J Islamabad Med Dental Coll 2022 182 Open Access Attitude of Physical Therapy Students Towards their Profession and Education in Punjab Tahir Mahmood1, AbdulSalam2, Iqra Waseem3, Aqsa Khalid4, Umer Maqsood5 1Senior Lecturer, Physical Therapist, Imran Idrees Institute of Rehabilitation Sciences, Sialkot, Pakistan. 2Assistant Professor and Head of Department, Imran Idrees Institute of Rehabilitation Sciences, Sialkot, Pakistan. 3Assistant Professor, University Institute of Physical Therapy, Lahore, Pakistan. 4Medical Officer, Sundas Foundation, Sialkot, Pakistan. 5Assistant Professor, Department of Physical Therapy, Azra Naheed Medical College, Lahore, Pakistan. A B S T R A C T Background: The quality of medical teaching can be refined based on the attitude of the students towards their clinical and teaching environment. The objective was to determine student attitudes towards their profession and education in Punjab. Methodology: This cross-sectional survey was conducted from 20th July to December 2021 after taking ethical approval. The data was collected through an online google document from physical therapy undergraduates and post graduates from different institutes of Punjab. The outcome was measured using “physical therapy student attitudes questionnaire (PSAQ)”.It had four sections, section A is about the knowledge of the profession, section B includes beliefs about future, section C is about patient exposure in clinical trainings and section D is about level of satisfaction from the learnings. The data was encoded and analyzed using SPPS V.23. The descriptive statistics and mean+ standard deviations were used to present the scores. The independent sample t-test was used to find the difference in mean scores of males and females with p value ≤ 0.05 taken as significant. Results: The current study comprised of 82(32.15%) males and 173(67.84%) females with mean age of 24.4 +6.5 years. The overall satisfaction level regarding knowledge, future beliefs, clinical exposure and learning was good with total mean± SD of 87.62+17.64 for males and 87.97+18.67 for females. There was no statistically significant difference of satisfaction among male and female students with P >0.05 Conclusion: The student attitude was quite satisfactory regarding their choice of physical therapy profession, good future, patient exposure and learning skills. There was no statistically significant difference based on the gender. Keywords: Education, Patients, Physical therapy, Satisfaction, Training. Authors’ Contribution: 1Conception; Literature research; manuscript design and drafting; 2,3 Critical analysis and manuscript review;4 ,5Data analysis; Manuscript Editing. Correspondence: Tahir Mahmood Email: tahirmahmoodphysio@gmail.com Article info: Received: February 16, 2022 Accepted: September 14, 2022 Cite this article. Mahmood T, Salam A, Waseem I, Khalid A, Maqsood U. Attitude of Physical Therapy Students Towards their Profession and Education in Punjab. J Islamabad Med Dental Coll. 2022;11(3): 182-187 DOI: https://doi.org/10.35787/jimdc.v11i3.851 Funding Source: Nil Conflict of Interest: Nil O R I G I N A L A R T I C L E https://doi.org/10.35787/jimdc.v11i3.851 J Islamabad Med Dental Coll 2022 183 I n t r o d u c t i o n Physical therapy is a health care profession and a part of the health care in multi-disciplinary rehabilitation. It has an integral role in health care system for decades. (1)This profession was started as a three years diploma in 1963. However, there was a demand for higher education and improved healthcare services.(2) To meet this need, universities started offering bachelor's degree programs in physical therapy (PT) in the late nineteenth century.(3) Good quality education is necessary and reflected in the quality of physical therapy services. To have a good physical therapy program, it is necessary to have diverse courses, qualified teaching staff, and well-organized clinical training. It is shown that almost 71% of undergraduate PT students feel that the difficulty level of course is greater than expected. The current educational system focuses on an important concept called student’s satisfaction.(4) As an academician, we can enhance students' understanding and learning by estimation of their satisfaction levels during their education and learning along with clinical trainings, tools for effective communication and proper time management.(5) This will enable us to modify the physical therapy program curriculum, clinical trainings and adopt new learning strategies in our institutions.