2005 - Learning Outcomes - Physiotherapy

LEARNING OUTCOMES AND
CURRICULUM DEVELOPMENT IN
AUSTRALIAN PHYSIOTHERAPY EDUCATION
Joan McMeeken, Gillian Webb, Kerri-Lee Krause,

Ruth Grant & Robin Garnett
The University of Melbourne

March 2005
A PROJECT FUNDED BY THE

AUSTRALIAN UNIVERSITIES TEACHING COMMITTEE
Acknowledgements
ACKNOWLEDGEMENTS
_____________________________________________________________________
The AUTC Project Team is grateful for the support given to this project in the first
instance by the Australian University Teaching Committee (the AUTC), Dr Peggy
Spratt, AUTC Secretariat and the Project Steering Committee, Professor Christine
Ewen and subsequently Professor Gail Hart (AUTC appointed Chairs of the Project
Steering Committee), Associate Professor Richard James and Ms Dawn Best.
The Project Team has also appreciated the significant contribution to this report made
by the heads of schools of physiotherapy in Australia and their academic contact staff
and by invited contributors, including Professor Joy Higgs and international
colleagues, Ms Lesley Bainbridge, Dr Lesley Dawson, Professor Nancy T. Farina and
Professor Pat Wrightson.
The members of the focus groups, students, recent graduates, employers and academic
staff gave of their time and knowledge of physiotherapy education. Further groups of
employers and academics completed the survey forms. We are especially grateful to
those contributors who gave extended feedback and responses.
The project team thanks Dr John Ainley (Australian Council for Educational
Research) and Mr Bruce Guthrie (Graduate Careers Council of Australia) for advice
about the Course Experience Questionnaire (CEQ).
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Executive summary
EXECUTIVE SUMMARY
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This report identifies, describes and evaluates curriculum development and review
processes and pedagogical innovations in Australian physiotherapy education. The
review focuses on these issues in relation to the requirements of new areas in health
education, which include multidisciplinary practice and information and
communications technology (ICT), as well as to the needs of key stakeholders such as
students and employers.
Data were collected using a range of qualitative and quantitative methods. The project
team consulted nationally with stakeholders including current physiotherapy students,
recent graduates, clinicians, academic staff, heads of schools of physiotherapy,
employers, representatives of the peak professional body, education experts and
international physiotherapy educators. In addition, the heads of schools have provided
the project team with examples of effective learning and teaching practices in their
courses. A selection of these is listed in this report. More information on these
examples of good practice will be disseminated in Stage 2 of the project.
Demographic data for physiotherapy students shows similar patterns of diversity to

those seen in the wider national student body in Australian universities. This diversity
stems from a number of factors including age, ethnicity and levels of prior education.
Accompanying the growing student diversity has been a rapid increase in the number
of schools of physiotherapy and also in the range of course types offered. These
include entry level masters courses and double degrees.
In order to contextualise this review of curriculum processes in physiotherapy, the

report outlines the national role of the Australian Council of Physiotherapy Regulating
Authorities (ACOPRA). The fact that registration is a requirement to practise as a
physiotherapist in every state and territory has significant implications for
physiotherapy curriculum development at the national level. ACOPRA was
established in 1995 to maintain a consistent national approach to physiotherapy
registration, to advise on standards and processes relevant to the recognition of
physiotherapy qualifications and to act as the custodian of the Australian
Physiotherapy Competency Standards (APCS). The primary function of ACOPRA is
that of accreditation of physiotherapy courses. Clear specification of learning
objectives both for entry level physiotherapy courses overall, and for individual
subjects is a requirement of the ACOPRA accreditation process; as is the need for
universities to demonstrate the outcomes of the course through the performance of
graduates in relation to the APCS in all key areas of physiotherapy practice.
Employers of recent physiotherapy graduates are generally highly satisfied with

graduates’ level of competence across a range of areas. In particular, they rate new
graduates’ professional behaviour most highly, along with their openness to new ideas
and receptiveness to the use of information and communication technologies (ICTs) in
healthcare settings. Despite the many strengths identified by employers, they also
perceive some weaknesses including: that some physiotherapy graduates do not
integrate some elements of theory and clinical practice and that, in some cases, this
was due to limited clinical experience during their undergraduate course. This was
particularly evident in their lack of preparedness to work in private practice. Other
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Executive summary
areas of clinical practice that employers perceive to be somewhat lacking among

recent graduates include paediatric physiotherapy and critical care physiotherapy.
Recent graduates’ satisfaction with physiotherapy courses is evaluated through the

Course Experience Questionnaire (CEQ). The outcomes of the CEQ provide a
valuable overview of new graduates’ views of their course experiences. National
responses over a number of years have consistently shown high levels of graduate
satisfaction with the quality of their course, along with consistent reporting of high
workloads.
Document analysis and discussions with academic staff and heads of schools of
physiotherapy confirm that entry level physiotherapy curricula are comprehensive,
respond to the need to include an increasing knowledge base and changing health
practices. Physiotherapy curricula across Australia also reflect an awareness that new
physiotherapy graduates are increasingly likely to begin professional life as
practitioners of first contact without the benefit of mentoring or preceptorship from
experienced physiotherapists in an increasingly constrained health sector.
As part of this review, the project team investigated the role of learning outcomes in
physiotherapy pedagogy and curricula. Our findings confirm that learning outcomes
in pedagogy and curriculum processes are considered to be important at all levels of
curriculum design, delivery and review, from the day-to-day class level to the year-
by-year course level. Academic staff, attach a high level of importance to writing
objectives, at all levels of the curriculum. Feedback from students suggests that they
are familiar with the concept of learning outcomes, which they most readily equate
with objectives; yet they do not necessarily appreciate the value and role of learning
outcomes in facilitating their learning. Our findings suggest that the discipline would
benefit from a more clearly articulated discussion of the distinction between and
complementarity of learning outcomes and objectives, as outlined in ACOPRA
requirements.
The project team found considerable evidence of assessment and monitoring of

learning outcomes on a national level from external bodies, such as ACOPRA, and
through government initiatives such as the Australian Universities Quality Agency
audits. Curriculum review at the institutional level is informed by quality of teaching
surveys and various forms of student feedback. As well, there is widespread evidence
of monitoring and, increasingly, of evaluation of support programs such as mentoring,
transition programs and specific programs to support students from Non-English
Speaking Backgrounds (NESB).
Many examples of good practice in learning and teaching were cited during the course
of this project. Students and graduates alike emphasise the value of small group
teaching, integration of theory and practice and learning in context. Early clinical
exposure is seen as highly desirable but not always available. Multidisciplinary
teaching is incorporated in all schools with a number having explicit subjects covering
this area. All schools report extensive use of ICTs in learning and teaching. Graduates
and students comment on the dedication of teaching staff and the support given to
students for their learning.
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Executive summary
Concerns were expressed at the increasing amount of content required to be included

in the curricula and the challenges facing curriculum developers in preparing students
to practice in increasingly complex work environments, with rapid increases in
knowledge and treatment approaches used in physiotherapy. Concerns about the
increasing workload imposed by the overcrowded curriculum were voiced by both
staff and students. Feedback from academic staff confirms the need for ongoing
educational research in the field of physiotherapy so as to inform curriculum change
and support existing good practice in physiotherapy education.
Several comments focussed on the fact that, throughout their working lives,
physiotherapy graduates need access to professional development to broaden and
deepen their skills and knowledge and formal postgraduate study to develop specialist
areas of knowledge. Employers expressed the need for graduates to have further
education in fields such as paediatrics, disability management, rural physiotherapy,
community physiotherapy and physiotherapy in the schools sector.
The issue evoking most concern and comment is that of the ability of schools of
physiotherapy and their professional clinical colleagues to continue to deliver
appropriate clinical education within current resource constraints. This is one of the
most significant challenges currently facing physiotherapy educators and the
profession as a whole. Appropriate clinical education is fundamental to preparing safe
and effective graduates reaching the expected competency levels as designated by
ACOPRA and the demands of the workplace. A considerable number of comments
related to the lack of funding or the small amount of funding available for clinical
education. Many respondents referred to the need for a post-graduation year of funded
supported practice as occurs in nursing, or a funded intern year as occurs in medicine.
Overall, the findings of this study confirm that Australian physiotherapy curricula
prepare students to work in Australian as well as overseas contexts. There is
widespread evidence of good practice and innovation in the learning and teaching of
physiotherapy. The study also confirms that Australian physiotherapists are highly
regarded both locally and internationally, reflecting the strength of Australian
physiotherapy education. Nevertheless, there is continued scope for enhancement of
current practice and an imperative to plan strategically for future developments in the
discipline. It is with these aims in mind that the project team makes the following
recommendations arising from the study.
Recommendations
The project team acknowledges the good practice in the learning and teaching of
physiotherapy that is taking place across Australia. We are making the following ten
recommendations as a result of the evidence gained in this project, which involved
extensive consultation with a wide range of stakeholders. These recommendations are
designed to enhance the good practices in the learning and teaching of physiotherapy
that are currently taking place.
The project team recommends the following:
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Executive summary
Clinical education
1. that the Federal Government should review the Commonwealth Course
Contribution Schedule and reclassify physiotherapy as a clinically based medical
science.
2. that a feasibility study be instigated to explore the merits of a regulated
preceptorship/mentoring system for new graduates in the workplace that
recognises that new graduates require support during their first year of
employment.
Physiotherapy education research

3. that federally funded competitive research grants should recognise the importance
of research into education in the health sciences, including physiotherapy.
4. that schools of physiotherapy value and promote physiotherapy education
research. Specifically, there is a need for research into:
4.1. innovative approaches to the design, delivery and review of physiotherapy
education, including clinical education, with a view to enhancing learning
outcomes
4.2. different approaches to the complex issue of multidisciplinary pedagogy and
practice
4.3. cost effective and high quality multimedia learning and teaching tools in
physiotherapy education
5. that schools of physiotherapy establish a collaborative research program to
provide evidence of good practice in clinical education. This will inform the
profession, in both the public and the private sectors, who are critical to the
delivery of clinical education.
Physiotherapy curriculum
6. that schools of physiotherapy and employers address the issue of 'the overcrowded
curriculum' in the light of recent research; new areas of practice; the need to value
private practice and issues pertaining to clinical education in public and private
practice.
7. that schools of physiotherapy further explore and implement strategies to include
the profession and many stakeholders in physiotherapy curriculum development,
delivery and review processes.
Physiotherapy learning outcomes

8. that schools of physiotherapy explicate the role and value of learning outcomes in
order to clarify the relevance of learning experiences for students and provide
them with a more coherent learning framework.
Collaboration
9. that physiotherapy educators and curriculum developers collaborate to determine
the most appropriate means of developing, sharing, promoting and disseminating
effective strategies in physiotherapy education.
Accreditation and quality assurance for physiotherapy education in Australia

10. that the Australian Council of Physiotherapy Regulating Authorities (ACOPRA)
continue to be the sole national standards advisory body for pre-registration
physiotherapy education in Australia.
iv
Contents
CONTENTS
_____________________________________________________________________
1 Introduction..........................................................................................................1
1.1 Aims and structure of report .........................................................................1
1.2 Physiotherapy in changing contexts..............................................................2
1.3 The changing nature of the student body .....................................................3
1.4 Resource implications of a feminised workforce .........................................3
1.5 Requirements for clinical education .............................................................4
1.6 Relationships between physiotherapy and other health sciences ...............5
1.7 Increasing role of technology and of globalisation ......................................5
2 Study design and method ....................................................................................6

2.1 Methods used in the project...........................................................................6
2.2 Review of the literature ..................................................................................6
2.3 Analysis of Course Experience Questionnaire responses............................6
2.4 An analysis of school of physiotherapy websites..........................................7
2.5 Focus groups....................................................................................................7
2.5.1 Current student focus groups ..............................................................8
2.5.2 Recent graduate focus groups..............................................................8
2.5.3 Staff focus groups..................................................................................9
2.5.4 Employer focus groups .........................................................................9
2.6 Discussions with heads of schools of physiotherapy ....................................9
2.7 National surveys to address curriculum issues ............................................9
2.7.1 Survey of heads of schools of physiotherapy ......................................9
2.7.2 Survey of employers of recent graduates..........................................10
2.8 The issues paper ............................................................................................10
2.8.1 The preparation of the issues paper ..................................................10
2.8.2 Responses to the issues paper.............................................................11
2.9 Nominations of examples of good practice in learning and teaching.......11
2.10 Summary .......................................................................................................11
3 National consistency and specification of learning outcomes in

physiotherapy .....................................................................................................12
3.1 Historical overview of the consistency and importance of Australian
physiotherapy education ..............................................................................12
3.2 Changes and challenges in contemporary Australian physiotherapy
education........................................................................................................13
3.3 The Australian physiotherapy educational accreditation process ...........14
3.4 The Course Experience Questionnaire .......................................................17
3.5 Focus groups of physiotherapy education stakeholders............................19
3.6 Survey of employers .....................................................................................19
3.7 National consistency of course-based learning outcomes at the
institutional level ...........................................................................................19
3.8 Information technology applications in health and their impact on
physiotherapy education ..............................................................................21
3.9 Summary .......................................................................................................22
3.10 Recommendation ..........................................................................................23
4 Staff and student understandings of physiotherapy learning outcomes.......24

4.1 Introduction...................................................................................................24
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Contents
4.2 Clarifying terms ............................................................................................24

4.3 Learning outcomes from a student perspective .........................................24
4.3.1 Students’ understanding of learning outcomes................................25
4.3.2 Students’ perceptions of the role of learning outcomes...................26
4.4 The most useful types of outcomes ..............................................................28
4.5 Achievability of learning outcomes .............................................................28
4.6 Beyond learning outcomes – the graduate perspective .............................29
4.7 Academic staff perceptions of the role and nature of learning outcomes29
4.8 Summary .......................................................................................................30
4.9 Recommendation ..........................................................................................30
5 Curriculum design, delivery, assessment and review, in physiotherapy

courses.................................................................................................................31
5.1 Curriculum design ........................................................................................31
5.1.1 Physiotherapy studies .........................................................................31
5.1.2 Graduate entry courses ......................................................................33
5.1.3 ICTs in learning and teaching ...........................................................34
5.1.4 Multidisciplinary learning and teaching...........................................35
5.1.5 The crowded curriculum....................................................................36
5.1.6 Changing student population.............................................................36
5.1.7 Cultural diversity ................................................................................37
5.1.8 Transition issues..................................................................................37
5.1.9 Full fee paying students ......................................................................37
5.2 Curriculum Delivery ....................................................................................37
5.3 Assessing and monitoring learning outcomes in undergraduate
physiotherapy degree courses ......................................................................38
5.4 Review processes in Schools of Physiotherapy...........................................39
5.5 Summary .......................................................................................................41
5.6 Recommendations.........................................................................................42
6 Clinical education and stakeholder involvement in curriculum....................43

6.1 Clinical education .........................................................................................43
6.2 Competition for scarce resources ................................................................43
6.3 Redefining clinical education.......................................................................44
6.4 Timing of clinical education.........................................................................45
6.5 Clinical education in a changing environment...........................................45
6.6 Possible solutions ..........................................................................................45
6.7 Professional and industry involvement in the physiotherapy courses.....47
6.8 Employers responses to the curriculum .....................................................47
6.8.1 Suggested changes in curriculum from employers ..........................49
6.9 Summary .......................................................................................................49
7 Employer satisfaction with physiotherapy graduates ....................................51

7.1 Introduction...................................................................................................51
7.2 Employers’ views on graduate competencies and attributes ....................51
7.2.1 Employers’ satisfaction with physiotherapy graduate
competencies across eight areas.........................................................51
7.2.2 Employers’ satisfaction with physiotherapy graduate attributes ..54
7.3 Main strengths of physiotherapy graduates...............................................57
7.4 Perceived weaknesses of recent graduates .................................................58
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Contents
7.5 Challenges of supervising recent graduates ...............................................59

7.6 Employer feedback on selected features of curriculum delivery .............60
7.7 Preparing to work in multidisciplinary health care settings ....................60
7.8 Physiotherapy graduates and information technology .............................62
7.9 Summary .......................................................................................................63
8 Quality of learning and teaching in entry level physiotherapy......................64

8.1 Good practice identified during the project ...............................................64
8.2 List of examples of good practice in physiotherapy learning and teaching
received from Australian schools of physiotherapy ..................................64
8.2.1 University of Canberra.......................................................................64
8.2.2 Charles Sturt University.....................................................................64
8.2.3 Curtin University of Technology .......................................................64
8.2.4 Griffith University ..............................................................................65
8.2.5 La Trobe University............................................................................65
8.2.6 The University of Melbourne.............................................................65
8.2.7 The University of Newcastle...............................................................65
8.2.8 The University of Queensland............................................................65
8.2.9 University of South Australia ............................................................65
8.2.10 The University of Sydney ...................................................................66
8.3 Dissemination of the project findings and examples of good learning and
teaching strategies.........................................................................................66
9 Strategic directions to enhance learning and teaching...................................68

9.1 Curriculum design, delivery, assessment and review, in physiotherapy
courses............................................................................................................68
9.2 Dissemination of web-based physiotherapy course information..............69
9.3 Staff and student understandings of physiotherapy learning outcomes..69
9.4 Employer satisfaction with physiotherapy graduates ...............................69
9.5 Professional and industry involvement in university education...............69
10 Conclusions.........................................................................................................70
10.1 Student learning in a research based academic and clinical
environment..................................................................................................70
10.2 Current challenges in university education................................................70
10.3 Selected challenges in physiotherapy education ........................................71
10.3.1 Funding and resourcing physiotherapy entry level courses ...........71
10.3.2 Multiple transitions for students .......................................................71
10.3.3 Staffing issues ......................................................................................71
10.3.4 Addressing diverse student needs in clinical settings ......................72
10.3.5 Collaboration with clinical educators ...............................................72
10.3.6 Physiotherapy in changing contexts ..................................................72
11 References...........................................................................................................73
Appendices...................................................................................................................74
A. Glossary of terms used in the report ................................................................75
B. Abbreviations .....................................................................................................76
C. Entry level physiotherapy courses....................................................................77
vii
List of tables
LIST OF TABLES
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Table 1 Numbers of participants in focus groups ..........................................................8

Table 2 CEQ 2002 National Responses: CEQ scale results ordered by size of mean
per cent agreement given by physiotherapy graduates ................................................18
Table 3: Employers’ mean rating of graduate competencies and mean range across
institutions....................................................................................................................52
Table 4: Employers’ mean rating of graduate attributes in rank order ........................55
Table 5: Entry level physiotherapy courses in Australia .............................................77
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Ch 1: Introduction
1 INTRODUCTION
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1.1 Aims and structure of report

The aim of this report is to identify, describe and evaluate curriculum design,
development and review processes in Australian physiotherapy education. It also
highlights selected exemplars of good practice and pedagogical innovation in the
discipline.
Chapter 1 contextualises the study. It provides an overview of broad changes in the

Australian higher education sector, followed by key issues and questions facing the
discipline of physiotherapy within this setting. This is followed by an explanation of
the study design and methods used to achieve our goals.
In a discipline where students are expected to graduate with sufficient skill and
expertise to equip them for independent practice, learning outcomes are critical. A
significant portion of the study was devoted to examining learning outcomes in the
discipline. Chapter 3 explores the extent to which there is clear specification and
national consistency of learning outcomes from entry-level physiotherapy degree
courses. It does so by explaining the Australian physiotherapy educational
accreditation process and the national role of the Australian Council of Physiotherapy
Regulating Authorities (ACOPRA). A range of data sources, including the Australian
Course Experience Questionnaire, are used to argue for broad national consistency of
generic learning outcomes, while also emphasising the many unique qualities of
physiotherapy courses across the nation. Included in this chapter is a discussion of
ways in which physiotherapy degree courses reflect the pace of technological change
in applications pertaining to physiotherapy and the health sector more generally.
Chapter 4 provides evidence of staff and student understandings of learning outcomes

in physiotherapy. In particular, the team sought the input of current students and
recently graduated physiotherapists to determine the degree to which they understood
the purposes of having specific learning outcomes and the degree to which they
considered these outcomes as attainable.
At the heart of this study was a close investigation of learning outcomes within the
broader context of physiotherapy curriculum design, delivery and review in Australian
universities. This is the subject of Chapters 5 and 6.
In light of the critical role of employers we sought information on their levels of

satisfaction with recent physiotherapy graduates and their learning outcomes. These
stakeholders were also asked to comment on perceived strengths and weaknesses of
curriculum design and delivery associated with physiotherapy graduate attributes.
These findings are presented in Chapter 7.
During the course of this project we have identified many examples of good practice
and innovation in the teaching and learning of physiotherapy, as well as in curriculum
design and review processes. A selection of these is included in Chapter 8 of this
report with a view to setting the scene for Stage 2 of the project which focuses on
1
Ch 1: Introduction
national dissemination of these good practices among the physiotherapy higher

education community.
A number of recommendations emerged from our wide consultation with employers,

physiotherapy educators, current students and recent physiotherapy graduates during
the course of this study. These are listed in the Executive Summary and at the end of
relevant chapters. The recommendations have implications for policy and practice
across the sector at both the national and institutional levels. Chapter 9 identifies
broad institutional strategic directions associated with these recommendations. It also
highlights key elements of good practice identified during the study and comments on
approaches to further enhancing curriculum processes and the quality of learning and
teaching in physiotherapy. The final chapter, Chapter 10, draws together and
summarises the conclusions from the study.
1.2 Physiotherapy in changing contexts

