E d u c a t i o n a l P e r s p e c t i v e A n In t r o d u c t o r y A rticle o n t h e C o n c e p t of P r o g r a m m e D e v e l o p m e n t in P h y s io t h e r a p y T r a in in g A B S T R A C T : The m ove to an o u tco m e s-b a sed edu ca tio n a n d training system in South A fric a p rese n ts h ig h er edu ca tio n a n d training institutions w ith a challenge to review th e ir curricula a n d to a d a p t to ch a n g es bro u g h t a b o u t by the new education a n d health care dispensations. K ey a sp ec ts o f the m ove to outcom es- b a se d edu ca tio n a n d training as co n ta in ed in the South A frica n Q ua lifica tio n s A u th o rity (SA Q A ) Act, inform ation regarding the N a tio n a l Q u alifications F ra m e w o rk (N Q F ) a n d o th e r m atters inform ing curriculum review are addressed. The D e p a rtm e n t o f P h ysio th era p y o f the U niversity o f the O range Free State has j u s t c o m p le te d the f i r s t p h a se o f restructuring its education a n d training p ro g ra m m e in o rd er to su b m it the q u a lifica tio n f o r registration on the NQF. The rationale b eh in d the sh ift to an outcom es-based, stu d en t-cen tred curriculum a n d the key fe a tu r e s o f the p ro g ra m m e are briefly discussed, as this is the f ir s t step tow ards the registration o f u nit standards/qualifications, a p ro c e ss w hich a ll ed u c a ­ tion a n d training institutions w ill have to em b a rk upon soon. K E Y C O N CEP TS: O U T C O M E S-B A SE D E D U C A T IO N A N D TRAINING, C U R R IC U L U M REVIEW, P H Y SIO T H E R A P Y P R O G R A M M E , C R IT IC A L A N D S P E C IF IC O U T C O M E S KRAUSE MW, MSc PHYSIOTHERAPY' (UOFS) VILJOEN MJ, D.SOC.SC. (UOFS)2 BEZUIDENHOUT MJ, B.A., DIPL IN TERTIARY ED. (UOFS)3 fa c u lty of Health Sciences, University of the Orange Free State Faculty of Health Sciences, University of the Orange Free State Faculty of Health Sciences, University of the Orange Free State INTRODUCTION As the world gallops to the new m illen­ nium , higher education is becom ing increasingly more complex, with institu­ tions facing many new challenges. The pressure is on to com plete new pro­ gram m es with standards that will satisfy the criteria for registration, taking cogni­ sance o f extrem ely im portant issues regarding new policy developments such as the SAQA (South African Qualifica­ tions A uthority) Bill, the NQ F (National Q ualifications Fram ework), the H igher Education Act, and the m ove towards an em phasis on primary health care in the country; a paradigm shift from teaching to learning; new delivery modes; the urge for quality prom otion and quality assur­ ance; disadvantaged students; capacity CORRESPONDENCE: Prof. M.W. Krause Head: D epartm ent of Physiotherapy School o f Allied Health Professions Faculty of Health Sciences U niversity o f the O range Free State P O Box 339 BLO EM FO N TEIN 9300 Tel (051) 401 -3290 (w) (051) 436-6669 (h) Fax (051) 401-3304 building and public accountability, to name but some. Physiotherapy training centres are experiencing sim ilar pres­ sures and realise the urgent need to revise the traditional South A frican Physiotherapy curriculum. This article aims at applying the regu­ lations o f the SAQA Act (RSA 1998) in a physiotherapy curriculum review pro­ cess. It is im portant for educators to understand the Department of Education’s new ‘paradigm ’ o f outcom es-based edu­ cation and training (OBET) and becom e equipped with the know ledge and skills required to design program m es dem on­ strating O BET principles in order to be able to register qualifications w hich com ply with SAQA conditions. SAQA AND THE NQF The idea o f a National Q ualifications Fram ew ork arose from debates, research and policy form ation for education and training in the early 1990s (SA Q A 1997). It was developed out of initia­ tives involving rep resen tativ es from labour, m anagem ent, governm ent and providers o f education and training, and finally agreem ent was reached on the concept of transparent national standards, understood as specific descriptions of learning achievem ents agreed upon by all major stakeholders. T hese standards are to be housed within a qualifications fram ew ork designed to prom ote lifelong learning, integrate education and training, recognise learning gained outside o f formal institutions and allow for flexible program m es, credits and qualifications. The draft o f the NQ F Bill was passed