R E S E A R C H A R T I C L E U n d e r g r a d u a t e R e s e a r c h S t u d e n t P e r c e p t i o n s A B S T R A C T : Health professionals are required to generate evidence via research in order to validate their practice. Undergraduate students in the professions allied to m edicine com plete a research com ponent in their fin a l yea r o f study. The assumption is that this com ponent will equip them with the knowledge, skills a nd attitudes to undertake research as clinicians. In this retrospective study, a questionnaire was used to examine the perceptions and experiences o f students relating to their research projects. The study population was students studying in the professions allied to m edicine on the Tygerberg Campus o f the University o f Stellenbosch. The response rate was 77% (n - 1 0 6 ). O f these students, 69% enjoyed implementing their research project, whilst 28% did not. However, physiotherapy students experienced this com ponent o f their course m ost negatively. The m ost positive perceptions o f the students related to educational benefits and interest, whilst the most negative results related to time restraints and stress. In planning f o r the future, it is im portant to evaluate the outcom es o f the research com ponent o f the undergraduate curriculum and its possible effects on the developm ent and practice o f the physiotherapy profession. K E Y WORDS: UNDERGRADUATE RESEARCH ; STU D E N T PERCEPTIO NS; PHYSIOTHERAPY; E V ID E N C E DAWSON D, BSC1; FAURE M, M.Phil’; JULIUS B, BSC (HONS)1 1 Physiotherapy Department University of Stellenbosch INTRODUCTION Physiotherapists are becom ing increas­ ingly accountable to the client, the m edi­ cal aid societies paying for services and the public at large. The need for increased accountability has accelerated interest in generating appropriate and acceptable evidence for endorsing many areas o f clin ical p ractice (Law and Baum 1998). This can only be achieved through evidence-based practice, which in turn is grounded in appropriate and valid research. However, it has been suggested that no body of evidence exists at present to prove that the overwhelm ing m ajority o f physiotherapeutic clinical practice tech n iq u es pro duces the best effect (N ew ham 1997; T hom son-O ’Brien and M oreland 1998). A requirem ent o f the degree curricu­ lum for physiotherapists and m any other health care professionals, is that students undertake research under the supervision o f lecturers, individually or in groups. The culm ination o f this research project is a w ritten and/or verbal presentation. In A ugust each year the Tygerberg Cam pus o f the U niversity o f Stellen­ bosch hosts two academ ic year days. One is a Faculty Academ ic Year Day (FAYD) w here lecturers and clinicians attached to the Faculty present their research findings. The other is a Student A cadem ic Year D ay (SA Y D) w here selected students present the results o f their research projects to students and staff o f the Faculty. It has been observed that student attendance at both o f these occassions is poor. This is in spite o f the Faculty policy o f freeing students from lectures and clinical responsibilities in order to attend these presentations. In order to exam ine the student attendance and perceptions o f these two occasions a questionnaire was distributed to all students in the M edical Faculty. This questionnaire was a convenient vehicle in w hich to question the stu d en ts’ atti­ tudes tow ards, and subjective e x p e­ riences of, their ow n research projects. METHODS AND MATERIALS A retrospective study was done m aking use o f a questionnaire that w as com piled by three researchers from the D epart­ m ent o f P h y sio th era p y in co nsultation with one person from the Departm ent o f C om m unity H ealth and one person from the D e p a rtm e n t o f C o n su m e r Studies. The questionnaire was divided into four sections, and included both qualitative and quantitative questions relating to: • personal inform ation, including year o f study and departm ent • attendance at both o f the academ ic year days • students’ perceptions o f various aspects o f both o f the academ ic year days • the students’ experiences and percep­ tions o f their own research projects The questionnaire was distributed and collected by the class representatives o f each class on two occasions: • at the end o f 1998 to ail fin a l yea r students from the professions allied to m edicine and fifth ye a r medical and dental students; • early in 1999 to all students attending lectures on cam pus, except the second year students who had ju st arrived on the M edical Cam pus and would not yet have had the opportunity o f attending the academ ic year days. C O RRESPO ND EN C E TO: D Dawson D epartm ent o f Physiotherapy, Faculty o f M edicine, PO Box 19063, Tygerberg 7505 Tel: (021) 938-9300 (W) SA J o u r n a l o f P h ysio th e ra p y 2001 V o l 57 No 1 3 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. ) TABLE 1. Total response rate per department 1998 Total Nos in Class Total No of Responses % Response Rate Physiotherapy (PT) 44 37 84 Occupational Therapy (OT) 28 26 93 Nursing (N) 27 19 70 Human Nutrition (HN) 25 16 64 Speech Therapy (SpT) 13 8 62 TOTAL 137 106 77 TABLE 2. Numbers of physiotherapy responses compared to total