physiotherapy, M ay 1986, vol 42 no 2 37 Deficiencies in Physiotherapy Education JOHLYNE C. BEENHAKKER SUMMARY A Study was undertaken to determine a cur­ riculum which would best meet the health care needs of South Africa, From the results of the study, the competencies required for effective physiotherapy practice were determined. When comparing the proposed curriculum to training in South Africa, areas of weakness in the present curricula were established. These areas j of deficiency are delineated and the methods i for improving physiotherapy education are dis­ cussed. i OPSOMMING ( 'n Studie is onderneem om die leerplan te bepaal wat die beste aan die gesondheidsver- j sorging-behoeftes van Suid-Afrika sou voldoen. s Van die uitslae van hierdie studie is die bekwaamhede vasgestel wat vir die effektiewe ' praktyk van fisioterapie benodig word. Toe die j voorgestelde leerplan met die opleiding in I Suid-Afrika vergelyk was was areas van swak- heid in die huidige leerplanne beslis. Hierdie areas van tekortkoming word uiteengesit en metodes vir die verbetering van fisioterapie- opleiding word bespreek. P h y s i o t h e r a p y e d u c a t o r s h av e a n o bl i g a ti o n to tr a in p ra ct it io ne rs w h o will m eet th e needs o f th e society which the y will serve. T o o o ft en ho w eve r, c u rr ic u l a are cha ng ed fol low ing tr en ds in o th e r co u nt ri e s w it h o u t mu ch t h o u g h t be in g given to w h e th e r these c ur r ic u l a are best suited f o r S o u t h A fr i c a wh ich has b o t h First and T h ir d wor ld pro bl em s. C u rr i c u la fol lo w ed in this c o u n t r y ar e ma in ly subject oriented a n d are ba se d o n th e m i n i m u m n u m b e r of ho ur s req u ir ed fo r each subject. H o we v er , if time become s th e c o n s t a n t , c a p a b i li t y will b e c o m e the v a ri ­ able.' Until we are able to define the type o f p r ac ti ti on er &e wish to p r o d u c e , a n y eff or t to d r a w up a rele van t w rri cu lum c a n n o t succeed. Ed u c a to r s nee d to g a t h e r as m u c h i n f o r m a t i o n as possible re g a r d i n g th e fu n c t i o n s a n d th e re q u i re d beh av iou rs o f a p hy si o th e ra p i st fr o m as m a n y sources as possible. A m o n g s t the v a ri o u s sou rc es av ail abl e are self repo rt s, t a s k analysis, c o ns u l ti n g with experts, rev ie wi ng t h e l i t e r a t u r e a n d t h e c r i ti c a l i n c i d e n t technique. Several o f the se m e t h o d s were used in my s t u dy to dra w up a list o f co m p et en c ie s which are re q ui re d fo r Johlyne C. Beenhakker, D.Physio. Educ., B.Sc. Physio­ therapy. Associate Professor an d Senior Lecturer, Physiotherapy Department, Medical School, University of the Witwaters- rand effective p h y s i o th e r a p y pract ice. A q u e s t io n n a i re was devised f r o m th e list o f co mp et en cie s and this was sent for r a t in g by p h y si o th er ap i st s in vari ous fields o f p r a c ­ tice. F r o m th e results o f the q u e s t io n n a i re , areas o f st re n gt h s a n d weaknesses in th e present cu rr ic u l u m co u ld be est ablished. T h e a rea s o f deficiency a nd their possible h an d li n g are discussed below. A R E A S O F D E F IC IE N C Y 1. In te rp e rs o n a l b eh av io u rs an d skills Effective c o m m u n i c a t i o n is r eq ui re d fo r ac c u ra t e his­ tor y ta k in g an d fo r reacting to the pati ent with em pat hy. S ki l ls w h ic h ar e r e q u i r e d a r e li st e n in g a tt e n t i v e l y , h e a r i n g t h e c o v e r t m e s s a g e t h e p a t i e n t is s e n d i n g , follo wi ng ve rba l an d n o n - v e r b a l leads a n d e n c o u ra g i n g pa ti e n ts an d th e ir families to discuss th e ir h ope s, fears and fr ustr ations. P er r y fo u nd th a t n on -v er ba l c o m m u n i ­ ca ti o n ac c o u n t e d fo r 93% o f all c o m m u n i c a t i o n o f feelings an d it is therefore essential t h a t p hy si oth era pi st s are a w a r e o f this i m p o r t a n t a sp ec t o f in t er p e r so n al r el at io n sh ip s .2 T h e p h y s i o th e r a p i s t also need s to u n d e r s t a n d the psy c ho lo g y o f stress a n d th e p a t i e n t ’s an d his fa m il y ’s r e a c t io n to illness a n d dis