into law as the SAQA A ct (Act 58 o f 1995). The objective of the NQF, as laid out in the Act, is to create an integrated na­ tional fram ew ork for learning. Enhanc­ ing quality in education and training, access, mobility and progression are key objectives, and it is reiterated that atten­ tion should be given to the speedy redress o f past discrim ination in educa­ tion, training and em ploym ent. Through these objectives, the N Q F envisages to contribute to the full personal develop­ ment o f each learner and the social and econom ic developm ent o f the nation at large (SAQA 1997). The N Q F is an eight-level fram ew ork established to give recognition to general education and training (GET) (level 1 and lower), further educaton and train­ ing (FET) (levels 2 to 4), and higher 20 SA J o u r n a l o f Ph y s io t h er a p y 1999 V o l 55 No 4 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. ) education and training (HET) (levels 5 to 8). The levels pertaining to the HET band, including university education and training, are (RSA 1998): N Q F level 5: d ip lo m a s; o ccu p a tio n a l c e rtific a te s; N Q F level 6: first degrees; higher diplo­ mas; N Q F level 7: higher degrees; pro­ fessional qualifications; NQ F level 8: doctorates and further research degrees. SAQA is in the process o f refining level descriptors. For the purpose o f this article suffice it to say that it sometimes may be difficult to draw distinctions between levels, and that the guidelines SAQA has provided, should be studied carefully. Writers o f standards need to consider the intention behind the stan­ dard, that is, the occupation, activity, or learning process that a learner who has achieved the outcomes required for the standard, is qualified to undertake. The South A frican Q ualifications Authority com prises a chairperson and m em bers nom inated from education, labour, business, universities, technikons, colleges, adult basic education and train­ ing, the teaching profession and special education needs. Its functions include (RSA 1998): • The development o f the NQF: policies, guidelines and criteria for registration and accreditation. • The implementation of the NQF: regi­ stration, accreditation and assignment o f functions to the bodies satisfying the requirem ents (registration o f stan­ dards/ qualifications). • A dvising the M inisters o f Education and Labour. • Consulting with all relevant parties. OUTCOMES-BASED EDUCATION AND TRAINING (OBET) The move to outcom es-based education and training may present educators with a challenge big enough to be called a “paradigm shift” (Lubisi et al. 1997), but the concept is not entirely new. Good teachers, it is argued, have always m ea­ sured the value o f their instruction in term s o f what the learners have gained, that is, the outcom e o f the teaching- learning process. C urriculum develo p m en t for o u t­ com es-based education and training will take as point o f departure the proposed results of the learning, rather than the content that has to be m astered. In con­ trast to a content-based education and training program m e (with a focus on objectives), the em phasis in outcomes- based education and training is on the outcom e (result) o f the process, i.e. the com petence (interaction between know ­ ledge, skills and attitudes) o f the learner as a result o f the learning activity. If correctly applied, the focus on outcomes encourages the developm ent o f flexible, integrated and relevant instructional pro­ grammes. Differentiation is made among d ifferen t types o f outcom es, w hich should be taken cognisance o f in any instructional program m e (Nel & Bezui- denhout 1998). Critical outcomes The critical cross-field education and training outcomes describe the proposed results o f education and training in the broader sense o f the word. These are generic and people-directed skills and com petencies, that extend across curri­ cula. They should be seen as principles and as such they should direct the edu­ cation and training processes, as well as the development o f learning programmes and m aterial, that is, these outcom es should inform the specific outcom es. (RSA 1998). R egulation 7(3) o f the SA Q A Act (RSA 1998) stipulates a num ber o f cri­ tical outcomes which boil down to: a) id en tify in g and solv in g p roblem s and em ploying critical and creative thinking; b) working in a team/group; c) organising and managing oneself and one’s activities; d) collecting, analysing