POSITIVE Total PT NEGATIVE Total PT Interesting topic 16 3 Uninteresting topic 2 0 Learnt a lot/educational 29 4 Stressful/pressured 6 2 W ork in groups 7 0 W ork in groups 2 0 Good g u idance/ support 2 1 Poor g u idance/ support 2 0 Stimulating/interesting 29 3 Too few credits 3 3 Contribute to knowledge 6 2 Time consum ing/ lack 24 11 Enjoy research 7 1 Dislike research 5 3 Other 16 4 O ther 9 4 TABLE 3. Strongest trends in perceptions POSITIVE Nos Nos NEGATIVE Nos Nos of PT of HN of PT of HN Learnt a lo t/ educational 4 11 Time consum ing/ lack 11 1 S tim ulating/ interesting 3 9 Interesting topic 3 5 T he study p o p u latio n therefo re included all other students from the d ep artm en ts o f p h y sio th erap y (PT), o ccu p atio n al therap y (O T ), speech therapy (SpT), hum an nutrition (HN), nursing (N), m edicine (M) and dentistry (D ) w ho a tten d e d c lasse s on the Tygerberg cam pus during 1998. This led to the exclusion o f the sixth year m edi­ cal and dental students, as they spend m ost o f their tim e in clinical activities away from the Tygerberg cam pus. A research project, com pleted early in the second sem ester o f their fourth year, is a com pulsory com ponent o f the curriculum for students from the p ro fes­ sions allied to m edicine, although an optional com ponent in the medical and dental curriculum . This often results in predom inantly those m edical and dental students who are interested in research follow ing this option. T herefore, for the purposes o f this article, only that infor­ m ation relating to the research experi­ ences and perceptions o f fourth year students o f 1998 in the pro fessions allied to m edicine (n=106), will be pre­ sented and discussed. Special reference to physiotherapy students will be made w here appropriate. Q ualitative responses initially were coded independen tly by two o f the researchers into categories o f positive and negative attitudes. As com m ents could easily be placed in either o f these broad categories, 100% agreem ent on the initial coding was reached. These categories w ere then further refined by the sam e two reseachers into subcate­ gories o f them es in accordance with qualitative m ethodology. C onsensus was then reach ed by all three o f the researchers on the final them es which are docum ented in Table 2. RESULTS T he total resp o n se rate w as 42% (n=588). The response rate o f the fourth year students in the departm ents allied to m edicine are given in Table 1. The students’ enjoym ent o f research, or lack thereof, is shown in Figure 1. However, as can be seen from F igure 2, the physiotherapy students o f 1998 were m ore negative towards their research projects than students from other depart­ ments. The responses o f the physiotherapy students in relation to all o f the other students concerning the positive and negative them es are outlined in Table 2. The m ajority o f the positive responses suggested that they had learnt a lot, and that it had been an in terestin g and stim ulating experience. Tim e issues were the overw helm ing negative responses, w hile am bivalence for research p e r se and its im portance for practice was implied. P h y sio th era p y stu d en ts and those students from the D epartm ent o f Human N utrition differed m ost strongly in their perceptions o f their research projects. T he m ain differen ces are show n in Table 3. This table also highlights the possible relationship betw een stress and time constraints and the way that students experienced these research projects. O f the 37 physiotherapy students who responded to the questionnaire, 32 did not attend the research presentations at SAYD. O f these, eight students indicated that they did not attend due to their w o rk lo ad s, ten students b lam ed too m any academ ic deadlines or tasks and three students indicated that they had a previous appointm ent. In reply to the question, “How did you spend your class free time on Faculty A cadem ic Year D ay?” twelve students responded that they had spent part o f the tim e relaxing or sleeping, thirteen others had spent tim e studying or w orking on 4 SA J o u r n a l o f P h y s io th e ra p y 2001 V o l 57 No 1 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. ) FIGURE 1. Enjoyment of research project FIGURE 2. Departmental responses - enjoyment academ ic tasks w hile fourteen had had clinical dem ands. In responding to the question “W hat w ould m otivate you to attend the presentations?” ten physio­ therapy students said a lighter workload, and only three said a greater interest in research. DISCUSSION In Figure 1 the responses o f students suggest that, in total, m ore students did enjoy the research project than those w ho d id n ’t. However, in Figure 2 it can be seen that a significant num ber o f physiotherapy students responded that they had not enjoyed this com ponent. F eed b ack from q u alitativ e q u estions indicated that pressures associated with tim e constraints contributed strongly to the lack o f enjoym ent w hich students from m ost departm ents experienced. Comments such as “I enjoyed the research but not enough tim e” , and “ ... had to be rushed” , were m ade by a num ber o f stu­ dents. On the other hand, the Human N utrition students w ere the m ost posi­ tive towards their projects, w ith the tim e fa c to r b eing m entioned le a st often (Table 3). T he research p ro to co l is com pleted by the end o f the third year o f study in this departm ent. T hese students are then given a six week “block” to work fulltim e on collectin g and analysing their data at the beginning o f their fourth year. For the next few months the stu­ dents are not given “class tim e” to com plete their projects, but m ust do so in their ow n time. In contrast, the phy­ siotherapy students were only given one afternoon per week for six m onths of th eir fo u rth y ear to w o rk on their projects. It is obviously m ore difficult to w ork in such a “stop/start” manner. Interestingly, the lack o f credits w hich m ight be translated as lack of recognition for the am ount o f w ork done or, m ore seriously, as a lack o f recognition for the im portance o f the research module, was o f concern to physiotherapy students. The underlying rationale for includ­ ing the research com ponent into the undergraduate curriculum , is that having had first hand experience o f the research process, students will develop research skills and a questioning attitude to prac­ tice and to the literature. It is assum ed that as graduates, physiotherapists - and other health care clinicians - will utilise these attributes to evaluate their com petence and to ju stify their practice as clinicians. W h e th e r th e se a im s are b ein g achieved as efficiently and effectively as possible is questioned by m any (K itchen 1999; Summers e ta l 1998). In motivating their innovations for a research curricu­ lum for medical residents, Sum m ers et al (1998) state that “... even residents who are academ ically m inded can be dissuaded by the seem ing drudgery o f scientific inquiry.” They suggest that one reason for this reluctance is the notion that the research requirem ent is considered to be only another hurdle in the goal o f the .completion o f their resi­ dency. The notion o f the drudgery asso­ ciated with a research project “killing” enthusiasm for research in physiotherapy students, was also raised by Kitchen (1999). If this process, central to p ro fes­ sional practice is considered by under­ graduates to be only another hurdle to get over, the question to be asked then is w hether there is m uch chance that, as clinicians, research will be afforded the status that is essential for the development o f effective, evidence-based practice? O ne th e re fo re needs to exam in e w hether the process o f research and its p ro d u ct, w h eth er a w ritten o r oral presentation, achieves its purpose and thereby ju stifies its inclusion in the undergraduate curriculum as m erely an isolated and self-fulfilling module. Is it not m ore im portant that the “research” process is both integrated, and central, to an inquiring and rigorous approach to professional practice w hich should be fostered in undergraduate - and post­ graduate - students througho ut their courses? In this way it m ight be m ore likely that the research process will becom e an integral part o f everyday professional practice. The Research and Development Group (R D G ) o f the C h artered S ociety o f Physiotherapy (1996) state that the con­ cept o f research focusses on the concept o f evaluation as understood in clinical physiotherapy. Awareness o f a question that needs to be answ ered or a problem that needs to be addressed, collection and critical evaluation o f inform ation, form ulation o f the problem , interven­ tion, docum entation, re-evaluation and SA J o u r n a l o f P h ysio th e ra p y 2001 V o l 57 No 1 5 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. ) reflection are all skills both o f clinical d ecision m aking and research. B oth processes are thus closely related. By integrating research skills into clinical skills in order to enhance evidence-based practice and the m ethods o f inquiry used in each, a solid foundation can be laid for integrating practice and research. M oore (1997) raises the need for the d e v elo p m en t o f a strong cu ltu re o f research in physiotherapy. She m aintains that without such a culture, physiotherapy can be “nothing m ore than an art, though like m edicine and law it will always be partially an art” . One way o f contribut­ ing to, and keeping up to date with pro­ fessional developm ents is achieved by critically reading the literature, applying research principles in interpreting the results and im plem enting these findings in clinical practice, w here appropriate. A further m ethod o f contributing to the developm ent o f a profession, is by undertaking research projects and par­ ticipating in congresses, research pre­ sentations and other academ ic m eetings. N ew ham (1997) stresses the im portance o f attending m eetings at w hich research findings are presented, in order to im ple­ m ent relevant findings into practice. However, only five out o f 37 physio­ therapy students attended the academ ic presentations at the university, with their reasons for not attending reflected by factors such as their workload and time pressures as has already been discussed. Students in all o f the departm ents in the Faculty o f M edicine indicated that more encou ragem ent from lecturers would motivate them to attend the presentations. The prim ary purpose o f academ ic activities and projects at undergraduate level, is to educate students (Kitchen 1999), and “education” im plies a change in behaviour or attitude. A lthough many students felt that the research com po­ nent was a “good experience” and felt satisfaction in acquiring new skills only three out o f the total num ber o f 106 stu­ dents related the im portance o f research to the profession, w ith com m ents such as “research is vital for the advancem ent o f any profession” . D o the m ajority o f students really see this com ponent as only the academ ic “hurdle” suggested by Sum m ers et al (1998) B arriers to research, and the enjoym ent thereof are not peculiar to our students. N olan et al (1994) in Law and B aum (1998) included the lack o f tim e as well as a lack o f research skills as being detrim ental to the research process for clinicians. A lack o f funding, as well as service pressures, w hich also can be linked to a lack o f time, were am ongst the barriers identified by Newham (1997), while T hom son-O ’Brien and M oreland (1998) included problem s with research m ethods and applicability o f studies. It therefore appears that in the last 20 years very little progress seem s to have been m ade in addressing these difficulties, as Balin et al (1980) include a “lack o f tim e and funds” as well as a “lack o f fam i­ liarity w ith the research process” at the top o f a list o f barriers to research! Unless due care is taken, our profes­ sion will not develop an evidence-based character. It m ight be in developing and integrating an inquiry-based approach into all o f the com ponents o f theory and practice included throughout all four years o f the undergraduate curriculum , that both the skills of, and positive atti­ tudes towards, research, m ight be fo s­ tered. Clearly, choices have to be made about “core” know ledge and skills not only for treating clients, but also for the continuation o f the profession. M illson (2000) suggests that we may not only lose physiotherapists to other professional fields because o f disillu­ sionm ent but the loss o f elem ents o f our role to other disciplines might accelerate. M ost importantly, we might risk the dissatisfaction o f patients, other profes­ sionals and medical aids because o f our failure to provide evidence based prac­ tice and capitalise on efficiency (M oore 1997). The expansion o f our professional know ledge base is o f vital im portance in physiotherapy. T he responsibility for this task rests with each and every m em ­ ber o f the profession (Higgs et al 1998). However, it is the responsibility o f the universities to ensure that at the end o f their undergraduate training, physiothe­ rapists are equipped not only w ith a range o f technical skills but also with the know ledge and attitudes w hich might ensure the survival o f our profession (H unt et al 1998). In c rease d d iscu ssio n b etw een all interested parties, form ally and infor­ mally, needs to take place in order to share experiences and provide a focus for educational innovation at undergra­ duate and post-graduate levels. If such collegiality is achieved through clinical special in terest gro ups, surely m ore interaction needs to take place at all levels o f the lecturing fraternity too. We m ust continue to develop strategies that will increase our students’ involvem ent in and enjoym ent o f research not only so that it can be integrated into all aspects o f professional practice, but also to ensure optim um developm ent o f our profession. Only then m aybe we can fulfil our prim ary goal o f providing the highest quality o f care to achieve the best outcom es for our clients in a m anner w hich is cost effective (Sum m er 1998). REFERENCES B alin A J, B reslin W H, W eirengen K A S, S hepard K F 1980 R esearch in physiotherapy philosophy: B arriers to involvem ent and use am ongst C alifornian physiotherapists. Physical T herapy 60: 888-895 H ig g s J, T itc h e n A 1998 R e se a rc h and K now ledge. P h y siotherapy 84(2): 72-79 H unt A, H iggs J, A dam son B, H arris L 1998 U niversity E ducation and the Physiotherapy P rofessional. P h y siotherapy 84(6): 254-264 K itchen S S 1999 E ditorial - A re student research projects good for research and pra c­ tice? P h y sioth era p y R esearch International 4(3): iv-vi L aw M, B aum C 1998 E v id e n c e -B a se d O ccupational Therapy. C anadian Journal o f O ccupational T herapy 65(3): 131-135 M illson H 20 0 0 L etter to the Editor. T h e South A frican Journal o f P hysiotherapy 56 (I): 28 M oore A P 1997 R esearch, the C o llaborative A pproach: C linicians and academ ics. P hysio­ therapy 83(5): 229-234 N ew ham D J 1997 P hysiotherapy fo r B est Effect. P hysiotherapy 83(1): 5 -1 1 S um m ers R L, W oodw ard L H, S anders D Y, G alli R L 1998 R esearch cu rricu lu m for resi­ dents based on the structure o f the scientific m ethod. M edical T eacher 20 (I) : 35-37 T he R esearch and D ev elo p m e n t G roup 1996 P h y s io th e ra p y R e se a rc h a n d C o n tin u in g Professional D evelopm ent: T h e w ay forw ards. P h y siotherapy 82(9) T h o m s o n -O ’B rien L, M o re la n d A 1998 E v idence-based P ractice Info rm atio n Circle. P hysiotherapy C a n ad a 50(3): 184-189 6 SA J o u r n a l o f P h y s io th e ra p y 2001 V o l 57 No 1 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. )