ability. She needs to be sensitive to th e i n d i v i d u a l ’s ne e ds an d his feelings o f an xi e ty a n d have th e skills to c o pe with these prob lems. T h e c u r r i c u l u m th e r e f o r e needs to c o n t a i n at least tw o b e h a v io u r a l science cou rs es in or d er to ba la n c e the h it he rt o m or e scientific a n d technical aspects o f training. Th e cou rs es m u s t c o m p r is e c o m m u n i c a t i o n skills, cu l­ tu r a l a n d social di fferen ces to illness, th e varia bles in 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. ) 38 Fisioterapie, M ei 1986, deeI 42 no 2 the fam il y s t r u c tu r e a n d the m e t h o d s o f m a n a g i n g the re act ion to stress. P h y si o th e ra pi st s need to develop basic cou ns el lin g skills a n d s h ou ld have an u n d e r ­ s t a n d in g o f th e i r o w n b e h a v i o u r a n d re a c t io n to the sick o r h a n d i c a p p e d pers on . M o t i v a t i o n an d be h a v io u r m o d i f i c a t i o n a r e a l s o i m p o r t a n t a s p e c t s o f t h e be h a v io u r a l science courses. T h e p a ti e n t needs to be m o t iv a t e d in o r d e r t h a t he m ay ta k e an active pa rt in his t r e a t m e n t p r o g r a m m e and n o t b ec o m e a passive and oft en unwilling recipient o f he al th care. 2. T eam w ork It is ess ential f o r he a lt h pr of ess io na ls to dev elo p the relative in te rp er so na l and c o m m u n ic a t io n skills in o rd er t o w o r k effectively an d with sensitivity in a te am . It is ad v o c a t e d t h a t u n d e r g r a d u a t e st u d e n ts o f th e va rious disciplines s ho ul d mix socially an d wh ere possibly a c a ­ d em ic all y in th ei r early ye ars o f tr a i n i n g . 3,4 O nce they hav e le a r n t so m e o f th e skills p ecu li ar to th ei r o w n pro fessions, they sh oul d be b r o u g h t to g e t h e r fo r c o m ­ bined lectures, w a rd r o u n d s an d case pr es en tat io ns . T his will en c o u ra g e a g re a t e r u n d e r s t a n d i n g o f their m u t u a l p r o b l e m s a n d w ill e s t a b l i s h c o - o p e r a t i v e b eh a v io u r p a tt er n s. O nly w he n s t ud en ts are able to p o o l th ei r res ources an d skills will ther e be recog nitio n o f sh a r e d respo nsi bi lit y a m o n g s t m e m b e rs o f th e t e a m a n d a closer a p p r o a c h to peer e qu iva le nce a nd m u t u a l respect. P ro b l e m solving exercises by small gro u ps o f students f r o m va ri o u s disciplines could be in tr o d u ce d int o the b e h a v io u r a l science cours es. C o m b i n e d w ar d r o u n d s in t he clinical years will f u r th e r e n h a n c e u n d e r s t a n d i n g of e a c h o t h e r ’s p r o f e s s i o n s . H e a l t h p r o f e s s i o n a l s als o require m a n a g e m e n t , leadership an d c o ll ab o ra ti ve skills in o r d e r to f u n c t io n effectively in a t e a m . 5 It m u s t be re m e m b e r e d t h a t if st u d e n ts req u ir e c o m m u n i c a t i o n skills fo r t e a m wo rk, fo r m al lectures need to be replaced by sm all g r o u p disc uss ion s. T h is will also en abl e s t u ­ d en ts to a c q u ir e p r o b l e m solving skills which will p r o ­ vide th e m with a flexible a p p r o a c h to the m a n a g e m e n t o f pr o b l e m s in an u n k n o w n future. 3. T eaching E d u c a t i o n o f th e pa ti en t, his fam ily a n d o t h e r care givers is a n int egr al p a r t o f p h y si o th e ra p y . Very few cur ri cul a c o n t a i n cou rs es in tea c h in g m e t h o d s an d in a s t u dy by S o t o s k y 6 it was f o u n d t h a t 5 1% o f the p h ys io ­ th e r a p is t s su rv ey ed did n o t believe t h a t they were a d e ­ q u at el y p r e p a r e d in te ac h in g skills a lt h o u g h they felt t h a t a m a j o r c o m p o n e n t o f the p ro f es si on is t h a t of edu ca ti on . N o w t h a t p h y s i o t h e r a p y as si st ant s are reg isterable in S o u t h A frica, ph y si ot he ra pi st s are exp ected to tr ai n these s u p p o r t i n g p e rs o nn el , while p hy si o th er ap i st s in te a c hi ng h os p i ta l s have always h ad a c o m m i t m e n t to st u d e n t tr a in in g . A n i n t r o d u c t o r y c o u rs e in ed u c a t io n a l m e t h o d o lo g y needs th er ef o re to be included in the preclinical years so t h a t st u d e n ts m ay hav e the required te a c h in g skills w hen de al in g with p ati en ts and their families. Since 1985 se n io r s tu de n ts a t th e Un iversity of the W i t w a t e rs ra n d h av e assisted in the tea c hi n g o f basic e le c tr ot h er ap y an d m o v e m e n t m oda li ti es which has in tr o d u ce d th e m to so m e simple tea c hi n g skills. 