organising and critically evaluating information; e) co m m unicating effectively (orally and in writing); f) using science and technology effec­ tively and critically; g) dem onstrating an understanding of the world as a set o f related systems by recognising that problem -solving contexts do not exist in isolation; h) co n trib u tin g to the fu ll personal developm ent o f each learner and the social and econom ic developm ent o f the society at large, by m aking indi­ viduals aware o f the importance of: i. a variety o f strategies to learn m ore effectively; ii. participating as responsible citizens in the life o f local, national and global com m unities; iii.being culturally and aesthetically sensitive across a range of social contexts; iv. ex ploring education and career opportunities; and v. developing entrepreneurial oppor­ tunities. Specific outcomes Specific outcom es are context-specific. They endorse critical outcom es, but are form ulated within the context of a speci­ fic program m e, that is, the context w ith­ in which they are to be demonstrated. They describe the com petence learners should have at their disposal in special areas of learning at specific levels. These outcom es serve as basis for evaluating learners’ progress, therefore details o f the level o f complexity, scope and learning context should be included in specific outcom es (Lubisi et al. 1997). Vocational / professional outcomes The vocational outcom es em pow er a specific group for a specific career. In the case o f a professional degree they constitute the profile o f the graduate; therefore these outcom es, for example, will include the conditions set forth by the particular professional board, such as themes related to professional prac­ tice and conduct. AN OUTCOMES-BASED PHYSIOTHERAPY CURRICULUM The D epartm ent o f Physiotherapy o f the U niversity o f the Orange Free State during 1998 em barked upon a series of developm ent activities which resulted in an innovative physiotherapy curriculum, designed within the broad fram ework set out in the SAQA Act. The concept o f outcom es and their m easurem ent is also becoming an essen­ tial feature o f health care delivery. In the development of vocational (professional) q ualifications the em phasis has been transferred from input and content of education to its outcom es, particularly as a means o f achieving and recording specific levels o f competence. SA J o u r n a l o f Ph y sio t h e r a p y 1999 V o l 55 No 4 21 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. ) T his D epartm ent o f Physiotherapy fully and enthusiastically supports the move to innovative education and train­ ing strategies as described. Due to the changes in physiotherapy practice and the environm ent in which physiothera­ pists work, they are increasingly required to operate as independent practitioners and they are com m itted to evidence- based practice. They have to evaluate and reflect upon their practice and initi­ ate and respond to change. Therefore it is the duty and responsibility o f educa­ tion and training institutions to prepare the future practitioners accordingly. The training o f a physiotherapist must en ­ com pass m ulti-disciplinary and inter­ professional education and training with outcom es that are strongly related to high-level skills and aptitudes. THE DEPARTMENT OF PHYSIOTHERAPY, UOFS The D epartm ent o f Physiotherapy o f the UOFS up to now has followed a tradi­ tional instructional mode. C urrently a Bachelor of Science degree with honours status is offered, based on a sequential four-year course in a single discipline. With th’e new curriculum a movem ent to more problem -based and resource- based education and training is envisaged. In revising the program m e the general aims and outcomes have been formulated and the staff mem bers are now in the process o f defining specific outcom es, in order to select appropriate contents, compile workbooks and lay a foundation for evaluation. Detail concerning the level o f complexity, scope and learning context included in the formulation of specific outcom es is crucial if assess­ ment is to be transparent, fair and effec­ tive (Lubisi et al. 1997). The curriculum review process In order to put ourselves in the picture as far as educational reform is concerned, the lecturers o f the Departm ent attended every possible developm ent opportunity, for exam ple the staff developm ent ses­ sions offered in the Faculty o f Health