|Year : 2018 | Volume
| Issue : 1 | Page : 30-36
Structured curriculum delivery in undergraduate physiotherapy education: A qualitative study
Kavitha Raja1, Jakson K Joseph2, Jerin Mathew3
1 Department of Basic Science, JSS College of Physiotherapy; JSS PMRC, Mysore, Karnataka, India, India
2 Department of Basic Science, JSS College of Physiotherapy, Mysore, Karnataka, India, India
3 City Neuro Centre, Mysore, Karnataka, India
|Date of Submission||05-Nov-2017|
|Date of Acceptance||18-Apr-2018|
|Date of Web Publication||19-Jun-2018|
Dr. Kavitha Raja
JSS College of Physiotherapy, Mysore - 570 004, Karnataka
Source of Support: None, Conflict of Interest: None
CONTEXT: Physiotherapy curriculum has undergone a major change in the past several years. Over time in addition to content, some of the skills are given less importance, resulting in attrition of skills with increase in theoretical knowledge.
AIMS: The aim of this study is to assess the feasibility and response to a structured method of curriculum delivery
SETTINGS AND DESIGN: The study was conducted at College of Physiotherapy in Karnataka. The study design is qualitative.
SUBJECTS AND METHODS: Method of data collection for Phases I and III was through interviews using both in-depth interviews and focus group discussions. For Phase II, a multi-step Delphi approach was undertaken.
STATISTICAL ANALYSIS USED: Triangulation was performed from the interview output, and the codes and themes were extracted. Trustworthiness of emergent themes was assessed through interviews conducted on a different cohort of faculty members and students.
RESULTS: Predetermined themes that were assessed are ease of integration of subject from student's point of view and carryover of theoretical knowledge and skills in to the clinical work. The new themes that emerged after Phase I were that practical classes were important in all subjects and vertical and horizontal integrations of subjects are required. Phase II consisted of development of manuals and checklists. Phase III results revealed that the new system assisted teachers in delivering uniform knowledge across batches and helps students to understand the relevance of subjects studied.
REFLECTIONS: Comments from Phase III are indicative of the achievement of the goals identified in Phase I through the methods described in Phase II.
Keywords: Clinical competencies, knowledge-centric learning, physiotherapy skills, practical classes
|How to cite this article:|
Raja K, Joseph JK, Mathew J. Structured curriculum delivery in undergraduate physiotherapy education: A qualitative study. Physiother - J Indian Assoc Physiother 2018;12:30-6
|How to cite this URL:|
Raja K, Joseph JK, Mathew J. Structured curriculum delivery in undergraduate physiotherapy education: A qualitative study. Physiother - J Indian Assoc Physiother [serial online] 2018 [cited 2020 May 28];12:30-6. Available from: http://www.pjiap.org/text.asp?2018/12/1/30/234690
| Introduction|| |
Physiotherapy education in India and the rest of the world has undergone a vast change in the past three decades. From being an ancillary service where a physiotherapist (PT) performed as a prescriptive applicator, the PT of today is often a first-contact reflective practitioner. In the previous role, a great deal of emphasis was placed on practical skills. With the change from a 3-year to a 4½- year course in India, the load of theoretical subjects increased greatly. Along the way, the emphasis placed on practical skills was diminished.,,,,, The practical skills were expected to be imparted during clinical rotations. However, this was often not possible due to the volume of procedures (both evaluatory and interventional) increasing day by day.
The curriculum of the University is an illuminatory one, despite a few errors and its many detractors. The syllabus offers a framework which gives ample opportunity for innovative curriculum delivery., Considering this, the College of Physiotherapy embarked upon a challenging and ambitious project of structuring the curriculum delivery under the broad terms of lesson plan (theory), practical manual (practical skills), and student clinical assessment logbook (SCALB), which is devoted to translational practice of theory and practical skills on the individual patient in the clinic. This was instituted in the academic year 2014–2015.
The objective of this paper is to analyze the impact of this educational practice on learning outcomes in the students and teaching methods and behavior in teachers.
| Subjects and Methods|| |
The methods section is divided into three phases. Phase I consists of needs assessment, Phase II consists of development of the structure of curriculum delivery, and Phase III consists of assessment of impact. The study was approved by the ethical committee of the medical college.
The study design of all three phases is qualitative.,
The sample consisted of:
- Representative students of I, II, III, and IV Bachelor of Physiotherapy (BPT) in 2013–2014 (who have successfully completed their university examinations in the relevant year) and teachers teaching core physiotherapy subjects in the 4 years for Phase I
- Teachers of various core physiotherapy subjects in 2014–2015 for Phase II
- Representative students of I, II, III, and IV BPT in 2016–2017 and teachers teaching core physiotherapy subjects in the 4 years for Phase III.
volunteers were sought from the enrolled students of all 4 years of BPT. Volunteers from each year where there were >4 participants were interviewed using focus group discussion (FGD). When the number of volunteers was four or less, in-depth interview (IDI) method was utilized. Thereafter, IDI was conducted with an alumnus to ascertain the trustworthiness of the findings. The results of these were triangulated with observational data from examinations and clinical rotations taken from teachers [Figure 1].
To overcome the issues identified in Phase I, a succession of meeting of the department faculty members was conducted to brainstorm possible solutions. These meetings revealed that there was consensus in the need to structure and formalize curriculum delivery with measurable outputs and metrics. Thereafter, a three-round Delphi process was organized to formally put the suggestions to practice [Figure 2].
At the end of 2016–2017 sessions (following 3 years of implementation), data were collected again as in Phase I [Figure 3].
The predetermined content areas , that were utilized for the data collection for Phases I and II are depicted in [Table 1].
|Table 1: List of predetermined content areas used for interview in Phases I and II|
Click here to view
The framework used for data collection is depicted in [Table 2].
| Results|| |
The numbers of participants from the student community are depicted in [Table 3].
The number of participants from the teacher community who participated is depicted in [Table 4].
Data saturation occurred at the third FGD with students. Triangulation of the data collection methods was conducted, and the codes and themes were extracted , [Table 5].
Observations from faculty were collated to identify the following information:
- Students seemed to be studying only to pass examinations
- The purpose of the subjects studied was not understood
- Despite instructions, students rarely practiced procedures in exercise therapy and clinical PT subjects
- Students rarely carried essential instruments with them to clinics
- Procedures were not followed according to the standards, and there was no carryover of using guidelines in the clinical areas
- During practical classes, only a handful of students actually practiced, while the rest were observers or merely learned procedures by rote
- Although procedures were explicitly taught, in the clinics, they used shortcuts, for example, approximating range of motion instead of using a goniometer.
Based on triangulation of the themes extracted from students and observations of teachers in Phase I, the following issues were identified:
- Poor understanding of the relevance of the curriculum
- Poor adherence to standards and guidelines while performing procedures
- Inability to integrate learning at different levels and translate to practice.
Following triangulation of themes, the following areas were identified as thrust areas for Phase II.
- Need to articulate learning objectives more clearly for theory, practical, and clinical areas
- Practice of skills must be articulated adequately, incorporated in timetable, and made mandatory
- Integration of subjects at year and across years must be achieved through curriculum delivery
- Translation of knowledge and skills to the clinical practice must be achieved through setting up of standards to be assessed
- Clinical rounds must be conducted and patient care to be assessed on an ongoing basis
- Competencies expected to be achieved must be articulated and assessed periodically.
A three-round Delphi process was organized to formally put the suggestions to use. The output of this process was the following innovations to address each of the thrust areas identified in Phase I [Table 6].
|Table 6: Salient points of curriculum restructuring relevant to thrust areas|
Click here to view
The students were introduced to the new system and teachers were trained in the use of the system. Students were expected to carry the toolkit with them to practical and clinical classes, and the practical manual had to be completed to be eligible for university examinations. Moreover, BPT III- and IV-year students had to complete the SCALB pertaining to their specific subjects. Interns had an additional SCALB requirement. Moreover, fortnightly, seminars are conducted on selected topics for the entire college to bring about vertical integration of subjects [Table 7].
|Table 7: Structure of a seminar conducted as part of vertical integration of subjects|
Click here to view
The results of the interviews conducted in Phase III are depicted in [Table 8].
IDIs of faculty were conducted to assess acceptability and feasibility. The results are depicted in [Table 9].
As there were unexpected themes that emerged from the faculty interviews, FGD was conducted with recently appointed faculty to assess the trustworthiness. Five faculty members with nil to 7 years of previous teaching experience were interviewed for this phase [Table 10].
|Table 10: Themes extracted from faculty interviews in Phase III to assess trustworthiness of emergent themes from senior faculty interviews|
Click here to view
Reflections and the road ahead
The shift in focus of PT education to theory has been well documented from across the world. While this is inevitable in light of the vast amount of research generated in the field, the value of the shift away from practical skills is arguable. The vast majority of PTs rely on their interviewing and clinical examination skills to reach a hypothesis and plan management strategies. To put the theoretical knowledge and research evidence to use, the skills of clinical examination cannot be overstated., This is a lacuna that we identified. One of the arguments is the lack of time to have dedicated practical classes. At our college, we have dealt with this problem by adhering to the university mandated number of practical classes through the methods described in Phase II. While the university mandates only two laboratories for core physiotherapy, we have dedicated a laboratory for each subject. This effectively obviates the need to juggle schedules. With a clear-cut practical lesson plan and a list of competencies to be mastered, there is clear communication between students and teachers on the learning outcomes.
Staff attrition is a reality in most of the colleges. Often, staff changes happen in the middle of the academic year. Many staffs being young and their teaching may be ineffective. Hence, clear learning outcome and knowledge domain can help bringing about some amount of uniformity and constitution consistency.
The acceptability of the system is clear from the results of Phase III. Both teachers and students are appreciative of the system. A large amount of planning is required, and continuous review and revision of the curriculum are also required. Despite this, most of the teachers are happy with the structure. There were a few reservations on the actual effectiveness of the system, and teachers were of the opinion that training was necessary and disciplined adherence to the system was essential for clear benefits. Clarity in the knowledge acquisition methods and purpose is necessary for student involvement. Integration of various subjects is also essential as students may not entirely grasp the purpose of some of the peripheral subjects. We have made an effort in this direction by means of general seminars. Moreover, project-based assignments are created to achieve this end.
The shift from teacher-centric learning (apprentice model) to knowledge-centric learning with emphasis on reasoning and critical thinking has been well documented as essential in higher education and more so in health-care professions., The comments from Phase III are indicative of the achievement of this shift with the methods described in Phase II.
This study is a qualitative study. No effort has been made to make objective comparisons of results between Phase I and III. This is not possible as examinations are conducted by the university, and the curriculum delivery design described here is limited to our college. Examination pattern at the university level does not reflect this structure.
All the materials that are described in Phase II are available freely. We have made major revisions in academic year 2017–2018 based on review of the documents by a new set of faculty not engaged in the initial development and a consensus meeting with some of the original developers.
As this is a preliminary study, no definitive conclusions can be drawn and further longitudinal studies over a period of 5 years (completion of course of one batch) are warranted to draw conclusions. This is a future direction of this study. The sample size was restricted upon data saturation for all phases. As this was done in a single center, data saturation occurred quickly. Hence, a future direction is to involve other institutions in the study and enhance the sample size.
We are deeply indebted to faculty members who contributed to Phase II: Annie Thomas, Kavya MS, Nagarjuna N, Prashanth M, Renukadevi M, Sandeep PH, Siddharth Mishra, Vijay Samuel Raj. We appreciate the effort of the following faculty as well: Alagarasan P, Nityal Kumar, Sharvani B, Nagina Nikath, Aditi Bhandiwad, Parameshwar Anche, Ashwini N Raj, Ajitha M, Bipin Puneeth, Siddesh NS and Saumen Gupta, students, and alumni who participated in Phase I and III.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dalton M, Davidson M, Keating JL. The Assessment of Physiotherapy Practice (APP) is a reliable measure of professional competence of physiotherapy students: A reliability study. J Physiother 2012;58:49-56.
Delany C, Bragge P. A study of physiotherapy students' and clinical educators' perceptions of learning and teaching. Med Teach 2009;31:e402-11.
Dalton M, Davidson M, Keating J. The Assessment of Physiotherapy Practice (APP) is a valid measure of professional competence of physiotherapy students: A cross-sectional study with Rasch analysis. J Physiother 2011;57:239-46.
Meshram S. Physiotherapies constructive learning theory: Exploring the possibilities for this interactive teaching learning methods in physiotherapy education. J Nov Physiother 2015;5:1-5.
Krause KL. Best Teaching Practice in Physiotherapy Education: What Can We Learn From Research? In: Centre for the Study of Higher Education, University of Melbourne Inaugural. Victoria; 2006. p. 1-5.
Panhale PV, Bellare B, Jiandani M. Evidence-based practice in physiotherapy curricula: A survey of Indian Health Science Universities. J Adv Med Educ Prof 2017;5:101-7.
The Curriculum of the Rajiv Gandhi University of Health Sciences is An Illuminatory One Despite a Few Errors and Its Many Detractors (Professor Kavitha Raja, Personal Communication, 2017 October 23); 2017.
Baxter P, Jack S. Qualitative case study methodology: Study design and implementation for novice researchers qualitative case study methodology: Study design and implementation. Qual Rep 2008;13:544-59.
Suter WN. Qualitative data, analysis, and design. In: Introduction to Educational Research: A Critical Thinking Approach. 2nd
ed. USA: SAGE; 2012. p. 342-86.
Taylor-Powell E, Renner M. Analyzing Qualitative Data. Madison: University of Wisconsin-Extension; 2003. p. 3658-12.
Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004;24:105-12.
Brazil K, Ozer E, Cloutier MM, Levine R, Stryer D. From theory to practice: Improving the impact of health services research. BMC Health Serv Res 2005;5:1.
Alderson P. The importance of theories in health care. BMJ 1998;317:1007-10.
Alhaqwi AI, Taha WS. Promoting excellence in teaching and learning in clinical education. Taibah Univ Med Sci 2015;10:97-101.
Bortone J. Critical Thinking and Evidence-Based Practice in Problem-Based Learning Tutorial Groups: A Critical Case Study [Ed.D]. Sacred Heart University; 2007.
Ahmed AK. Teacher-centered versus learner-centered teaching style. J Glob Bus Manag 2013;9:22-34.
Mason M. Sample size and saturation in PhD studies using qualitative interviews. Forum Qual Soc Res 2010;11:1-14.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]