(6) Interest in student satisfaction at undergraduate and graduate level is well- established within higher education in many countries but depends upon several factors. (7)The students’ attitude and knowledge about their profession, results in good reputation and a positive impact leading to social awareness and it is other way with decreased satisfaction.(8) In this era of emerging professions and advancement, physical therapy profession has gained importance. There is a need of educational foundations that enable students to build up their skills based knowledge and attitudes.(9, 10) Not much studies done in Pakistan have addressed students’ attitudes in knowledge about the profession, beliefs about future, patient exposure in clinical trainings and level of satisfaction from the learnings. The objective was to estimate students’ attitudes towards their profession and education in Punjab and find any gender-based difference. This will help to implement new strategies for further improvement in the profession of physical therapy. M e t h o d o l o g y This cross-sectional survey was conducted from 20th July, 2021 to 15th December 2021 after taking ethical approval (Ref# IIRS/DPT/IERC-372). The data was collected online using Google document. We included physical therapy undergraduates and post graduates from different private institutes of Punjab including Agile Institute Rehabilitation sciences Bahawalpur, Bakhtawar Amin College of Rehabilitation Sciences, Multan, Imran Idrees Institute of Rehabilitation Sciences, Sialkot, Azra Naheed Medical College, Lahore and University Institute of Physical Therapy, Lahore. The calculated sample size was 255 by applying parameters, 𝑍1 − 𝛼/22 𝑃(1−𝑃) 𝑑2 where, 𝑍1 − 𝛼/22= 1.96 (Standard normal variants at 5% type I error (p<0.05), P= 0.79 (Expected proportion in population) and d= 0.05 (absolute error). (11)The online Google document was prepared based on the mentioned outcome tool with addition of basic details and informed consent, ensuring the privacy and confidentiality of the provided responses. The outcome tool was “physical therapy student attitudes questionnaire (PSAQ).”It had four sections including A, 6 Questions related to the knowledge about the profession, 5 Questions in J Islamabad Med Dental Coll 2022 184 B related to beliefs about future, 7 Questions in C related to patient exposure in clinical trainings and 7 questions in D is related to level of satisfaction from the learnings. The responses were based on Likert scale; absolutely agree, agree, neutral, disagree and absolutely disagree. The outcome tool had 0.71 content validity and 0.69-0.75 for its subdivisions. The Cronbach’s alpha coefficient for reliability was 0.86 and 0.32-0.86 for its sub divisions. ( 12) The responses were added according to scale in each column to measure the average response of the students. After that, the scores were added up for each of the four domains to summarize the total scores using Likert scale. The data was encoded and analyzed using SPPS Version 23 .The descriptive statistics included mean ±standard deviations that were used to present the scores , independent sample t-test was used to estimate and compare the scores based on gender with significance set at <0.05 (95% CI). R e s u l t s The mean age of the participants was 22.5+6.5years. The current study comprised of more females as compared to males, participants belonging to middle class were 226 (88.62%). 71.36% of the participants were from 2nd to 4th professional year . (Table 1) The sum of all domains of PSAQ were calculated separately. The combined scoring showed no significant gender-based difference with P value >0.05. (Table *This scoring is sum of all boxes within male and females The response of the students showed that 120 (47.05%) agree that they were willing to be physical therapist in future and 140 (54.90%) had good theoretical background, others are presented. (Figure 1) Table: IDemographics of the participants (N=255) Descriptive Statistics Frequency (%ages) Gender Male 82(32.15%) Female 173(67.84%) Socioeconomic Status Upper Class 19(7.45%) Middle Class 226(88.62%) Lower Class 10(3.92%) Professional year 1st year 45(17.64%) 2nd year 88(34.50%) 3rd year 56(21.96%) 4th year 38(14.90%) 5th year 23(9.01%) Masters/MPhi l 5(1.96%) Age Groups 19-21 181(70.97%) 22-24 68(26.66%) 25-27 03(1.17%) 28-30 03(1.17%) Table :II Sum of Scores and their Means Group Statistics Domain Gender N Mean + SD Std. Error Mean P –Value Knowledge about the profession Male 82 21.82 + 3.84 .42 0.604 Female 173 21.54 +4.10 .31 Future Beliefs Male 82 16.63+5.44 .60 0.244 Female 173 17.45+5.11 .39 Patient exposure