Sciences, and studied literature on curri­ culum review, prim ary health care, out- com es-based education and training, and new trends in education, not only in South Africa, but world-wide. The prin­ ciples underlying the SA Q A Act, it becam e clear, represent global changes in education and training and thus we realised that if we wanted to still be relevant and provide our physiotherapy students with relevant and applicable education and training, the UOFS phy­ siotherapy curriculum would have to be review ed and adapted or changed com ­ pletely. The lecturers in the Departm ent, with the assistance of staff from the Division o f E d u cational D evelopm ent in the Faculty, held a w orkshop to decide on a modus operandi. A SW O T analysis was done (perceived strengths and w eak­ nesses in the current curriculum were w eighed up, opportunities curriculum review would afford, were identified, and possible threats the whole process o f educational innovation and renewal might hold, were pointed out). Following a session during which OBET, SAQA, the NQ F and other relevant information were discussed, the D epartm ent em ­ barked on the process o f com piling an innovative physiotherapy program m e. O utcom es o f an O B ET p hysiotherapy p rogram m e T he professio n al ph y sio th erap ist, as defined by this Departm ent, is a m ember o f the health care profession who em ­ phasises the use o f physical approaches in the pro m o tio n , m ain ten an ce and restoration o f an individual’s physical, psychological and social well-being. The core skills used to achieve this are manual therapy, therapeutic exercises and the application o f electrophysical m oda­ lities. T hrough assessm ent, problem ­ solving clinical reasoning, treatm ent and education individuals’ specific needs are addressed in order to optim ise their functional ability and potential. The critical outcomes, which are gene­ ric and not context-bound, as specified in the SAQA Act (South A frica 1998), will be pursued throughout the four-year Physiotherapy programme. In the UOFS Physiotherapy D epart­ m ent’s striving to deliver physiothera­ pists of high quality, who are relevantly trained to address the health needs o f the people, and who will be life-long learn­ ers, and at the same time satisfy the requirem ents o f the SAQA and the NQF, the follow ing specific outcom es have been form ulated, and are considered a synopsis o f outcom es to be developed during the respective stages o f physio­ therapy students’ education and training: Knowledge The student qualifying as physiothera­ pist from the D epartm ent must be able to • dem onstrate a basic know ledge of normal human developm ent, struc­ tures, pathological conditions; • apply the principles in manual thera­ peutic exercises and the application of electro-physical m odalities (as under­ stood in preventative, therapeutic and rehabilitative prom ative health); • dem onstrate fundam ental and core k n ow ledge required to q ualify as physiotherapist, as well as knowledge obtained through elective rotations; • evaluate and assess health care sci­ ences and services, by applying the principles o f health sciences. Skills The student qualifying as physiotherapist from the D epartm ent must be able to • dem onstrate the necessary clinical skills to be able to practise preven­ tative, therapeutic, rehabilitative and prom otive physiotherapy; • demonstrate relevant diagnostic skills; • com m unicate scientifically and pro­ fessionally; • dem onstrate problem -solving skills and be able to work in a group; • dem onstrate technological and other appropriate physiotherapeutic skills; • dem onstrate know ledge and skills pertaining to health care and social services that can be used in response to the varied needs o f the patient. Practice and health care service deliv­ ering The student qualifying as physiothera­ pist from the Departm ent m ust be able to • dem onstrate sound know ledge o f pro­ fessional practice in the public and private sectors; • dem o n strate k n ow ledge about the health care policy o f the country, and global trends and issues in health care; • w ork as a m em ber o f the multi-pro- fessional health team and dem onstrate know ledge of the roles o f the other m em bers o f the team; 22 SA J o u r n a l o f Physiotherapy 1999 V o l 55 No 4 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: "OLD" AND "NEW" CURRICULUM ELEMENTS "Old" curriculum "New" curriculum Passive learners Active