Good Practice in Australian Physiotherapy Education

Students attend a tutorial session related to the issues surrounding caring for patients with end stage disease in adults and children. This is a joint session between Cardiopulmonary and Neurological Physiotherapy courses. The focus is mainly on end stage neuromuscular and/or respiratory disease.
Physiotherapists are frequently confronted with these situations and students are generally unprepared when it comes to dealing clinically with the complexities of managing the patient with end stage / terminal disease. It was determined that a tutorial session examining the role of the physiotherapist, clinical decision making and the emotional aspects of end stage disease was necessary.
 
Students are provided in advance with short case studies of patients with end stage neurological, neuromuscular and respiratory disease. These are case studies in which the tutors have been personally involved. Questions are provided for each case study which direct the students toward exploring and reflecting on:

• The effects of end stage disease on body systems and function
• The role of the physiotherapist in treating patients with end stage disease
• Clinical decision making and clinical reasoning in treatment planning for those with end stage disease
• The effects on the patient and family of terminal / end stage disease
• Their own emotional response and concerns related to caring for such patients.
   

The tutorial session activities include general discussion and identification of the student's issues and concerns related to the physiotherapy management of patients with terminal / end stage disease. Times when students have actually come into contact with end stage patients are identified.
 
The case studies are presented and discussed. Specific physiotherapeutic management clinical reasoning, treatment plans and techniques for the patients concerned are explored. Time is then spent discussing the effect of terminal / end stage disease on the patient's family, carers and involved health care workers. Students are encouraged to reflect on their own emotional response and concerns. Practical strategies for dealing with the emotional aspects of treating patients with terminal / end stage disease are identified and discussed.

In the 2nd year of the course students complete separate subjects in the core physiotherapy areas of musculoskeletal and cardiopulmonary physiotherapy. An example of the cross specialty teaching is in a practical/tutorial class scheduled towards the end of the session; classes in the two areas are combined and facilitated by teaching staff from both areas. Students are presented with two case studies and are then guided in the process of clinical reasoning about these cases. The client problems used in the case studies involve chest wall and thoracic spine pain, and thus reflect the overlap between these two areas of practice. The cardiopulmonary lecturer deliberately facilitates the case study in which the client's problems are primarily musculoskeletal in origin and the musculoskeletal lecturer facilitates reasoning in the case where the problems are primarily cardiopulmonary in origin.
The aim of the strategy is to encourage students to access and integrate knowledge from both clinical areas. The case studies are deliberately chosen to elicit students' assumptions about the different areas of physiotherapy practice. This process of shared facilitation challenges them to recognize how they may have segregated their knowledge and then challenges them to develop strategies that take a more holistic approach to patient care.
 
We feel that introducing this strategy at a 2nd year level influences students' learning as they develop further knowledge in core areas and prepares students for latter subjects that require more advanced integration of knowledge and reasoning, such as Complex case management.