pESEMBER 1977 F I S I O T E R A P I E TRAINING FOR THE FUTURE 13 J. C. B E E N H A K K E R , B.Sc. (Physio) (Rand)* njt is noodsaaklik dal die opleiding van fisioterapeute r s ie n word in die tig van die huidige en loekom stige be- , eftes van die gem eenskap. P rojekte wal in 1975 en io76 deur voorgraadse stndente aan die U niversiteit van lyjtwatersrand onderneem is, bring die behoeftes en lortkom inge in die leergang aan die tig. M etodes om f-grdie nildagings te benader word bespreek en die be- lloefte aan dicpgaande navorsing om trent opleiding word leklemtoon. In order to ensure th at our students will be able to meet the challenge o f the fu tu re, m ore thought must . e given to cu rricu lu m design and planning. At present one o f the functions o f the Professional Board and of the South A frican Society o f P hysio­ therapy is to m ain tain standards o f train in g in order * ensure that on g rad u atio n the p h y sio th erap ist is rtlmpetent and capable o f being “ let loose on the public”. Who decides u p o n these standards? M inim um stan­ dards have been laid dow n regarding the num ber o f hours o f clinical train in g req u ired before a student may graduate. C ertain syllabuses have been accepted as meeting the requirem ents o f train in g and are often based on those fro m U n ited K ingdom train in g centres. Do any o f these standards ensure th a t w e are really training physiotherapists w ho will be equipped to practice in o u r co u n try w ith its different problem s and needs? H av e these standards ever been p u t to the test to ensure th a t they are w h at the p rofession requires from its m em bers? The necessity fo r objectives in M edical E d u catio n is not a new concept and a w ealth o f lite ra tu re is av a il­ able fro m A m erica and G reat B ritain especially. T his obviously also applies to p h y sio th erap y and if we are to keep up w ith advances in M edical E d u catio n we must review o u r train in g in earnest. This has not escaped the L ectu rers’ G ro u p o f the South A frican Society o f P h y sio th erap y and mem bers from all tra in in g centres are com m itted to th e problem of evaluating p h y sio th erap y education by defining its objectives and investigating m eans o f achieving these obiectives. There is a danger that, in m ain tain in g the high stan- « r d s w hich have been arriv ed at a rb itra rily , a certain 'Jg id ity will develop w hich will be an obstacle to change. M any o f these standards are also artificially high and do n o t b e a r m uch relatio n sh ip to the social needs o f the com m unity in w hich o u r physiotherapists will serve. Can we be certain th at o u r exam ination system is ensuring th at students have assim ilated sufficient know ­ ledge to cope w ith the problem s th a t they will en­ counter in dealing w ith the p atien t, his fam ily and all members o f the health team ? G re a t stress is laid on motor skills and basic know ledge, b u t are these the only criteria fo r assessing a professional person? T here is a danger th a t we m ay be train in g students to pass exam inations, ra th e r th an aim ing to produce a professional person w ith an enq u irin g m ind w ho is adaptable and creative. T h ere is a g reat deal of evidence that students w ho do well in exam inations do no t necessarily m ake th e best physiotherapists. F u rn e a u x 1 even found th a t the n eu ro tic in tro v ert was the one who did best in exam inations! * Senior L ecturer, A cting H ead, Sub D ep artm en t of P hysiotherapy, U n iv ersity o f th e W itw atersrand. D.P.E. (R and) O ur present exam ination system tends to influence the teaching of an excessive am o u n t of factual know ledge and, as P rofessor S im pson6 says, “ tests be­ come self-confirm ing, becausc w h at they m easure best is the special training the candidates have been given to p reco n d itio n them fo r the experience o f being exam ined”. Students learn to answ er in the w ay th at they th in k the exam iner w ishes them to reply and we all know that, in o u r train in g schools, the students find o u t w ho their exam iners w ill be in o rd er to gear th eir replies in this direction. T h is leads them to a n ti­ cipate w hat the exam iner w ould like to h e a r and does no t reflect w h at they have really learnt o r how they w ould apply this knowledge. In o rd e r to m ain tain these high standards, it is felt th a t a reasonable fa ilu re rate is essential. H ow ever, it is com m on know ledge th a t th e bell-shaped curve should not ap p ly