The final decade of the last century saw great changes in the higher education sector.
The completion of the implementation of the Dawkin reforms resulted in the creation
of a unified national system of higher education in Australia and significant increases
in the numbers and diversity of students attending universities, and in the courses on
offer. Financial contributions by students towards the cost of their higher education is
an accepted norm as is the reality that all universities must attract income from a
diversity of non government sources if they are to prosper. Students have become
more critically evaluative of their university experience, and opportunities for them to
be so have increased through provision of internal individual university surveys and
through the Course Experience Questionnaire (CEQ). Most universities, following
wide consultation with key stakeholders including employers of their graduates, have
delineated a set of generic graduate qualities/capabilities/attributes which they expect
their new graduates to exhibit.
Growth in physiotherapy courses and student numbers mirror in part changes in the
sector overall. In 1994 for example, there were just six entry level bachelor courses in
physiotherapy nationally, in 2004 there are 16 courses, with another two on the
drawing board (See Appendix C). Not only has there been a significant increase in
program numbers but also in their diversity, with physiotherapy now offered as a two
year Graduate Entry Masters degree and as a five year double degree (eg with sports
science) as well as through the more traditional bachelor course of four years
duration. The student body itself is becoming increasingly diverse.
Changes in health care delivery have been a feature too, with day surgery admissions
and short hospital stays with early discharge of acutely ill or post surgery patients,
commonplace. Community management of patients with chronic conditions also
exemplifies such change. The community is also changing. For example, information
about medical conditions and their management is more readily available, including
via the internet, leading to an expectation by members of the community of greater
participation in clinical decision making. Another example is related to the
increasingly multicultural society where communities of specific and mixed ethnic
groups have particular cultural and communication needs.
Changing contexts for physiotherapy education are not only confined to the higher
education and health sectors but also are regulatory in nature. In 1994 the Australian
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Ch 1: Introduction
Physiotherapy Competency Standards (APCS) were finalised and adopted following

widespread consultation with the profession, registration boards, employers and
schools of physiotherapy. The APCS have been a key factor in guiding curriculum
development in physiotherapy and form an integral part of the accreditation of
physiotherapy courses by the Australian Council of Physiotherapy Regulating
Authorities (ACOPRA). ACOPRA was previously known as the Conference of
Physiotherapy Regulating Authorities and was established by the Australian Health
Ministers Advisory Council (AHMAC) to facilitate the implementation of a
Commonwealth Mutual Recognition Act, to advise it on measures to maintain a
consistent national approach to registration issues in that context and to recognise for
the purposes of registration, new or altered courses for the education of
physiotherapists for practice.
1.3 The changing nature of the student body

The Commonwealth Department of Health and Aged Care in 1999 identified that
more than 4 million people (23 per cent of the population) were born overseas,
making Australia one of the largest immigrant communities in the world. In 2002, the
per centage of Australian students in the Non-English Speaking Background (NESB)
category commencing their university studies was just 3.70 per cent of the total
commencing cohort. (The Department of Education, Science and Training (DEST)
definition limits the NESB characteristic to students who are born overseas and who
have lived in Australia for less than 10 years.) It is likely that a much greater
proportion of commencing students in 2002 spoke a language other than English at
home. The diversity of the commencing student body in 2002 by equity group
distribution also reveals the following - low socio-economic status (SES) (15.25 per
cent), indigenous students (1.53 per cent), rural and isolated (18.48 and 1.53 per cent
respectively). Many universities have implemented special schemes to encourage and
enable students from particular equity groups to undertake a university course.
School leavers and mature aged students, students from rural locations and students
born outside Australia, are well represented in the physiotherapy student cohort but
indigenous Australian students and SES students are under represented in proportion
to their numbers in the Australian population. School leaver entrants invariably have
very high tertiary entrance scores, given the demand for entry into physiotherapy
courses, and students entering graduate courses have high university grades. Most
courses attract international students and all graduate entry master courses are full fee
paying. Overall, the diversity of the student body enrolling into physiotherapy is
increasingly bringing with it a need for additional support systems in both university
and clinical environments.
The student population was approximately half female and half male in the mid
1990s, but in the last few years, in common with the university population more
generally, physiotherapy has increased its proportion of female students. Sixty-four
per cent of graduates from undergraduate courses in 2003 were female, along with
two-thirds of the intake into physiotherapy in 2004. Of note is the fact that over 50 per
cent of the intake into graduate entry physiotherapy courses in 2004, were male.
1.4 Resource implications of a feminised workforce

The physiotherapy workforce is predominantly female. This has a significant effect on
university academic staff where the proportion of women is generally 80 per cent and
3
Ch 1: Introduction
in clinical departments which provide clinical education where the proportion is close
to 100 per cent.
Maternity leave costs place a disproportionate financial burden on university

physiotherapy schools. As well as this cost there are the additional resources required
to recruit and prepare new staff for a teaching role. The breaks in careers vary in
length from a few months to several years. For those staff who return whilst their
children are young there are significant difficulties in obtaining childcare places and
managing these costs. For those returning several years later there are requirements
for additional learning due to the rapid changes in both health and education sectors.
Parallel factors affect women involved in clinical teaching in the clinical departments.
The particular challenges for more senior women continue in their responsibilities for
aged parents and relatives. This can be an additional pressure as physiotherapists are
highly skilled expert professionals in the management of many of the health problems
of the elderly.
1.5 Requirements for clinical education

High quality, broad, clinical experience under expert guidance in an entry level
physiotherapy course is critical to the achievement of the APCS competencies, which
are an integral part of accreditation of physiotherapy courses by ACOPRA. This
education experience is essential too, for a graduate physiotherapist to function
effectively as a practitioner of first contact, whether in a major teaching hospital
department or in solo practice.
Do the APCS reflect contemporary practice? The competencies were reviewed in

2002, with changes made subsequently. They are currently undergoing another major
review. Widespread consultation has been a feature in both reviews.
However, the continuing provision of a comprehensive clinical education experience

is under significant pressure on a number of fronts. These include the considerable
growth in student numbers, continuing availability of quality clinical placements, and
health and higher education sectors under significant financial pressures. There is a
need to consider both greater diversity and innovative approaches to clinical
placement experience and supervision models. For example, figures from the
Australian Physiotherapy Association (APA) and the Australian Bureau of Statistics
(ABS) indicate that approximately 50 per cent of physiotherapists in the workforce
work in private practice, yet few students are able to be placed in this setting.
Pressures have resulted in employers and physiotherapy educators alike articulating a
need for a transition year between graduation and autonomous practice, where a
preceptorship model would be in place (inclusive of the private sector). Whilst
funding such a transition year is a challenge, this would provide an opportunity for the
development of innovative supervision models.
Mention has already been made of the growth in physiotherapy courses and student
numbers. This is well illustrated by the following statistics: in 1995 there were 693
graduates from 6 undergraduate courses, in 2005 it is estimated that 1113 students
will graduate from 16 courses comprising undergraduate, graduate entry and double
degree offerings. Schools of physiotherapy are finding it increasingly difficult to
secure clinical placements for their students, and clinical educators/supervisors are
4
Ch 1: Introduction
feeling that their capacity to adequately educate and supervise students is being
pushed to the limit.
1.6 Relationships between physiotherapy and other health sciences

Whilst physiotherapists are practitioners of first contact they also work as members of
multidisciplinary health teams. The APCS competencies recognise the importance of
this role through the elements and performance criteria underpinning the seventh
competency: Operates effectively within the health care setting (ACOPRA 2002a
p56). But to what extent do courses provide students with opportunities to work with
students from other health professions, to appreciate the roles of other health
professionals and to work in multidisciplinary teams as undergraduates by way of
preparation for practice? To what extent is an appreciation of the team approach and
experience therein, something which occurs after graduation?
1.7 Increasing role of technology and influence of globalisation

Students graduating from universities today are likely to have a number of different
careers in their working lifetimes. Most universities have delineated a set of graduate
attributes which they expect their students to exhibit upon graduation and in their
working lives. A commitment to life long learning (and information literacy skills
facilitating such learning through life) is integral to all sets. School leavers entering
university often do so with computer literacy and data search skills well beyond those
of some of their lecturers.
Australian universities without exception have recognised the value of information

technology in learning and teaching, and the opportunities that flexible delivery
allows for students to learn ‘in place’ not necessarily requiring physical attendance on
campus during their course of study, thereby facilitating a national and global reach
for students. The ready access to electronic information and the immediacy of
exchange with fellow students in any part of the world has provided opportunities for
the globalisation of education. Technology is an increasing feature of the health
system too, not only for patient care on site but also by telemedicine and technology,
and it is vital in storing and retrieving information.
To what extent do physiotherapy courses, curricula and clinical education experiences

reflect the increasing role of technology in learning and teaching? To what extent do
employers consider physiotherapy graduates to be work ready in an information
technology sense? To what extent do Australian physiotherapy courses prepare
graduates to be recognised internationally?
5
Ch 2: Study design and method
2 STUDY DESIGN AND METHOD

_____________________________________________________________________
This chapter outlines the range of methods used to collect data for the purposes of this
project. A glossary of key terms has been included in Appendix A. Specifically, the
term ‘school of physiotherapy’ is used throughout this report to describe the academic
unit which has direct responsibility for the discipline of physiotherapy.
2.1 Methods used in the project

The data for the project were gathered iteratively, using a variety of different methods,
with each method building on the information gained in the previous one.
The data sources that we used were:

• advice from the project steering committee;
• review of the literature;
• analysis of Course Experience Questionnaire responses;
• review of school of physiotherapy websites;
• focus groups with current students, recent graduates and staff in five regional
and metropolitan schools of physiotherapy;
• focus groups with employers of physiotherapists in three locations;
• consultations with heads of schools of physiotherapy;
• national surveys of employers of physiotherapists;
• surveys of heads of schools of physiotherapy;
• responses by curriculum and discipline experts and by heads of schools of
physiotherapy to an issues paper that summarised the initial findings of the
project; and
• descriptions of examples of good practice in learning and teaching by heads of
schools of physiotherapy.
2.2 Review of the literature

The project team conducted a review of recent literature relating to learning outcomes
and curriculum development in physiotherapy. The information gained in this way
provided a valuable basis for all the later stages of the project. It is proposed that this
information be published on the Web as an annotated bibliography in Stage 2 of the
project. As such, it will provide a useful academic resource for physiotherapy staff,
students and employers in future.
2.3 Analysis of Course Experience Questionnaire responses

The Course Experience Questionnaire (CEQ) is a survey that is sent to university
graduates approximately four months after they have completed a course of study at
an Australian university. In the CEQ, graduates are asked to express the extent of their
agreement or disagreement with statements about their course experience on a five-
point Likert scale. All questionnaires sent out to recent graduates include 13 core
items that provide results that are grouped into two scales, the Good Teaching Scale
and the Generic Skills Scale and a single core item, the Overall Satisfaction Item.
Another 36 items that make up eight further scales are optional, and each university
can choose independently whether to include them in the CEQ or not. The
6
institutional response rate to the CEQ in 2003 for all fields of study ranged from 25.8
per cent to 63.8 per cent, with an average of 44.5 per cent.
The project team obtained CEQ data from recently graduated physiotherapy students
for 2002 and 2003 from the Graduate Careers Council of Australia (GCCA). While
CEQ data need to be interpreted with caution because they were not obtained from a
random sample of students, they are useful for identifying possible patterns in
graduates’ responses which could be investigated further using other methods.
The CEQ results show graduates’ responses to a group of items amalgamated into
scales, such as the Appropriate Workload Scale or the Learning Resources Scale. The
GCCA also provided the project team with Year 2002 physiotherapy graduates’
responses to the 49 individual questions that made up the CEQ scales. This enabled
the project team to make a more detailed comparison between graduates’ responses to
particular questions than was possible using the scale results.
2.4 An analysis of school of physiotherapy websites

A search of information about Australian University entry level physiotherapy courses
was conducted, first using the DEST site, ‘Which Course? Which University?’
http://www.dest.gov.au/tenfields/health/health.html. From this link, a search under the
heading for each university led to a summary of the Health courses available,
including physiotherapy. In December 2004, DEST launched a new website ‘for
prospective and continuing higher education students’ www.goingtouni.gov.au which
provides a broad range of information about tertiary education, including courses
offered at different institutions as well as fees, loans and scholarships. Another search
was made using the links from the APA website ‘Working and studying’
http://apa.advsol.com.au/scriptcontent/aboutphysio_schools.cfm?section=foryou
which connects directly to relevant web pages for physiotherapy courses in each
Australian university’s website.
2.5 Focus groups

Focus groups were held in three locations involving five different schools of
physiotherapy. Their purpose was to identify and discuss key issues in the learning
and teaching of physiotherapy that could be investigated further in subsequent stages
of the project. The schools selected for focus groups represented a range of different
course designs: examples of long established and more recently established courses,
and courses from rural/regional areas as well as from metropolitan areas. For
budgetary reasons, the focus groups all took place in the Eastern States of Australia.
Heads of schools of physiotherapy or their delegates invited students, graduates and
staff to take part in the focus groups, sending them a standard letter and project
information provided by the project team. A balance of genders was encouraged.
Students who had started their course immediately after leaving school as well as later
entry students were invited to attend. The graduates invited had all completed their
courses in 2002 and 2003. In some cases, employers were contacted and asked to
encourage their recent graduates to attend. The project team recognises that the
participants in the focus groups represent only a small proportion of the students and
staff involved in physiotherapy education. However we attempted to draw from a
wide cross section of the relevant populations and to validate the opinions expressed
in the focus groups with data from surveys and experts.
7
Table 1: Numbers of participants in focus groups
School of Physiotherapy Students Graduates Staff Employers

Location 1
New regional 7 2 4
Total 7 2 4 3
Location 2
Established metropolitan 11 4 9
New regional 9 1 6
Total 20 5 15 10
Location 3
Total 10 2 16 6
Employers of the recent graduates from the public and private sectors, in all three
locations, were also contacted through schools of physiotherapy and, in some cases,
through the local branch of the APA. Many of them were experienced clinical
educators who had employed many recent graduates from a number of different
universities.
Each focus group was facilitated by two members of the project team, with one
member in common for all groups to provide consistency. The facilitators used a
semi-structured interview approach lasting from one to two hours. They asked a series
of pre-prepared open-ended questions. The facilitators took notes during the focus
group sessions which they reviewed and extended as soon as possible after the focus
group had concluded. The conversations were also taped, with the permission of
participants. Some of the tapes were replayed in order to extract exact quotes.
2.5.1 Current student focus groups

The 37 students who participated in the focus groups were male and female students
in Year 2 and Year 4 of their undergraduate physiotherapy course, and six graduate
entry masters students from one university. The students who volunteered to be
involved in the focus groups represented a mix of students who had begun their
physiotherapy course as school leavers as well as those that had begun at a later stage.
The facilitators did not record students’ ages. They asked them a series of questions
about their preferred learning and teaching methods; their understanding of the
meaning and purpose of learning outcomes; and the use of ICT and multidisciplinary
learning and teaching in their course. They also gave them an opportunity to make
undirected comments.
2.5.2 Recent graduate focus groups

Only a small number of recent graduates volunteered to participate – nine in total.
Some graduates apologized that they could not attend because they were working long
hours or had prior engagements. The facilitators asked the graduates a set of pre-
prepared questions about the aspects of their courses that they have found to be
particularly useful in their working life; which learning and teaching strategies they
8
found most helpful; whether their teachers made learning outcomes explicit and, if so,
whether they thought these outcomes were achieved.
2.5.3 Staff focus groups

All physiotherapy academic staff were invited to attend the staff focus group held in
their school. Clinical educators and those responsible for curriculum development
were particularly encouraged to contribute. Staff members who were unavailable were
invited to submit comments or to have a phone interview at a later date. The thirty
five staff who participated represented a range of ages, years of employment,
educational experience, and learning and teaching approaches. The majority of staff
were female although males were represented at most venues. They were asked
questions such as which of their teaching strategies they consider to be most effective
in promoting student learning and how they ensure that their curriculum meets the
needs of employers.
2.5.4 Employer focus groups

Nineteen employers took part in the focus groups. The majority came from large,
metropolitan, public institutions. However, employers from the private sector
participated in two of the three employer focus groups, as did employers from
regional centres. The facilitators asked the employers about their perceptions of the
recent graduates they employed, including: how well prepared they were as
physiotherapists; which aspects of their university education were most effective and
which aspects could be improved; how well they worked in multidisciplinary teams
and how competent they were at using ICT. The facilitators also discussed with
employers their preferred relationships with schools of physiotherapy.
2.6 Discussions with heads of schools of physiotherapy

All heads of schools of physiotherapy were consulted at key stages during the AUTC
project by email and during discussions at meetings on 19/20 May and 28/29 October
2004.
2.7 National surveys to address curriculum issues

The literature review, focus group discussions and meetings of heads of schools drew
attention to some important emerging issues in physiotherapy curriculum
development and learning outcomes. In order to investigate these issues on a national
basis, the project team developed and distributed two surveys: one to heads of schools
of physiotherapy and one to employers of recent graduates.
2.7.1 Survey of heads of schools of physiotherapy

A survey was sent to the head of every school of physiotherapy in Australia to collect
information about issues in curriculum design, development and review. The survey
asked about the structure of the curriculum; integration of biomedical and behavioural
sciences with professional knowledge and practice; curriculum review processes and
recent curriculum changes. It was also used to gather information about the
demographics of students that graduated in 2003 and the students who began courses
in 2004, as well as special groups targeted for recruitment and support programs for
particular groups of students. Finally, the survey gained information about key
stakeholders in the development and review of the curricula, and the information
technologies introduced into the curriculum in the past five years.
9
2.7.2 Survey of employers of recent graduates

A second survey, which addressed the outcomes of the physiotherapy educational
process and employer satisfaction, was sent to employers in the public and private
sectors. The survey asked employers to rank recent graduates they had employed from
each university on the eight graduate competencies required for professional practice
by ACOPRA. These included such factors as: the ability to ‘assess client’s abilities,
problems and needs’ and to ‘demonstrate professional behaviour appropriate to a
physiotherapist’. It also asked employers to rank the recent graduates on ten generic
attributes, such as: ‘highly developed communication and interpersonal skills’ and
‘openness to new ideas’. Employers made each of these rankings on a three point
Likert scale labelled ‘Satisfactory’, ‘Good’ and ‘Excellent’. They had the option to
‘Comment on particular strengths’ for each competency and attribute. The project
team did not include any unsatisfactory categories in the Likert scale as its focus was
on identifying the strengths of recent graduates. The survey also obtained employers’
views on the attrition rate of recently employed graduates; the information
technologies they use in their workplaces; and the relationships that employers would
like to have with schools of physiotherapy.
The Australian Physiotherapy Association (APA) helped the project by sending out
the employers’ survey by email to members of APA’s Physiotherapists in Leadership
and Management Group and to some large private practice groups in the
Physiotherapists Business Association (PBA) in all States and Territories – a total of
approximately 300 employers. Paper copies of the surveys were also sent to
employers who had participated in focus groups.
Some employers, particularly in Melbourne and Brisbane where focus groups had
been held, responded promptly to the survey. However, on the whole, responses to the
survey were slow. Therefore, once the due date for submitting the survey had elapsed,
the project officer made phone contact with the employers of large numbers of recent
graduates in the public and private sectors of States and Territories other than Victoria
and Queensland. A total of 44 completed surveys were received - 31 responses from
employers in public institutions and 13 from employers in private practices.
2.8 The issues paper

2.8.1 The preparation of the issues paper
The results from the employers’ surveys, as well as findings from earlier stages of the
project, and advice from the Steering Committee informed the writing of a short
issues paper. This paper highlighted some of the challenges to the education of
physiotherapists that had been raised in focus groups by students, graduates, staff and
employers. Its purpose was to obtain feedback from key stakeholders and curriculum
experts on the preliminary findings of the project.
The issues paper was sent to a number of physiotherapy curriculum and discipline
experts in Australia, Canada, the United States of America (USA) and the United
Kingdom (UK). It was also sent to members of ACOPRA, to the National Office and
State Branches of the APA and to the accrediting bodies for Medicine and Pharmacy.
The recipients were invited to comment on whether the paper identified the important
current issues in physiotherapy education and whether there were other important
issues that should be included. They could elect to respond confidentially if they
wished.
10
2.8.2 Responses to the issues paper

