Academic journal article Journal of Allied Health

Factors Affecting Curriculum Content and the Integration of Evidence-Based Practice in Entry-Level Physiotherapy Programs

Academic journal article Journal of Allied Health

Factors Affecting Curriculum Content and the Integration of Evidence-Based Practice in Entry-Level Physiotherapy Programs

Article excerpt

Decisions about auricular content in entry-level health professional programs are influenced by a variety of external and internal factors. However, little is known about how lecturers make decisions about the curricular content to be included or excluded from entry-level programs. This study aimed to explore the factors influencing such decision making regarding curricular content in entry-level Australian and New Zealand programs for physiotherapy, as well as how evidence-based practice (EBP) is integrated into the teaching and learning framework. Thirteen lecturers from 13 institutions (100% response rate) responsible for teaching a core part of physiotherapy practice, electrophysical agents, participated in a semistructured telephone interview. Decision making for curricular content involved an overall democratic process with the program team, but the day-to-day content was determined by the lecturer. Factors that lecturers reported as impacting on the choice of curriculum were current clinical practice, evidence, and accreditation or registration requirements. Thematic analysis of open-ended questions identified four main themes relating to the integration of the EBP paradigm within teaching: resource materials, use of broad definitions of evidence, inclusion of specific instructional strategies, and context of curriculum. Lecturers used a variety of research methodologies as a backdrop for the presentation of techniques and interventions that are used commonly in clinical practice despite limitations in the evidence base. The results highlighted tensions that exist when designing entry-level curricula with the need to prepare competent and safe practitioners while working within an EBP paradigm. J Allied Health 2007; 36:17-23.

ENTRY-LEVEL PROGRAMS for the health professions must ensure that beginning practitioners are competent and safe to practice within the scope of their discipline and that they are aware of the current dominating paradigms within health care.1,2 The move away from apprenticeshipbased education models for allied health care professions toward university-based degrees provided for the need for predictable and standardized training and also implicitly encouraged health professions to explore, innovate, and experiment while providing students with new and sometimes controversial material within the curricula.3 At the same time, however, lecturers involved in health care education have to respond to local and international trends in clinical practice, the demands of accreditation and registration authorities, and workload and time constraints.4,5

Accreditation systems for physiotherapy (known as physical therapy in some countries) such as the Australian Council of Physiotherapy Regulating Authorities Ltd. in Australia and the Commission on Accreditation in Physical Therapy Education in the United States offer limits and guidance but do not provide an hour-by-hour description of required curricular content. Specific decisions concerning curricula (such as what should be included, removed, and excluded; the mode of teaching and nature; and type and scheduling of assessments) are the responsibility of the lecturers. Little is known about how lecturers make decisions and the factors that impact on choice of curricula.

Competence with electrophysical agents is a core requirement of beginning physiotherapy practitioners. Consistent with this, subjects on electrophysical agents have been included in entry-level physiotherapy curricula since the inception of the profession.6,7 Electrophysical agents consist of three main energy forms (thermal, sound, and electric and electromagnetic energy) that can be applied for therapeutic (and sometimes diagnostic) purposes and biofeedback.8-10 Table 1 summarizes the variety of electrophysical agents currently used by physiotherapists in Australia and New Zealand.

Over the past decade, evidence-based health care has become a global philosophy underpinning the decisionmaking process in the clinical management of health care consumers. …

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