to education. T he stan d ard of students entering the train in g centres is becom ing increasingly high and o u r students are a very select body o f persons. One should expect m ost o f them to do well, yet, w hen an exam iner m arks consistently high, she is accused of having very low standards. T h e w hole m ethod o f exam ination needs to be re­ vised in o rd er to ensure th a t w h at we are testing is tru ly reflective of th e stu d en t’s ab ility to apply, analyse, synthesise and evaluate, and is not m erely a test of recall and o f sim ple m o to r skills. T h is can only follow when th e obiectives have been defined. W ith this in m ind, several w orkshops have been held this year regarding the curriculum . U n til we a re sure o f w hat these objectives are and how they can be evaluated, we will n o t be sure o f w hat the exam ina­ tions are m easuring. I strongly believe th a t the train in g of students in o u r country is ad eq u ate and th at we are producing good p o ten tial physiotherapists. W ith basic training, w hich should include scientific research m ethods, the stu d en t will gain the ab ility to question, reason and a p p ly h e r knowledge. She should be able to evaluate a p atien t as regards his d isab ility and to plan a p ro ­ gram m e o f treatm en t to suit his needs, w ithin the available resources o f the com m unity. She should know w here to go fo r advice ab o u t a ltern ativ e tre a t­ m ent program m es and m ust obviously be aw are of w h at these alternatives are.’ N o student can possibly becom e p erfect in every technique th a t is th o u g h t to be necessary, b u t the student w ho has a good educational train in g will be able to m odify and ad ap t after graduation. N one o f us can boast o f proficiency in all the various techniques, so h o w can we expect our students to acq u ire these skills in the few years o f study? M any techniques ex­ pected o f students are, to m y m ind, specialties in w hich the graduate can do a n in-depth study a t a later stage. T h e p h y sio th erap ist o f the fu tu re will have to have a g reater vocation fo r service to h e r country rath er than fo r th e treatm ent o f the individual. T h ere tvill have to be a m ove aw ay fro m a to tally hospital-oriented tr a in ­ ing to one o f com m unity health in a m ulti-disciplinary team . T h e p h y sio th erap ist will therefore have to be able to w ork independently in the com m unity and to work in a peer relatio n sh ip w ith o th e r professional people.1 O ther m em bers o f the health team are n o t in ­ form ed o f w hat role physiotherapy can play and, in a survey done by R . F e h le r2 as an undergraduate^ in 1975, it was obvious th at the know ledge of the m edical R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 14 profession regarding o u r profession is very inadequate. It is th e responsibility o f every p hysiotherapist to im ­ prove th is situation. In o rd e r to give o u r students an o p p o rtu n ity of doing research and o f w orking w ith m edical students, o u r th ird year students joined th e medical students in Physiology I I this year. I t is h oped th at they will gain insight into research w hich will stand them in good stead fo r th eir fo u rth year projects and, hopefully, in w orking fo r h ig h er degrees. But, m ore im p o rtan t, they will have learned to w ork w ith others in obtaining in fo rm atio n and in solving problem s. M ethods o f evaluating w hat has been learned are essential and the m ethods o f exam ining a student will have to be modified. H ow can we ensure the m ain te­ nance o f high standards, w hich are obviously assessed in the ex am in atio n room w here th e student is under stress and is not functioning in her norm al capacity? C o ntinuing assessm ent w ould elim inate p a rt of this problem , pro v id in g th at we really know w hat we are assessing. W e have not proved th a t w hat we are m easuring is that w hich we ho p e the student has learned. R ather, we have dem onstrated th a t som e students have better recall than others. M ost students eventually learn one thing, and that is to pass exam inations. W hen students do fail, o r barely pass, observers a re satisfied th at the standards w ere high. A re we then really ensuring th a t these young people are adequately equipped to m eet the challenge o f the tim es? W ill they be able to take th e ir place in society as tru ly professional people? D o o u r train in g centres and o u r professio nal bodies know w hat these challenges are