Responses to the issues paper from curriculum and discipline experts
Twelve responses to the issues paper were received and were considered by the
project team in the light of the requirements of the project brief. Two were from
experts in the UK, one was from Canada, one was from the US and nine were from
Australian experts.
Responses to the issues paper from heads of schools of physiotherapy

Heads of schools of physiotherapy discussed the issues paper in detail during their
October 2004 meeting. The project team distributed notes from the discussion to
heads of schools for review, and some of them submitted further written comments at
a later date.
2.9 Nominations of examples of good practice in learning and

teaching
Heads of schools were asked to nominate educational case studies from their schools
that illustrate good practice in learning and teaching, for showcasing to others. They
were sent a template to complete for each example of good teaching practice. Thirty
examples were received. These resources will be shared using a website in Stage 2 of
the project.
2.10 Summary
In summary, the project team initially conducted a literature search into learning
outcomes and curriculum development, and also looked at CEQ data from graduates
of physiotherapy and other health disciplines. This information guided the questions
discussed in focus groups with staff, students, recent graduates and employers. We
then canvassed employers’ views on their satisfaction with recent graduates and their
preferred relationships with schools of physiotherapy more widely, through a national
survey. We summarised our findings in an issues paper, which we used to gain
feedback from Australian and overseas curriculum experts, including heads of schools
of physiotherapy. Data gathered from all these sources have been analysed and
synthesised into this report. The heads of schools have provided the project team with
examples of good learning and teaching practice in their courses, which will be
disseminated in Stage 2 of the project.
11
Ch 3: National consistency and specification of learning outcomes in physiotherapy
3 NATIONAL CONSISTENCY AND SPECIFICATION OF

LEARNING OUTCOMES IN PHYSIOTHERAPY
_____________________________________________________________________
3.1 Historical overview of the consistency and importance of

Australian physiotherapy education
It is the role of professional health care practitioners to practise in a
manner which demonstrates professional autonomy, competence and
accountability, to engage in lifelong learning and to contribute to the
development of the knowledge base of their discipline (Higgs 1993).
Physiotherapists are primary health care professionals concerned with the assessment,
diagnosis, treatment and prevention of dysfunction and impairment of movement in
people of all ages and within a wide range of contexts. There are numerous areas of
professional physiotherapy practice within the health, education and related systems
and within industry. Physiotherapists require a broad range of knowledge and a
variety of skills, including the desire and capacity for continuing to learn for the
duration of their professional lives.
Physiotherapy education began in Australia in the late 1890s. By 1908 there were
courses preparing physiotherapists in three states. These students were undertaking
biomedical science subjects at the Universities of Melbourne, Adelaide and Sydney.
The major teaching hospitals of these cities such as the Melbourne Hospital and the
Adelaide Hospital, oversaw clinical preparation for professional practice. For the next
80 years the main processes for specification of educational goals and consistency of
learning outcomes was through interaction between the heads of the respective
physiotherapy schools within Australia and increasingly in discussion with colleagues
internationally. In 1993 the heads of physiotherapy schools in Australia and New
Zealand commenced regular twice-yearly meetings. The purpose of the Australasian
Heads of Physiotherapy Schools meeting is to provide a regular forum for the open
exchange of information and discussion of matters relating to physiotherapy education
including curricula, teaching and assessment methods, research matters, and physical
and human resources. The forum is designed to provide opportunities for
collaboration in the sharing of resources for the teaching of entry level and
postgraduate physiotherapy.
Australian physiotherapists have been keenly sought and recruited internationally as

clinicians for decades. In particular, their reputation in the United Kingdom has been
outstanding. Since 1990 national and global changes have increased the requirements
for professional mobility with the introduction of the Trans Tasman Mutual
Recognition agreement between Australia and New Zealand, and the Bologna
Agreement in the European community. Canada and the United States of America
have increasingly aligned their educational requirements for physiotherapy, and all
courses in North America have moved to graduate entry. The International Society for
Educators in Physiotherapy was instituted in 1995 following an earlier symposium in
1991 during the World Confederation for Physical Therapy Conference. The
International Society for Educators in Physiotherapy has a membership spanning all
continents with approximately 35 countries represented. The three physiotherapists in
12
the present project team are founding members of the Society, with two having served
as president. The purpose of the Society is to identify and share common issues,
themes and strategies including innovative educational practices for the enhancement
of physiotherapy education around the world.
These developments through the 1990s demonstrate the recognition by Australia’s

leading physiotherapy educators of the importance of addressing professional
education from a national and international perspective. They also reinforce a
preparedness to collaborate and share good practice in an increasingly competitive
environment. Within the Australian (and global) community there is a growing need
for the knowledge and skills of highly trained physiotherapists. Research evidence is
clearly demonstrating the cost benefits of physiotherapy in the maintenance and
restoration of health and function in a wide range of health problems. Increased
numbers of physiotherapy students, courses and participating universities, as well as
reduced funding and growing problems in the provision of clinical education, present
significant challenges for the preparation of physiotherapists for the workforce.
3.2 Changes and challenges in contemporary Australian

physiotherapy education
In a paper entitled, Sustainable undergraduate education and professional
competency (Crosbie et al. 2002), the senior staff of physiotherapy schools in
Australia and New Zealand outline the changing nature of physiotherapy education.
They describe the exponential growth of knowledge and the pressure this has put on
staff and students alike. Students are expected to source a wide range of professional
literature in their course while staff are challenged to cover the growing quantity of
material in the curriculum. The curriculum needs to be comprehensive because, unlike
many other professions, physiotherapy graduates are increasingly likely to begin their
professional working life without the mentoring and preceptorship of an experienced
physiotherapist.
While the number of physiotherapy courses has increased from six to sixteen since
1996, and the number of graduates has increased by 20% between 1996 and 1999,
new graduates’ access to expert clinical supervision has decreased. Two further
universities have commenced the process of accreditation for physiotherapy courses
and an additional two universities have indicated that they are considering offering
courses. Should all these courses be introduced, the strain on the clinical education
providers may be unmanageable.
Changes in medical technology, shorter lengths of hospital stay, cuts to outpatient

services, increased privatisation of physiotherapy access, and a small number of
experienced clinical educators in the relatively under-resourced physiotherapy
community health sector, have created unsustainable pressures on clinical educators.
The crowded curriculum also makes it hard for staff to include much-needed fields of
study, such as rural health and gerontology, unless they are able to remove some other
aspects of the curriculum.
Preparing physiotherapy students to work overseas, where different countries have

different compulsory requirements for registration, places an additional burden on
Australian curricula. Such a consideration is important for the full realisation of
globalisation and to ensure that local, and the increasing numbers of international
13
students, are prepared for professional practice. In 2003 about five per cent of the 715
new graduates from Australian physiotherapy courses were international students. In
some schools that intake is now 15 per cent and rising.
The Australasian Heads of Physiotherapy Schools have called for discussion about the
curricula and consideration of alternative models, such as giving students ‘core
competencies’ onto which they can build progressively during their professional life
or the instigation of ‘some form of structured internship’ for the first years of
graduates’ professional working life (Crosbie et al., 2002). Recognition of the costs of
such an internship with funding, as is provided for other health professional courses
such as medicine and postgraduate nursing, is a necessary corollary of its
implementation.
The project team determined that there are a number of existing processes that enable
the specificity of national requirements for accreditation of physiotherapy courses in
Australia: through analysis of the Australian Council of Physiotherapy Regulating
Authorities (ACOPRA) guidelines, the results of the Course Experience
Questionnaire (CEQ), the websites of the universities which offer entry-level courses
in physiotherapy, and through discussion with focus groups and subsequent surveys
based on the information from the focus groups.
3.3 The Australian physiotherapy educational accreditation process

The profession of physiotherapy in Australia has been subject to State registration
requirements since the first Victorian Act was passed in 1922. As State registration
boards emerged they carried the responsibility for recognising the graduates of the
physiotherapy courses in their respective States. The boards reviewed new or
substantially changed educational curricula. In 1990, with the support of the
Australian Government, a working party comprising representatives of the Australian
Physiotherapists Registration Boards, the Australian Examining Council for Overseas
Physiotherapists and the Australian Physiotherapy Association was established. This
working party had the responsibility to develop competency standards relevant to
physiotherapists entering the professional workforce in Australia. A steering
committee, which included representatives of the schools of physiotherapy and
physiotherapy employers as well as the working party organisations, guided the
development. An extensive nationwide iterative consultancy process ensued,
culminating in the development of the Australian Physiotherapy Competency
Standards (APCS) in 1994. Regular review of the APCS was planned from the outset.
The current standards were revised in 2002. The consultative process has already
commenced for a further review, which is planned for completion by the end of 2005.
As the APCS were being developed, the Australian Health Ministers Advisory
Council (AHMAC) established the forerunner of the Australian Council of
Physiotherapy Regulating Authorities (ACOPRA) in 1992. This body was to advise
the AHMAC on measures to maintain a consistent national approach to physiotherapy
registration issues including that of new or altered courses for the education of
physiotherapists. ACOPRA was established as an independent body in early 1995.
The membership of the ACOPRA board includes one representative from each of the
eight physiotherapists’ registration boards in Australia and one nominee each from the
APA, and the schools of physiotherapy. The terms of reference for ACOPRA are:
14
• To explore issues relevant to a consistent national approach to physiotherapy

registration;
• To advise on standards and processes relevant to recognition of physiotherapy
qualifications; and
• To act as custodian of the Australian Physiotherapy Competency Standards
(APCS). (ACOPRA 2002b p4)
ACOPRA recognises that there is inevitable change in health and education systems,
in local and international communities’ expectations of its health professionals, in the
rapid growth of information technology and the effects of increasing globalisation.
ACOPRA aims to be both proactive and responsive with respect to these changes.
A primary function of ACOPRA is the responsibility for the accreditation of

physiotherapy education courses in Australia. This rigorous process provides a
mechanism that ensures quality education and encourages enhancement of learning
and teaching through innovative educational practice. It has the responsibility to
ensure that the Australian community is provided with competent beginning
practitioner physiotherapists who are eligible for physiotherapy registration in
Australia. The ACOPRA documentation states that accreditation ‘protects the
standing of higher education physiotherapy awards in Australia, assures the
educational community and the general public that the programs accredited are
appropriate to the award conferred, and ensures compatibility of tertiary awards in
physiotherapy and their national and international recognition’ (ACOPRA 2002b
p4).
The current national accreditation process is based on the conclusions of the Higher
Education Council’s report, Professional Education and Credentialism, December
1996. This report described a ‘good practice’ model and enunciated principles for
course review and accreditation processes It identified that the internal quality
assurance processes of universities primarily secure academic quality of university
courses related to professional preparation. However, alignment of these courses with
the critically important requirements of professional practice, both in Australia and
overseas, was best achieved by appropriate processes of professional accreditation.
The report advised that accreditors should recognise university quality assurance
processes, and focus on the learning outcomes of the graduates.
The following ACOPRA principles guide the physiotherapy accreditation process:

• That criteria used in accrediting programs do not intrude upon the diverse
and unique character of individual programs/institutions;
• That there is recognition that excellent education programs may differ in many
respects and that educational objectives may be achieved in a variety of ways;
• That innovation in achieving educational objectives should be encouraged;
• That while an accreditation process may review a number of input elements, it
will not be prescriptive in terms of precise curriculum details;
• That evaluation and outcomes will include the way in which the program in
physiotherapy approaches the development and assessment of competency in
physiotherapy students (as outlined within the APCS);
• That an educational program should address the professional issues relevant
to the time; and
15
• That the process of accreditation should be based on the principles of equity

and justice in that the profession should be assured that objective criteria will
be employed and there will be an appeal mechanism built into the process.
(ACOPRA 2002b p5)
ACOPRA evaluates a physiotherapy course and the university’s capacity to meet

specified standards with respect to the curriculum, the process of education, the
mechanisms employed to ensure quality outcomes, the resources available and the
performance of graduates. Student selection and progression, staff expertise and their
opportunities for development, and secure arrangements for supervised clinical
education are addressed. ACOPRA provides procedures and guidelines for
universities and accreditation committees for the accreditation process.
The accreditation committee of ACOPRA comprises equal representation from the

registration boards, the APA and the heads of schools of physiotherapy. The Chair of
ACOPRA is also a member. Each accreditation team has six members with two from
each represented group. The university submitting for accreditation provides
extensive documentation to support its case. Following an initial review of the
materials and the sourcing of any further documentation that may be required, a site
visit is made to the university. The site visit team must include two physiotherapy
academics (one of whom is a senior academic and familiar with university processes)
and two non-academic physiotherapists. These normally include two of the ACOPRA
accreditation committee familiar with the submitted documentation, a local State
registration board representative and an additional physiotherapist from interstate.
Care is taken to ensure the membership is familiar with all academic, professional and
registration requirements.
Clear specification of learning outcomes for entry-level (both undergraduate and

graduate entry) physiotherapy degree courses is a requirement of the ACOPRA
accreditation process. It should be noted that ACOPRA uses the term ‘program’ rather
than ‘course’ and ‘program objectives’ rather than ‘learning outcomes’ in its
guidelines and procedures. All physiotherapy courses must be accredited by
ACOPRA for graduates to be recognised by state physiotherapy registration boards to
practise as physiotherapists. National consistency of learning outcomes is also
enhanced through the ACOPRA accreditation process.
The ACOPRA accreditation process is based upon two sets of standards, which must
be met for courses to be accredited. These are the ACOPRA Standards for the
Accreditation of Physiotherapy Programs at the Level of Higher Education Awards
and the Australian Physiotherapy Competency Standards (ACOPRA 2002a). These
standards are an integral part of the ACOPRA documentation provided to universities
seeking accreditation for their physiotherapy courses. ACOPRA receives and
considers recommendations from the accreditation committee and makes the final
decisions regarding accreditation to be conferred on a particular course.
Under Standard 1 of the ACOPRA Standards, namely, The Outcomes of Programs

through the Performance of the Graduates… universities must demonstrate that they
have a program whose graduates will meet the Australian Physiotherapy Competency
Standards (APCS) in all key areas of physiotherapy practice…across all ages and
from acute to community contexts (1.1) and evaluative procedures shall be conducted
16
by the educational institution to assess the outcome of its program in terms of the
standards of the graduates… and action should be taken on the basis of that
evaluation to continually improve the standard of graduates particularly in relation to
the APCS (1.2) (ACOPRA 2002 p13).. Two members of the AUTC project team have
been on the accreditation committee of ACOPRA since the national accreditation
process began. The accreditation committee members are in the privileged position of
having access to all elements of the physiotherapy academic and clinical curricula of
the Australian courses. They also have full awareness of the degree to which national
consistency of course based learning outcomes/ objectives at the institutional level is
achieved. The processes undertaken for the AUTC project have enabled triangulation
of all sources of information to validate the ACOPRA accreditation.
ACOPRA Standard 5, namely, ‘The Curriculum’, requires that: ‘The curriculum is

designed in sufficient depth and breadth to ensure that the desired outcomes of the
program can be achieved, that is the preparation of graduates as competent entry
level physiotherapists who meet the APCS (ACOPRA 2002b p15). Quite specific
guidance on curriculum details required is given in the ACOPRA document provided
to universities. These include the requirement to provide the learning objectives for
each subject, methods of assessment and how they relate not only to the subject
objectives but also to the the course objectives, and an explanation of how the validity
and reliability of the assessment process will be monitored. (Cross referencing of each
subject and the course overall against the APCS is also a requirement.)
Whilst specifying standards to achieve national consistency of learning outcome,

ACOPRA welcomes and encourages individual courses in the development and
delivery of innovative educational processes to achieve these outcomes. As part of the
ACOPRA accreditation process the heads of physiotherapy schools in Australia
evaluate the performance of their entry level graduates using feedback from both the
employers of the new graduates and the graduates themselves. All courses include a
common element in evaluative surveys of employers of graduates. This common
element comprises the eight major units of the APCS. The common element has been
incorporated into the survey of employers undertaken by the AUTC project team. In
recognition of ongoing changes in health and education, the maximum period of
accreditation is seven years. All universities which achieve accreditation for their
courses, are required to provide reports on changes and on specific requirements
pertinent to their own courses. A number of universities which have commenced
courses, or have indicated that they intend to offer courses, are still to achieve
accreditation.
Most universities have enunciated generic skills, which are expected of their
respective graduates. Many of these skills are incorporated within those expected by
ACOPRA and have also been identified in the CEQ.
3.4 The Course Experience Questionnaire

The CEQ data from recent physiotherapy graduates has been collected each year since
1993. The reorganization of the CEQ into core and optional scales occurred in 2002
making direct comparison with the earlier years difficult. In evaluating the extent to
which there is national consistency of generic learning outcomes from undergraduate
physiotherapy degree courses responses from the 2002 and 2003 CEQ surveys have
been used since these were both collected in the same format. The national data from
17
the CEQ 2002 for physiotherapy graduates has been aggregated in Table 2. The Code
of Practice warns against using the data to compare institutions in a simplistic way.
The AUTC project team noted the mean and standard deviation values for the items
considered. The large standard deviations indicate a high degree of variability in the
data and comments regarding mean values must be cognisant of this variability.
Table 2: CEQ 2002 National Responses: CEQ scale results ordered by size of
mean per cent agreement given by physiotherapy graduates
CEQ scale Mean SD N

Agreement
(%)
Intellectual Motivation Scale 83.8 29.6 37
Graduate Qualities Scale 75.3 24.6 148
Overall Satisfaction Item (core) 74.4 43.7 386
Generic Skills Scale (core) 72.7 29.0 385
Learning Resources Scale 72.3 27.4 130
Student Support Scale 62.8 28.2 127
Clear Goals & Standards Scale 59.9 39.2 86
Learning Community Scale 55.7 28.9 92
Appropriate Assessment Scale 48.4 37.8 86
Good Teaching Scale (core) 43.4 32.7 385
Appropriate Workload Scale 29.5 29.3 159
The 2002 CEQ national results indicate that on average graduates of physiotherapy
courses in 2001 expressed a high level of satisfaction with their undergraduate
courses. Graduates demonstrated a high mean percentage agreement with items about
the Generic Skills they had developed in their physiotherapy course. Items in the
Graduate Qualities and the Learning Resources scales also rated highly. Not all
universities chose to ask all the CEQ questions so the number of graduates who
responded to each scale varies. All courses sought information on the Overall
Satisfaction Item, Generic Skills Scale and Good Teaching Scale. The 37 graduates
from one university, who responded to items concerning the Intellectual Motivation of
their course, rated their experience on this scale highly. Good Teaching Scale and
Appropriate Assessment Scale received lower ratings by graduates. These results in
the Good Teaching Scale may be partly due to lower results in the larger cohorts of
responders from the larger courses. These scores need to be considered by individual
universities within the context of their own learning environments in order to analyse
the reasons for the discrepancies in scores across the scale items.
Graduates who completed the CEQ consistently indicated that they did not have an
appropriate workload in their responses to the Appropriate Workload Scale, where
mean values were less than 35.3 per cent for all institutions who used the scale.
Bachelor degree courses in physiotherapy all have high workloads. The necessity for
an understanding of biomedical and behavioural sciences, the scientific theory
underpinning physiotherapy and clinical experience comprises a workload equivalent
to five university years. In the present circumstances these five academic years are
undertaken in four years. This is causing increasing concerns about workload
particularly as more students undertake part time work for financial reasons. The
workload and attendant financial concerns are compounded when students are
18
required to temporarily relocate to regional or rural centres for clinical placements.

