A model for community physiotherapy from the perspective of newly graduated physiotherapists as a guide to curriculum revision

Abstract

Background. Limitations in physiotherapy curricula have been reported. Work-based experiences, especially during compulsory community service, could inform curricula. Objective. To develop a model of community service physiotherapy to guide curriculum reform. Methods. In this appreciative inquiry, trained physiotherapy students conducted tele-interviews with newly graduated physiotherapists. Twelve recently graduated community-service physiotherapists -heterogeneous in gender, mother tongue, university attended and work setting -were purposively recruited. Two coders applied Tesch's coding technique to the transcripts; one did paper-based work and the other used AtlasTi software. Consensus was reached and a member check done. Results. Four themes identified were: (i) the essence of community physiotherapy; (ii) the collaborative nature of community physiotherapy; (iii) prerequisites for a positive practice environment; and (iv) community physiotherapy as a gateway to personal growth and professional development. Physiotherapists consult clients from varied cultural backgrounds, ages and health and disease profiles. Health education is a key intervention, but clients emphasised therapeutic touch. Team work enhances services, especially within a context of poverty, and prevents isolation. New graduates have to deal with inefficient management, lack of transport, inadequate equipment and needs resilience. They want discipline-specific supervision. Conclusion.Community physiotherapy makes specific demands, especially for novice therapists. Service-learning in authentic diverse contexts would foster professional development and cultural competence. Clinical competency should remain the backbone of the curriculum, complemented by competency in health education. Different ways of reflection would facilitate lifelong learning and growth in attributes such as resilience, which is necessary for dealing with sub-optimal practice environments.

Home-based rehabilitation: Physiotherapy student and client perspectives

“…[2,4,6] The students stated that being proficient in isiXhosa would have helped in HBR to minimise the verbal communication barrier. They reported that an introductory isiXhosa course in their 1st year seemed irrelevant to them at the time.…”

“…[2,4] These communities are often situated in under-resourced areas. Experiencing the real-life context of clients is vital for students so that they will ultimately provide effective interventions and develop social responsibility.…”

“…[12] HBR leads not only to academic learning and personal development, but also to an understanding of social accountability and responsibility. [2,3] However, to gain maximum benefit from the learning opportunities available, students should be prepared effectively before exposure to HBR. [4] There is a scarcity of literature on HBR in the physiotherapy context, specifically with regard to the students' or clients' perceptions.…”

“…Experiencing the real-life context of clients is vital for students so that they will ultimately provide effective interventions and develop social responsibility. [2] Students witness the roles of poverty and society in health first-hand during home-based rehabilitation (HBR). Students report feeling overwhelmed when witnessing the realities of life in poor households.…”

“…[1] Physiotherapy education should produce graduates who are competent in addressing the health needs of the people within the community context. [2] Graduates need to serve as health advocates and be accountable for making informed decisions to improve healthcare. [3] To enable them to be more effective in this regard, graduates need exposure to the realities of the healthcare system, socioeconomic health determinants, and clients' real-life situations through PHC.…”