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Compare/Contrast: International Physiotherapy Education

@Koestrizer @Voxel

Finally got around to starting this thread. I think a useful way to go about this might be to discuss what we think the biggest strength and the biggest limitation of the education we’ve done so far.

@Koestrizer forgive me if I’m wrong, but I believe you’re studying physiotherapy in Germany?

Anyways, my thoughts as a Bachelor of Physiotherapy student in Australia:

Without a doubt, I think the biggest strength in the education that I’ve received is the broad spectrum of topics we’ve covered. Due to licensing structure for physiotherapists in Australia, graduates must be able to manage simple clinical cases in paediatric, musculoskeletal, sports, neurological, cardiorespiratory, geriatric, vestibular, oncological and orthopaedic physiotherapy. We also recieve a good amount of training (2 or 4 semesters, depending on the stream you select) on finding, conducting, analysing and appraising research. Personally, I feel that being exposed to a wide variety of clinical pictures has allowed me to develop a more robust philosophy of clinical care and the injury-performance spectrum. For example, it has forced my to modify my internal “model” of a good exercise and rehabilitation program, to the point that I can appropriately scale and modify stimuli to most individuals. However, having spoken to peers, I feel that this may be a reflection of a personal strength in identifying patterns between different sets of information. Without trying to brag, I feel like many of peers are left confused by the massive spectrum of possible therapeutic choices, and have failed to identify spectra or gradients of therapies and human function. I feel like this may be indicative of a failure to:

  • understand key foundational principles of human function and physiology
  • see the “big picture” in regards to seeing the “case” as an individual within the context of their environment, symptoms and diagnosis
  • think critically about what we are taught and make our own decisions

I don’t think these failures are personal failures by any other students, but instead a failure of our education to facilitate these qualities.

And that’s what brings to my the biggest drawback I perceive in my education. Though I could go on about how I feel the education they give us on exercise prescription is far too brief, I am more concerned about how my university education seems to stifle students’ abilities to think more deeply about the patient in front of them. I think the way they teach us to interpret assessment results is far too black-or-white, and doesn’t facilitate students to try and make clinical decisions in the presence of shades of grey (i.e. assessment findings that are inconsistent or confusing). Moreover, I think the way they teach and assess management techniques is far too focussed on perfect explanation and handling, and not enough on clinical reasoning in the selection and progression of therapy techniques. I also think that the education tries to get students to think about clients’ lifestyle and social situation, but doesn’t do a good job of assessing it so it never feels that important.

How would I improve the education I’ve received?

  • I would spend less practical time teaching how to perform techniques unless incorrect performance of the technique will be ineffective or dangerous. Instead, I would spend more time in practicals creating discussions on clinical cases.
  • I would not provide students with simple case studies in tutorials, but try and ramp up the complexity of cases as soon as possible
  • I would be less prescriptive in the style of teaching, and facilitate students to make their own decisions with a solid clinical justification. In exams, I would assess students less on their ability to perform a management technique, but instead focus more on their ability to select and progress a technique, and explain how it would fit into a client’s management plan within the context of their occupation, lifestyle and social status.
  • I would spend more time teaching soft skills of communication, and perhaps integrate learning from field such as social work and occupational therapy
  • I would provide more foundational information highly relevant to physiotherapy, such as theories of mtor learning and motor control, physiology of the neuromuscular system and classical mechanics (physics). However, I would do so within the lenses of human movement, function, and disability, rather than have these subjects taught as pure sciences.
  • I would hold educators to a higher standard. Some educators are clearly more passionate than others, and do a far better job providing accessible, digestible information than others. I would also ask that clinical educators do a better job of identifying and disclosing their own biases prior to and during our education.
  • I would get rid of group assignments. Seriously, group assignments are stupid and useless. I understand that they are used to assess students’ abilities to contribute to large documents such as ergonomic reports or original research, but they are not an accurate reflection of a student’s ability. I also understand they are supposed to teach students to work in a team, but they do not because students within groups lack accountability for their (non-) contribution.

Things I loved about my education and would like to see more of

  • The amount of critical thinking and clinical reasoning required in some courses was exceptional. I would love if it were more consistent
  • I loved the fact we did three anatomy and two physiology courses. I feel that the understanding of “first principles” of human function I took away from that to be incredibly helpful. However, the emphasis on examinations to assess these subjects led to far too many cramming sessions, and a low retention of information. I think teaching these courses through a more practical lens (I.e. through the lens of human function) and with a de-emphasis on examination will increase their utility
  • I like how early courses are more general and shared by participants in a multiple of degree fields. However, I think that having these multi-disciplinary courses early into the degree path is counter-productive, as students do not understand enough about their own subject fields to effectively communicate their contributions to a clinical case, yet alone understand where another clinician’s expertise are needed.
  • This is more to do with the university that I study at (The University of Queensland), but my degree has given me access to numerous highly-published and highly regarded researchers in a number of fields. However, this is a double-edged sword as these researches do not disclose their biases prior to and during an education session. The unfortunate fact is that highly-regarded researches are usually highly-specialised in their own field, and therefore (in my eyes) have a tendency to provide somewhat biased information, and once again miss the “big picture” of clinical management

Hey man, love the thread and I’m going to get back to it as soon as I can! I’m just a little swamped right now. I appreciate that you took the time mate.

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