Many students are unable to work their regular jobs and are obliged to pay
accommodation costs at the university as well as at the regional or rural location.
National consistency for the learning outcomes of physiotherapy graduates was

considered in the range of focus groups and subsequent surveys of employers.
3.5 Focus groups of physiotherapy education stakeholders

These focus groups provided an opportunity to consider the national consistency of
learning outcomes from entry level physiotherapy degree courses. Academic staff
construct learning outcomes; students and recent graduates are expected to consider
learning outcomes in their own learning; and employers are arbiters of whether the
learning outcomes have been achieved. The findings from the staff and student focus
groups are described in Chapter 4 and the findings from employers are described in
Chapter 7.
Members of the community are also critical stakeholders in consideration of the value
of physiotherapists to health. The funding available for this project was insufficient
for the development of a national community survey.
3.6 Survey of employers

The survey of employers further confirmed that national consistency of course based
learning outcomes is achieved at the institutional level. In considering the learning
outcomes of the recent physiotherapy graduates who worked for them as
physiotherapists, employers considered questions based on the current ACOPRA
national accreditation requirements. The learning outcomes in the eight areas of
professional work specified by the APCS demonstrated that graduates met these
learning outcomes satisfactorily and many exceeded this level. Employers also rated
their satisfaction level with the graduates from identified universities in a range of
generic abilities and indicated specific strengths in these attributes. The results of the
employers’ survey are described in greater detail in a Chapter 7.
3.7 National consistency of course-based learning outcomes at the

institutional level
ACOPRA explicitly encourages a diversity of learning and teaching approaches to
physiotherapy education. Within this framework a number of pedagogical approaches
to education have been adopted in different courses. The AUTC project team found
some universities had developed clear philosophical approaches to their educational
models, whereas others conveyed an implicit understanding of the educational
context. The information available from websites was viewed and nominated
academic staff members responded to a survey question regarding the academic
framework of the course.
The university website is a frequent source of prospective students’ information. The

project team identified that all schools of physiotherapy websites are readily
accessible through the Australian Physiotherapy Association (APA) Website.
http://apa.advsol.com.au/scriptcontent/aboutphysio_schools.cfm?section=foryou
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Each Physiotherapy School has its own style of presenting information to students on
the web: some present short summaries of each course and its prerequisites while
others start with a ‘Welcome’ from the Head of School, a description of the work
done by physiotherapists, the job prospects for graduates and include commonly
asked questions and answers as well as course requirements. The project team’s
review of websites showed that for undergraduate courses, five out of ten courses
described pedagogy used in the course. One University described it thus:
‘Physiotherapy is a health profession which deals with the prevention and
treatment of human movement disorders. Physiotherapy services are used
in a wide variety of areas such as health care organisations, community,
sports and workplace settings, schools and private practices. The
physiotherapy profession is committed to effective communication with
members of the health team, the community at large and the continuing
education of its graduates. Staff and students of the School are actively
involved in a number of research projects which range over several areas
including the investigation of human motor performance, musculoskeletal,
neurological and cardiopulmonary physiotherapy, occupational health
and clinical reasoning.’
‘In common with other Departments … the School promotes students

development of generic (i.e. communication and teamwork skills) as well
as discipline-specific knowledge and skills. The course is designed to
promote self-direction and encourages the graduates to have a sense of
their own individuality and creativity.’
‘Graduates of the undergraduate and postgraduate programs in

physiotherapy will be prepared for a range of career opportunities. These
include physiotherapy clinical practice, clinical education,
administration, research, and consultancy within the public and private
health care sectors.’
For graduate level entry courses two out of five described the pedagogy.
Approximately half the websites indicate the learning outcomes that students can
expect from their courses. These sites describe the learning outcomes of the
physiotherapy courses in general terms. For example,
‘The objectives of this program are:
• To provide students with the theoretical knowledge, skills and clinical
competencies required of an entry level graduate in physiotherapy.
• To develop abilities to extend knowledge in physiotherapy practice and
organisational management and
• To provide skills in research for physiotherapy.’
Although it is possible to follow information links along many branching paths,

information gathering is a somewhat idiosyncratic process according to the
requirements of individual universities. On some websites further course information
is only accessible with a student password.
The project team supports the present individual university processes of audits and the
rigorous quality control of academic standards and the ACOPRA processes for the
maintenance of overall national consistency in learning outcomes. We consider these
20
processes important to maintain physiotherapy academic and professional standards

and to demonstrate to the community that its expectations of accountability, health
and safety are met by preparing graduates for professional registration as
physiotherapists. The project team recommends that a variety of philosophical and
pedagogical approaches continue to be encouraged. It is supportive of innovation and
creative curricula with subjects designed to address the ultimate desired learning
outcomes in a variety of ways. The project team considers that ACOPRA has
developed a rigorous process of accreditation that is pertinent to the needs of
physiotherapy education. Its guidelines and requirements should continue to be
sufficiently flexible to allow emerging trends in education and needs in health care to
be accommodated, whilst holding responsibility for the standards of newly graduated
physiotherapists.
A recently appointed head of a school of physiotherapy responsible for the

development of a new course stated that:
‘the accreditation process is very positive … it was a useful tool to reflect
on the process and the (educational) program as it is developed. It also
gets peer reflection, review – useful in developing a quality program.’
As discerned from the various survey and accreditation processes, there is evidence
that reasonable consistency is being achieved in physiotherapy entry level education.
There is clear specification and national consistency of learning outcomes from
undergraduate and, where applicable, graduate entry physiotherapy degree courses.
Nevertheless this could not be discerned from the information obtainable from the
university websites. The websites demonstrated little consistency of information for
prospective physiotherapy applicants. The project team suggests that Australian
schools of physiotherapy consider their websites and indicate more clearly the
learning outcomes from their physiotherapy courses as well as their particular
educational philosophy, and the pedagogical features of their particular courses.
3.8 Information technology applications in health and their impact

on physiotherapy education
ACOPRA, in its accreditation process, has been cognisant of the growing importance
of information and communication technology (ICT). Those components of the APCS
which ‘acknowledge the pace of change in information technology application in
health and their impact on physiotherapy’ and which must be demonstrated by
graduates of accredited physiotherapy courses include the competency units on
evaluation ‘(evaluates the effectiveness of physiotherapy intervention’), health care
(‘operates effectively within the health care system’), and on management (‘applies
management skills in physiotherapy practice’) (ACOPRA 2002b).
For example, one of the two elements under the competency unit, Health Care, is that
the beginning physiotherapist demonstrates skills in a range of information
technology systems that facilitate operation within the health care system, with the
attendant performance criterion ‘demonstrates the ability to use the World Wide Web
to access information relevant to physiotherapy practice.’ Similar examples can be
provided for evaluation where the beginning physiotherapist is expected ‘to
demonstrate familiarity with electronic databases that provide access to clinical trials
and systematic reviews of clinical evidence’ and management where the beginning
21
practitioner is expected to ‘recognise the needs of the community through research

based information’ ACOPRA 2002b).
As mentioned above, cross-referencing of each subject and of the course overall

against the APCS is a requirement of the submission for accreditation. Also as
previously noted the APCS are reviewed regularly to ensure that they reflect
contemporary practice.
There does not appear to be any disparity between the type of computing technology
used in the profession and that which is used in the education of physiotherapists.
Students enter universities with a range of computer based skills. These are further
developed during the tertiary educational process, particularly in the skills of
searching for research evidence-based information and assignment writing. Students
develop communication and presentation abilities, which include the use of
multimedia. In the clinical environment, they are exposed to and gain experience in
patient record input and retrieval and the use of diagnostic databases. Health
technology used in diagnosis and treatment is part of both the academic and clinical
curricula.
3.9 Summary
Historically, the robustness of Australian physiotherapy education has meant that
Australian physiotherapists have been sought and recruited internationally as
clinicians for decades. Developments in physiotherapy education in the 1990s
demonstrate the recognition by Australia’s physiotherapy educators of the importance
of addressing professional education from an international as well as a national
perspective, and preparing physiotherapist students accordingly.
The entry level physiotherapy curriculum needs to be comprehensive for a variety of

reasons. These include: an increasing knowledge base; changing health practices; and
the potential for solo practice. In an environment where funding is constrained, new
physiotherapy graduates are increasingly likely to begin professional life as
practitioners of first contact, without the mentoring or preceptorship of experienced
physiotherapists. These additional needs contribute to the challenge of
accommodating additional topics in an already full curriculum.
Following a comprehensive iterative process involving key stakeholders, including

registration boards, the profession, and university schools of physiotherapy, beginning
practitioner competencies were agreed in 1994 – the Australian Physiotherapy
Competency Standards (APCS) – the eight competencies becoming, in effect,
nationally specified learning outcomes.
Registration is a requirement to practise as a physiotherapist in every state and

territory. The Australian Council of Physiotherapy Regulating Authorities (ACOPRA)
was established to advise AHMAC on measures to maintain a consistent national
approach to physiotherapy registration, to advise on standards and processes relevant
to the recognition of physiotherapy qualifications and to act as the custodian of the
APCS. ACOPRA was established as an independent body in 1995, and a primary
function is responsibility for the accreditation of physiotherapy courses. Accreditation
is based on standards which must be met. Clear specification of learning objectives
both for the entry level physiotherapy course overall, and for individual subjects is a
22
requirement of the ACOPRA accreditation process; as is the need for universities to

demonstrate the outcomes of the course through the performance of the graduates in
relation to the APCS in all key areas of physiotherapy practice.
Outcomes are also evaluated through the Course Experience Questionnaire (CEQ).
The CEQ and its core scales provide a valuable overview of new graduates’ views of
their course experiences. National responses over a number of years have consistently
indicated high levels of satisfaction with the quality of their course experience by
physiotherapy graduates despite consistent reporting of high workloads.
Consistent surveys of employers as part of the ACOPRA accreditation process have

confirmed that national consistency of course based objectives and of beginning
practitioner competencies are achieved and often exceeded in accredited courses.
Employers have also expressed satisfaction at the generic attributes exhibited by new
graduates of these courses.
Whilst the information provided through accreditation requirements, the CEQ data,
employer survey results and discussion with focus group participants suggest clear
specification and national consistency of learning objectives, this could not be
discerned from information available from university websites for prospective
physiotherapy applicants. Understanding and interpretation of learning outcomes is
explored in a later chapter of this report.
3.10 Recommendation
The project team recommends:
• that the Australian Council of Physiotherapy Regulating Authorities
(ACOPRA) continues to be the sole national standards advisory body for pre-
registration physiotherapy education in Australia.
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Ch 4: Staff and student understandings of physiotherapy learning outcomes
4 STAFF AND STUDENT UNDERSTANDINGS OF

PHYSIOTHERAPY LEARNING OUTCOMES
_____________________________________________________________________
4.1 Introduction
In a discipline where students are expected to graduate with sufficient skill and
expertise to equip them for independent practice, learning outcomes are considered
particularly important. The project brief made specific mention of the need to examine
learning outcomes in the discipline within the context of curriculum design, delivery
and review. This chapter reports staff and student understandings, and use of the term
‘learning outcomes’ in physiotherapy. Chapters 5 and 6 provide a curriculum context
for these learning outcomes, while chapter 7 reports on employer satisfaction with
physiotherapy graduates’ learning outcomes.
4.2 Clarifying terms

Early in our conversations with students, graduates and academic staff, it became
apparent that not all stakeholders shared common understandings of the term ‘learning
outcomes’. Some staff respondents used the terms ‘objective’ and ‘outcome’
synonymously, while others drew distinctions between the teacher-directed nature of
objectives and the student-centred connotation of outcomes. Students also typically
used the terms interchangeably. A probable explanation for the dual usage of these
terms is that ACOPRA requires institutions to report on ‘objectives of the program’
and ‘learning objectives for each subject’, along with ‘outcomes of the course through
performance of graduates’. Staff are then expected to translate these terms for their
own use and for the purpose of developing learning resources for students.
We recognise that in the broader curriculum literature, there is much debate about
nomenclature and meaning when discussing objectives and outcomes in learning and
teaching and it is beyond the scope of this report to debate the issue. For the purposes
of this report, we use the term learning outcomes to refer to what students learn and
what they are expected to know, understand, or be able to do as a result of a learning
process.
As a result of the feedback received across a range of stakeholder groups, we

conclude that learning outcomes are best understood from an hierarchical perspective.
At the broadest level, graduates of a particular institution are expected to be equipped
with a broad range of generic outcomes or attributes upon graduating. These are
accompanied by more discipline-specific program and subject level outcomes
(ACOPRA calls these objectives). At the more specific end of the hierarchy are the
module and weekly outcomes, followed at the most detailed level by lecture or
session outcomes. This hierarchy provides a useful backdrop to understanding
possible sources of confusion around the topic when it comes to stakeholder
perceptions and highlights the need for clarification at the individual School level as
to what is meant by the term ‘learning outcome’ and how it relates to ‘objectives’.
4.3 Learning outcomes from a student perspective

In order to gauge students’ understanding of the purpose and attainability of learning
outcomes, we conducted five focus groups comprising current undergraduate students
in their second and fourth year of study across five institutions in three states. In some
24
cases the students were enrolled in graduate entry courses. Where their views differ
notably from those of undergraduate entry students, this point is noted. A further five
focus group discussions took place with recent graduates of the respective institutions
to determine their retrospective views on learning outcomes.
4.3.1 Students’ understanding of learning outcomes

Our discussions with undergraduate students reveal that they typically understand
objectives and learning outcomes to be synonymous. This is in large part due to the
fact that their teachers predominantly use the term ‘objectives’ to refer to student
learning outcomes at the beginning of classes or in manuals.
There was widespread awareness of learning outcomes among the student body, best
illustrated by the following comment:
‘We get learning outcomes left, right and centre. We get them in the
subject outline, we get them at the beginning of every PowerPoint lecture,
we get them every fortnight when we finish a case, we get them in ‘What
you need to know’ sheets. The lecturers emphasise them. I’ve never had
any difficulty in following them. Our lecturers are really good at giving us
what we need to know in lectures.’
In general, students distinguished between two types of learning outcomes. The first
type was the more general outcome such as that found in course guidelines. Students
found these to be less helpful as they were too broad to be of particular assistance in
their learning. The second type of outcome students identified was the more specific
set of weekly objectives and lecture objectives which students found to be more useful
for guiding their learning.
While these general impressions are important, it is also worth noting a range of
understandings expressed by current students and recent graduates. These are not
necessarily representative of the student perspective but they do shed light on the
variability in students’ perceptions of the concept of learning outcomes and what
institutions might do to communicate more effectively the importance and value of
learning outcomes in the student experience.
When asked for examples of learning outcomes, typically students and graduates
encountered some difficulty. This is best summarised by a recent graduate who
commented:
‘I was aware that there were base levels we had to meet – certain
standards of practice or knowledge to pass or fail – what those specific
things were I don’t know.’
Another graduate recalled learning outcomes as being characterised by long sentences
with big words and largely unhelpful. However, one student expressed her
understanding of a learning outcome in the following way:
‘My ultimate learning outcome is, Can I do my job as a physiotherapist
when I graduate at the end of this year? And the way that sort of comes
through is: When I go on Clinical, can I actually perform? Am I able to
apply the things I have learned and use the reasoning thought processes
that they’ve been teaching me?’
25
It was particularly gratifying to have one recent graduate reflect on their

understanding of the developmental nature of learning outcomes in their course, as
follows:
‘In first year the focus was on developing basic skills, communication and
patient handling. Second year focussed on specific skills, then the
rationale for doing it – musculo-skeletal mostly. Third year developed
further. Fourth year gave us good theoretical knowledge and reasonable
treatment and application. These are trends I can only notice in retrospect
because you don’t know what they’re expecting as you’re doing it. Not
something you can appreciate till you finish.’
While some of these understandings certainly are developmental in nature, there may
be some merit in academics emphasising the ways in which learning outcomes
combine to progressively achieve a coherent whole in the educational experiences of
undergraduate students. This sense of coherence seemed to be lacking among
undergraduate interviewees.
4.3.2 Students’ perceptions of the role of learning outcomes

Students identified the main purpose of learning outcomes or objectives as a guide to
exam preparation and as providing a general framework within which to structure
their study. Across institutions, students agree that learning outcomes are most useful
as a ‘guide’, a ‘helpful framework’, a ‘checklist’ and as a learning tool. Several
students said they referred to learning outcomes before assessments and exams since
they were an important source of help: Objectives help you learn for the exam.
It should be noted, however, that not all students see learning outcomes as a core part
of their learning. One student perceived learning outcomes as ‘just another way of
putting course content in outline form.’ Across institutions a selection of students
admitted to ignoring the stated learning outcomes, their perception being that:
‘Students mostly tune out of learning outcomes.’ Some graduates from another
institution concurred with this view, saying: ‘For every course we were given a list of
things you had to know, but somehow you didn’t take that much notice.’
Within the scope of the present study there is no way to verify how widely held this
perception might be, but it should be noted. If schools of physiotherapy see learning
outcomes and objectives as integral to students’ learning, this should be
communicated and demonstrated through good practice in both writing and
reinforcing of such outcomes. The valuing of learning outcomes should also be
reinforced among students using a range of pedagogical approaches with a view to
ensuring that students do not routinely ‘tune out of learning outcomes’ which are so
fundamental to their learning and practice.
Outcomes help students to ‘link concepts’ in the words of one student. They also
provide a sense of security in helping students to know what they need to learn.
Students see them as a vehicle for lecturers to indicate what is important:
‘You know that all you need is in the lectures.
They give you a framework to tell you how much detail you need.’
Learning outcomes help to identify ‘core elements’ and direction for learning since
there is ‘lots of information’ to be processed. Students also appreciate that learning
26
outcomes can function as a form of reinforcement – a checklist for learning and a

‘handy’ reference guide.
A few students commented on the importance of consistency in the use of outcomes

in university as well as clinical settings. One student said that learning outcomes help
students to transfer what they learn in class across to clinics. Another expressed the
view that clinical supervisors should be more overt about expressing learning
outcomes as the university lecturers do:
‘It would be good if clinical supervisors would communicate their
objectives - this would help students.’
In the eyes of students across several institutions, there is inconsistency in the way
lecturers use learning outcomes:
‘Some lecturers are better than others at giving us learning outcomes.’
However this did not seem to pose particular problems from their point of view.
Typically students saw learning outcomes as something provided by lecturers which

determined what students learned. There was relatively little sense that students saw
themselves as active participants in the translating of these outcomes other than using
them as a tool to guide learning. However one student demonstrated a more proactive
approach to the use of learning outcomes, commenting that:
‘I use the objectives as guidelines. I prioritise them. If something seems
irrelevant I disregard it or ask the lecturer why we need to know it. I
generally won’t follow through with an objective unless I understand the
relevance of it to the big picture.’
Another comment highlighted the role of learning outcomes in helping students make
the transition from university classrooms to clinical settings. However, the critical
importance of students playing an active role in making such links is evident from the
following:
‘That’s where I really use outcomes – on my clinical placements. At
University you just speed read them in class, punch holes in them and put
them in your folder then never look at them again. I generally look at
those outcomes when I go on prac and make sure in myself that I am
achieving those outcomes and if I’m not, I re-evaluate myself and talk to
my supervisor.’
This level of self-reflection and proactivity on the students’ part was not widespread
among the interviewees, but in another focus group discussion, three Graduate Entry
Masters students agreed on the importance of taking the responsibility for relating
learning outcomes to the purpose of the learning experience.
There may be merit in considering ways of encouraging students at all levels to

understand that learning outcomes do play a key role in their learning, but that this
role is further enhanced when students take an active part in translating the outcomes
for themselves, in asking questions about their relevance as part of the larger course,
and in seeking to understand how best to prioritise outcomes and translate them from
one setting to another.
27
4.4 The most useful types of outcomes

Many current students and recent graduates agreed that ‘general’ and ‘less well
defined’ learning outcomes were least useful for their learning.
‘Sometimes the objectives are broad, and you’re not sure how much you
should read
Objectives need to be more precise and limited’
Students appreciate specific learning outcomes which are clearly expressed, that is:
‘from this lecture you need to know this’. A recent graduate confirmed this saying:
‘Learning outcomes are put at the front of the manual. I read them then
didn’t usually go back to them. They were not very specific… the general
ones were not specific enough to be useful.’
There is general agreement among students that ‘some lecturers are better than others
at giving us learning outcomes’. Some clearly provide learning outcomes week by
week and these are typically well received from the student point of view. One student
went further to differentiate between the outcomes written in course outlines and
those provided by the lecturer each week:
‘I rarely look at [learning outcomes] on the subject outline so that doesn’t
work for me. But some of our lecturers have been really consistent in
giving every week the objectives for this week, and I find that is really
helpful. I wouldn’t look at it on the course outline, but to have it sitting
there – it is usually the first thing or the last thing on my lecture notes,
saying ‘This week you should be able to know this. You should be able to
apply it in this way. And that’s really helpful because it’s broken down
rather than having half a dozen or ten outlines for the whole subject…so it
is much more specific and in that way you can know whether you are
achieving it or not.’
From the student perspective, there is much to be said for lecturers putting effort into
translating the written outcomes in course outlines into practical realities during
lectures and in breaking these down week by week. These regular cues and reminders
from lecturers help to support students’ learning by translating the words on a page
into something meaningful and manageable for students in face-to-face settings.
4.5 Achievability of learning outcomes