in clinical trainings Male 82 24.55+5.60 .62 0.873 Female 173 24.43+5.68 .43 A- Level of satisfaction from the learnings. Male 82 24.62+5.56 .61 0.944 Female 173 24.57+6.08 .46 All Male 82 87.62+17.64 1.95 0.844 Female 173 87.98+18.67 1.42 J Islamabad Med Dental Coll 2022 185 PT=Physical Therapist Figure 1: Students Response about their Profession D i s c u s s i o n This cross-sectional survey was conducted on 255 physical therapy undergraduates and post graduates to find out students’ attitudes towards their profession and education. The student attitude was quite satisfactory regarding their choice of physical therapy profession, good future, patient exposure in clinical trainings and learning skills. This study reports satisfactory males and females mean scores in Domain A which includes choice of profession and happiness after getting admission. According to another study, the students from Spain and Czech Republic were found to be happy in getting admission in physical therapy profession and working as physiotherapist.(13) In our study, more than half of the students were satisfied with the clinical and patient exposure in their institutes and hospitals. The students in Saudi Arabia had good satisfaction level regarding clinical and practical sessions at individual level but the sample size was less as compared to this study.(14) The mean satisfaction score was 24.62±5.56 for males and 24.57±6.08 for females with no difference of satisfaction regarding their learning. They were willing to work as Physical therapist in future with no difference of response based on the gender. The level of satisfaction had an impact on the academic performance and choice of career and the respondents were in favor of the physical therapy as a choice of profession in line with findings of You Lim. (15) In Brazil, 1st year students were more satisfied compared to 3rd,2nd and 4th year physical therapy students. (16)A recent study in Chili reported positive perception of undergraduate students about their learning environment with less positive attitude of first year students. Literature favors that most of the students choose this profession because of their interest in it. ( 12)The high rate of admissions can be due to a perception that a physical therapist helps others , encourages sports related activities, works manually and this profession has multiple job 0 20 40 60 80 100 120 140 160 180 Want to be PT Potentials rightly Utilized Aware of the job prospects Recommend to others Good theoretical background Teaching is mostly associated with patient assessment and treatmentAbsolutely Agree Agree J Islamabad Med Dental Coll 2022 186 opportunities.(17) The performance is based on clinical trainings and patient exposure during study years, which is predictor of license exams in different countries.(18) The overall satisfaction of students was good regarding knowledge, future beliefs, patient exposure and learnings in their institutes. The evidence supports that organization and teaching are the actual factors that influence the students level of satisfaction.(19) In contrast, according to a recent finding in Ethiopia, student satisfaction was low as compared to the current study.(20) The current study highlighted student perception and their level of satisfaction. There is further need to enhance the skills of the enrolled students, so that better future clinicians can serve the community. The online data has affected generalization of the results and there were fewer respondents from the master class which can further affect the external validity of the study. C o n c l u s i o n The student attitude was quite satisfactory regarding their choice of physical therapy profession, good future, patient exposure in clinical trainings and learning skills. There was no statistically significant difference based on the gender. R e f e r e n c e s 1. Leeftink A, Bikker I, Vliegen I, Boucherie R. Multi- disciplinary planning in health care: a review. Health Systems. 2020;9(2):95-118. doi: 10.1080/20476965.2018.1436909 2. Sana A, Rashid H, Ilyas M, Danish H, Sheraz M, Atif A. SWOT Analysis of Physiotherapy Profession in Pakistan. Res J Pharm Technol. 2018;11(10):4553-8. doi:10.5958/0974-360X.2018.00833.8 3. Babur N, Ashfaq M. A journey from post matriculation diploma to post professional clinical doctorate: a historical perspective of Physical Therapy profession in Pakistan. Int J Rehab Sci. 2012;1(1):8-9.