4. H elping th e p a tie n t to realise his p o te n tia l T h e reh ab i li ta t io n o f a p a ti e n t in th e h o sp it al does n o t necessarily eq u ip th e p a t i e n t to f u n c t i o n at h o m e a n d socially. Unless th e p hy si o th e ra p i st is aw ar e o f the p a t i e n t ’s h o m e cir cum st anc es, she will n o t be able to set realistic goals o f t r e a t m e n t n o r will she be able to re c o m m e n d mo d if ic ati on s fo r effective daily living. T h e items relating to final reh ab i li ta t io n were gene­ rally ra te d low in this s t ud y a n d m a n y ph ys i o th er ap i st s d id n o t c o n si d e r t h a t the se were th e fu n c t i o n s o f their pr of ession. T h is also appl ie d to co m p e t e n c y st at e m en ts de a lin g with th e in v o l v em e n t o f the fam ily in the te am a p p r o a c h . T h es e low ra tin gs were possibly d u e to the fac t t h a t st u d e n ts receive m o s t o f th ei r tr ai n i n g in the h o s p i t a l set tin g a nd the y ar e o ft en u n a w a r e o f the pr o b l e m s an d f r u s tr a ti o n s o f the p a ti en t a n d his f a m il y ' By in t r o d u c i n g st u de n ts to c o m m u n i t y p hy si oth era py d u r i n g th e ir tr ai n i n g an d by p ro vi di ng effective te a m w o r k skills, the p h y s i o th e ra p i s t will b eco me aw ar e of her e x p a n d e d role in he a lth care. Sh e s ho ul d also realise t h a t th er e is a co n si d er ab l e a m o u n t o f m at eri al w hi ch is c o m m o n to all he a lt h p ro fe ssi on al s an d th a t o ve rl a p o f skills a n d pr o ce d u r es is n o t only inevitable b ut also desirable. 5. C o n su lta tio n a n d A d m in istra tio n T o o few physi othe rap ists are aw are o f their i m p o rt a n t roles as a d m i n i s t r a t o r s an d c o n s u l ta n t s an d these areas were co nsi de red desi rable b u t n ot essential by the m a j o ­ rity of the p hy si o th er ap i st s surveyed. T h e technical ar eas rel ati ng to safe a n d effective t r e a t m e n t s were r a n k e d the highe st a nd p h y s i o th e ra p i s t s were inclined to rat e highly only th o s e items co n ce rn e d with direct p a ti e n t care. It is i m p o r t a n t f o r s t u d e n ts to be aw ar e o f the o r g a n i s a ti o n o f he a lth services in S o u t h Af ri ca and to be able to assess th e needs f o r c o m m u n i t y o r rur al h e a lt h services. This ca n be achieved by s h o r t course^ in these areas and by enc our agi ng small research p r o j e c t in t h i rd an d f o u r t h year. It is also essential to provide c o ur se s in a d m i n i s t r a t i o n an d fo r st u d e n ts to observe the adm in is tra tiv e skills w hic h are req u ir ed in hospitals, in pr iv ate practice, in special schools an d in teaching. 6. E xercise Science P h y s i o t h e r a p i s t s ar e id e al ly e q u i p p e d to b e co m e specialists in Exercise Science because o f th e ir good b a c k g r o u n d in physics, a n a to m y , physiology an d m ov e­ men t. H ow eve r, m u c h o f this w o r k is being ta k en over by o t h e r pr of ess io nal s becau se o f t he p h y s i o t h e r a p i s t ’s relu ctan ce to specialise in this field. G r e a t e r stress needs to be placed o n ar eas such as analysis o f p a tt e r n s o f m o v e m e n t, b io m ec h a n ic s and th e p re s c ri p t io n o f exercise p r o g r a m m e s ta i lo r ed to the i n d i v id u a l’s needs. T h is will include p r o g r a m m e s for inj u re d sp o r ts m e n , fo r p at ie n ts with car di ac o r chroni c 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. ) physiotherapy, M ay 1986, vo l 42 no 2 39 re s p ir a t o ry p r o b l e m s a n d fo r the elderly. A go o d i n t r o ­ d u c ti o n s h ou ld be given a t u n d e r g r a d u a t e level and p o s t - g r a d u a t e c o u r s e s a t v a r i o u s c e n t r e s s h o u l d be offered on a reg u la r basis. C O N C L U S IO N In the st ud y to d e te r m i n e c u rr ic u l a r co n te n t , it was fo u n d t h a t items rel ating to th e psy cho-social aspects of care as o p p o s e d to physical tr e a t m e n t were generally rated low. T hi s p r o b a b l y reflects the rei gning p a r a d i g m within th e p ro f es si o n b u t in o r d e r to m e et f u t u r e needs o f heal th care an d the e x p a n d i n g role o f the profession, a ch ang e in em ph as is in p h y si o th e ra p y e du c a t io n is required. T h e challenge o f g re at er a u t o n o m y wit hi n the pr of es ­ sion m a k e it ess ential t h a t s t u d e n t s a t t a i n the skills necessary to assess a p a ti e n t fully, to pla n a tr e a t m e n t p r o g r a m m e w hic h will me et the p a t i e n t ’s needs a n d to w o rk in close c o n s u l ta t io n with o th e r he al th w orkers. Jl P h y s i o th e ra p i s t s will have to a cce pt t h a t m a n y o f the te c hn iq ue s th ey pr es ent ly p e r f o r m will be d o n e by assistants an d o t h e r s u p p o r t i n g pers onn el. T h e role o f the p h y s i o th e ra p i s t is ch an g in g an d the p h y si o th e ra p y s t u d e n t sh ou ld be m a d e aw are o f the m a n y facets of her pro fession. Sh e sh oul d perceive the i m p o r t a n c e of her c a p ac it y as a tea ch er, co n s u l ta n t , a d m i n i s t r a t o r and re s e ar c he r, in a d d i t i o n to her t r a d it io n a l clinical role. P h y s i o th e r a p y e d u c a t o rs mus t n o w decide w h et h er they req u ir e p ro fe ssi ona l leade rs w h o will seek feasible so l u ­ ti o ns to the m a n y p ro b l e m s in h e a lt h c ar e, o r w h e t h e r they wish to tr ai n p r i m a r y d o er s who will only w o rk with co m f o r t u n d e r direction. References 1. Simpson M. Evaluation and Education. Leech 1985; 55(1): 6-8. 2. Perry JF . Non-verbal Communication during Physical Therapy. Phys Ther 1975; 55(6): 593-600. 3. Lloyd KN. Combined Training Institution of New Uni­ versity Hospital of Wales. Physiotherapy 1971; 55(6): 73. 4. Simpson MA. M edical Education. A Critical Approach. London: Butterworths, 1972. 5. Simpson M. The health team. Leech 1985; 55(1): 13. 6. Sotosky J R . Physical T h era p is t’s Attitudes towards Teaching. Phys Ther 1984; 64(3): 347-349. CORRESPONDENCE T o th e E d ito r: 1 sha re D r F u t e r a n ’s c o n c e r n a b o u t P h y s i o t h e r a p y tr aining in Geriatrics. As fa r as 1 k n o w , all sc ho ol s include t r a in i n g in this area. However, it w ould a p p e a r th a t som et h in g is lacking — p e rh a p s Geria tr ic s a n d G er o n to l o g y are ta u g h t by people w h o are n o t ex p er t s o r hav e little in te re st in the subject and th u s c a n n o t c o m m u n i c a t e e n th u s ia s m for, f r evoke interest in the subj ect in thei r st ud ent s. C ou ld o u r e d u c a t o rs tak e a closer look at this aspect? H. A. Wilson C o n tro l P hysiotherapist, A d d i n g t o n H o sp it al , D u r b a n E R R A T U M ‘A p r el im in ar y st udy o f chair s with fo r w a rd sloping seats an d sitting p o s t u r e s ’ 1985; 41(3): 74-77 and ‘Are you sitting co m f o r ta b ly ? U s e r s ’ p e rc ep t io n s o f a pelvic tilt c h a i r ’ 1985; 41(4): 119-115. T he a c k n ow le d ge m en t sh oul d read: This w o rk was s u p p o r te d by the M ed ic al Resea rch Council o f S o u t h Af ri ca a n d D r H y m a n Goldb erg. F o r O rth o p a e d ic A p p lia n c e s , S u rg ic a l corsets, C e rv ic a l c o lla rs, C h ild re n ’s shoes & b oots, A r tific ia l lim bs, Latest in p la s tic m o d ific a tio n . F o r H irin g a n d s e llin g o f H o s p ita l E q u ip m e n t a n d S ic k ro o m re q u is ite s - W heel ch a irs , w a lk in g aids, C om m odes, H o s p ita l b eds,' T ra c tio n a p p a ra tu s Visit the o rth o p a e d ic m echanicians A. C. MILLER & Co. Technicians registered w ith the S.A. M e d ica l and D ental C o u n cil 275 BREE STREET JOHANNESBURG T ele p h o n e (0 1 1 ) 337-4763 P.O. B o x 3412 J o h a n n e s b u rg 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. )