Learning outcomes identified in lectures were generally considered achievable
through study and revision. Students typically described lecturers as approachable and
committed to helping students achieve the learning outcomes by, in some cases,
holding extra teaching sessions of revision lectures. In the clinical setting, one student
expressed the need for clinical supervisors to give feedback that was more closely
aligned with the learning outcomes of the course.
‘The objectives are manageable if you’re willing to spend a lot of time.’
‘In neuro pracs, even people that do study find it is lots to take in.
Sometimes it is unmanageable.’
A further concern was that some tutors in problem-based learning (PBL) sessions
were seen to be ‘passive’ and did not give assistance when it was needed. It should be
noted that it is, in fact, the role of a PBL tutor to facilitate students’ learning and
problem-solving rather than directing and taking the lead discussion. Overall, PBLs
28
were identified as very successful in assisting students to achieve the identified

learning outcomes and in helping to raise their awareness of their achievements. PBL
scenarios from early undergraduate years were easily recalled by one graduate student
up to three years later.
4.6 Beyond learning outcomes – the graduate perspective

Several recent graduates commented that while learning outcomes were important,
they were only a guide to ‘know if you’re on the right track’. Their view was that
learning outcomes did not encompass all there was to know in a practical sense:
‘For example, interaction with patients, empathy. There’s a place for
learning objectives but you needn’t tick off all the boxes and your training
hasn’t failed if you can’t tick off all the learning outcomes.’
The message seems to be that while learning outcomes provide a guide as to the
necessary skill set for physiotherapists, they do not cover all that one needs to be able
to do as a practising physiotherapist.
Interestingly, one of the staff members interviewed commented that she believed that
‘hidden messages about professionalism and compassion’ were inherent in the work
of academics in physiotherapy teaching and that these were key learning outcomes.
4.7 Academic staff perceptions of the role and nature of learning

outcomes
There are mixed views among staff across institutions with regard to the meaning and
appropriate use of the terms ‘learning outcome’ and ‘objective’. Some staff viewed
the two terms as synonymous and used them accordingly. A smaller proportion of
academic staff interviewees sought to distinguish between the two concepts, stating
that objectives were about what staff wanted to achieve, while outcomes were about
what students could do as a result of their learning. One group of academics also
allied the learning outcomes in physiotherapy with the institution’s graduate
attributes, stating that learning outcomes reflected these attributes. Some staff say that
the learning objectives from a course should be measurable. Others say that they write
their objectives in terms of student learning outcomes. For many academic staff
‘learning objectives’ and ‘learning outcomes’ are synonymous. This staff member
perceived objectives as designed to lead to learning outcomes.
‘Objectives are only as good as learning outcomes. It is all about the
students and what they are learning’
In two instances and in two different institutions, academics indicated that they
required students to write down their own objectives for learning in the subjects in
question. At the end of the semester, students were asked to review where they
thought they were and what they had accomplished. This was an innovative approach
to learning outcomes which was not apparent among the rest of the respondents.
Academic staff interviewees typically expressed the view that they used learning
outcomes constantly during lectures and practical classes and they believed that these
were made clear for clinical placements. Several also commented that they used
learning outcomes as a ‘major prompt for revision’ or as ‘guidance for exam
preparation’. One academic commented on the policy of her department to aim for
‘student friendly learning outcomes’ with an emphasis on students understanding the
purpose of these.
29
Staff perceptions are that ‘students take (learning outcomes) them very seriously’ and
that they ‘achieve them, but often may not know this’. There is some awareness among
academic staff that ‘students tend not to read the student learning outcomes in the
manuals so it’s much more effective if they are right up front in the lecture’. This is
consistent with students’ preferences for having the learning outcomes explicated
progressively lecture by lecture. One academic also noted that ‘students will pick
inconsistencies in student learning outcomes’, specifically with regard to assessment
and exam questions which are not in harmony with the stated learning outcomes.
4.8 Summary
Learning outcomes perform important functions at all levels of curriculum design,
delivery and review, from the day-to-day class level to the year-by-year course level.
Feedback from students suggests that they are familiar with the concept of learning
outcomes which they most readily equate with objectives. Some even feel that they
are ‘bombarded with objectives’. This no doubt reflects the importance which
academic staff attach to writing objectives at all levels of the curriculum.
While our project brief required a focus on the role of learning outcomes in pedagogy
and curriculum processes, our findings suggest that the discipline would benefit from
a more clearly articulated discussion of the distinction between and complementarity
of learning outcomes and objectives, as outlined in ACOPRA requirements. In
considering ways to enhance physiotherapy pedagogy and curriculum design and
development, we argue for the complementary roles of teacher-focussed objectives
and student-centred learning outcomes. Further, we contend that while it is important
to provide students with written information about learning outcomes it is equally
important to provide them with opportunities to reflect on what the outcomes mean
for them personally. Student responses in this study reflect the need to translate
learning outcomes from a long list in the course outline to meaningful and
manageable chunks. Students need to be given strategies on how best to make use of
learning outcomes to enhance their learning and their experiences in the classroom as
well as in clinical placements. This is being done in some cases, but is not as
widespread as it might be.
Learning outcomes play an important role in helping students to understand the links
between different dimensions of their study, from the class level, to the year level, to
the course level, and between university and clinical contexts. In order to enhance the
quality of students’ learning and their sense of course coherence, there would be
considerable merit in monitoring consistency in use of outcomes as a guide to learning
and practice at all levels of the physiotherapy curriculum, within institutions and
between university and clinical settings.
4.9 Recommendation
• that schools of physiotherapy explicate the role and value of learning
outcomes in order to clarify the relevance of learning experiences for students
and provide them with a more coherent learning framework.
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Ch 5: Curriculum design, delivery, assessment and review, in physiotherapy courses
5 CURRICULUM DESIGN, DELIVERY, ASSESSMENT AND

REVIEW, IN PHYSIOTHERAPY COURSES
_____________________________________________________________________
5.1 Curriculum design

The data gathered from heads of schools, academics, students, graduates and
employers reflect instances of good practice in curriculum design at institutional and
program level, and details are given down to individual subject areas. The information
gathered predominantly covers undergraduate entry courses. Where there has been
discussion of graduate entry courses this has been separately noted.
In focus group discussions, there were many aspects of the physiotherapy curricula
that staff, employers and students appreciated. For example, undergraduate and
recently graduated students valued the breadth of experience they had gained from
working in different clinical placements and had learned a great deal from their
clinical supervisors.
There are eleven Australian schools of physiotherapy offering sixteen different entry
level physiotherapy degree courses between them (Appendix C). The courses have
many features in common: they all aim to meet the required accreditation standards of
ACOPRA. However there is also variation between them at the program structural
level (eg undergraduate, graduate entry master, double degree) at the subject structural
level (eg schools have different kinds and different sequences of clinical experiences)
and at the pedagogical level (eg schools vary in the extent to which theory and
practice are integrated at different year levels).
There is general consensus amongst the schools of physiotherapy that the diversity of
curriculum approaches gives strengths to the physiotherapy courses, however issues
of quality assurance become more complex. This diversity allows graduates to
achieve the ACOPRA competencies /learning outcomes using a diversity of learning
and teaching approaches taking into account the geographical differences of
individual universities and their respective missions, goals and foci. It also accounts
for the graduate entry programs in a number of the universities.
One academic member of staff stated:
‘The course reflects an international trend in physiotherapy education in
structuring the curriculum to meet the Australian Physiotherapy
Competency Standards. It makes these explicit as learning objectives,
teaching methods and assessment procedures throughout the course. The
current undergraduate course uses clinical profiles extensively in the
professional subjects to develop skills in clinical reasoning and integrate
the core concepts with clinical practice.’
5.1.1 Physiotherapy studies

Undergraduate courses are very diverse in their description of curriculum. One
university commented that their small numbers enabled them to have a focus on
student centred learning approaches and the ability to address individual student's
needs. Many use a lifespan approach to curriculum development. One university
refers to a lifespan approach, developing graduates with generalist skills but
specialising in rural practice.
31
‘Lifespan (eg paediatrics) and other generic skills (eg ethics) are threaded
throughout the entire curriculum.’
Most courses emphasised the development of professional behaviours and attitudes

towards clinical practice, learning and knowledge development. These included a
focus on reflective practice in a collaborative environment. Staff (both academic and
clinical) all come from a clinical background and therefore feel they have a practice
based approach.
‘Behavioural sciences underpin the development of good professional
practice and communication skills. These skills are further developed with
course elements addressing professional responsibilities, ethics, legal
responsibilities, management skills and the physiotherapist's role in the
health care system.’
The ethos and philosophy of the curriculum is what is important and needs to be
conveyed to the students. A lot of implicit behaviours are expected of the students
which academics and clinicians feel are role modelled in varying degrees by the
teaching staff. Introduction to the 'profession' and the modelling required to become a
physiotherapist was considered important by many academics and clinicians but it
was felt that it was not necessarily made very explicit to students in their curricula.
The study found a strong emphasis in physiotherapy courses on the integration of

academic and clinical learning. The embedded nature of the physiotherapy program
within a multidisciplinary faculty or school emphasises the development of both
professional identity and cross disciplinary skills.
‘Key elements of the program are to enable students to develop as
effective health care team members, be reflective practitioners and have a
sound understanding of self directed learning as it exists in the overall
career pathway of a physiotherapist.’
A number of universities discuss the need for integration of the biological,

behavioural and biomedical science subjects. Integration of the academic program of
biomedical, behavioural and physiotherapy sciences in a clinical context based on
research evidence was a common theme.
‘Physiotherapy research underpins the course material.’
One university has an integrated learning and teaching program incorporating clinical
education throughout the four years with students attending clinics from the beginning
of the course. In this program staff from the clinical schools are involved in
curriculum development and design throughout the program. The academic program
in the school of physiotherapy is based on a problem based learning approach that
introduces the students to common health problems that they will encounter in their
clinical practice. These problems are used to encourage: in depth understandings of
the biomedical and physiotherapy sciences that underpin practice; the development of
the students' ability to work collaboratively in a group; the development of skills in
clinical reasoning and clinical decision making. These problems introduce the
students to learning about issues of practice in an integrated manner. This approach to
learning prepares the students for the context in which they will develop their
practice.
32
‘Integrated academic and clinical practice commences in year 1. A

problem-based learning education paradigm enhances contextual
learning. Biomedical and behavioural sciences subjects are integrated
within the problems. Research forms the basis of the clinical reasoning
processes underlying clinical practice.’
A few of the universities discussed the vertical and horizontal mapping of their
curriculum. As reflected in the previous chapter some students have sensed a lack of
coherence in their courses. Curriculum developers may need to be encouraged to use
strategies such as broad curriculum organisers or concept maps for students to enable
them to have an overall understanding of the learning outcomes that they are expected
to achieve.
5.1.2 Graduate entry courses

All Graduate entry courses build on pre-existing knowledge and use case studies to
integrate knowledge. Biomedical and in most cases behavioural science prerequisites
enable this to occur. Many use a systems integrated approach in the teaching of the
biomedical sciences and use clinical profiles to contextualise the learning in
physiotherapy practice.
‘The … graduate entry curriculum framework is a 2 year, 4 semester
model using an integrated clinical academic pattern. Coursework draws
significantly on the student’s previous undergraduate studies in exercise
science, with assumed knowledge of physiology and applied physiology,
neurosciences, anatomy, biomechanics and behavioural sciences.’
The early introduction of clinical studies is a feature of the graduate entry Master of
Physiotherapy courses.
‘Clinical education is introduced early in the program in order to provide
students with early, sequential and integrated exposure to a variety of
patients with problems of increasing complexity.’
In all cases research based practice was emphasized and clinical competencies are
developed in parallel with specific clinical knowledge and skills. One university
stated that their Graduate Entry Masters course was based on three philosophies
‘Evidence based practice introduced in semester 1 and gradually
increases with clinical exposure.’
‘The early part of the course builds on students' pre-existing knowledge

and establishes an appropriate knowledge base particularly in the
biomedical and behavioural science subjects.’
‘Case studies are used to provide a ‘systems integrated’ approach and

provide a basis for applying discipline knowledge, reinforcing principles
and concepts, problem solving, critical thinking and clinical reasoning. In
addition, case studies provide a medium for incorporating cultural issues,
ethical issues and an international perspective into the curriculum.’
‘Curriculum mapping of course outcomes and unit outcomes facilitates

the integration of material.’
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5.1.3 ICTs in learning and teaching

ICTs appear to be embedded in an implicit way in all aspects of learning and teaching
in both the education and health environment. Students in all universities have access
to computers and the Internet. All students are instructed in the use of search engines
for evidence-based practice and critical analysis of the information gained from the
web. University staff frequently obtain feedback pertaining to curriculum design and
delivery from students and clinicians, and introduce new courses in response to
perceived needs. For example, new ICT based learning resources are being developed
and evaluated in many physiotherapy subjects. All schools use the Internet to give
students access to Web-based resources and some use ICT for online courses, tutorials
and videoconferences.
All universities cited examples of how ICT was used in both the delivery of their
curriculum, using knowledge management systems such as 'blackboard' or 'web raft',
as well as using ICT as a teaching tool in discussion forums and interactive computer
aided learning packages. An example of innovative practice in this area is the use of
an on line workbook. Students can download this workbook and fill in additional
elements during the lecture, when the cases are talked about, so that theory and
practice are linked. In the following lecture, the lecturer responds to points from the
previous lecture that students found difficult.
Students in large metropolitan teaching hospitals use the health sector’s software
programs for data management regarding patients. As well, some students are exposed
to the use of telemedicine, for example in paediatric consultations where the patient is
at a rural location. This is a developing area of practice, which the schools of
physiotherapy must be aware of and take advantage of wherever possible. Medical
informatics has not been widely commented on by participants in this study.
Many applications of information technology are being using in schools of

physiotherapy. The hardware, software and staff training associated with maintaining
and updating ICTs makes considerable demands on the budgets of the schools of
physiotherapy. Some staff said that they would like more advice on effective ways of
developing and running online subjects. Employers comment on the graduates’ ability
to use technologies effectively and their keenness to learn on the job especially using
ICT.
Some academic staff acknowledged that developing specific computer based learning
packages is costly in terms of time commitment and that to do so well requires
specialist knowledge. While several academic staff indicated that they would like
more ICT education a smaller number of staff were highly competent in the use of
ICT as a tool for student learning and had developed sophisticated interactive
programs. The Australasian Heads of Schools of Physiotherapy share information
about computer aided learning packages that have been developed for their respective
courses and that are available for exchange or purchase. They are all concerned at the
very significant resources that are required to develop appropriate packages. The
experience of this group since its inception has been that unless the multimedia
products are very sophisticated, introduced appropriately and perceived to be relevant,
students will be reluctant to use them. Students much prefer ‘tutors to computers’.
Any multimedia needs to be well integrated into the curriculum and teaching methods.
34
In order for more effective use of multimedia, most academic staff require further
education. Additional time and resources are required to support both staff education
and the development of curriculum materials. Preparing courses for flexible delivery
using multimedia is normally a time-consuming and expensive process. Considerable
further research is required to establish the forms of multimedia that are truly cost-
effective learning and teaching tools. The research indicates that student enthusiasm
for this form of lecture delivery for example, is often minimal. Compared with initial
intentions, actual usage may be very limited (Bell, Cockburn, McKenzie and Vargo,
2001). It was also evident that students required specific preparation for the effective
use of multimedia.
There are a number of excellent multimedia packages suitable for a range of health
professions. The award winning ‘an@tomedia' co-developed by anatomists, medical
and physiotherapy academics is an excellent example of such as package (Eizenberg,
Briggs, Barker and Grkovic, 1999). In the interprofessional clinical practice of
students and later in their professional lives, there is further opportunity for
collaborative learning in health informatics. As many health professionals, such as
physiotherapists are highly mobile during their early professional careers, national and
international collaboration to enable smooth transition in learning between these
global boundaries would be desirable. It is important that in both the academic and
clinical education environments health professional students are introduced to the
health informatics tools they will need to use.
Clinical education experiences within Australia frequently occur at rural or regional

clinics that are geographically distant from the universities. The Internet is used to
improve communication, provide social support and promote problem solving
abilities. During this project, there were a number of examples described by staff and
students where password protected web sites for students and academic staff provide
access to course and subject materials, forms, and requirements for submission of
assignments via the web site. Access to a bulletin board, private e-mail, survey
instruments, and Internet links were also available on such sites.
The educational multimedia developed specifically for physiotherapists is relatively

limited. Therefore, the project team argues strongly for rigorous research and
evaluation of the impact of ICT and multimedia on learning outcomes in
physiotherapy education. Currently available materials require evaluation of pedagogy
and content, the students' perceptions of usefulness and on their cost effectiveness as
an educational tool.
5.1.4 Multidisciplinary learning and teaching

Multidisciplinary learning and teaching to work in health teams is a common theme at
all universities and staff are increasingly enabling students to learn together in such
teams during their undergraduate years. Five schools of physiotherapy have
introduced subjects that bring together students from different health professions to
work collaboratively. One school of physiotherapy has implemented a new subject,
Foundation Skills for Allied Health Professionals for first year students in
physiotherapy, occupational therapy, podiatry and speech pathology; another is
introducing an integrated online course for four hundred students from different health
professions.
35
One university with a large faculty representing health sciences such as

physiotherapy, medicine, speech pathology and audiology amongst others said:
‘[The] introduction of a structured program of Inter Professional
Educational Experience is occurring in 2004 as part of an … initiative
where students from all health disciplines work on a common clinical
problem in small multidisciplinary groups. It is planned to introduce inter
professional learning initiatives into all years of the undergraduate
physiotherapy program in the near future to prepare graduates for
changes in the delivery of health care services and improve inter
professional communication…’
Another university with a large faculty has physiotherapy, dental, pharmacy, nursing
and medical students working collaboratively in its rural health module.
All universities expose their students to the roles of health professionals during their
clinical practice. This was also seen by employers to be a key issue in the graduates'
abilities to work effectively in the public and private health environment. Some
employers discussed the need for the students to have a firm understanding of their
own profession and its knowledge and skills before they could effectively engage in
multidisciplinary health teams.
This is a complex area of curriculum design and delivery that needs careful
consideration of issues such as timetabling, resources available and cross discipline
collaboration. Further understanding of this area needs to be gained from research and
international examples of good practice in the learning and teaching in
multidisciplinary curricula.
5.1.5 The crowded curriculum

The question of what should be included in the undergraduate/ graduate entry level
curriculum and the level of expectation of the competencies required of the graduating
physiotherapist requires further exploration. In an article in the APA Journal in 2002
Crosbie et al discussed the increasing problem of determining what core teaching is
required for entry-level practitioners.
Many respondents in this AUTC study reflected these concerns. As new areas of
practice open up for physiotherapists and as health practice changes, the curriculum
needs to be able to adapt and change. Curriculum content needs to be evaluated for its
relevance on a continuing basis so as to address some of the problems of
overcrowding. Concern is expressed that students are not spending enough time on
core areas of practice as there are so many areas of the curriculum to be covered.
5.1.6 Changing student population

It was acknowledged by most of the participants in this study that there was an
increasing diversity of the student body in physiotherapy courses. Sources of diversity
include age, gender and ethnicity. With changes in the nature of the students entering
physiotherapy a number of issues require consideration.
All undergraduate physiotherapy students have access to support services provided by

their university, their faculty or their school of physiotherapy. These include programs
for international students, students from non English speaking backgrounds (NESB),
students with disabilities, and special needs students. Two universities have
36
specialized tutoring programs for indigenous students. Some schools have specific
programs provided by staff of the school. One school of physiotherapy identified a
program to support students at risk of failing; another two had programs within the
school for international students. Peer tutoring and mentoring by students in higher
years for specific groups such as rural students and international students are in place
in some schools of physiotherapy. Students said in focus groups that they appreciated
such support. These additional programs are considered important both in the
academic environment and clinical learning environment. Clinicians stated that NESB
students commonly needed extra support for learning in more intensive, one on one
clinical encounters.
5.1.7 Cultural diversity

All respondents discussed the impact on curriculum of the increasing diversity of both
the student body and the community in general. This diversity has required that
changes are made in the content of curricula as universities attempt to respond to such
challenges in their teaching. For example, case studies are developed, based on
patients from a diverse range of populations, requiring students to understand
individual views of health and illness.
5.1.8 Transition issues

Curriculum design needs to respond to different periods of student transitions. In
undergraduate physiotherapy courses students encounter two main areas – their
transition from school based learning to university style learning and their transition
from academic learning to experiential learning in the clinical environment. These
transition issues require consideration and their management should become
embedded within the curriculum. In the graduate entry courses consideration should
be given to the particular transition needs of those returning to study, and to study as a
mature age student.
5.1.9 Full fee paying students

A larger percentage of physiotherapy students are now required to fully fund their
own studies. All the graduate entry courses are full fee paying, some universities have
full fee paying local students and nearly all have full fee paying international students.
This provides additional stresses on students in managing intense study programs as
well as needing to financially support their university places. Hence additional
pressures are placed on staff as there is a high cost for academic failure for these
students. While these issues were not explored in the present study they warrant close
monitoring and investigation in the future.
There is an increase in the demands that students make on university staff as the
higher education environment becomes more customer oriented. While this issue is
not unique to physiotherapy the discipline arguably faces some unique challenges as
the physiotherapy courses preclude the higher rates of part time paid employment
enjoyed by students in other courses with fewer contact hours.
5.2 Curriculum Delivery