and are physiotherapists doing anything about finding th e answ er? R esearch is at present un d er way at the U niversity o f the W itw atersrand to assess w h at m odalities ar com m only used by the p ractising physiotherapist nr today and w hat skills should be acq u ired by the futur physiotherapist. W e intend to do in-depth research inte som e o f these m odalities and by analysing o u r tech° niques in this m anner we will be able to accept 0f reject these in term s o f scientific evidence. T h ere is m uch th at still needs to be done and our professional Society should be encouraging research into topics th a t have tru e m eaning fo r the profession M any o f th e subjects chosen fo r a higher degree are on obscure o r barely-related topics, w hich do n o t fulfil the needs o f o u r profession. W hat we need are w orkshops and brain-storm ing sessions to w ork o u t w h at is required to “ provide adequate and reliable p h y siotherapy services”. From these we can w ork out o u r objectives o f train in g and of continuing education. References 1. D yer, L., T h e C hanging R o le of the R em edial Pro­ fessions, The Leech, 46, 1 ,1 5 , 1976. 2. F ehler, R., U npublished U n d erg rad u ate Project, 197(5 3. F u m eau x , W . D ., T he Chosen Few: A n Examination o f Some Aspects o f U niversity Selection in Britain. O xford U niversity Press, L ondon, 1961. 4. G lauber, K. A., A N ew R o le fo r Physiotherapy in M edicine, T he Leech, 46, 1, 3, 1976. 5. Johnson, G., In reply to question “W hat direction should Physical T h erap y E ducation tak e in ade­ quately preparing fu tu re physical therapists” P hysical Therapy, 52, 4, 448, 1972. 6. Simpson, M. A., M edical E ducation — A Critical A pproach. B utterw orth L ondon, 1972. 7. W einberg, L., U npublished U n d ergraduate Project 1976. D E C E M B E R 19?7P H Y S I O T H E R A P Y PSYCHOSOCIAL RELATIONSHIPS, TRAINING AND ATTITUDE WITH REFERENCE TO PHYSIOTHERAPISTS* L A U R A W E IN B E R G , H ierdie studie het sekere aspekte o m tren t die benadering van finale jaar studente to t die professie, hu l opleiding, pasi'ente en hulself aan die lig gehring. Vraelyste en 'n opleidingsessie het daarop gew ys dat terapeute opleiding behoort te ontvang in dinam iese sielkunde. “Successful physical th erap y depends not only on physical therapy techniques but upon the psycho­ social relatio n sh ip s w hich th e th e ra p ist develops w ith the p a tie n t.”1 P h y sio th erap y as a fo rw ard look in g profession is becom ing increasingly concerned w ith the psychothera­ peutic p o ten tial o f the relatio n sh ip w hich th e patients form w ith th eir physiotherapists. P h y sio th erap y is m ore than a collection o f techniques — it appears to be a specific type o f interpersonal relatio n sh ip o f which techniques are b u t a part. T h e fu nctional role o f the therapist is evolving into som ething new and diverse, but one com m on facto r in being a p hysiotherapist is th at o f helping o th er persons. * A sum m arised report on a survey presented to the D epartm ent of Physiotherapy, U niversity o f th e W it­ w atersrand during undergraduate training. B.Sc. (Physio) (R and) “T h e first objective o f the physical th e ra p ist is t a help the patients to help them selves.”2 T h e psychological pow er inherent in the role o f the p hysiotherapist can be understood when we consider th at d isab ility represents a n attack u p o n the body, p ersonality and external w orld o f the p atien t. Rush pointed out th at “ in 50% o f adults w ith a physical disability, em otional factors determ ined the success of re h a b ilita tio n : in children, the figure runs as high as 7 5 % .!1,3 In this study, the a u th o r isolated the h elper — the th erap ist — as the key v ariab le fo r survey. In the helping relationship, the helper (who is functioning at high levels of interpersonal dim ensions) can offer a helpee (who is functioning at low levels) the experience of being understood sensitively and deeply. T h e ability of the therapist to have insight, self-aw areness and self- understanding will enable her to develop genuine and congruent p hysiotherapist-patient relationships, and ulti­ m ately both the p atien t and the th erap ist will benefit. It was hypothesised that, after training in dynamic psychology, perception o f self w ould change in the d irection o f becom ing a self w hich w ould seem more com fortable, confident, less anxious and w ith value goals m ore readily achievable. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )