E d u c a t i o n a l A r t i c l e I d e n t i f y i n g A d d i t i o n a l S e l e c t io n C r it e r ia f o r P h y s i o t h e r a p y S t u d e n t s i n Z a m b i a . A B S T R A C T : The purpose o f this study was to investigate additional fa cto rs that should be included in the selection process o f physiotherapy students in Zambia. A qualitative research design was chosen. Focused group discussions and semi-structured interviews were used f o r data collection purposes. The results o f the study show ed that besides pre-selection achievement, a num ber o f non-academ ic variables should be included in the selection process o f students because o f their potential to influence academic performance. KEYWORDS: PRE-SELECTIO N CRITERIA, PH YSIO TH ERAPY STUDENTS, ZAMBIA. NKANDU EM, Dip.PT, BSc(Hons) PT, MSc PT ; A p a r t m e n t o f Physiotherapy, University of Stellenbosch INTRODUCTION In the past, the num ber o f students who sought adm ission into physiotherapy schools was much lower than is the case now (Nayer, 1992). M eanwhile, criteria used in the selection o f prospective students into tertiary studies are increas­ ingly being questioned (Loux, 1996). Those charged with the responsibility o f selecting students from a large num ber o f applicants are now faced with the problem o f how to select students for the limited vacancies available. Various pre-selection academic criteria are used for adm ission into the schools of physiotherapy. The use o f pre-selec­ tion grades is widely accepted because they are readily available, considered reliable and they give tangible evidence o f the applicants’ potential for continued academic achievem ent (Nayer, 1992). Physiotherapy program m es in most African countries use the results o f the General Certificate o f Education (GCE) or its equivalent. Generally, physiothe­ rapy program m es require applicants to have acceptable pre-selection grades in M athematics, Biology, Chemistry, Phy­ sics or Physical Science. N on-academ ic CORRESPONDENCE: Esther M Nkandu University o f Stellenbosch Departm ent o f Physiotherapy P.O. Box 19063 Tygerberg 7505 South Africa Tel: (021) 938-9302 (w) E-mail: en@ gerga.sun.ac.za variables include interviews, psycholo­ gical tests, aptitude tests and autobio­ graphical letters. The interview process gives an insti­ tution the opportunity to exam ine inter­ personal skills, the suitability o f the applicant and also assists in verifying inform ation provided. Psychological tests are necessary when assessing the personality traits required for a specific profession. Beside pre-selection grades, the Allied Health Professions A dm ission Test (AHPAT) is com m only used in A m erica (Nayer, 1992). Two types o f letters are generally used namely those that are open ended, re q u e stin g a refe­ rence on a blank page, and the stan­ dardised recom m endation form with specific questions to fill in. These letters are used to measure the w riting skills o f the applicants. N um erous studies have shown that pre-selection grades play a m ajor role in predicting academ ic perform ance. Kerr (1985) found a strong correlation between “O ” level marks and academ ic perfor­ mance am ongst physiotherapy students in Ireland. Studies am ong m edical stu­ dents (Razali, 1996; Hoschl and Kozeny, 1997) and nursing students (Brennan et al, 1996) have also made sim ilar con­ clusions. Two studies (M arais 1996; M okw ena 1997) done within A frica on physiotherapy students concluded that pre-selection grades w ere negatively related to academ ic perform ance. This was in contrast to a sim ilar study done in Zam bia (Nkandu, 1997). Interview s have been proved to show little or no significance in predicting academ ic perform ance am ongst p h y ­ siotherapy students (M arais, 1996). Balogun (1987) found aptitude tests to be significant in first year perform ance in physiotherapy w hile letters o f refer­ ence have been found to have a limited value (Nayer, 1992). Loux (1996) stated that the use o f scholastic achievem ents as the sole indi­ cator o f academ ic perform ance could give rise to enorm ous frustrations from applicants from disadvantaged or infe­ rior schooling systems. Razali (1996) found that students who were satisfied with their choice o f career faced fewer problem s with their studies though their perform ance was equal to those who were less satisfied with their choice. Nkandu (1997) found that over 50% o f the students in her study sample in Zam bia did not w ant to be physiothera­ pists. T hese students had originally applied for m edicine. Som e were not accepted on to the program m e while others were sent off the program m e due to inadequate academ ic perform ance. They then opted to study physiotherapy. In their final year o f study, a num ber o f these students reported that they were “beginning to enjoy the course” . Ginter and Dwinell (1994) considered other factors that could affect academic perform ance. Factors stressed in their study were loneliness and self-esteem. A dditional factors were disadvantaged schooling systems, interest in a profes­ sion, students perception o f the aca­ demic staff, burnout, physical disabilities and the quality o f tertiary academic environm ent. Som e studies (Corbet and 8 SA J o u r n a l o f P h y s io t h e r a p y 2000 V o l 56 No 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. ) mailto:en@gerga.sun.ac.za Madorsky, 1991; George, 1995) have shown that disabled individuals aspiring to enter medical professions are still faced with significant barriers and that institutions assume that disabled people, though o th erw ise' qualified applicants, cannot m eet the technical standards. T hese assumptions could be a lack of awareness o f the potential o f individuals w ith p hysical disab ilities. G eo rg e’s (1995) study gave a classic exam ple of Jim Post, a medical student with quadri- plegia. The greatest obstacles to the dis­ abled physicians, was the erroneous association, by their own profession, of physical disability with incompetence. Disabled medical students in Wu et a l’s (1996) study, perform ed as well as their able bodied colleagues. SELECTION CRITERIA Z am bia has one physiotherapy school based in the capital, Lusaka, at the E velyn H one C ollege. T he School opened in 1972 and offers, a three-year d iplom a program m e. T h e school receives a large num ber o f applications each year. C urrently, a degree p ro ­ g ram m e is being in tro d u ced at the University o f Zam bia in Lusaka. The entry requirem ents into the physiothe­ rapy school are as follows: 1. School leavers: GCE “O ” levels with credits (60-69% ) in any four o f the follow ing subjects: M athem atics, Biology, Chemistry, Physics, Physical Science/Science and at least a pass in English language. 2. M ature age: 21 years and above: - A t least 3 GCE “O ” levels credits and a recognised certificate in a relevant field. - 2 years continuous w ork expe­ rience in a.relevant field. - E m ployer’s sponsorship com m it­ m ent if sponsored. M ost o f the students who apply for this program m e are those straight from secondary school and so adm ission is based mainly on selection criteria num ­ ber one. Previously, the physiotherapy departm ent, as part o f the pre-selection procedure also conducted an interview. METHODOLOGY T he purpose o f this study was to iden­ tify additional factors, which should be considered when selecting students for physiotherapy training in Zam bia. A qualitative research-design was chosen for this com ponent o f the study. Focused group discussions and sem i-structured interview s w ere co nducted , w ith the groups o f people involved in the stu­ dents’ selection and training programme. The them e o f the discussions and struc­ tured interviews was: “W hat are the factors that should be considered in the selection o f physiotherapy students?’’ STUDY SAMPLE This consisted o f all five lecturers at the School o f Physiotherapy at Evelyn Hone C ollege, six sen io r physio th erap ists involved with the clinical supervision o f students at the University Teaching H ospital in L usaka and three external exam iners based in Lusaka. DATA C0LLECII0N PROCEDURES As it was a busy time o f the year, it was not possible to have one focus group discussion with the lecturers. Each one o f them gave 30-45 minutes o f their tim e for o n e-to -o n e sem i-stru ctu red interviews. Individual interviews were also conducted with three exam iners for sim ilar reasons. The clinical educators m ade time over their lunch period for a focus group discussion. This lasted for approxim ately one hour. Using voice recording facilities and note taking, data was collected. The notes taken described the focus groups or interview settings and also highlighted som e non-verbal behaviour o f the participants. The data was transcribed verbatim. DATA ANALYSIS Transcribing and categorising the infor­ m ation recorded, prepared the data for analysis. A nalysis o f the data was by categorising and com paring the different factors that arose under the given theme. RESULTS Factors the lecturers felt should be considered in the selection o f students for the physiotherapy program m e are highlighted below: The applicants needed to have very good G C E “O ” level grades in E n g ­ lish, M athem atics, Physical Science and Biology. O ther contributions were: LECTURER: “Selection o f students into the physiotherapy programme should not be based only on the pre-selection academic achievements o f the appli­ cants. Physiotherapy is a profession where we work very closely with people. These applicants should therefore have good personalities and should be fluent in English RESEARCHER: “What do you consider a good personality?” LECTURER: “The applicants should be well mannered, caring and should show respect to people especially those who are older... they should therefore have good communication skills ”. LECTURER: “Those who want to study physiotherapy must fully understand what physiotherapy entails. A lot of students apply fo r courses without any knowledge o f the profession. Applicants should have made contact with physio­ therapists in their work environment prior to applying...so when they come fo r interviews they should bring essays showing why they want to study physio­ therapy. This way we can also determine their writing skills". LECTURER: “Applicants must enrol into the programme out o f genuine interest and not because they don’t have anything to do. They should be willing and able to care fo r the sick”. RESEARCHER: “How are you going to determine that the applicant has the traits you are looking fo r? ” LECTURER: “This is why we need to re-introduce interviews which the appli­ cant must pass. We should also include psychological and aptitude tests ”. Further, the lecturers felt that they were not adequately trained to m eet the different needs o f disabled students. Their com m ents were: LECTURER: “Applicants need to be able bodied in order fo r them to cope with the demands o f the profession ”. RESEARCHER: “Are you not being biased against the physically disabled?” LECTURER: “We are not being biased against them. As physiotherapy lecturers we are not adequately trained to meet their different needs ”. SA J o u r n a l o f P h y s io t h e r a p y 2000 V o l 56 No 3 9 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. ) CLINICAL SUPERVISORS/EDUCATORS The selection criteria stated by the cli­ nical educators tallied with that outlined by the lecturers. Only one o f them felt that technical drawing should be included on the list o f recom m ended subjects. T he reason given was that this would facilitate the students’ understanding of treatm ent interventions like traction. Secondly it would help them understand the use and positioning o f equipm ent in ex ercise therapy. T he non-academ ic variables were that physically disabled applicants should not be accepted onto the program m e because o f the physical dem ands o f the profession. An exception was made for partially sighted students, “I f a person is able to see and is competent why not?" They further recom m ended that appli­ cants should be physically active in sport, and that they should have healthy b ehavioural p atterns. Two adverse behaviours were pointed out, namely smoking and alcohol consum ption. They felt that, as future health prom oters, physiotherapy students should be role m odels who should therefore not smoke or consum e alcohol. Further still, they recom m ended that applicants should be medically fit though they did not reach a consensus on HIV positive applicants. C/ED.l: “Students must have medical examinations prior to selection on to the programme” RESEARCHER: “What if they are HIV positive?" C/ED.l: “Well considering the length o f the course maybe they should not be accepted” C/ED.2: “No, the HIV status should not make a difference. Maybe if we all took HIV tests in this room some o f us would be positive ” C/ED.3: “What if at the end o f the train­ ing programme this person reaches a full blown picture o f HIV/AIDS and dies?” C/ED.4: “Well students might be nega­ tive on admission but might be positive during the training programme”. O ther recom m endations made were that since Z am bia had more female phy­ siotherapists than males there was a need to encourage a better gender balance. EXTERNAL EXAMINERS T hough stated by all categories, the extern al exam iners p laced g reater em phasis on pre-selection grades than those currently used. DISCUSSION Z am bia currently has a large num ber of students with good grades applying for vacancies in training institutions. As most o f the applicants into the physio­ therapy program m e q ualify for the current set criteria, it makes the process o f selection even more difficult. The recom m endation to raise the selection criteria higher than that, w hich is docu­ mented, is acceptable, as the school will then have few er students from w hich to choose. The country’s problem is the lim ited num ber o f institutions to which these potential students can send their applications. It is hoped that the intro­ duction o f a degree program m e will help address the problem o f limited vacancies. A num ber o f non-academ ic factors w ere raised w hich p articip an ts felt should be added to the selection process. The lecturers and clinical educators saw the need for prospective students to be able-bodied. They felt that they would not be able to meet the em otional and physical needs th a t the students would have during the course o f training if they were not. Their statem ents o f being “inadequately trained” and “physiothe­ rapy being a physically dem anding pro­ fession” seem to highlight the concerns o f earlier studies (C orbet and Madorsky, 1991; George, 1995). Unlike the lecturers and clinical educators, Wu et al (1996) suggested that having disabled students was very im portant as they would bring with them a unique perspective and em pathy because o f their personal expe­ rience with illness. The marginalisation o f disabled students goes against equal rights and opportunities (W HO, 1986). On the other hand, considering the inad­ equate num ber o f staff at the Physiothe­ rapy School in the E velyn H one College, the school may not be able to give the disabled students the extra attention they m ight require during the training program m e. The im plication o f this scenario is that disabled individuals w ishing to study physiotherapy will not be allowed on to the program m e in spite o f their h av in g em pathy, academ ic ability and interest in the profession. T he recom m endation o f having stu­ dents with healthy behavioural patterns is a valid one though difficult to insti­ tute. Health professionals are key role players in health prom otion and should be role models in health related beha­ viours. N kandu and Amosun (1997) con­ cluded that som e o f the students in their study sample indulged in unhealthy life­ style behaviours and w ould not be ideal role models. W hile a correlation between behavioural patterns and academ ic per­ form ance has not been docum ented in physiotherapy, it is im portant for train- ing program m es to em pow er students to enhance healthy behavioural patterns. CONCLUSION There is a need for com m ittees that are charged with the responsibility o f select­ ing physiotherapy students to consider non-academ ic variables in the selection process because o f their potential to influence academ ic perform ance. These variables should include age, gender balances, interest (and the desire o f the student to succeed in the selected pro­ fession), know ledge o f the profession, com m unication skills and personality profiles. Health related behaviours should also be enhanced in order to make pro­ fessionals who will be role models for their peers and in the com m unities where they will practice their profession. REFERENCES Balogun JA 1987 Predictive validity o f the Allied Health P rofessions A dm ission Test. Physiotherapy Canada 3 9 (l):3 9 -4 2 Brennan AL, B e st D G , Sm all SP 1996 Tracking student progress in a baccalaureate nursing programme: academ ic indicators. Canadian Journal o f N u rsing Research 24(2):85-97 Corbet B and Madorsky JG 1991 Physicians with disability, in rehabilitation m edicine- adding life to years. W estern Journal o f M edicine 154:514-521 George SC 1995 Ready and able. Journal o f the N ew Physician 44:12-18 Ginter EJ and D w inell PL 1994 The impor­ tance o f perceived duration: L oneliness and its relationship to se lf esteem and academic perform ance. Journal o f C o lle g e Student D evelopm ent 35:456-460 10 SA J o u r n a l o f P h y s io t h e r a p y 2000 V o l 56 No 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. ) H oschl C and Kozeny J 1997 Predicting academic performance o f medical students: the first three years. American Journal o f Psychiatry 154:S87-S92 Kerr K 1985 Pre-entry requirem ents and academ ic performance in the primary degree cou rses in physiotherapy at the Ulster Polytechnic. Physiotherapy 71(11 ):468-472 Loux A D 1996 The use o f confidential reports for the selection o f prospectus students for the Cape Technikon. South African Journal o f. Education 16(4): 194-200 Marais M R 1996 A n evaluation o f the out­ c om es o f the students’ selection methods into the BSc (Physiotherapy) degree programme at the University o f the Western Cape. M Sc (Physiotherapy) T h esis, University o f the Western Cape M okwena K 1997 Matric rating: Is it predictor for student performance in physiotherapy at Medunsa? Abstracts International Congress o f South African Society o f Physiotherapy, Cape Town, Pg 19 Nayer M 19 92 A dm ission criteria for entrance to physiotherapy schools: H ow to choose am ong m any applicants. P hysiotherapy Canada 4 4 (3 ):4 1 -46 Nkandu EM 1997 The relationship between pre-selection criteria and academic perfor­ mance o f physiotherapy students in Zambia M Sc (Physiotherapy) T hesis, University o f the Western Cape Nkandu EM and Am osun SL 1997 Health beliefs and practices o f health professional students o f the University o f the Western Cape. C H A S A Journal o f C om prehensive Health 8(3 & 4): 135-141 Razali SM 1996 M edical school entrance and career plans o f M alaysian medical students. M edical Education 30:418-423 Wu SSH , Tsang P Wainapel SF 1996 Physical disability am ong American medical students. 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