[ Available at : https:// www. Academia .edu/47594523/A_Journey_ from_ Post _Matriculation _Diploma _to_Post Professional_ Clinical_ Doctorate_ A_Historical_ Perspective_of_ Physical_Therapy_Profession_in_Pakistan] [ Cited 16 September ,2022] 4. Siddiqi FA, Azim ME, Babur MN, Osama M, Waheed A, Memon AR. Psychological Stress and Satisfaction with Life among Physical Therapy Students of Rawalpindi / Islamabad, Pakistan. J Pak Med Assoc. 2019 Jul;69(7):973-975. PMID: 31308565 5. Chan ZC, Chan HY, Chow HC, Choy SN, Ng KY, Wong KY, et al.Academic advising in undergraduate education: A systematic review. Nurse educ. today. 2019 Apr 1;75:58-74. https://doi.org/10.1016/j.nedt.2019.01.009 6. Fidalgo P, Thormann J, Kulyk O, Lencastre JA. Students’ perceptions on distance education: A multinational study. Int. J. Educ. Technol. High. Educ2020;17(1):1-18. doi.org/10.1186/s41239-020- 00194-2 7. Muskens M, Frankenhuis WE, Borghans L. Low- income students in higher education: Undermatching predicts decreased satisfaction toward the final stage in college. J Youth Adolesc . 2019;48(7):1296-310. doi: 10.1007/s10964-019- 01022-1 8. Van Schalkwyk SC, Hafler J, Brewer TF, Maley MA, Margolis C, McNamee L, et al. Transformative learning as pedagogy for the health professions: a scoping review. Med Educ. 2019;53(6):547-58. doi: 10.1111/medu.13804. 9. Worum H, Lillekroken D, Roaldsen KS, Ahlsen B, Bergland A. Physiotherapists’ perceptions of challenges facing evidence-based practice and the importance of environmental empowerment in fall prevention in the municipality–a qualitative study. BMC geriatrics. 2020;20(1):1-17. doi: 10.1186/s12877-020-01846-8 10. Timmerberg JF, Dole R, Silberman N, Goffar SL, Mathur D, Miller A, et al. Physical therapist student readiness for entrance into the first full-time clinical experience: A Delphi study. Phyl Thera. 2019 Feb 1;99(2):131-46. doi.org/10.1093/ptj/pzy134 11. Khan M, Maqsood U, Saleem N, Mahmood T, Arshad HS. Knowledge, experience, attitude and barriers of postgraduate physiotherapy students toward extracurricular research activities. Rawal Med J. 2021;46(1):118-22. 12. Tedla JS. Construction of a new questionnaire for assessing physical therapy student attitudes towards their education and profession and testing its validity and reliability. Phys. Ther. Rehabil. Sci. 2017;6(1):20-5. doi.10.14474/ptrs.2017.6.1.20 13. Gotlib J, Białoszewski D, Opavsky J, Garrod R, Fuertes NE, Gallardo LP, et al. Attitudes of European https://doi.org/10.1080%2F20476965.2018.1436909 http://dx.doi.org/10.5958/0974-360X.2018.00833.8 https://doi.org/10.1016/j.nedt.2019.01.009 https://doi.org/10.1007/s10964-019-01022-1 https://doi.org/10.1007/s10964-019-01022-1 https://doi.org/10.1093/ptj/pzy134 J Islamabad Med Dental Coll 2022 187 physiotherapy students towards their chosen career in the context of different educational systems and legal regulations pertaining to the practice of physiotherapy: implications for university curricula. Physiotherapy. 2012;98(1):76-85. doi: 10.1016/j.physio.2011.02.003 14. Alahmari K, Shanker J, Gular K. Pysical therapy student’s satisfaction during their practical and clinical training sessions at Abha, Saudi Arabia. A cross-sectional study. General and Professional Education. 2017;2017(1):3-7. 15. Kim YL, Lee SM. Effect of satisfaction in major at university on academic achievement among physical therapy students. J. Phys. Ther. Sci.2015;27(2):405- 9. doi: 10.1589/jpts.27.405 16. Czapievski FdN, Sumiya A. Assessment of the degree of satisfaction of physical therapy students with the academic experience. Fisioterapia em Movimento. 2014;27:119-25. doi.org/10.1590/0103- 5150.027.001.AO13 17. Fuente-Vidal A, March-Amengual J-M, de Souza DLB, Busquets-Alibés E, Sole S, Cañete S, et al. Factors influencing student choice of a degree in physiotherapy: a population-based study in Catalonia (Spain). PeerJ. 2021;9:e10991. doi: 10.7717/peerj.10991. 18. Kume J, Reddin V, Horbacewicz J. Predictors of physical therapy academic and NPTE licensure performance. Health Prof. Educ.2019;5(3):185-93. doi.org/10.1016/j.hpe.2018.06.004 19. Sofroniou A, Premnath B, Poutos K. Capturing student satisfaction: A case study on the national student survey results to identify the needs of students in stem related courses for a better learning experience. J. Educ. Sci2020;10(12):378. doi.org/10.3390/educsci10120378 20. Temesgen MH, Girma Y, Dugo T, Azeze G, Dejen M, Deres M,et al. Factors Influencing Student’s Satisfaction in the Physiotherapy Education Program. Adv Med Educ Pract. 2021;12:133. doi: 10.2147/AMEP.S289134. https://doi.org/10.1590/0103-5150.027.001.AO13 https://doi.org/10.1590/0103-5150.027.001.AO13 https://doi.org/10.1016/j.hpe.2018.06.004 https://doi.org/10.3390/educsci10120378