Good Practice in Australian Physiotherapy Education

A tutorial program has been developed to assist Non-English Speaking Background (NESB) students to communicate knowledge and skills being developed during Year 1 of their coursework in the Undergraduate Physiotherapy Program at the School of Health and Rehabilitation Sciences, The University of Queensland
Staff who are part of the teaching team for these students offer a series of small group tutorial sessions related to each topic area of a professional course whereby the student is facilitated to communicate the knowledge and skills being gained. The topic areas are developed in conjunction with the course coordinator and NESB students are invited to participate in the program. Students prepare for the topic areas and are asked to rate their confidence to communicate their knowledge and skills prior to and following the series of tutorials. The program encourages the student to articulate their knowledge, demonstrating through oral, manual and written formats their capacity to understand and integrate information and skills required for their practice as physiotherapists
 
The program was developed to address the rote learning issues more prevalent in NESB students who struggled but manage to pass the pre-clinical years although supplementary exams were prevalent in this student group with tutorials frequently required to prepared for the supplementary exam. Thus knowledge were being acquired but the learning outcomes were limited as it became evident in clinical practice that this group of students frequently found it difficult to demonstrate the application and integration of knowledge and skills required during their clinical practice. Such students were often experiencing recurrent failure in their clinical placements. This prompted the need to change the way these students were being taught - there was a need to develop the knowing / thinking / reasoning / application and reflection cycle in a more effective way with these students which was generally successfully being acquired by students whose primary language was English. Accordingly, all domestic and international students from a NESB were invited to participate in a tutorial program that has now been running for 3 years. Students have been more successful in their pre-clinical years and are being closely monitored for their ability to manage when on clinical placement.
The students report increased confidence in their oral and written communications and although would enjoy a formal tutorial program to continue in each year, following year 1 they are supported by a mentoring program (see Attachment 1) and in preparation for clinical practice, participate in a 4-week pre-clinical program to foster an understanding of communication in the Australian Heath Context (see Attachment 2).

Assessment is known to drive learning, so for learning objectives to be met, assessment must reflect those objectives to allow students to demonstrate the nature of their learning. (Gibbs 1995). Where integration of various aspects of learning is important, a challenge exists to find ways of teaching and assessing which provide opportunity for that integration to occur and its importance and relevance to be appreciated. A further challenge is to find a way of assessing students, which is in itself a continuation of learning and an enjoyable experience. A possible solution can be found in the concept of "performance" in the form of role-play.
Students in year one undertake a course with major themes in 'communication', 'understanding disability' and 'developing professionalism'. It is anticipated that by the end of the course students will have acquired both knowledge and skills. To test the integration of knowledge and skill and the ability to actually apply them in a real world situation, students are organized into self -selected groups of six students and required to develop a role -play response to a given scenario. In the role play, the dialogue and actions are to be used to illustrate the group's awareness and acknowledgement of human / patient rights, their understanding of communication skills and their ability to make caring attitudes explicit to a patient. A short summary report is prepared and presented to clarify which elements of the play represent fulfillment of these objectives. The play and the verbal presentation are part of the assessed exercise, which includes a two- minute question time. Total time for the presentation is 12 minutes. Students receive this information by handout, which also includes information on the assessment criteria. A copy is posted to the Web CT.
 
Groups are given their scenario once all students are allocated. The scenarios are developed by the teaching staff and raise a range of issues that require attention to patient rights, good communication skills, professional conduct and sensitivity and compassion in patient or client management. Individual mark sheets for each scenario are prepared, reflecting the expectation of the issues to be raised.
Students allocate the workload and responsibilities within their group and are required to sign an acceptance of the shared mark based on equity of load carried. The group scenario presentation has an assessment weight of 15%.
 
Question time allows both the students and the examiners, who have taught in the course, an opportunity to clarify issues or to extend the learning of the group around issues that arise from the handling of the scenario.
There has been strong group cooperation and commitment to the exercise. There is strong evidence of integration of the learning and skill development as well as strong indication by the use of humor (and cross dressing !), that student learning has been an enjoyable experience in modules of a course that are heavily focused in small group discussion and peer supported learning.
 

Each student is required to work with two other students and make a video of themselves performing three physiotherapy assessment and treatment techniques taught in the first semester. One student acts as the patient, while the other student controls the video camera and also critiques the "student therapist" using the assessment sheet utilized during practical examinations of this subject.
 
Once the video is complete the "student therapist" is required to watch the video and complete a self-evaluation of their performance using the assessment sheets.
At least one week later the video process is repeated. The same or different techniques are chosen to be performed. The student therapist self-evaluates the performance on the second video and receives a written evaluation from the observing student.
 
The student is then required to compile a report based on the observing students critique and their self-evaluation of both video sessions. The report briefly summarises each technique, provides an in-depth critical appraisal of their performance, discusses what was done well and what needs improvement, compares the observation between the student observer and their own self-evaluation and includes a section about changes over time (from video one to video two).

A new subject, HLT101 Foundation Skills for Allied Health Professionals was offered for the first time in Autumn 2004 to the first year students in physiotherapy, occupational therapy, podiatry and speech pathology. This subject was designed, presented and assessed by an interdisciplinary team of academics.
The School of Community Health is in an optimal position in that four allied health courses (occupational therapy, physiotherapy, podiatry and speech pathology) are offered at the same time on one campus. When students from these courses graduate they need to be able to work effectively in a range of mixed discipline health care teams.
Essentially graduates from these four disciplines need to be able to learn to work together so that on graduation their different contributions will complement the care of their clients (Leathard 1994). CSU has captured an ideal opportunity to enable these four health disciplines to learn together in the same learning environment, and to evaluate the effects of this learning model.
HLT101 includes content that all allied health disciplines require as a foundation. In the past the subject content was taught to each discipline in isolation. HLT101 not only draws students together, but is constructed so that students work cooperatively and collaboratively in interdisciplinary learning groups. Students learn about the process of reflection and how this will enhance their learning. As well, involvement in the project has encouraged lecturers to reflect on their own scholarship in teaching and the learning experiences of their students.
 
Studies have found that if team conflict and failure are to be reduced, allied health professionals need greater understanding of individual roles, skills and expectations, in order to avoid stereotyping that may at times be negative (Hilton 1995; Pietroni 1991). As well, this understanding needs to be developed early in their education if it is to prove effective (Clark 1997). Prior to 2004 students from these courses were enrolled in the same subjects to learn anatomy, physiology and psychology. However, informal observation revealed that students tended to sit in their discipline groups within the lecture theatre. In HLT101 first year students specifically learnt about teams and teamwork, professional roles, and communication skills, all of which have been reported to be vital to the ability of a health professional to work effectively in teams (Pietroni 1991; Clark 1997; Hilton 1995). Interdisciplinary group work formed the foundation of this subject.

Lecture and tutorial components are undertaken as multidisciplinary teams (students from Physiotherapy, Pharmacy, Psychology, Nutrition and Nursing may be involved). The topic areas are explored from a multidisciplinary team perspective. This subject covers two aspects of working as a health professional. The first is communication and the second is self-management.
Communication will include:

• Understanding the effects that illness/pain/ongoing disability have on a client's ability to communicate
• Consideration of different language and cultural backgrounds
• Developing listening skills
• Developing interviewing skills
• The practice of written and verbal communication

Self management will include:

• Working as part of a team
• Interpersonal skills and conflict resolution
• Stress management and planning
• General OH & S principles