There was general acceptance that small group teaching using case based or problem
based learning was an important teaching and learning tool. As well, all respondents
including students commented on the need for learning to be in context. Many
different approaches in curriculum delivery are used to simulate the clinical
37
environment. These included videos, role-plays, sessions with expert practitioners and
computer aided learning programs. In many instances case studies are used to
integrate learning, and evidence based practice seen as essential in (most, if not ) all,
courses. Case studies based on patients seen by students in clinical practice are
commonly used to drive discussions around theory and management after students
return to their university.
‘The curriculum uses teaching methods which integrates classroom,
clinical and research experiences in a way that teaches the students to
apply their knowledge in increasingly complex situations.’
One university highlighted the diversity of teaching staff involved in the delivery of
their curriculum.
‘The undergraduate program is developed around the concept of
physiotherapy as an applied clinical science. The foundation biomedical
and behavioural sciences are introduced to physiotherapy students by
academic experts in these fields during the first and second years.
Specialist medical and other academics and professionals also contribute
to various courses bringing their own expertise to the total mix of the
program. This is done in parallel with physiotherapy studies. From the
beginning of the program emphasis is placed on the importance of
physiotherapy clinical practice which is founded on science and is
evidence based.’
The integrating of the theory and practical sessions was also seen by students to be
important in their ability to comprehend the relevance of what they were being taught.
This theme of integration and linking of theory and practice was repeated by students
and staff as one of the key elements of good delivery of the curriculum.
Other aspects of curriculum delivery also helped student learning. Those raised
frequently by students were: they learned a lot from good lectures, from mentoring by
students in higher years, peer group work and self-directed learning tasks. Students
appreciated the accessibility of staff and found it very valuable when an expert
physiotherapist demonstrated assessment and management of specific patients.
Students in a graduate entry program commented that the peer and group learning
environment was very motivating and that the staff were very approachable so that it
was easy to ask questions regarding content.
5.3 Assessing and monitoring learning outcomes in undergraduate

physiotherapy degree courses
All schools of physiotherapy review their physiotherapy curriculum regularly, both at
the course level and the subject level. They align their curricula with university and
faculty policy, with generic graduate attributes for their university and with the APCS.
The focus of the reviews is usually at a number of levels including content and
reviews of learning and teaching experiences.
Assessment and monitoring on a national basis of the fitness for purpose of learning
outcomes from entry-level physiotherapy courses is facilitated by requirements of the
ACOPRA accreditation process. ACOPRA clearly specifies the learning outcomes
required for gaining full accreditation. It requires the provision of satisfactory
38
evidence from surveys of new graduates and from the employers of those graduates
that they demonstrate fitness for purpose against the beginning practitioner
competencies (APCS) and the ACOPRA Standards. This has been demonstrated to be
a very effective way to assess fitness for purpose of the learning outcomes of a
physiotherapy course. Following the achievement of full accreditation, ACOPRA
continues its monitoring role for physiotherapy courses through follow up reports
incorporating surveys as described above.
The results and evaluation of surveys of employers of new graduates for ACOPRA
accreditation purposes includes perceived strengths and weaknesses; what the
university proposes to do to address the weaknesses; and how it plans to assess the
effectiveness of such intervention. As well as addressing the specific ACOPRA
requirements, many physiotherapy schools seek additional survey material from new
graduates and their employers on a regular basis and are able to provide rich data
analysis for the ACOPRA accreditation process.
5.4 Review processes in Schools of Physiotherapy

There is an extensive process of review within all schools of physiotherapy as
required by their respective universities. The more recently introduced Australian
Universities Quality Agency (AUQA) evaluation of universities is also impacting on
schools of physiotherapy. These processes were confirmed by the survey of
academics. This survey also asked academic staff to nominate the additional
stakeholders they consulted for review rather than identifying stakeholders from a
proscribed list. All schools of physiotherapy consult widely on a regular basis with
stakeholders within the university sector, clinical educators, employers and with
accrediting bodies in the course of their evaluations. Of the 10 universities responding
to the survey, all identified their staff and public and private employers of graduates
as stakeholders whilst eight indicated that students, clinical educators and the APA
were consulted. Seven universities identified that they consulted with their State
Physiotherapist Registration Board. Whilst not nominated by all universities as
stakeholders, graduates are routinely contacted for feedback regarding their fitness to
practice and ACOPRA undertakes a full curriculum review as part of its processes.
One university noted that:

‘Students and lecturers are involved in curriculum review through the
formal evaluation process undertaken by the Centre for Education
Learning and Teaching (CELT), and through the physiotherapy
curriculum review committee (PCRC). The PCRC meets in week 11 of
each semester, and has representatives from each year of students and the
physiotherapy lecturing staff. The student representatives are responsible
for compiling a report from blinded feedback that covers all subjects
taken by the students in that semester, the clinical placements, and other
factors such as resources (library computers etc). The PCRC is invaluable
for capturing an overview of the program, and especially students’
perspective of how well subjects within a semester balance each other,
vital information that is missed with the individual subject evaluations
performed by CELT. The course coordinator is responsible for compiling
an action plan resulting from the feedback, for relaying the information to
the relevant parties and assisting in the implementation of the action plan,
and for reporting back to the next meeting.’
39
Another university uses computer technology for evaluation by students:

‘Each subject and year of the course is evaluated by students using the
School’s on-line evaluation tool – Course Evaluation on the Web. This
evaluation tool assists in the process of student and staff reflection on
learning and teaching and provides a mechanism for managers and
coordinators to improve the quality of the program.’
A third approach was described thus:

‘The Course Evaluation Instruments for each course are reviewed
regularly by the Program Director and by all teaching staff involved in
the course. This occurs formally in fortnightly Physiotherapy Program
Review meetings and less formally in course meetings. Every two weeks,
the program team has a Program Meeting to respond to and review
current curriculum, staffing and other issues that may affect the running
of the program. Twice a year, the program team holds a full day planning
day, where minor to moderate changes to the curriculum may be made in
response to student feedback, staff feedback, and discussions with external
stakeholders such as clinical educators, employers and the APA.’
A further mechanism employed by many courses accredited to date is a specific

professional or community advisory or consultative committee, which includes
employers of physiotherapists. These committees interact with university academic
staff in the ongoing review of curricula. This constructive two way process enables
courses to keep abreast of changes in the health sector that impact new graduate
physiotherapists in the professional workforce. It also ensures the community is aware
of educational developments or changes. Physiotherapy courses are additionally
advantaged by the number of teaching staff who are also in clinical practice. In all
courses some academic staff are also practising clinicians who contribute high levels
of clinical relevance to their teaching and ensure contemporary management is
conveyed to students. The clinical educators are in a privileged position to influence
program content, although it was noted that in some locations the clinicians would
like further involvement to influence course content and delivery.
One school surveys annually both the employers of the new graduates nine months
after graduation and the new graduates to get both opinions on whether the graduates
are adequately prepared for practice.
All schools of physiotherapy, apart from the very newest, have made changes to their
courses during the past few years. They make changes in the timing or the emphases
of particular subjects and clinical experiences in response to student feedback and
perceived student, community or employer needs. For example, one university had
made changes to its curriculum in response to University policy:
…’University has recently adopted a teaching and learning plan that has,
as its main focus, outcomes-focused education. This change is
necessitating a current review of the entry level physiotherapy curriculum
and the horizontal and vertical mapping of learning outcomes for the
entire course.’
Another school stated that following a major review:
40
‘The current Bachelor of Physiotherapy program was the result of taking

into consideration advances in the profession, the changing health needs
of the community and the changes in student learning.’
A number of universities have made curriculum changes to reflect changes in the

health needs of the community, advances in the profession and the need to integrate
research into teaching. The need for students to be able to evaluate research findings
and apply them in evidence-based practice was also a consideration for curriculum
change.
In all courses surveyed staff used a variety of methods for evaluation: questionnaires,
staff-student liaison meetings, on line feedback. The topics reviewed included issues
such as feedback on individual subjects, lecture content and presentation, the staff
members teaching in small groups, clinical education and administrative support.
Clinical education is monitored by feedback gained from clinicians, physiotherapy

managers and students in relation to both content and process in the delivery of
clinical education.
There was very little evidence gathered in this project on evaluation of teaching
methods. All universities adapt and modify their learning and teaching materials in
response to student feedback and advances in physiotherapy knowledge. Planning
days around curriculum design, content and delivery were held in a number of
universities. These curriculum planning days include staff, students and external
stakeholders.
Each university has its own processes for approving minor and major course changes.
These start within the school and include the faculty and then central university
committees.
5.5 Summary
There is extensive assessment and monitoring of learning outcomes on a national
level from ACOPRA and through AUQA audits; at an institutional level in quality of
teaching surveys; and from individual subjects via student feedback. As well,
monitoring of support programs such as mentoring, transition programs and
administrative support is extensively carried out.
In discussions on curriculum design and delivery many examples of good practice

have been cited. Students and graduates alike emphasised the value of small group
teaching, integration of theory and practice and learning in context. Early clinical
exposure was seen as highly desirable but not always available. Development of
concept maps or other tools to enhance the students understanding of the role and
value of learning outcomes in helping their study would be useful. Multidisciplinary
teaching was incorporated in all schools with a number having explicit subjects
covering this area. All schools reported extensive use of ICTs in learning and
teaching.
Little evidence was gained on the philosophy underlying curriculum design in the
different schools or why different teaching methods had been chosen. Comments from
one respondent referred to the lack of evidence for teaching and learning in
41
physiotherapy. This is considered in an article by Chipchase, Dalton., Williams, and

Scutter (2004) ‘Is education immune from evidence based scrutiny?’
5.6 Recommendations
• that federally funded competitive research grants should recognise the
importance of research into education in the health sciences, including
physiotherapy.
• that universities prioritise physiotherapy education research. Specifically, there

is a need for research into:
o innovative approaches to the design, delivery and review of
physiotherapy education, including clinical education, with a view to
enhancing learning outcomes
o different approaches to the complex issue of multidisciplinary
pedagogy and practice
o cost effective and high quality multimedia learning and teaching tools
in physiotherapy education.
• that schools of physiotherapy and employers address the issue of 'the

overcrowded curriculum' in the light of recent research; new areas of practice;
the need to value private practice and issues pertaining to clinical education in
public and private practice.
• that schools of physiotherapy further explore and implement strategies to

include the profession and stakeholders in physiotherapy curriculum
development, delivery and review processes.
• that schools of physiotherapy explicate the role and value of learning

outcomes in order to clarify the relevance of learning experiences for students
and provide them with a more coherent learning framework.
• that physiotherapy educators and curriculum developers collaborate to

determine the most appropriate means of developing, sharing, promoting and
disseminating effective strategies in physiotherapy education.
42
Ch 6: Clinical education and stakeholder involvement in curriculum
6 CLINICAL EDUCATION AND STAKEHOLDER

INVOLVEMENT IN CURRICULUM
_____________________________________________________________________
6.1 Clinical education

Clinical education is a key component of physiotherapy curricula and constitutes a
large part of all courses. This was the area of the curriculum that elicited the most
comment and also the most concern. The majority of responses from clinicians,
graduates and students stressed the importance of clinical education early in the
program to enable students to understand the relevance and importance of what they
were learning. In most courses the majority of the direct clinical exposure occurs in
the third and fourth years of the course but all courses incorporate teaching relevant to
clinical practice early in the course.
Major issues in clinical education were inadequate funding for clinical education, lack
of qualified clinical teaching staff, lack of support for clinical staff from universities
in the education process and from health sector employers for the education role and
lack of accommodation for students in rural areas. The places for clinical education
are becoming increasingly pressured with patients spending less time in hospitals, less
job opportunities for physiotherapists in the acute sector, no government funding for
physiotherapy clinical education, the increasing number of students and more schools
of physiotherapy
‘Clinical education is making demands on clinicians who are under
resourced to provide core clinical services let alone supervise students.
The increasing number of students in public hospital placements is the
bottleneck.’
Physiotherapy is a keenly sought after degree in the universities. Such popularity

places pressures by universities for the schools to take extra students. The pressures
on the schools are also exacerbated by the change in funding for universities and the
demands to take more fee-paying students – both local and international. The
development of health professionals is costly and time consuming. They require very
different teaching methodologies and environments to the students studying, for
example, Arts or Science. The funding models need to reflect the medical science
nature of physiotherapy courses with their extensive clinical needs. Such funding has
been recognised for medicine and dentistry for decades. Recently there has been
Federal Government recognition that there are significant costs associated with the
practical components of teaching and nursing. It is timely to acknowledge the need in
physiotherapy education.
6.2 Competition for scarce resources

There are increasing numbers of physiotherapy schools competing for clinical
placements. With an already under resourced (or not at all resourced) system,
clinicians are especially concerned at how these students will gain adequate clinical
experience. Some academics and clinicians expressed concern at a perceived need for
1000 hours of clinical practice experience. One thousand hours of clinical experience
is apparently still perceived by some as a requirement for a program, despite the fact
that ACOPRA has been careful to make no specification of hours of clinical
experience in guidelines and procedures for accreditation and the WCPT removed the
43
requirement for 1000 hours of clinical experience in physiotherapy courses of member

countries in 1991. Quite apart from that however, the burgeoning number of
physiotherapy courses and a constrained health sector is concerning clinicians and
academics. The ACOPRA standards (5.8) make it very clear that clinical experience
must be of 'sufficient breadth, depth and comprehensive coverage to ensure that the
objectives of the program are met, and that students have the opportunity to integrate
theoretical concepts into clinical practice'. In 2002 ACOPRA enunciated a position
statement 'The primacy of an comprehensive physiotherapy clinical education
experience' and drew the attention of all universities with schools of physiotherapy or
those contemplating commencing a physiotherapy program, to the primacy of a
comprehensive physiotherapy clinical placement experience.
Discussions between clinical coordinators, head of schools of physiotherapy, and

articles in professional journals reflect a growing disquiet as to how the profession
will manage to support the clinical needs of new courses of physiotherapy. The
universities participating in this research project all have different amounts of
financial and academic support for the clinical facilities associated with their
universities. Private practice is not used substantially; reasons given for this are loss
of income for the private practice and issues regarding insurance.
Rural clinical education was another major concern. Lack of accommodation, travel
costs and lack of access to learning materials were some of the issues described. It is
well documented that students are more likely to work in the rural area if they have a
rural clinical experience (Carroll & McMeeken 2000). Another critical issue is the
lack of appropriate physiotherapists in the rural areas able to be involved in the
education of the students.
6.3 Redefining clinical education

In each school of physiotherapy, one or more members of staff have responsibility for
the clinical education component of the curriculum. These clinical co-ordinators have
responsibility for ensuring the placement of students in clinical locations for clinical
education purposes.
These clinical coordinators from all schools of physiotherapy in Australia and New
Zealand have met annually for the past three years. The concerns of the profession
regarding clinical education have been discussed in detail with the group
acknowledging the need to further consider what constitutes clinical education and
how it can be effectively and equitably delivered. There is a need to inform the
profession, who are critical deliverers of clinical education, of different models and
methods of clinical education. This requires a collaborative research program to be
undertaken to have more evidence on good practice in clinical education.
The profession is an important stakeholder in the development of appropriate

physiotherapy courses and is the key body involved in the delivery of clinical
education. Clinical staff in public hospitals are deeply concerned about the pressures
on them to provide high quality clinical education within the limited time and
resources available to them. There is no Federal Government funding available for the
clinical components of physiotherapy education and clinicians find it a great strain to
manage their own case load as well as educating students. They see this problem
becoming exacerbated in the future as new schools of physiotherapy are opened and
44
new courses, such as Graduate Entry Masters courses, are developed resulting in an
increasing number of students needing clinical supervision. Clinical staff recognise
that new graduates also need extra supervision in their first year. In some workplaces
this is difficult to provide because there are so many students requiring supervision.
Clinical staff feel that universities do not always appreciate the time and the costs of
providing high quality clinical education and should make more funding available to
them. Some have suggested that funding from additional fee-paying places in
physiotherapy courses be used to boost the funding of clinical supervision in future.
6.4 Timing of clinical education

Early clinical experience was seen to be important by most respondents but is not
available at all universities. It is important that the academic and clinical components
are seen as a continuum and that the clinical component is not viewed as ‘training’ or
‘a placement’ taken at the end of the course. Clinical education requires integration
with the academic program, to enable the graduates to be able to enter the workforce
well prepared to practice independently. The most positive feedback from clinicians
was obtained when clinical education was described as developed collaboratively
between academics and well-qualified clinicians.
The students are required to develop technical expertise, clinical reasoning abilities,
advanced interpersonal skills; and the knowledge and self directed learning skills that
will enable them to become life long learners. Clinical education is essential in
educating physiotherapists to meet the levels of expertise expected of them by the
community. To facilitate this learning, close links need to be attained and maintained
between the schools of physiotherapy and the health sector providing the clinical
education component of the courses.
6.5 Clinical education in a changing environment

The graduating physiotherapist must be able to deal with uncertainties in the health
sector, changes in the knowledge they need for practice and the ability to question
their values and beliefs as they work in a diverse community. Their experiences prior
to graduation need to give them the time and opportunity to develop these skills
among others in order to be effective clinicians.
The health care arena in Australia is rapidly changing; more emphasis is being placed
on community care and early discharge of the patients from acute care. Government
agencies are directing more of the health care dollar into health promotion and
prevention of injury and disease. This requires that physiotherapists be educated to
become flexible independent health practitioners aware of and sympathetic to the
changes taking place in the health sector. The community into which the new graduate
enters is changing, it is more multicultural with specific and mixed ethnic groups,
each requiring appropriate skills in communication and cultural awareness.
6.6 Possible solutions

Physiotherapists on graduating must be independent practitioners, yet unlike their
counterparts in medicine there is no funding for an internship year. Therefore the
undergraduate clinical program is of paramount importance in ensuring that the
graduating physiotherapist is a competent, safe and independent practitioner with the
ability to deliver efficient integrated and appropriate clinical outcomes. One head of
school stated:
45
‘This is where the physiotherapy profession needs to think deeply about its
profession and the recognition of a beginning practitioner versus an
experienced practitioner. This is where the concept of a provisional
registration year might be an option. That is all new graduates would be
required to work under supervision in their first year of practice (whether
in the private or public sector). There are many ways that this supervision
could be achieved, even for new grads working in rural or remote areas,
which could be linked to a hospital or other non government, private
organization.’
Physiotherapy students need to engage in their professional practice in order to learn

to have the conversations that enable them to understand the culture of the profession.
The circumstances in which this takes place are increasingly difficult as the
physiotherapists in health sector have less time to enter into these conversations.
Employers in all focus groups said that students require practice in managing the
finite resources of their workplaces. They must learn to consider the cost effectiveness
of treatment, for example, to weigh up how frequently they should treat patients
according to the resources available. Sometimes limited resources mean they should
cease treatment altogether.
It would be beneficial to clinicians and students if the physiotherapists providing

clinical education were able to gain some form of qualification in experiential
learning and teaching. With formal qualifications in clinical education there would be
a strong argument for paid supervision.
While some clinical educators have very close links with schools of physiotherapy,
others would like more consultation about the curriculum, more influence on the
selection and assessment of students and more feedback about whether their
suggestions are implemented. Some clinical staff are keen to broaden their university
contact from joint responsibility for the supervision of students to the development of
joint research projects with university staff. Others would like more professional
development courses run by university staff.
Senior staff, in clinical education environments, are also employers of new graduates.
The close nexus between clinical education and supervision of students to mentoring
of new graduates provides an excellent example of professional educational
development. In many instances the middle level physiotherapists are undertaking
postgraduate courses and demonstrate by role modelling and active encouragement
the next phase of professional education. Carroll and McMeeken (2000) found that,
without exception, the new graduate physiotherapists in their study had undertaken
continuing professional education. The 74 new graduates that responded to their
survey had all completed from five to more than 30 hours of continuing professional
education in the past year. This proportion of graduates undertaking formal
postgraduate education has declined in recent years with the introduction of full fees
for postgraduate education in physiotherapy. In order to foster such life long learning
and provide appropriate health services to the community, postgraduate education
similar to that available to new medical doctors and nurses is strongly recommended.
46
6.7 Professional and industry involvement in the physiotherapy

courses
All schools of physiotherapy acknowledge the importance of consultation with the
physiotherapy profession and other stakeholders in developing their curricula.
The amount of consultation varied between the schools according to responses from
academics. Most schools have representatives of the profession and key stakeholders
on school advisory committees. One school has professional representatives on key
school committees such as planning and budgets, selection, undergraduate curriculum
and clinical education. All schools reported consultation with professional colleagues
at times of curriculum reviews. Many schools had regular interaction with the APA
and representatives of their special groups in developing curricula. Feedback is gained
by all schools on the graduates' competencies, skills and preparedness for work on
graduation.
In response to the project's survey of employers of physiotherapists, which asked

about professional involvement with schools of physiotherapy, 86% said that they had
involvement. Usually this was in the form of providing clinical education. The next
most common element was involvement in advisory committees followed by the
opportunity to give lectures. Some respondents stated attendance at workshops. When
asked what they valued most in their relationship with the schools of physiotherapy
comments included
‘Putting something back into the school and the opportunity to look at
new grads coming out.’
‘Opportunity to motivate students and graduates to engage in an evidence

based approach including clinical research.’
On being asked what they would like changed in their relationship, the largest number
of responses related to increased support for clinical education (31%). For example,
typical comments were: ‘More time and /or resources for supervision’ and ‘More time
with university clinical coordinator’. Twenty nine per cent stated that they would like
to have more opportunities to be involved in curriculum development.
Further comments reflected ongoing concerns with clinical education and the
relationship with the universities and the support given to clinicians. Finally two
people commented on the wish to have:
‘More opportunities to discuss future needs of the profession in line with
changes in health policy and the big picture of health.’
In responses gained from focus groups, which involved employers of

physiotherapists, one group identified the need for support for clinical educators.
Another group felt there should be more reciprocity, integration and collaboration
between the profession and the universities. The third group felt that they had a good
relationship with their university but could perhaps have more involvement in student
selection and access to student feedback from clinics.
6.8 Employers responses to the curriculum

The health sector is changing rapidly which means that it is important for the new
graduates to be prepared for the changing environment and the pressures within it,
especially the rapid through-put of patients and the need for discharge planning.
47
In the Health sector there is increasing emphasis on working effectively in teams

using a bio-psychosocial model and some respondents felt that this may not have
enough emphasis in the courses. Some clinicians stated that physiotherapists are now
required to take a far greater role in clinical decisions concerning patient
management; for example physiotherapists are one of the key decision makers in
discharge planning for many patients. This means that the new graduates need to be
better prepared for this role.
‘Changing modes of community physiotherapy need to be reflected in the
curriculum preparation for workplace realities.’
A number of employers, in both the public and private sector, commented on the need
for graduates to have supervision for one year on graduation, such as occurs in
medicine and nursing. Comments were that this supervised year could be managed in
a number of different models taking into account rural and remote issues and the
variety of different work environments, as discussed in the previous section.
Comments were made that the students have excellent ICTs skills and in many cases
help staff with ICTs. The graduates on the whole, have very good assessment and
problem solving skills for less complex patients and satisfactory levels of skill with
the more complex patient. They are keen to learn and learn quickly on the job.
Graduates do not compartmentalise their knowledge as some employers indicated
they had in the past and are fully committed to lifelong learning. Employers are
pleased with their professional skills, their approaches to patients, and they have good
communication skills with an ability to ask appropriate questions. On the whole they
need to have a greater awareness of how to work in a big institution, their place in
multi-professional teams and how to fit into the health care hierarchy. Particular
mention was made of the students from a regional university that they had a
‘Good feel for rural practice, rural life and working; willing to work in
rural areas.’
Some concerns were expressed about whether the graduates from the two year
graduate entry level masters courses would have enough time in their courses to
develop the competencies required to practice. Overall however there were many
comments on the advantages that these students have in terms of their life experiences
and communication skills.
Employers also expressed concern about the adequacy of the graduates to meet the
workforce demands. Issues such as time management, management of resources,
working with more complex patients and diverse settings were given as examples.
‘My opinion is that the physiotherapy courses don’t adequately prepare
students for the diversity of work and lack of support, especially for rural
areas. Curriculum changes should focus more on problem based learning,
rather than problem solving.’
The project data indicates that some physiotherapists in private practice think that
university courses prepare students preferentially for work in the public sector rather
than in private practice. They would like to employ graduates who have more
awareness of the differences between the public and the private systems. They voiced
their need for graduates with more relationship building skills in a paying
48
environment, more experience in cost effective evidence based practice, better

business acumen and a greater appreciation of the importance of marketing.
6.8.1 Suggested changes in curriculum from employers

Some employers felt that if there were more flexible entry processes for potential
students it would help later recruitment issues where some health sectors such as the
rural sector have difficulty in attracting and retaining staff. Universities offering
graduate entry courses appear to have acknowledged this issue by broadening entry
options.
Some comments were made that students need to be encouraged to consider

alternative ways of delivering physiotherapy such as with a community focus. A
graduate from one university commented on this:
‘It was good having your eyes open to lots of areas of physio. You know
you’ll never get stale because you can venture into new areas. The
broadness of the course was definitely something that’ll help me as a long
term physio.’
Comments also related to the need for graduates to understand about resources and
cost effectiveness of different types of health courses.
‘Students need to be better able to consider the cost effectiveness of
treatment, eg to weigh up how frequently they should treat patients and to
realise that it is sometimes necessary to cease treatments altogether.’
It was also considered, by many employers, that there should be a greater focus in the
curriculum on the primary health care sector, chronic disease management and the
national health priorities. Graduates require some different skills to work in the
private sector including health promotion and injury prevention in the community.
Some employers said that graduates needed further education in fields such as
paediatrics, disability management, rural physiotherapy, community physiotherapy
and physiotherapy in the schools sector
6.9 Summary
There was a great deal of concern regarding the ability of the schools of
physiotherapy and their professional clinical colleagues to be able to continue to
deliver appropriate clinical education and therefore safe and effective graduates
reaching the expected competency levels as designated by ACOPRA and the demands
of the workplace. Many respondents commented on the need to have a regulated,
supervised year of practice for new graduates as occurs in medicine and nursing. The
imperative of funding for clinical education and professional development for clinical
educators were strong themes, both in the focus groups and in responses to the
questionnaires.
Employers and university staff are very aware that there has been a rapid increase in
knowledge and treatment approaches used in physiotherapy during the past decade,
and that this is likely to increase still further in future. University staff, provide
courses that give students fundamental principles and practices in physiotherapy, they
also foster evidence based practice and lifelong learning skills. However it is not
possible for entry-level university courses to cover all aspects of physiotherapy in the
time available. Throughout their working lives, physiotherapy graduates need access
49
to professional development to broaden and deepen their skills and knowledge and
formal postgraduate study to develop specialist areas of knowledge.
6.10 Recommendations
• that the Federal Government should review the Commonwealth Course
Contribution Schedule and reclassify physiotherapy as a clinically based
medical science.
• that a feasibility study be instigated to explore the merits of a regulated

employment.
• that schools of physiotherapy establish a collaborative research program to

provide evidence of good practice in clinical education. This will inform the
profession, in both the public and the private sectors, who are critical to the
delivery of clinical education.

50
Ch 7: Employer satisfaction with physiotherapy graduates
7 EMPLOYER SATISFACTION WITH PHYSIOTHERAPY

GRADUATES
_____________________________________________________________________
7.1 Introduction
During the course of this project, employer perspectives were sought in two main
ways. First, we conducted focus groups in three states with invited employers of
recent graduates. These employers were selected on the basis that they represented
both public and private organizations ranging from large metropolitan hospitals to
rural hospitals to private practices. While some attempt at representation across the
sector was made, we acknowledge that these employer focus groups did not represent
all states and territories of Australia, nor did we have equal representation from the
public and private sector. Nevertheless, the contribution of these stakeholders in the
form of focus group discussion was a most valuable one for several reasons. First, the
focus group contributions formed the basis for the ensuing survey of employers which
was distributed to a much wider sample of employers across the country. Second, the
employer focus groups raised issues which were subsequently identified in the project
issues paper and validated by a range of stakeholders including heads of schools and
curriculum experts in the field of physiotherapy. Thus we have good reason to argue
that the focus group findings included in this section are representative of a broad
range of views held by this stakeholder group.
The second form of data collection among the employer stakeholder group was the
employer survey which sought employers’ opinions of the physiotherapy graduates of
2002 and/or 2003 who they had employed in the past two years. The survey was sent
to 300 potential employers of recent physiotherapy graduates. These potential
employers were members of the Physiotherapists in Leadership and Management
Group and Physiotherapy Business Australia. Further extensive networks within the
APA, the universities and clinical educators were used to develop the employer list.
Despite several follow up requests the response to the surveys was disappointing. In
part this may be due to repetition of surveys to employers. All physiotherapy
programs are required to undertake regular surveys of graduates and of employers for
the purpose of ACOPRA accreditation. A total of 44 employers of recent graduates of
physiotherapy responded to the AUTC Employers survey. The survey responses from
some employers from large public hospitals related to 15 - 20 students from one
school of physiotherapy whereas other responses related to one or two students. Thirty
one responses were received from public institutions and 13 from private practices.
Each Australian State and Territory was represented in the responses and their
employers considered graduates from every course, which had graduated
physiotherapists in the respective years.
7.2 Employers’ views on graduate competencies and attributes
7.2.1 Employers’ satisfaction with physiotherapy graduate competencies across

eight areas
The first section of the employer survey was based on the current ACOPRA national
accreditation requirements, where graduates of physiotherapy are expected to have
acquired a beginner practitioner level of competency in eight areas of their
professional work. Employers were asked to rate their satisfaction level with the
51
APCS competencies of graduates from identified universities and to indicate specific

strengths that they had observed. The strengths are noted in the section to follow.
Employers rated graduates performance as ‘satisfactory’ (scored 1), ‘good’ (scored 2)
or ‘excellent’ (scored 3). Table 3 lists the eight professional competencies areas
stipulated by ACOPRA, along with the mean level of satisfaction and the mean range
of ratings recorded by employers across Australia.
Table 3: Employers’ mean rating of graduate competencies and mean range

across institutions
Competency area Mean Mean

rating range
(1: satisfactory; across
2: good;
3: excellent) institutions
Professional behaviour: demonstrates professional 2.61 2.33-2.89
behaviour appropriate to a physiotherapist
Assessment: assesses the client’s abilities, problems and 2.15 1.33-2.60

needs
Interpretation and diagnosis: interprets and analyses 2.06 1.67-2.50

assessment findings for the diagnosis of client’s problems
and definition of client’s needs
Planning: develops a physiotherapy intervention and 2.08 1.33-2.44

management plan to meet defined goals
Implementation: implements physiotherapy strategies 2.11 1.33-2.42
Evaluation: evaluates the effectiveness of physiotherapy 1.92 1.33-2.27
Health care: operates effectively within the health care 2.10 1.89-2.44
system
Management: applies management skills in physiotherapy 1.59 1.33-1.86

practice
Employers’ satisfaction with physiotherapy graduates’ competence across the eight

areas is best summarised by the following comment: ‘[some graduates] are
outstanding in all these competencies, most are very satisfactory’. Employers
recorded the highest mean level of satisfaction with recent graduates’ demonstration
of professional behaviour appropriate to a physiotherapist. The graduates of all
universities were perceived to be highly professional with an average of 2.61. In most
elements of this survey employers indicated that there were individual differences
between graduates. This comment was not made with respect to professional
behaviour. This view is reinforced by the relatively low mean range of ratings across
institutions.
52
The average of all employers’ satisfaction with graduates’ capacity to assess their
clients’ abilities, problems and needs was 2.15. While only one university’s average
result scored below 2.00, this item represented the most variable set of responses from
employers (range: 1.33 to 2.60). It is not clear from the data whether this reflects
individual or institutional variability.
Another important competency required of graduate physiotherapists is the ability to

interpret and diagnose the client's problems and define client needs. The mean level of
satisfaction on this item was 2.06, with the graduates of two universities rating less
than 2.00. One employer commented:
‘For simple non complex patients I would label them excellent but for
more complex patients with multiple problems I would rate them good. We
must provide ongoing skills/training to improve in this area prior to
rotation into a more acute and demanding area.’
A private practitioner commented: ‘A greater focus on clinical reasoning for private

practice type patients in the latter years might assist.’
Recent graduates’ ability to develop a physiotherapy intervention and management

plan yielded a national mean satisfaction level of 2.08 with graduates of three
universities between 1.00 and 2.00. One employer commented that graduates:
‘Utilise goal setting and tools effectively. (In) Department processes (eg
clinical meeting where all staff present) support collaborative problem
solving, peer review and mentored learning approach.’
Another employer indicated that it was ‘Good that (they) adapt very quickly to
environment, adopt sustainable active/self management approach incorporating
health promotion messages’. Several employers indicated that recent graduates
improve in this area with experience.
Employers were also asked to rate their level of satisfaction with graduates’ ability to
implement physiotherapy strategies. The mean satisfaction level on this competence
was 2.11, with graduates of two universities less than 2.00. The range of ratings for
graduates from nominated institutions was relatively high (1.33 to 2.42). There is
evidence that ongoing learning and guidance is required as reflected in this comment:
‘Effectiveness of implementation often dependant on the willingness of the
individual to utilise the skills of their senior to modify the implementation
phase of service delivery.’
Graduates’ ability to evaluate the effectiveness of physiotherapy was rated relatively

low compared with other competencies, with an average satisfaction rating of 1.92.
Several employers suggested that further skills could be developed in this area. One
senior public sector employer noted:
‘Short rotations of new graduates (eg 3 months) do not facilitate effective
evaluation skills, especially in chronic/complex conditions. Longer
contacts developed excellence in evaluation.’
As evaluation of health care outcomes from a community, economic and professional

perspective is essential, consideration of undergraduate and postgraduate professional
education strategies is required.
53
Employers are relatively satisfied with recent graduates’ ability to operate effectively
within the health care system with an average rating of 2.10. Graduates of two
universities rated slightly under 2.00. Private practitioners considered that recent
graduates would benefit from a more detailed understanding of compensation
systems. One employer commented that the graduates ‘readily appreciate the dynamic
with other health professionals. Work hard at developing/improving relationships’.
Another employer considered that ‘Clinical meetings and supervision by seniors is
required to facilitate and maximise networks and liaison with outside agencies and
internal health workers.’
The ability of recent graduates to apply management skills in physiotherapy practice

received the lowest satisfaction rating of 1.59. This finding is to be expected, with
many employers commenting that it was a skill too early to judge and one which
develops with experience.
7.2.2 Employers’ satisfaction with physiotherapy graduate attributes

The second part of the employer survey considered ten generic attributes reflected in
the expectations of most universities and in the professional attributes expected by
ACOPRA in new graduates and by the APA in its members. Employers were asked to
rate their level of satisfaction with these attributes as manifested in recent
physiotherapy graduates. Table 3 presents the mean satisfaction ratings, arranged in
rank order, and the mean range of ratings across institutions. As for the graduate
competencies, employers identified a number of strengths and some areas of
weaknesses among graduates. These are discussed in the section that follows.
54
Table 4: Employers’ mean rating of graduate attributes in rank order
Physiotherapy graduate attributes Mean rating Mean range

(1: satisfactory across
2: good;
3: excellent) institutions
Openness to new ideas 2.49 2.11-2.92
Receptiveness to the use of information technology as applied 2.40 2.13-2.67

to health
Highly developed communication and interpersonal skills 2.17 1.33-2.67
Capacity for independent critical thought and self-directed 2.15 1.67-2.42

learning
Ability and confidence to participate effectively in 2.15 2.00-2.33

collaborative learning as a team member, while respecting
individual differences
Well developed cognitive, analytic and problem-solving skills 2.06 1.67-2.58
Understanding of the methodological bases of research activity 2.01 1.63-2.45
Understanding and appreciation of social and cultural diversity 1.93 1.67-2.18
Ability to plan work and to use time effectively 1.77 1.00-2.17
Leadership capacity 1.71 1.33-2.09
Employers recorded the highest mean levels of satisfaction with graduates’ openness
to new ideas (mean: 2.49). Physiotherapy graduates of all universities scored greater
than 2.00. Employers identify several strengths in this area, including the fact that
recent graduates ‘have demonstrated a thirst for new/fresh ideas.’ A leading public
employer from one State indicated:
‘Graduates have undertaken assisted project work, accepted
responsibility for portfolio work within the team, conducted quality
activities and undertaken service development and service review.’
In a second State a comment was (Graduates) ‘Seek out additional input from senior
staff and use this appropriately, show eagerness to learn and develop.’
Receptiveness to the use of ICT as applied to health also received high levels of
satisfaction with an average score of 2.40 and all universities scoring greater than
2.00. This was seen by one commentator as an ‘extremely strong point in …
graduates. Excellent computer skills and ability to use online resources.’
Highly developed communication and interpersonal skills were evident with an

average employer satisfaction score of 2.17. Graduates from all universities except
55
two scored more than 2.00. Employers noted interdisciplinary communication as an

important skill. A Western Australian public employer noted:
‘Generally very confident and competent individuals. This may be more
from background pre Physio. All seem very flexible and able to adjust
style to demands at different times ie can easily switch from interacting
with senior staff member to poorly educated patient with ease.’
Recent graduates’ capacity for independent critical thought and ability to participate
in collaborative learning as a team-member scored similar satisfaction levels among
employers. They commented that:
‘Many of our more outstanding new graduates have excelled at self -
directed learning, but have also availed themselves of all our senior
clinicians, in each area, to learn from’ , and
‘Very strong commitment to professional development and self directed

learning, good use of online education resources.’
Employer feedback on graduates’ team skills had the lowest variability of all graduate
attribute ratings in the survey (range: 2.00-2.33). This suggests consistency across
institutions in preparing graduates to work and learn with all professional colleagues,
while respecting individual differences. Representative comments include:
‘Strong commitment to team processes but also unafraid of pointing out
procedural or process issues.’
‘Well educated on aspects of team work.’
‘Graduates have fitted in extremely well with physio staff and with
multidisciplinary team members.’
It appears that employers are generally satisfied with graduates cognitive, analytic and
problem-solving skills, recording an average score of 2.06. Graduates from all
universities except two scored more than 2.00. From Victoria a public hospital
employer stated ‘graduates who have done PBL have better generic problem solving
skills generally … and ability to apply generic problem solving skills to clinical
situations’ and in Queensland it was commented that ‘These students are in the top
1% of academic high achievers so this skill is expected- it is the love of the job that is
evident in the very high achievers that makes them want to do their very best.’ From
Tasmania a comment was ‘Show willingness to accept criticism and asks for help
readily - constantly trying to improve skills - not content to just 'get by'. Highly
motivated’ and from South Australia ‘Good lateral thinking ability’.
Recent graduates’ understanding of the methodological bases of research activity was

deemed to be good, with an average score of 2.01. One university scored less than
2.00 with a range of 1.63 to 2.45.
Three graduate attributes received an average satisfaction rating of less than 2.00,
although still satisfactory, from employers. These were: graduates understanding of
social and cultural diversity, their ability to plan and use time effectively and their
leadership capacity. Understanding and appreciation of social and cultural diversity
scored an average satisfaction rating of 1.93 with four universities scoring less than
56
2.00. A major public sector employer commented: ‘This was quite variable amongst
new graduates and probably requires more emphasis from us as employers
particularly as it relates to local cultural diversity.’
Recent graduates’ ability to plan work and to use time effectively was deemed
satisfactory with an average score of 1.77. The range of responses on this item was the
second largest (1.00 to 2.17) indicating considerable variability among institutions
and individuals. Graduates from three universities scored more than 2.00. Comments
from employers suggest that they consider that new graduates develop this ability
with experience and guidance. Leadership capacity was also seen to be variable and
several respondents indicated that there was limited opportunity to show leadership at
this stage of graduates’ professional careers. The average score was 1.71 with all but
one university scoring less than 2.00.
The results of this survey indicate widespread employer satisfaction regarding the fact
that recent graduates meet the stipulated ACOPRA learning outcomes. Graduates are
more than satisfactory in the knowledge, clinical abilities and professional attributes
required to begin their professional careers as physiotherapists.
7.3 Main strengths of physiotherapy graduates

