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
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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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@Koestrizer how’s the schedule looking mate?

Right now less crazy (mainly because I just let things slide). But of course I forgot this thread and want to offer my sincere apologies!!

I’m now working on a response to detail my own program and then we can start responding/ comparing.

Let me start by describing the situation over here and especially the one I am in in my physiotherapy education.
I’m doing my states exam in physiotherapy and bachelor in therapy sciences - physiotherapy in Germany and am currently near the end of my third semester.
Here we have the first situation that might seem strange - because it is. The academization of physiotherapy is something new and still in it’s development over here. Right now the majority of physios and physio education programs are apprenticeships/ skilled occupations (I don’t know if Australian’s have a similar job education program to us. I know the USA for example is very different and they don’t have a comparable job education system, so an apprenticeship isn’t really something that exists over there in the form it does here).

So we currently have several ways and levels of degrees to become a physio right now.
To my knowledge, each one has to include the state exam. Which may sound like a good idea in theory but with how it’s done right now, it’s actually one of the biggest critiques I have.
Here’s why: The curriculum for the state’s exam hasn’t changed in forever and is in no way up to modern scientific standards. We have to essentially learn, and prove that we’re able to perform, techniques that hopefully even the slowest person has come to realize, are plain wrong and outdated bullcrap.

The whole physio landscape here, as it is the case in some other countries as well, is very much divided and there’s a big divide between eminence based knowledge, which has it’s foundation in older bio-medical-theories and justifies itself essentially with “this is how we’ve always done it” and “he who heals is right”. On the other side you have the evidence based practitioners, whom you’re probably more familiar with. The problem is: You have to acquire that knowledge in large basically all on your own while you learn a lot of stuff that I’m sure I’m never going to actually learn.

Let’s zoom out a bit and lay out the structure of what I’m doing (and when I say I, that is very much meant that way because as I said there are different and tbh much easier ways of becoming a physio here).
I am studying for 4 years in total. After 3 years I’ll have to pass my state exam, at which point I am a licensed physiotherapist. After 4 years I’ll have my bachelor of science degree.
The first year of my education was solely dedicated to learning in physio school and studying at the university. We would practice practical techniques on ourselves.
Beginning with the third year we start at the hospital (our school and whole program is bound to the university hospital in town - one of the largest hospitals of this region). From now on we work mornings at the hospital and afternoons/ evenings at the university and/ or school. Every 3 months we switch our deployments to different departments (neurology, internal medicine, orthopedics, surgical, pediatric, psychiatry and one deployment outside the hospital).

The advantage here is the huge pool of patients we get to treat. However the focus is very much hospital and super early rehabilitation based naturally. We do have outpatient treatments that come in once or twice a week so we can have some more structured and longevity focused therapy approach.
The treatment of our patients in large parts very independent with some supervision but not that much. That is both a positive and a negative in my book because a lot of us do not feel confident
and self sufficient when making therapy decisions but I personally enjoy that.

So I see some first similarities here.

One big negative is the horrible organization and incredible workload. We do get paid above average (for a dual study/ apprenticeship education program) but it doesn’t match what you have to put in and honestly it seems this is actually breaking people (down). A lot of that stems from the non existent communication between the university and the physio school. On average I would say we have to put in 60 hours a week, if you want to be somewhat caught up. I also had 16 exam performances of various kinds last semester alone! That is honestly completely insane and we are also the last batch of students to endure this because they changed the whole program.

Also the university education is in large parts just laughable and a complete waste of time. Now I have to remind you at this point that I already have a degree, so scientific working isn’t new to me, like it is to most of my peers. That’s the only thing we’ve covered so far, that I would deem useful otherwise. A lot of our university classes are aimed at interprofessional cooperation and we have them together with students of other occupations (like nurses). Those are complete garbage and far outside the reality of the medical field.

I’ve already hinted at this but by a very long margin, my biggest point of critique is the focus of the theoretical and practical education we receive at school. It’s outdated and in parts just disprooven and wrong. We focus so much on the details of techniques like manual therapy (which aren’t specific to begin with) and PNF (which is okay but definitely nothing essential) or Bobath (which… yeah whatever) and not enough on active treatment options and things outside of a hospital setting.

So far: Non existent. Not kidding. There will be a a very very brief class on this but from what I’ve hear, it’s useless.

I will give this more thought but we can start with this.