learners; learner involvement Examination driven Continuing evaluation Rote (superficial) learning Critical thinking, reflection, active learning Content-based Outcomes-based, integrated knowledge, relevance Lecturer-centred and text-book bound Learner-centred; learning facilitation; group and team work Syllabus-bound, rigid and non-negotiable Learning programmes serve as guide for innovative and creative learning Lecturer responsible for students' learning Learner responsible for learning, motivated by continuing evaluation and feedback Emphasis on achievements Emphasis on outcomes (what the learner knows, can do and understands) • m aintain the personal, ethical and professional standards applicable to physiotherapy; • dem onstrate knowledge o f the essen­ tial acts and regulations concerning the health care dispensation, labour system and other relevant areas that have a bearing on physiotherapy as profession and in practice. Attitudes T he student qualifying as physiothera­ pist from the D epartm ent must be able to • dem onstrate a holistic approach to patients and in the social milieu; • dem onstrate a positive approach to health care services at all the levels; • dem onstrate a com m unity-orientated and primary health care approach in service rendering; • dem onstrate understanding o f and a sensitivity for transcultural issues and norms; • em bark on activities related to life­ long learning; • show insight into his/her limitations regarding knowledge and skills and the necessity o f becoming a life-long learner. C ritreria to assess and validate these outcom es m ust be developed. These should subscribe to the principles o f for­ m ative and summative evaluation. M ajor changes in the South African education and training and health care dispensations, and the need to conform to the global shift in emphasis from con- tent-based and teacher-directed curricula to outcom es-based and learner-directed curricula represent the driving force behind the revised fram ew ork o f this Department. With this new education and train in g program m e the D epartm ent hopes to make a major shift from “old” curriculum elements to innovative ideas and approaches, as contained in Curri­ culum 2005 (in Bitzer 1997): Table 1 CONCLUSION The Green Paper (D epartm ent o f E du­ cation 1998) states that in the NQ F the em phasis will be on high quality pro­ gram m es and internationally recognised qualifications which integrate education and training, preparing learners for life­ long learning as well as a career/profes­ sion. This is to be attained through out­ com es-based education and training, where the prem ise is that more attention should be paid to what emerges at the end o f the process o f teaching and learn­ ing than to the inputs. There are numerous questions which cannot be addressed in this article as this field is extrem ely com prehensive, how ­ ever, the underlying principles o f educa­ tional transform ation, which have to be taken cognisance o f when qualifications (program m es) are subm itted for regi­ stration to SAQA and the NQF, ought to be mentioned: Equity and equality, demo- cratisation, developm ent, quality effec­ tiveness, academic freedom, institutional autonom y, and public accountability (Nel & Bezuidenhout 1998). A nother im portant aspect o f p ro ­ gram m e design which has not been touched upon here, is the m atter o f cre­ dits required for a qualification to be registered. This is linked to notional learning hours, and is a topic which w ar­ rants a discussion o f its own, as are the criteria for the registration o f qualifica­ tions, as spelt out in the Act, and the bodies involved with SAQA, such as the S tandards G enerating (SG B s) and National Standards Bodies (NSBs). REFERENCES B itz e r E M . 1997. P ro g r a m b e p la n n in g en d ie N K R . U n p u b lish ed w ork in g docu m ent. A c a d e ­ m ic D e v e lo p m e n t B u reau, U O F S D ep artm ent o f Ed u cation . 1 9 9 8 . G re e n P a p e r on F u rth e r E d u c a tio n a n d T rain in g: P r e p a r ­ in g f o r th e T w e n ty - fir s t C e n tu r y th ro u g h E d u c a tio n , T rain in g a n d Work. D ep artm ent o f E d u cation , Pretoria. L u b isi C, W ed ek in d V, Parker B & G u ltig J. 1 9 9 7 . U n d e r sta n d in g o u tc o m e s - b a s e d e d u c a ­ tio n : K n o w le d g e , cu rr ic u lu m a n d a ss e s sm e n t in S ou th A fric a . S A ID E , B raam fon tein . 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