis that a quasi-distance physical therapy curriculum can effectively meet the needs of students enrolled in physical therapy programs.

Futter, M. J. (2003). "Developing a curriculum module to prepare students for community-based physiotherapy rehabilitation in South Africa." Physiotherapy 89(1): 13-24.

 

BACKGROUND AND PURPOSE: With the rapid turnover and consequent demand for hospital beds and the inadequate number of physiotherapists, increasing numbers will need to work in community settings in South Africa in the future. Education of students at the University of Cape Town was required to move away from a disease-centred, hospital based curriculum to a community-based programme in order to meet the rehabilitation needs of the majority of the disabled population in the country. The aim of this study was to identify the gaps in the undergraduate curriculum and to make the required curricular changes to ensure that, on graduation, the students would be competent and confident to work in community settings.

METHODS: A module on community physiotherapy preceded a four-week placement in an historically disadvantaged community with no access to rehabilitation facilities. Seventy-five students provided severely disabled persons and their caregivers with rehabilitation and education programmes in their homes. The students were provided with two sessions of clinical supervision weekly. At the end of the placement they were examined on their ability to treat patients in a home environment and were also scored on their block performance over the month. Students evaluated the placement as a learning experience and the clinical supervisors kept records throughout the two years on gaps in the content of the community physiotherapy module.

FINDINGS: The majority of students found the placement a valuable learning experience and suggested that it should be developed into a multi-disciplinary student rotation. The clinical supervisors identified several topics that were essential to include in the community physiotherapy module to help the students in moving from a medical model to a bio-psychosocial model in the management of their clients.
CONCLUSION: The study achieved its aim of identifying the gaps in the existing undergraduate programme that needed to be addressed in order to prepare students to be competent and confident to practise in community settings on graduation. Changes to the curriculum were done incrementally during the year and also at the beginning of each of two years. These have been in operation for the past five years.

Gosling, S. C. (2003). Shaping the education of physiotherapy students to meet changing professional needs. The World Confederation for Physical Therapy Congress, Barcelona.

 

PURPOSE: The project was set up to review and update the Curriculum Framework for Qualifying Programmes in Physiotherapy, a document produced jointly by the professional and statutory regulatory bodies for physiotherapy in the UK. The review was particularly timely given significant changes in physiotherapy education and practice (including the profession's growing evidence base and technological advances), changes in health care delivery, and the need to ensure that physiotherapy students are properly prepared for their future professional role.
DESCRIPTION: The project entailed an initial survey of views on the previous version of the document published in 1996 and educational and professional developments that needed to be taken into account in producing a new curriculum framework. After the data gathered through the survey had been analysed, a series of workshops was organised using the CSP's representative structures, followed by focus groups and interviews. A draft version of the document was then considered at a consensus-building conference, before a final version was produced.
OBSERVATIONS: The new curriculum framework places a particular emphasis on the importance of students being helped to develop the skills required for professional practice in a context of significant change and, in particular, to engage in evidence-based health care in effective collaboration with others within the health care team to deliver care that is sensitive to patient need. The document has been well-received, both within and outside the profession. The strong linkages made within the document between professional and statutory expectations and the quality assurance requirements of government agencies (within the health and university sectors), should increase its usefulness and contribute to joint efforts to explore how the multiple stakeholders can work in greater partnership, using more streamlined documentation and processes to assure the quality of health care education.
CONCLUSIONS: The new document provides a solid statement of expectation of qualifying programmes of physiotherapy in the UK, while affording programme providers appropriate freedom to develop curricula that best reflect their institutions' expertise, profile and clinical links. It also reflects major trends occurring in health care delivery and education without inhibiting further development or risking the document becoming quickly dated. The process of producing the document has highlighted a number of issues that are being explored in on-going project work. This is primarily focusing on optimising the quality of clinical education experienced by students and enabling students to make a smooth transition into professional practice as newly-qualified physiotherapists.

Higgs, J. and J. McMeeken (1997). "Benchmarking in physiotherapy education: a collaborative project." Australian Journal of Physiotherapy. 43(2): 83-9.

 

Many factors including demands for accountability and funding reductions give rise to the need for educational institutions to demonstrate their quality for purposes of public accountability and in order to attract students, both local and international. Benchmarking is a process which can address this need. Benchmarking also is a strategy for program evaluation and development which can be used in other fields such as clinical practice. The project reported in this paper concerns the schools of physiotherapy in Australia and New Zealand. It utilises the concept of benchmarking within a collaborative context in order to incorporate the most positive aspects of seeking and achieving excellence within a peer review framework.

