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).

At the University of Newcastle, Occupational Therapy students participate in a largely Problem Based Learning program Physiotherapy students study under a program that includes foundation study of relevant scientific and behavioural disciplines and the study of specific physiotherapeutic management of conditions. In each area eg neurological, musculoskeletal, study includes many selected case-based discussions which develop clinical reasoning skills through use of true cases backed up by video resources.
Preparation for this joint tutorial session involved development of a scenario for a patient undergoing rehabilitation following stroke. Both groups of students worked with common derived learning goals that included exploration of pathology, impairments, assessment, goal setting and appropriate interventions related to the patient.
 
OT and PT students addressed the learning goals from their own professional perspective. Students in pairs groups developed information related to one of the learning goal areas. The lecturers ensured that all aspects of the learning goals were covered.
In the joint two hour session, 12 OT students joined with 13 PT students .They presented their topic using illustrative OHP sheets and a one page handout for five minutes and answered questions. The presentation included demonstration of assessment tools/ methods and intervention techniques where appropriate.
 
Discussion was facilitated by the lecturers, one from each discipline, to consider the decision making, the specific roles of the therapists and any differing philosophies of management. Students then considered how these roles might overlap and how best they could collaborate to manage this patient.
Later feedback from physiotherapy students suggested that they found that the session was valuable in gaining insight into the role and philosophy of the occupational therapist in the neurological area and further knowledge about stroke patient management.
 
It is planned to continue to run this tutorial and attempt to develop other joint sessions with other health professionals where appropriate. Student learning and valuing of other health professionals only occurs through first hand experience. These shared learning experiences, followed up by shared clinical experiences in later years are vital to develop co-operative graduate practice among health professionals.

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.

This subject is based in the clinical teaching facilities of the faculty where teaching and supervision is provided by experienced clinicians. Teaching consists of tutorials, bedside teaching, lectures, team meetings and supervised practice. Self directed learning is enhanced by the use of guided videos and readings.
The assessment in this subject encourages the students to develop materials around pertinent topics in gerontology. Students can produce posters, brochures, booklets, videos, CDs or DVDs. These should be applicable to a general audience, healthcare providers in aged care or a patient/care giver.
 

Clinical Conference is a 10CP capstone course undertaken by students in the last/final semester of studies prior to the final 8 weeks of clinical placements. The course aims to fully integrate the student's prior learning in exercise science with evidence-based physiotherapy knowledge and skills using complex clinical cases. These cases are complicated by 'real-life' moral, ethical and medico-legal issues. The students study four separate cases in detail and in a holistic manner, examining the progress of patients through a continuum of care (eg, early diagnosis, acute care, sub-acute needs, rehabilitation and through to re-integration back in to the community). Sessions are led by various members of different disciplines from the healthcare team that might be involved with such cases. The cases are updated and modified each year depending on medical advances or social change.

Case studies are used to provide a 'systems integrated' approach to the curriculum. They provide a platform for applying discipline knowledge, reinforcing principles and concepts, problem solving, clinical reasoning and critical thinking. The case studies also provide a medium for incorporating psychosocial, cultural and ethical issues and an international perspective into the undergraduate curriculum. The case studies are used to assist students with the management of patient problems with increasing levels of complexity whilst ensuring that they understand the limitations of their own skills. Whilst these case studies are horizontally integrated into the curriculum, students are also facilitated to develop skills for lifelong learning.
Whilst all streams use case studies for their teaching and learning, the Psychosocial and Professional streams have dedicated sessions that are used to consolidate and motivate student learning. These occur as tutorial sessions and master classes.
 
For the tutorial sessions, real life case studies of increasing complexity are developed and students are required to prepare relevant written work prior to class using self directed activities to guide their learning. Tutorial classes of two hours duration are used to develop students' critical thinking, problem solving and communication skills and explore the clinical reasoning associated with client problems. In the week following the class, students are required to submit a written report that requires students to reflect on their learning in the session and develop a patient evaluation, analysis, management plan and any other information required specifically for the rehabilitation of the patient.
Master classes provide an opportunity for students to observe an experienced physiotherapist assess and treat a real patient/client and discuss the clinical reasoning process used to determine the most appropriate management plan. Prior to the master class, students are encouraged to review the theory and practice related to the client's problem.
The session begins with an explanation and discussion of relevant background information, assessment and treatment of the patient/client, followed by further discussion of the assessment findings, clinical reasoning processes used in determining the results of assessment findings, development of a problem list and intervention strategies using an evidence-based approach. During this session, students participate in active discussion prior to and following the arrival of the client. These sessions allow students to participate in the critical thinking processes required in client management.

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.