SEPTEMBER 1980 P H Y S I O T H E R A P Y 73 presence of infection. A pplication is again through-and- through the chest wall w ith a large m alleable electrode placed posteriorly in the upper thoracic region and a medium m alleable electrode placed anteriorly over the sternum and p ectoral region. D osage is m ild therm ic for fifteen to tw enty m inutes. SWD applied thro u g h the chest unequivocally gives the p atien t a sense of w ell-being — perhaps on the cleus ex m achina principle. It m ay be th a t the effect is to relieve bronchospasm , n o t only to induce m ore gene­ ral relaxation, and it m ay be th a t m ucus is rendered less viscid; th e attrib u te of SW D of effecting vaso­ d ilatatio n m ay serve a purpose when used across the lungs o r it m ay serve only to increase th e v entilation: perfusion inequality. T his m ight prove an interesting field fo r research. T h ere should be no need to stress th a t o th er proce­ dures, such as vibrations and breathing exercises, should always accom pany the treatm en ts by shortw ave diatherm y. THE CRITICAL INCIDENT TECHNIQUE IN PHYSIOTHERAPY EDUCATION JO H L Y N E C. B E E N H A K K E R , B.Sc. (Physio) R e p o rt o f a pilot study undertaken to determ ine the behaviour o f an effective physiotherapist. The critical incident technique was used to collect data fr o m 30 practising physiotherapists and 300 separate incidents o f effective and in effective behaviour were identified. On the basis o f this study, the desirability o f objectively identifying curriculum content in physiotherapy educa­ tion has been established. O ne o f the problem s facing p h y sio th erap y educators today is w hat should be tau g h t and w h at should be deleted from the ra p id ly expanding un d erg rad u ate c u rri­ culum. W e m ust establish w hether the present syllabus is meeting the needs o f th e society in w hich the physio­ therapist w ill p ractice and ensure th a t th e needs o f the students are also being met. O f the m any studies th a t have been done by the various professions, one o f the m ost p rom ising m ethods o f determ ining cu rricu lu m content ap p ears to be the critical incident technique. By incident is m ean t a u n it o f observable hum an activity w hich is sufficiently com plete in itself to allow inferences to be m ade ab o u t the person p erfo rm in g the act. A critical incident is one w hich leaves th e reader little doubt regarding its effectiveness o r ineffectiveness. \ T h e critical incident technique was evolved by Ijflanagan (1954) and he has used it as a basis fo r studies in m any varied fields. Jensen (1960) and B arham (1963) have applied th e technique to different aspects o f N ursing and a large study in O rth o p aed ic tra in in g was described by M iller (1968). In these studies, practitioners in th e various professions w ere asked to describe a situation, record w h at action w as taken by the person observed and w h at the result o f the action was. Once the incidents had been collected, it was possible to identify the key actions o f the profession being studied. A p ilo t study was carried o u t by the Physiotherapy D epartm ent o f th e U n iv ersity o f the W itw atersrand to determ ine w hether the critical incident technique w ould be a practicable m ethod o f establishing w h at behaviours characterise an effective physiotherapist. METHOD Six physiotherapy colleagues w ere chosen to carry out the study and each was asked to ap p ro ach five senior physiotherapists representing hospital and private practitioners, as well as those fro m special institutions Senior L ecturer, A cting H ead, S ub-D epartm ent o f P hysiotherapy, U n iv ersity o f the W itw atersrand. Received 11 Ja n u a ry 1980. (W itw atersrand) D .P.E. (W itw atersrand)* Opsomming Verslag van 'n voorlopige studie wat onderneem is om die gedrag van ’n doeltreffende fisioterapeut vas te stel. Die kritiese insident tegniek is gebruik om data van 30 praktiserende