Johanson, M. A. (2004). "Factors influencing professional Master of Physical Therapy and Doctor of Physical Therapy students' program selection." Journal of Physical Therapy Education 18(2): 9-21.

 

BACKGROUND AND PURPOSE: In the mid 1990s, the number of applicants to physical therapist education programs began declining just as the first professional (entry-level) Doctor of Physical Therapy programs began. The decline in numbers of applicants prompted interest from physical therapy faculty regarding the factors applicants used to select programs. However, there is little data on what influences physical therapy applicants to choose a particular program. The purpose of this study was to determine if the factors students consider when selecting physical therapist education programs differs between Master of Physical Therapy (MPT) and Doctor of Physical Therapy (DPT) students.
SUBJECTS: Participants were 919 professional physical therapist students in 34 physical therapist education programs.
METHODS: Faculty members at 34 physical therapist education programs distributed questionnaires to 1,172 professional physical therapist students within the first 2 weeks of matriculation into programs in 2002. Faculty members returned 919 questionnaires, generating a response rate of 78.4%. The data were statistically analyzed using chi-square analysis, independent t tests, and logistic regression to determine differences in the importance of program selection factors based on degree level.
Results. Length of the program, matriculation date, size of the physical therapy class, and marketability of a degree from the institution were more important selection factors for MPT students than DPT students. Degree conferred, reputation of the program, reputation of the faculty, and the curriculum were more important selection factors for DPT students than MPT students.
DISCUSSIOON AND CONCLUSION: There were differences between master's degree and doctoral degree physical therapy students in the factors deemed important for selection of physical therapist education programs, especially among factors related to specific program characteristics. Regardless of degree level, the majority of students appeared to select programs on the bases of degree conferred and cost prior to the application process.

Liston, C. B. (1999). "Accreditation and quality auditing: how relevant are they to physical therapy?" Physical Therapy Reviews 4(2): 87-96.

 

The movement towards accreditation and quality audits in higher education seems to have been generated by the political mood towards public accountability of the professions. There is a complex interplay between accreditation, authoritative demands of governments and professions, as well as integration of quality and access issues. Standards may provide a benchmark for training providers, industry and training bodies, educators, state and federal authorities. They may also be applied in considering individuals for registration, certification, and other forms of recognition of skills, for setting curricula and in assessment of various kinds. Thus, they may be linked to accreditation and quality audits. Although accreditation and quality audits serve multiple customers, they should be responsive to the expressed interests of the real consumers, not interests that are interpreted by accreditors and auditors. This paper reviews accreditation and quality audits and explores their relevance to the health professions, particularly to the practice of physical therapy.

Madzivire, D. M. (2003). Evaluation of the adequacy of undergraduate physiotherapy training for the workplace. The World Confederation for Physical Therapy Congress, Barcelona.

 

PURPOSE: This research was undertaken to evaluate the overall adequacy of the Zimbabwe (UZ) undergraduate physiotherapy training for various physiotherapy workplaces, local and international.
RELEVANCE: Provided the opportunities to evaluate the PT training programme at UZ since this had not been done since inception:
SUBJECTS: One hundred and thirteen (113) graduate physiotherapists who had trained at UZ from the period January 1987 (when the degree programme was first established) to June 2001 were involved in the study.
METHODS: A questionnaire was used, and it was either mailed or hand delivered. It included demographic data, 23 competence statements grouped under 6 categories, and questions designed to establish the views of the graduates regarding the content and relevance of their course, duration of the course, organization and methods of teaching used in their undergraduate education. The 6 categories were derived from literature on core physiotherapy competencies which were in line with the objectives of the UZ curriculum of training for physiotherapy. The categories comprised of clinical practice, administration, research, professional qualities and growth, and teaching skills.
ANALYSIS: Data was analysed mostly in descriptive terms using the SPSS 8.0 for Windows. The data was pre-coded prior to entry in the SPSS programme. Frequencies on all items were generated for the descriptive data.
RESULTS: Altogether 83 questionnaires were received, representing an overall response rate of 73.5%. Overall, the graduates perceived themselves to be well prepared in almost all items in the six categories, while areas of weakness were to do with management of dermatological conditions and understanding of medico-legal issues.
CONCLUSION: The study points out to the need for emphasising bedside teaching, tailoring anatomy, physiology and social science subjects to the needs of physiotherapists; strengthening of the supervision of students during their clinical placements, and an improvement of the organization of clinical placements at all levels. A call is made for a review of the roles played by all stake holders in the organisation of, and supervision of students on clinical attachments.

Miller, B. K., K. J. Ishler, et al. (1999). "Gerontological initiatives for visionary education project: interdisciplinary training for occupational and physical therapy students." Gerontology & Geriatrics Education 19(3): 21-37.

 

This article presents outcomes of the Gerontological Initiatives for Visionary Education Project, a federally-funded Allied Health Training grant. The project utilized interdisciplinary mini-conferences, seminars, and community-based placements to train occupational and physical therapy students in geriatrics, needs assessment methodologies, and health promotion program development. Students developed and implemented health promotion programs targeting rural, community-dwelling older adults. A survey of student participants indicated significant student learning outcomes, and a survey of community representatives and interviews with key Project staff indicated positive community and institutional impacts.

Richter, R. R. and I. Ruebling (2003). "Model for development of outcome assessment surveys for allied health educational programs." Journal of Allied Health 32(3): 179-84.

 

This article describes a model for survey development used by the Department of Physical Therapy at Saint Louis University to assess the extent to which the program prepares students for a career as physical therapists. From a review of departmental documents including mission and philosophy statements and curriculum goals, eight performance outcomes (e.g., competence as a general practitioner, leadership, ethics, attitude for service, etc.) and two program characteristics (curriculum and program atmosphere) were determined. External documents including accreditation criteria for graduate performance were also reviewed and found to be consistent with the identified characteristics. Based on these findings, items for three surveys were developed and assessed. A 1-year alumni survey solicited feedback on the graduates' perceptions of their educational preparedness for clinical practice. The graduates' employers then were surveyed for an assessment of the graduates' job performance. A 3-year alumni survey followed up to reassess the graduates' perceptions of their educational preparedness and to track the alumni's activities since graduation. Other programs in physical therapy and other health care disciplines can use this model to develop valid survey instruments to assess their program's effectiveness.

Rowling, J. and L. Roberts (1999). "The use of acupuncture by chartered physiotherapists in the United Kingdom: a review of undergraduate students' attitudes and knowledge." Physical Therapy Reviews 4(2): 97-103.

 

The use of acupuncture by chartered physiotherapists has expanded in recent years. It is now readily available in many private and National Health Service (NHS) physiotherapy departments. In spite of acupuncture's increasing popularity, few physiotherapy or medical undergraduate syllabuses in the UK include acupuncture. This paper reviews the attitudes and knowledge of undergraduate physiotherapy and medical students towards acupuncture. Findings from studies on students' attitudes, their knowledge of acupuncture and its evidence base and correlations between knowledge and attitudes are discussed. Whilst students' attitudes towards acupuncture were generally very positive, students have been found to have very little actual knowledge of acupuncture. The willingness of future practitioners to accept (with very little prior knowledge) this treatment approach, raises a number of pertinent issues for the profession.

Scott, A. H., L. M. Chase, et al. (1995). "A national survey of admissions criteria and processes in selected allied health professions." Journal of Allied Health 24(2): 95-107.

 

A national survey of admissions criteria and procedures was conducted for allied health programs in diagnostic medical imaging, health information management, nurse-midwifery, occupational therapy, physical therapy, and physician assistant education. From a sample of 462, 63.2% responded. The survey canvassed general program information, prerequisites, admissions procedures, and demographic trends. Respondents were primarily from public institutions with faculty actively involved in admissions. The most common prerequisites were anatomy/physiology, physics, biology, chemistry, and psychology; and the most frequently required admissions criteria were GPA, references, interviews, science GPA, and writing sample. Standardized tests were rarely utilized. The following were the major prerequisite characteristics and skills considered: academic skills, communication skills, problem-solving abilities, maturity/confidence, motivation, and work/study habits. Changing demographics were reported, including an increase in second-career, older, and ethnically diverse applicants. Also discussed were nontraditional and minority applicant admissions issues. Future research suggestions include use of noncognitive variables, and academic and clinical outcome studies. The utility of this information for validation/revision of admissions criteria are presented.

Sellheim, D. O. (2001). Physical therapy students' approaches to learning: faculty beliefs and other educational factors that influence them, Ph.D.Thesis, University of Minnesota.