fisioterapeute te versam el en 300 aparte insidente van doeltreffende en ondoeltreffende gedrag is ge'identifiseer. Op grond van hierdie studie is die w enslikheid van objektiew e identifisering van kurriku- lum inhoud in fisioterapie-onderrig vasgesteh and training centres. T here were eight physiotherapists from private practice, five from cerebral palsy schools and institutions, th irteen in h o sp ital em ploy and four at train in g centres, w ho took p a rt in th e study. These 30 physiotherapists w ere given 10 form s each in w hich to rep o rt incidents w hich they considered to have had a positive o r negative outcom e, as regards effectiveness. T o ensure th e collection o f a full spectrum o f behaviours in the cognitive, psychom otor an d affective dom ain, the areas suggested fo r collection o f th e incidents w ere:— # Interpersonal relationship w ith th e patient, his fam ily o r o th e r m em bers o f th e health team . # Intellectual — use o f problem solving and other skills in the assessm ent o f th e p a tie n t o r situation as well as th e plan n in g o f a treatm en t program m e. 9 Technical — m ethods o f carrying ou t the assess­ m ent o r treatm en t program m e. O f the 300 form s given o u t, 180 w ere retu rn ed in tim e fo r the study w hich was lim ited to an in itial six week period. As several o f the form s h ad m ore than one rep o rted incident, 300 exam ples w ere collected w hich fell under two o r m ore of the m ain areas. Each incident was extracted fro m the fo rm and recorded on a sep arate card. T h e first analysis o f the data was done in June, 1979, w hen 194 incidents w ere identified. In July, a fu rth e r 106 incidents w ere categorised an d o f these only one was fo u n d to be a new b eh av io u r (T able I). E ach m ain a rea w as subdivided according to the incidents, and as new behaviours w ere received, new sub-areas w ere form ed, e.g. A -I-R elatio n sh ip w ith p a ­ tien t (a) Listens to p atien t, (b) E xplains to p atien t, (c) G ain s p a tie n t’s co-operation etc. ANALYSIS OF D A T A T h e valid ity o f the in terp re tatio n and classification o f the incidents was checked by subm itting a random sam ple o f th e cards to two o f th e co-workers. These w orkers then sorted out the cards u n d er the various areas and it was found th a t there was a ninety-five p e r cent agreem ent in th e ir classification as com pared 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. ) 74 F I S I O T E R A P I E SEPTEMBER 1980 T A B L E I CLASSIFICATION OF IN CIDENTS - A rea June 1979 July 1979 A Interpersonal I R elatio n sh ip w ith p a tie n t 46 33 79 I I R e latio n sh ip w ith fam ily 24 7 31 I I I R elatio n sh ip w ith h ealth team 24 17 41 B Assessment 41 21 + 1 63 new incident C Treatment 59 27 86 194 105 1 ♦EFFECTIVE/INEFFECTIVE F ro m y o u r experience, th in k o f a recen t situ atio n in w hich you observed o r you d id som ething w hich illus­ trated an adequate/inadequate* perfo rm an ce by a phy sio ­ therapist. 1. Briefly describe th e back g ro u n d to th e incident. 2. H ow experienced w as th e ph y sio th erap ist? Y ears since qualification. 3. H ow experienced w as th e observer? 4. D escribe exactly w h at the p h y sio th erap ist did. 5. W hat m o re effective/ineffective* b eh av io u r m ight be expected in a sim ilar situ atio n ? 6. W here was th e observation m ade? P lease tick th e a p p ro p ria te block. G en eral H o sp ital Special School P riv a te P ractice Special In s titu tio n O ther * Please delete th e one w hich is n o t a p p ro p riate. to m ine. T h is reaso n ab ly h ig h co rrelatio n led m e to assum e th a t a p an el o f th ree judges w ould be sufficient to so rt o u t an d categorise th e incidents in th e m ain study to be do n e in 1980. In o rd er to check the re li­ ab ility o f th e classification system, I re-classified a sam ple of the incidents tw o m onths afte r com pletion o f th e study. DISCUSSIO N F ro m the fav o u rab le results o f the p ilo t study, a full study is being p lanned in w hich p h y sio th erap ists fro m different p arts o f th e country will take part. A dditional in fo rm a tio n w ill be gathered concerning the in stitu tio n o r p ra c tic e in w hich th e observ atio n w as m ade an d the length of tim e since qualification o f the observer. A ran d o m sam ple o f a b o u t 200 physiotherapists will be app ro ach ed , th e n u m b er representing approxim ately 1/5 o f the total n u m b er of practising physiotherapists in S outh A frica. T hese w ill be draw n fro m different areas to ensure th a t all fields in w hich a p h y sio th era­ pist practises, are covered. Incidents w ill be collected an d classified u n til no m o re than one new b e h a v io u r is reported in every 100 incidents exam ined, in o rd e r th a t a sufficiently large an d representative sam ple o f behaviours is obtained. O nce all the incidents have been collected and clas­ sified, a list of effective an d ineffective beh av io u rs wiU- be draw n u p. * F ro m these specific observable b ehaviours, it is in ­ tended th a t a full set o f learning objectives w ill be established. By establishing th e k in d o f b eh av io u r a stu d en t should achieve to dem onstrate professional com petency, a cu rriculum can be planned w hich w ill m eet society’s needs. T h is will ensure th a t th e cu rriculum w hich has evolved som ew hat h ap h azard ly over th e years, is based on a m o re secure an d scientific fo u n d atio n . T h e in itial classification o f 194 incidents w as done in June, fro m th e first 106 retu rn ed form s. In July a fu rth e r 74 fo rm s w ere analysed and from the 105 incidents extracted, only one new in cid en t w hich re q u ire d an ad d itio n al sub-area w as found. References 1. B arham , V irg in ia Z. (1963). Id entifying effective b eh av io u r o f th e nursing in stru cto r th ro u g h critical incidents. E d. D . D issertation. U n iv ersity o f C ali­ fo rn ia, Berkely. 2. F lan ag an , Jo h n C. (1954). T h e critical incident tech­ nique P sychological Bulletin 51, 4. 3. Jensen, A lfred C. (1960). D eterm in in g critical re ­ quirem ents f o r nurses N ursing Research 9, 1. 4. M iller, G eorge E. (1968). T h e orthopaedic training study J. A m er. M ed. Assoc., 206, 3. T R E A T M E N T N O T E : STRAIGHT LEG RAISE AS L O R N A A healthy fit 19 year old am ateur cyclist presented w ith low back and leg pain, w hich occurred only during cycle training. A diagnosis of b ilateral sciatica w ith general hypom obility w as made. In M arch 1978, th e p atien t kicked a ball and his leg becam e “ lam e” fo r a sh o rt tim e. H e h ad com plete recovery in tw o m onths. T h e first nine m onths of 1979 were spent cycling in E urope. In A ugust 1979 he lifted a heavy weight, resulting in severe p a in in b o th legs down to his heels th a t night. T his recovered th e next day. In th a t m o n th he also had a severe fall off his * F o u rth year stu d en t B.Sc (Physiotherapy) U .C.T. Received 8 A ugust 1980. A TREATMENT TECHNIQUE N EL SO N * bicycle. D uring subsequent chiropractic treatm en t in Belgium, the p atien t was told th at he had S ch eu erm an n ’s disease. H is back was m anipulated, after w hich he still h ad p a in in his legs but only on cycling. In O ctober 1979 he had chiropractic treatm en t in South A frica. H e was given massage and “pressing on th e spine” , w ith relief fo r two weeks, after which he developed cram ps in the legs. T h e p a tie n t presented at Back C linic in M arch 1980 w ith low back pain an d “ lam eness” of his legs. H e reported neither leg p ain n o r leg cram ps. Because o f his sym ptom s his cycle training h ad been reduced from 120 km to only 50 km a day. O n subjective exam ination, th e p a tie n t reported pain of sciatic and low back distribution, w hich was referred 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. )