 

Studies have shown that students approach learning in different ways that influence the amount and quality of their learning. Although often overlooked, students' approaches to learning are influenced by many contextual and educational factors. This study examines the ways in which physical therapy teachers' and students' beliefs and conceptions about teaching and learning, teachers' instructional methods, and students' perceptions of learning experiences influence the students' approaches to learning. In addition, this study examines national trends in physical therapy students' approaches to learning., Qualitative data collection methods including semi-structured interviews of faculty and students, classroom observations, and document (syllabi) review were utilized. In addition, a national survey employing the Adelaide Diagnostic Learning Inventory for Medical Students (ADLIMS) 2 was used to profile students' preferred approaches to learning. This study found that the majority of physical therapy faculty in this sample hold conceptions of teaching categorized as teacher-centered (emphasizing transmission of knowledge and skills) while learners' beliefs and conceptions of teaching and learning are focused on acquiring knowledge and skills with an emphasis on deeper understanding and application. The profile of physical therapy students' approaches to learning also showed preferences for deep or strategic approaches to learning. Factors that appear to move students toward a surface approach in their learning include students' inability to see relevance in the material, assessment methods focused on recall of information, overload of curriculum content, passive teaching methods, students' lack of interest in content, and environments that are not conducive to learning. Factors that appear to move students toward a deeper approach to learning include awareness of the relevance and context of learning, appropriate sequencing of learning, assessment methods focused on reflective observation and clinical reasoning, adequate time to utilize deep approaches to learning, interactive learning, environments conducive to deep learning, connections between new learning and previous knowledge, and discussion with classmates. This study suggests that there is a connection between teachers' educational beliefs, effective teaching practices, and student learning outcomes. Implications of this study relate to potential changes in physical therapy educational practices.

Sellbeim, D. O. (2003). "Educational factors influencing physical therapist students' approaches to learning." Journal of Physical Therapy Education 17(2): 11-21.

 

BACKGROUND AND PURPOSE: Students approach learning in different ways that influence the amount and quality of their learning. These approaches include a surface approach characterized by memorization, a deep approach characterized by seeking understanding, and a strategic approach characterized by doing whatever is necessary to achieve high grades. Although often overlooked, students' approaches to learning are influenced by many contextual and educational factors. The purpose of this study was to examine physical therapist students' perceptions of learning experiences and how they influence the students' approach to learning. National trends in physical therapist students' approaches to learning also were examined.
SUBJECTS: Twenty-four physical therapist students (13 female, 11 male) from 3 midwestern physical therapist education programs (2 public, 1 private) participated in the qualitative component of this study. Seven hundred sixteen students participated in the national survey component, with a return rate of 45.7%.
METHODS: Qualitative data were gathered using audiotaped semistructured interviews of participants. In addition, a survey utilizing the Adelaide Diagnostic Learning Inventory for Medical Students, Version 2, (ADLIMS 2) was used to profile students' preferred approaches to learning nationally. Using a process of content analysis, dominant categories and patterns were identified, coded, and categorized throughout the data. Interview data were independently read and coded by a second peer examiner. Descriptive statistical analysis of the survey data was performed. Results. The qualitative and survey data indicated that physical therapist students showed preferences for deep or strategic approaches to learning. Factors that appear to move students toward a surface approach in their learning include inability to see relevance in the material, assessment methods focused on recall of information, overload of curriculum content, passive teaching methods, and environments that are not conducive to learning. Factors that appear to move students toward a deep approach to learning include awareness of the relevance and context of learning, appropriate sequencing of learning, assessment methods focused on reflective observation and clinical reasoning, adequate time to utilize deep approaches to learning, interactive learning, connections between new learning and previous knowledge, and discussion with classmates.
DISCUSSION AND CONCLUSION: Students' perceptions of learning experiences affect how they approach their learning. Faculty must develop and implement instructional methods and curricula that facilitate a deep approach to learning and avoid approaches that encourage students to overuse surface learning processes.

Simpson, B. P. (2003). "Web-based and computer-assisted instruction in physical therapist education." Journal of Physical Therapy Education 17(2): 45-9.

 

BACKGROUND AND PURPOSE: The Internet superhighway is rapidly advancing into higher education, and it now appears the digital medium is making its way into physical therapist education as well. The purpose of this study was to determine the frequency of use of computer-assisted instruction (CAT) and Web-based instruction in accredited professional (entry-level) physical therapist education programs within the United States as of January 2002.
METHOD: A survey instrument was designed and sent to all 186 accredited entry level physical therapist programs listed on the American Physical Therapy Association Web site. The survey sought to ascertain the number of physical therapist education programs using, or planning to use in the next academic year, student Web bulletin boards, Web-based courses, or CAT. Survey questions inquired about the types of classes offered in these formats, the presence of assessment and quality control measures, and the level of administrative support provided for development and maintenance of courses. Inquiry into the use of the Internet for faculty student communication and assignments was included along with questions regarding acceptance of prerequisites taken online. Involvement among private versus state-supported institutions was compared.
RESULTS: A total of 135 survey instruments (73%) were returned, with good representation from both private and public institutions (64 and 70, respectively, 1 missing data). Private and public institutions appear to be equally involved in CAI and Internet instruction, and programs within both settings are getting similar levels of technical support for development of Web-based courses. All program faculty regularly communicate with students using e-mail from their office computers, and 75% also communicate with students via e-mail from home. Use of the Internet for assignments is prevalent with, 83.1% of programs requiring students to access the Web to complete assignments in several or all courses. Web bulletin boards for communicating with students are utilized by 67.8% of programs, and 53.8% have a computer lab dedicated to their program. A large percentage of respondents (71.4%) reported utilizing computer-assisted technology (CAT) in some or all courses, and an additional 77% plan on adding CAT within the next academic year. A total of 41.5% of respondents reported courses taught at least partially online, from which 11.1% (15 programs) include 1 or more classes taught entirely online. An additional 10.4% of schools reported plans for adding some form of Web-based instruction in the next academic year. The types of courses most appropriate for 100% digital delivery appear to be those that do not involve clinical practice and hands-on skills such as administration, education, ethics, and pathology. Many programs (74%) allow online courses from accredited institutions to fulfill some or all admissions prerequisites, and the majority of programs (95.2%) favor the use of Web-based instruction in entry-level physical therapy.
DISCUSSION AND CONCLUSION: A substantial number of accredited entry-level physical therapist education programs are implementing computer-assisted and Web-based courses in their curricula. Most programs still lack adequate policies for evaluating online courses, which is a problem shared by most universities engaged in virtual education. As the use of these technological mediums increases, more attention to pedagogical, regulatory, and legal considerations will be necessary to ensure consistency in quality and accreditation standards within physical therapist education programs.

Stone, J. A. M., B. A. Haas, et al. (2004). "Utilization of research methodology in designing and developing an interdisciplinary course in ethics." Journal of Interprofessional Care 18(1): 57-62.

 

Development research methodology was utilized to design an interdisciplinary ethics course for students from seven disciplines: dental hygiene, nursing, nurse anesthesia, occupational therapy, physician assistant, physical therapy, and social work. Two research questions, 'What content areas should be considered for inclusion in an interdisciplinary course in Ethics?' and 'What design framework, format, or structure would best fit the content chosen?' guided the study. An interdisciplinary faculty design team conducted a comparative analysis of each of the seven discipline's codes of ethics to find common topics of interest. Further analysis then grouped these topics into eight categories of professional responsibility. The result was a fifteen-week course with validated content relevant to all disciplines.

Suter, L., M. Dunford, et al. (2003). Support systems to ease the transition from student to physical therapist: analyses and recommendations. The World Confederation for Physical Therapy Congress, Barcelona.

 

PURPOSE: To examine the existing support systems available to new graduates in the province of Ontario, Canada and make recommendations for future directions to aid in the transition from student to physical therapist.

RELEVANCE: The results of the study strongly demonstrated that new graduates are feeling the negative effects resulting from a lack of support. Literature indicates the need for support as a means to decrease stress, provide feedback, enhance leadership development and facilitate the evolution to experienced physical therapist.

SUBJECTS: Physical therapists who had graduated in the years 2000 or 2001, and were currently practicing in the province of Ontario.
METHODS: A self-administered survey was mailed to 274 new physical therapists. The survey was used to determine support systems currently available to new graduates and to formulate recommendations that could aid physical therapists as they begin to practice independently.
ANALYSIS: The closed and open ended survey questions were analyzed using a quantitative and qualitative approach respectively. The written responses for each question were recorded separately and then analyzed for any significant trends.

RESULTS: The study results revealed that the support systems most often utilized by new graduates included informal mentorship, co-worker communication, and continuing education. The top three areas in which support was deemed to be lacking were clinical decision making, clinical skills and administrative duties. Over 90% of new graduates expressed a desire to be involved in a mentorship program.

CONCLUSIONS: The study revealed that new graduates feel they would benefit from an increased availability of support systems to ease the transition from student to qualified physical therapist. The recommendations called for development of a formal mentorship program, coupled with more involvement from the provincial physical therapy association as a way to support new graduates. Data collection is currently underway that will see this provincial survey expanded to a national level.

Van Herp, G. (1997). "Iontophoresis: a review of the literature." New Zealand Journal of Physiotherapy. 25(2): 16-7.

 

The ability by physiotherapists to administer steroid antiinflammatory drugs has recently been debated. Iontophoresis can be considered as an alternative way of introducing corticosteroids into the inflamed tissue. However, iontophoresis as used by physiotherapists has been considered as a superseded technique for several years. Time devoted to the subject in electrotherapy curricula has been reduced or the topic has been eliminated entirely. Various reasons for the non-use of the technique can be mentioned. The development of new versatile iontophoretic drug delivery units. combined with newly designed electrodes, have greatly enhanced the safe and effective administration of water-soluble corticosteroids via iontophoresis. Recent research has provided evidence that iontophoresis offers the promise of therapeutic efficacy and cost-effectiveness and that it has the potential to be an alternative to injections. It is recommended that physiotherapy programs should reinclude iontophoresis into the core curriculum for electrotherapy. As physiotherapists do not have prescribing rights for medicines, iontophoresis performed by physiotherapists will require supervision of a prescribing general practitioner as well as an appropriate introduction in pharmacology.

Wong, H. (2003). Are physiotherapy educators ready for computer-mediated conferencing? The World Confederation for Physical Therapy Congress, Barcelona.

 

PURPOSE: The purpose of this project is to identify the readiness of faculty members in Canadian physiotherapy programs in the following defined areas: 1. Institutional readiness. 2. Knowledge of computer technology. 3. Affective readiness 4. Transfer of teaching from face-to-face to online environment.
RELEVANCE: Rapidly changing information technology is dramatically changing the way we transmit knowledge in higher education. Computer-mediated conferencing is being used widely in medical and nursing education but not in physiotherapy education. Therefore, this is a question that warrants formal investigation.
SUBJECTS: There are thirteen universities that offer physiotherapy programs in Canada. All thirteen Chairs/Directors of physiotherapy program were approached for interviews. In addition, twenty faculty members were approached for participation in a written survey.

METHODS: A qualitative, multi-case methodology was employed. Out of the thirteen Chairs/Directors, nine participated in the semi-structured interview. One interview was conducted face-to-face and the rest over the telephone. Thirteen faculty members from various Canadian physiotherapy programs responded to the written survey. The data collection process was performed from early March to early May, 2002.Triangulation of data was followed.
ANALYSIS: Data from the interviews and written surveys were aggregated, organized and categorized. Major themes and subthemes emerged
RESULTS: Moderate to strong institutional support identified among all universities represented; varying degrees of technological readiness were noted. Participants generally comfortable with basic computer technology, Six faculty members had used CMC in teaching. High level of receptiveness was demonstrated by Chairs/Directors and faculty members on the use of CMC in physiotherapy degree programs. Both Chairs/Directors and faculty members cited positive impact of CMC in physiotherapy education. Increase use of CMC anticipated in the Master's upgrade program for practising physiotherapists. A number of participants cited the role of online teacher as a facilitator of learning. Some participants indicated lack of affective and technological readiness among practising physiotherapists and physiotherapy students.
CONCLUSIONS: The infrastructure at all participating universities supports use of CMC in teaching. Additional time and resources are required to support faculty training and curriculum development. Participants varied on level of technological readiness. High level of enthusiasm/receptiveness is shown by most participants on the use of CMC in teaching and learning. Further student orientation on the use of CMC as a major learning tool needs to be developed. Recommendations on further research are made.

Wong, R. A., J. O. Barr, N. Farina and M. Lusardi (2000). "Evidence-based practice: a resource for physical therapists." Issues on Aging. 23(3): 19-26.

 

This article introduces evidence-based practice (EBP) as a framework for clinical decision-making by physical therapists. General concepts related to EBP are reviewed, including key definitions. Since EBP uses professional literature to solve clinical problems, it is important to understand how various sources of information are organized. Unscreened (eg, Medline, Cumulative Index of Nursing and Allied Health Literature) and screened (eg, Cochrane Library, Best-evidence ACP Journal Club, PEDro) databases and clinical guidelines are examined for its utility. Constraints and search strategies for electronic databases and practical suggestions for approaches to information retrieval are explained. Steps to be taken for assessing the strength and quality of evidence gathered are outlined with a focus on strategies for critical appraisal (CA) of the literature. Critical appraisal is discussed in relation to a hierarchy for the strength of evidence, and sample checklists for CA of individual research articles and systematic reviews are provided.

PROBLEM BASED LEARNING

Kell, C. and R. van Deursen (2003). "Does a problem-solving based curriculum develop life-long learning skills in undergraduate students?" Physiotherapy 89(9): 523-30.

 

BACKGROUND AND PURPOSE: In preparing undergraduates for professions that require a commitment to continuing professional development, Higher Education has an obligation to ensure that its graduates have the ability, confidence and desire to continue as educationally self-directed learners. It is suggested that undergraduate curricula can be used to facilitate self-directed learning development. This study compared the learning profile development over time of two full-time BSc (honours) Physiotherapy cohorts (C94 and C98) who experienced different curricular presentations of the same syllabus. Curricular changes intended to facilitate self-directed learning development were introduced before the second cohort.,
METHODS: Both cohorts completed the Guglielmino (1977) Self-directed Learning Readiness Scale and the Rezler and French (1975) Learning Preference Inventory on admission, at four selected points during the three-year courses, and seven months after graduation. A repeated measures analysis of variance was used to test for cohort change with change over time tested using a first order polynomial contrast.
RESULTS: Completed sample sizes were C94 = 31, C98 = 36. On admission both cohorts preferred a fact-based learning environment that was teacher-structured. Both curricula influenced students' learning profile development over time. C98 responded differently (p < 0.05) from C94. The former were better able to learn in student-structured, interpersonal and individual learning environments. Seven months after graduation, the learning environment flexibility of the C98 cohort had reduced.
CONCLUSIONS: C98 responded positively to the curricular changes introduced as an attempt to reduce dependence on the teacher of C94. However, these changes were short-term and did not extend into early postgraduate life, bringing into question the ability of the professional environment to reinforce and encourage fledgling postgraduate learning development.

Morris, J. (1993). "An overview of and comparison among three current approaches to medical and physiotherapy undergraduate education." Physiotherapy. 79(2): 91-4.

 

In recent years there has been widespread evaluation and reappraisal of the design and outcomes of medical and paramedical undergraduate education. The so-called traditional approach has been found to be wanting in terms of both student learning and the demands of clinical practice. This approach is compared and contrasted with two alternative approaches -- problem-based learning and problem-solving learning. Both alternative approaches are claimed to utilise design and methods which improve students' understanding and learning and foster development of the problem-solving skills believed to be central in effective patient management.

Saarinen-Rahiika, H. and J. M. Binkley (1998). "Problem-based learning in physical therapy: a review of the literature and overview of the McMaster University experience... including commentary by Hayes SH with author response." Physical Therapy 78(2): 195-211.

 

Problem-based learning (PBL), as implemented in the health sciences, is an educational method in which the focus of learning is a small-group tutorial in which students work through health care scenarios. The goals of the health care scenarios are to provide a context for learning, to activate prior knowledge, to motivate students, and to stimulate discussion. Learning is student-centered rather than faculty-centered, and self-directed learning is emphasized. The method was developed in the McMaster University medical school program and has since been adopted by many health care professional schools around the world. The theoretical basis and suggested advantages and disadvantages of PBL are outlined. Three approaches to PBL have been identified in the literature: completely integrated PBL curricula, transitional curricula, and a single-course approach. The advantages and disadvantages of each approach are addressed. The physical therapist (PT) program at McMaster University is a completely integrated problem-based curriculum. The history and process of PBL in general and in the PT program are reviewed. The implications of our experience for the development of other PBL courses and curricula are discussed. Evidence for proposed differences in students' performance and outcomes in PBL versus traditional curricula is critically reviewed. Recommendations are made for implementing PBL in PT curricula.

Smith, H. C. (2002). "A course director's perspectives on problem-based learning curricula in biochemistry." Acad Med 77(12): 1189-1198.

 

Knowledge of the applications of biochemistry, molecular biology, and genetics in the practice of medicine has been and continues to be a vital part of medical students' and continuing education. The technical background and the rapid expansion of information and new applications have made it an arduous task to learn and teach this material within the already crowded medical school curriculum. Problem-based learning (PBL) formats are rapidly being adopted at all levels of education as not only a major paradigm shift in education but also a solution for the instruction of biochemistry in medical school. Designing an effective biochemistry curriculum with PBL-based or lecture-based formats requires an appreciation for their strengths and weakness. The author's experiences in the Double Helix Curriculum at the University of Rochester School of Medicine and Dentistry (which employs PBL cases and complementing lectures) has shown that students are excited about learning in the PBL environment and explore in depth ways of integrating biochemistry, cell biology, genetics, and molecular biology into the practice of medicine. At the same time, complementary lectures greatly enhance uniformity in the quality and, importantly, the accuracy of the students' learning.

Solomon, P. (1994). "Problem-based learning: a direction for physical therapy education?" Physiotherapy Theory and Practice. 10(1): 45-52.

 

Problem-based learning has become an increasingly popular alternative in medical education. While physiotherapy educators have shown some interest in the philosophy of problem-based learning, few schools have adopted it as their curricular focus. This article explores the qualities instilled by a problem-based curriculum and examines whether this is an appropriate direction for physiotherapy education. The experiences of innovative medical schools suggest that problem-based learning is more enjoyable for the students, more effective in structuring knowledge and promotes self-directed learning skills. Although many questions remain, the physiotherapy profession can benefit from the efforts of medical education over the past two decades.

Solomon, P. E., J. Binkley, et al. (1996). "A descriptive study of learning processes and outcomes in two problem-based curriculum designs." Journal of Physical Therapy Education 10(2): 72-6.

 

This descriptive study presents learning processes and outcomes for students from two different problem-based curricula as they studied a health care problem. Students from a more classical, integrated problem-based curriculum and students from transitional curriculum generated similar issues for self-study. An integrated curriculum is defined as one that is problem based from the outset. There are no subject-related courses, and the majority of the content is introduced via problems, with the problem-based tutorial being the major integrative educational event. A transitional curriculum is defined as one that commences with a traditional subject-based curriculum and gradually moves toward a problem-based format as students progress through the curriculum. The students from the integrated curriculum spent more time searching for information in self-directed study and used a greater variety of resources. The students from the transitional curriculum were more satisfied with both their group's performance and their own performance. Scores on multiple-choice examinations were essentially the same for both groups. Both integrated and transitional curriculum designs are viable alternatives for physical therapy educators. This study highlights potential advantages and disadvantages of each.

Solomon, P. and E. L. Geddes (2000). "Influences on physiotherapy students' choices to pursue learning related to ethics in a problem-based curriculum." Physiotherapy Canada. 52(4): 279-85.

 

The purpose of this qualitative study was to examine the process by which physiotherapy (PT) students make choices to pursue learning related to ethics in a problem-based physiotherapy curriculum and to examine the factors that influenced those choices. Three randomly selected tutorial groups of PT students (n=17) and their faculty tutors were observed and audio taped as they studied a health care problem with ethical issues embedded in the presentation. Two weeks following study of the problem, focus groups were held with the tutorial groups and two faculty tutors participated in a semi-structured interview. Students also completed a questionnaire asking them to recall and rank the importance of their learning issues. Learning issues related to pathology and treatment were recalled by all students and ranked high in importance. Content analysis of transcripts identified four barriers to learning.

Webb, G. R. (2003). Teaching undergraduate physiotherapy students clinical reasoning skills. The World Confederation for Physical Therapy Congress, Barcelona.

 

PURPOSE: Clinical reasoning and clinical decision making are foundation cognitive skills needed by physiotherapists to be competent in patient evaluation and management. Problem Based Learning (PBL) is an educational model that focuses on small group collaborative learning and the discussion of 'authentic' problems which are designed with the dual intention of encouraging learning of basic science theory in an integrated manner and developing clinical reasoning skills. It is characterised as a student centred learning approach designed to facilitate students to become autonomous, self-directed life-long learners and critical thinkers.
RELEVANCE: The need for physiotherapists to develop excellent skills in clinical reasoning and decision-making is increasingly important. The health arena globally is changing at a very fast rate. Physiotherapists need to be able to make effective and safe decisions about patient management.
DESCRIPTION: This paper will describe the introduction of PBL at The School of Physiotherapy. The paper aims to increase the awareness and understanding of PBL in the processes of learning and teaching in an undergraduate physiotherapy education program. It will describe the process of clinical reasoning that the students are introduced to during their studies at the University of Melbourne. The reasoning process used by novices is different to that use by experts and needs to be made explicit to the students. PBL is an instructional method used extensively in health education that is characterised by the use of patient problems as a context for students to learn problem solving skills and acquire knowledge about the basic and clinical sciences. The problem is encountered first in the learning process and serves as a focus or stimulus for the application of problem solving or reasoning skills as well as a search for or study of information or knowledge needed to understand the mechanisms responsible for the problem and how it might be resolved.
OBSERVATIONS: The PBL process used at The School of Physiotherapy encourages students to use the 'language of physiotherapy' very early in their learning and it allows them to become familiar with the manner in which physiotherapists use clinical reasoning in their practice. It involves learners in an active, collaborative, student centred learning process that expects to develop problem solving and self educational abilities needed to meet the challenges of life and career in an increasingly complex environment.
CONCLUSION: By using examples from student responses to exam questions I will demonstrate the emergent development of clinical reasoning skills in first and second year physiotherapy students. I believe that the PBL process enhances the student's ability to develop skills in clinical reasoning and allows the students to develop a methodical approach to reasoning using hypothetico-deductive strategies common to novices.

Williams, R., J. MacDermid, et al. (2003). "Student adaptation to problem-based learning in an entry-level master's physical therapy program." Physiotherapy Theory and Practice 19: 199-212.