The survey for employers asked them to identify specific strengths of the
physiotherapy graduates they had employed in the past two years. Twenty two per
cent indicated graduates possessed good problem solving and clinical reasoning
ability indicating their ongoing capacity for appropriate clinical practice. Good
communication and patient relationship development were considered major strengths
by 18 per cent of employers, 15 per cent indicated sound knowledge and 14 per cent a
keenness to learn.
The employers identified several strengths of physiotherapy graduates. The top four
are as follows: i) good problem-solving and clinical reasoning skills; ii) good
communication and patient relationships; iii) a sound knowledge of the area; and iv)
keenness to learn. Over one fifth of employer respondents expressed particular
satisfaction with the clinical reasoning and problem-solving skills of recent graduates.
Problem based assessment was particularly strong in some graduates. One employer
indicated that:
‘Assessment is of high standard for straightforward patients and pretty
good for more complex patients i.e. those with multiple co-morbidities –
(the) emphasis on more global approach to assessment in the curriculum
rather than the former compartmentalisation assists with this.’
This response reflects the change in curriculum approaches which have been made to
accommodate the changing health environment.
A little less than one-fifth (18 per cent) identified communication skills as a particular
strength. Close to fifteen per cent viewed sound content knowledge and keenness to
learn as characteristic strengths of their recent graduates. Other strengths identified by
ten per cent or less of the employer respondents included good professional or work
ethic (10 per cent), good evidence-based practice (8 per cent). A much smaller
proportion of employers mentioned the following as strengths of recent graduates:
being a team player, confidence, adaptability, good ICT skills and good research
57
skills. Since employers were asked to nominate two main strengths, it is not clear
from the data whether the small numbers of employers identifying the latter set of
strengths reflects a lack of these strengths among the general graduate population, or
whether clinical reasoning and communication skills simply stand out from the rest of
the physiotherapy graduate competencies.
One private hospital employer commented on the fact that recent graduates had
strengths in the area of general ward practice and patient care. Another commented
that the recent graduates in her experience have been ‘very enthusiastic and keen to
contribute to professional development’ and to be involved in the APA. There is
general agreement among employers that recent physiotherapy graduates are keen to
learn and very adaptable. Many commented on students’ commitment to lifelong
learning and the obvious quality of their evidence-based learning.
In summary, strengths of recent graduates identified by employers include their:

• Clinical reasoning skills
• Professionalism
• Communication skills
• Confidence
• Confidence in the ‘core basics’ such as musculoskeletal groups
• Preparation of curricula vitae and the interview process
• Commitment to lifelong learning and evidence based learning
• Adaptability and readiness to learn on the job
• Ability to apply clinical reasoning skills to new areas
7.4 Perceived weaknesses of recent graduates

In addition to identifying strengths of recent graduates, the project team was charged
with evaluating employer satisfaction and making proposals for curriculum
development and improvement, based on these responses. As a result, we asked
employers to identify not only the strengths of recent graduates, but also the areas of
weakness and suggestions for improvement.
A few private practitioners commented on graduates’ lack of experience and skill in

private practice, including patient referral experience or understanding the health
system. One commented ‘we have taken the responsibility to ‘train them’’. There is a
shared perception among these practitioners that the ‘life and times of a private
practitioner are not addressed in their course’ and that they do not have sufficient
business practice experience in their courses.
Another employer of many years’ experience commented that ‘students don’t have the
same level of knowledge as five years ago’ and several agreed that the graduates are
very ‘variable’ in quality and skill level. Employers’ explanation for this skill
variability was essentially that skills depended heavily on students’ experiences
during the course of clinical placements: ‘it really depends on where students have
had experience’ and ‘paediatric and critical care strength [are] variable, depending
on undergraduate experience.’
58
These criticisms reflect the increasing difficulties universities face in providing

clinical experience for all undergraduate students in paediatric physiotherapy and
acute and critical care units.
Some employers noted that new graduates tend to focus on the physical problems
manifested by patients, rather than on the whole person. It was also felt that graduates
do not integrate theory and practice as effectively as they should and that, in some
cases, this was due to limited clinical experience during their undergraduate course.
One employer commented that this failure to integrate was partly attributed to the
changes in assessment practices in universities: since there is no clinical viva at the
end of the year, students do not integrate their theoretical and practical knowledge and
‘it shows up when they come to the workplace’.’
In addition to the issues raised above, individual employers identified the following as
isolated areas of weakness:
• graduates have poor experience with acute patients in large hospital settings;
• graduates lack recent experience with safe and independent practice in cardio
settings – the respondent recognised that it was very difficult to ensure recent
experience in all respects, ‘especially if their first clinical exposure to this was
in their third year – it’s 18 months since they have had that experience’ by the
time they graduate. Nevertheless, it is of concern that some of the important
recent experience is lacking.
• graduates are not used to working in multidisciplinary settings; and,
• graduates are not well prepared for private practice.
In identifying areas of weakness, employers made several suggestions regarding ways

in which graduates might be better prepared through undergraduate courses. These
include the need to:
• prepare graduates to prioritise so that they know how often they should see
patients;
• provide students with experience in decision-making and ‘not just seeing
patients every day because that’s what’s expected’. It is important to help
students prepare to be involved;
• ensure that students have good time management skills – ‘they must hit the
ground running and there are significant benefits in being trained for that.’
and,
• give students more exposure to community settings. One employer noted that
it is ‘often luck which determines whether they have exposure to these settings
during their course’.
7.5 Challenges of supervising recent graduates

Several employers commented on the obvious need for greater supervision of recent
graduates as compared with more experienced practitioners, but this was not seen to
be a weakness per se – rather an inevitable outcome of their lack of workplace
experience. This is a time needed for ‘fine tuning’ of graduates’ skills:
‘In first year out they need to learn how to survive in an organization and
[to adjust to] our expectations of them as members of the department.’
59
There was widespread agreement and acknowledgement that recent graduates require
a great deal of additional support and are ‘resource intensive’. Some felt that
supporting graduates was easier in large hospitals with their infrastructure than in
smaller contexts and organizations.
However, one regional employer from a large organization did imply some weakness
in recent graduates’ lack of awareness of how large organizations work:
‘They need to learn about department life – there are 50 staff in the
department, they all have different occupations. Students need to learn
about layers of seniority. They need to clarify expectations from both
groups.’
By contrast, another individual expressed the view that graduates over the past three
years, in particular, have demonstrated a good understanding of organisational life.
7.6 Employer feedback on selected features of curriculum delivery

Employer views were mixed as to the relative benefits of fully integrating clinical and
theoretical components, as is done in some courses, or fully academic teaching in
blocks of time with clinical education closely aligned to students’ clinical block
placements. There was no consensus as to which model of clinical education was
more beneficial.
One employer expressed the view that, ‘the primary health care is missing in the
coursework’ of some physiotherapy courses.
Several Melbourne-based employers commented on the strengths of the Clinical

School model in familiarising students with how organisations operate. There was
agreement among employers associated with this model that this is a very worthwhile
approach to preparing students for workplace skills, adding that this approach ‘helps
students feel confident in areas such as musculoskeletal and the core basics’.
A particular weakness identified by several employers across states is that graduates

seem to have relatively little exposure to multidisciplinary teams. One employer
commented that her public hospital allocates particular time and resources to ‘helping
them to adapt to this’.
Another weakness is that new graduates ‘struggle with multitrauma patients’ but the
employer was quick to say that ‘this was understandable’ as it was not necessarily a
common aspect of their experience during training.
7.7 Preparing to work in multidisciplinary health care settings

A feature of the changing health care world is the emergence of multidisciplinary
health care teams. In these teams, individuals representing a range of complementary
professions, work together to care for the health needs of the whole person. Thus in
preparing physiotherapy graduates for the workplace of the 21st century dual
challenges emerge. The physiotherapy curriculum must cater for a broader education
which moves beyond professional and disciplinary boundaries but at the same time, it
must meet the needs of employers who demand that physiotherapy graduates have
high level skills and attributes which fit the purposes of increasingly complex and
highly accountable work environments. A significant feature of the survey and focus
60
groups for employers was the focus on employers’ views on how university curricula
could best prepare graduates for work in multidisciplinary health care settings.
Many employers commented on the importance of experience in multidisciplinary

health settings, noting the critical importance of understanding one’s role in a
multidisciplinary team: ‘it’s important to clearly understand your role and that of
others in the team’. Another commented ‘it’s not something you learn out of textbook,
it’s not until you have clinical practice that you realise what teamwork involves’.’
One private practitioner noted the increase in the private sector of multidisciplinary
settings: ‘the reality is that a lot of care is team-based’.
While acknowledging that experience is the key to working effectively in a

multidisciplinary team, one employer noted that ‘it would be great if the end of their
course could focus on a more holistic, integrated approach’ to physiotherapy practice
which encompassed a more multidisciplinary approach. Another commented on
perceived shortcomings of a curriculum which exposes physiotherapy students to a
range of other professions and includes a ‘lecture on the role of the speechies or the
OT’, but which places little emphasis on working with members of other professions
in a range of settings. A single lecture on such topics as the role of various health
professionals, including nurses and doctors, was not deemed to be sufficient by the
employers in our focus groups. In response to this shortcoming, one employer noted:
‘We try to let them spend some time sitting with speechies and OTs on
clinical placements.’
Another employer response to the need for physiotherapy and other health
professionals to learn to work together in teams is a project which aims to ensure that
students from different health professions are placed together during clinical
placements. The project requires that students form a multidisciplinary group which
aims to solve a case as a team. The aim is to ensure that the team works together,
learning how to contribute their respective skills to the situation.
Another employer admitted that in her experience, physiotherapy students on

placements are often not involved in the ‘teamwork side of things’, admitting that ‘we
often send students to have their tea break [during the team meetings] but perhaps we
should do more to include them.’ Others shared the view that universities are not
necessarily the most appropriate place for developing students’ multidisciplinary team
skills and that these can be most effectively developed once graduates arrive in the
workplace. This is summarised as follows:
‘so much of the team-based work practice is setting specific – I don’t
know how universities could prepare students for that.’
Thus, in identifying perceived weaknesses of new graduates, it is equally important to
identify areas which employers themselves may need to improve upon, or which skills
are most appropriately developed over time in the workplace environment.
Several employers commented that new graduates do not have difficulty learning to
work in teams and that they typically enjoy the interaction with team members. Others
conceded that multidisciplinary teams do not always operate smoothly, observing that
‘there’s a bit of angst in the relationship between physios and nurses because of
issues such as ‘no lift’ – nurses call physios to do lifting and this is a problem but it’s
61
a profession-wide issue’. Another feature of multidisciplinary teams is the fact that in

some institutions, physiotherapy students interact on a regular basis with students in
other disciplines, such as occupational therapy. This may be a function of the
institutional structure or timetabling. Thus, some graduates are clearly more
comfortable interacting with colleagues in other professions since they have had
greater exposure to them during university study. A further observation was that the
more experienced Graduate Entry Masters students tend to bring their life skills and
maturity to the workplace ‘and that’s a real advantage’ in multidisciplinary team
settings.
One sports physiotherapist expressed the view that in this area, in particular, graduates
require the ability to work in multidisciplinary teams:
‘Increasingly we use a bio-psychosocial model, especially in the treatment
of pain. There is a need for the university curriculum to reflect this
change.’
One employer summarised the requisite skills for functioning in a multidisciplinary

team as follows:
‘Two skill sets are needed
1. graduates need to be confident about their competence [as
physiotherapists] before being part of a multidisciplinary team;
2. they also need to have assertiveness and group skills. They don’t
necessarily have to learn those skills in multidisciplinary teams but they
do require them to be able to operate effectively in teams.’
7.8 Physiotherapy graduates and information technology

Many employers volunteered that they and their staff often learn from new graduates.
Furthermore, recent graduates frequently act as the major resource for ICT expertise
in clinical departments. The employer survey supported the information obtained in
the focus groups. In the results of the surveys the overall mean was ‘good’ at 2.40
with a standard deviation of 0.17. Graduates of all courses were ‘good to excellent’ in
their use of ICT. Receptiveness to the use of information technology and multimedia
as applied to health is high with an average score of 2.40 and all universities scoring
greater than 2.00. This was seen by one commentator as ‘Extremely strong point in …
graduates. Excellent computer skills and ability to use online resources’. Another
stated that the recent graduate ‘Helps stimulate quest for up to date
knowledge/practices amongst other staff members’, but ‘refreshingly do not overuse.
Remain patient oriented and do not treat from a keyboard’.
In summary, employers were unanimously impressed with the information technology

skills of new graduates. Representative comments include:
‘The graduates can do anything. They teach us. They have familiarity with
databases, software processors and how to manipulate programs. It’s
fantastic.’
‘Their [PowerPoint] presentations are wonderful. You could take them

anywhere.’
‘You just marvel at what they can do.’
62
Chapter 5 provides additional information about ways in which information and

communication technologies are incorporated into the physiotherapy curriculum.
7.9 Summary
On the whole, employers of recent physiotherapy graduates are highly satisfied with
graduates’ level of competence across a range of areas. In particular, they rate new
graduates’ professional behaviour most highly, along with their openness to new ideas
and receptiveness to use of ICTs in healthcare settings. Despite the many strengths
identified by employers, they also perceive some weaknesses including physiotherapy
graduates’ general lack of familiarity with working in multidisciplinary settings and
their lack of preparedness to work in private practice. Other areas of clinical practice
that employers perceive to be somewhat lacking among recent graduates include
paediatric physiotherapy and critical care physiotherapy.
In the previous chapter we commented on the problem of the overcrowded curriculum

and the challenges faced by curriculum developers in preparing students to practice in
increasingly complex work environments. Clearly it is not feasible to attempt to
simply add content to the curriculum. More innovative and thoughtful approaches are
needed, including critical evaluation and review of curricula and their relevance.
Consideration may also be given to mechanisms enabling postgraduate opportunities
for study, which may include coverage of some material deemed important but not
included in undergraduate curricula. In addressing some of the perceived areas of
weakness in the curriculum, it will be particularly important for employers and
curriculum developers to continue to collaborate to ensure that physiotherapy
curricula are responsive to changing needs and healthcare settings, while maintaining
the academic rigour so fundamental to preparing competent and professional
graduates. Furthermore, it is critical that these innovative curriculum design and
delivery practices be shared at a national level for the fostering of scholarly
approaches to curriculum processes in physiotherapy.
7.10 Recommendations
• that a feasibility study be instigated to explore the merits of a regulated
employment.
• that schools of physiotherapy and employers address the issue of 'the

overcrowded curriculum' in the light of recent research; new areas of practice;
the need to value private practice and issues pertaining to clinical education in
public and private practice.
• that schools of physiotherapy further explore and implement strategies to

include the profession and many stakeholders in physiotherapy curriculum
development, delivery and review processes; and

63
Ch 8: Quality of learning and teaching in entry level physiotherapy
8 QUALITY OF LEARNING AND TEACHING IN ENTRY

LEVEL PHYSIOTHERAPY
_____________________________________________________________________
8.1 Good practice identified during the project

Examples of good practice in teaching and learning were highlighted throughout the
AUTC study by students, graduates, staff and employers. The overall picture of
physiotherapy education was very positive.
Students in particular were strongly supportive of small group learning that used the
context of practice to integrate their learning. Academic and clinical staff were, on the
whole, seen to be supportive, approachable and dedicated to facilitating student
learning. Experiential practice, in the university setting and in the clinical arena, was
seen to be extremely important in facilitating the learning of the students and
graduates.
Academic staff in their responses gave examples of practice that demonstrated their
understanding of the need to reflect changes in education and the health care sector,
Many innovative examples were given of the use of ICT for both the delivery of
content as well as for the administration of courses.
8.2 List of examples of good practice in physiotherapy learning and

teaching received from Australian schools of physiotherapy
8.2.1 University of Canberra

1. Communication and self-management topics covered in teams from five
disciplines for 1st and 2nd year Graduate Entry Masters students
8.2.2 Charles Sturt University

1. Integration of knowledge from two specialty areas using case studies for 2nd year
students
2. Cross disciplinary learning and teaching in Foundation Skills subject for 1st year
students
3. Problem solving techniques for complex case management for 4th year students
8.2.3 Curtin University of Technology

1. Case studies to integrate students’ discipline knowledge and clinical reasoning
skills with psychosocial, cultural and ethical perspectives for 2nd and 3rd year
undergraduate students and 1st and 2nd year Masters
2. Additional Development Assessment Form used to Enhance Physiotherapy

Student Feedback and Clinical Performance for 4th year undergraduate and
Masters
3. Course Evaluation on the Web: A mechanism for online student feedback for all
undergraduate and Masters students
64
8.2.4 Griffith University

1. Integrated Clinical and Academic Learning for all students
2. Information Technology Resources: Blackboard for all students
3. Integration of legal and ethical issues into complex cases scenarios for
students in their final semester
8.2.5 La Trobe University

1. Students develop a guide book and DVD to prepare 3rd year students for
spinal injury placement
2. Experience in the principles and practices of self-directed learning, interactive

teaching and peer and self assessment for Women’s Health unit for 4th years
3. Self evaluation of 1st year ‘student therapist’ using video
8.2.6 The University of Melbourne

1. Third year student conference organised by 4th year students taking a
professional education elective
2. Problem based learning for all subjects in order to contextualise and integrate
student learning
3. Clinical school model to facilitate clinical education for all students
8.2.7 The University of Newcastle

1. End-stage disease case study tutorial for 3rd year students
2. Collaborative learning related to neurological patients between physiotherapy

and occupational therapy students 2nd year students
3. Clinical practice workbooks for 1st and 2nd year students
8.2.8 The University of Queensland

1. Using role play to assess and enhance the integration of learning in first year
2. A tutorial program for international and ESL physiotherapy students for 1st
year ESL students
3. Integrated experiential teaching and learning in paediatrics for 1st year, 2nd
year, 3rd year and Graduate Entry Masters students
4. Use of a computer database in physiotherapy practical examinations.
8.2.9 University of South Australia

1. Plagiarism assignment for all students
2. Project U, a unique undergraduate research training initiative for 4th year

students
65
3. Research training with a future for 3rd and 4th year students: Bachelor of
Physiotherapy with Honours
8.2.10 The University of Sydney

1. PEDRO online resource, and basis for teaching evidence based practice
2. Community health placement (learning about wellness) in clinical practicums
3. Problem-based learning in paediatrics
4. Integrated clinical and academic curricula
8.3 Dissemination of the project findings and examples of good

learning and teaching strategies
During Stage 2, in 2005, the project team will create a new project website that
disseminates the main findings of the project and presents the examples of current
good practice in learning and teaching physiotherapy provided by schools of
physiotherapy.
The dissemination strategy will be determined in the light of the recommendations of

the Steering Committee and the findings of the two AUTC projects on dissemination.
It is likely to include:
1. A project website which:
• disseminates the important findings from Stage 1 of the project;
• provides examples of case studies and good, current teaching and learning
practice presented in a rich, contextualized, multimedia way. The website
will include examples of appropriate, innovative approaches to curriculum
development, assessment, integration of information and communication
technologies, multidisciplinary team work and support for particular
groups of students.
• provides an annotated bibliography of recent research in physiotherapy
learning outcomes and curriculum development.
2. Preparation of a booklet for physiotherapy educators that introduces and

explains the website.
3. Forums and workshops for university staff, clinical educators, course

designers and employers at gatherings such as:
• Australasian Heads of Schools of Physiotherapy meetings;
• meetings of the Australian Council of Physiotherapy Regulating
Authorities (ACOPRA);
• the annual conference of the Australasian and New Zealand Association
for Medical Educators (ANZAME), the Association for Health
Professional Education, the annual conference of the Australian
Physiotherapy Association (APA), the annual Australian and New Zealand
66
clinical educators conference, a meeting of a physiotherapy educators

group.
4. Articles in journals and newsletters read by physiotherapy educators and

employers.
67
Ch 9: Strategic directions to enhance learning and teaching
9 STRATEGIC DIRECTIONS TO ENHANCE LEARNING

AND TEACHING
_____________________________________________________________________
The project brief required the project team to identify strategic institutional directions
arising from the study. We present these in the expectation that they will form the
basis for collegial discussions among staff of schools of physiotherapy, with a view to
enhancing curriculum processes and student learning outcomes in the discipline. It is
imperative that schools of physiotherapy determine their own approaches to putting
these broad strategic directions into practice within their unique institutional contexts
and the needs of their student body.
9.1 Curriculum design, delivery, assessment and review, in

physiotherapy courses
When developing curricula, academic and clinical educators are advised to consider:
• the dynamic nature of the health systems;
• increasingly diverse community contexts;
• the community’s expectations of health professionals;
• the changing roles of physiotherapists in a multidisciplinary approach to health
care; and
• innovative approaches to curriculum design, delivery, assessment and review.
Physiotherapy academic and clinical educators could assist students by clarifying and
justifying the philosophy underpinning their pedagogical approaches to physiotherapy
education.
Curriculum developers are advised to ensure that:

• curriculum coherence is made explicit to students at all stages of their course.
This may include the development of relevant learning materials and the use
of strategies, such as concept maps;
• issues of professional identity formation and professional expectations are
made explicit. In particular, these issues should be addressed in the context of
an increasingly diverse student body; and
• curricula reflect and are responsive to current developments in the area of
ICTs in the discipline, including health informatics and telemedicine.
In order to achieve these curricula outcomes, it is important for schools of

physiotherapy to:
• provide professional development for both academic staff and clinical
educators within continuing education and formal discipline-specific
coursework and higher degree programs;
• provide research opportunities and incentives for staff;
• have appropriately qualified staff.
It is also important for schools of physiotherapy to identify and explore ways to

disseminate examples of good learning and teaching. The project team supports the
collaborative exchange of information between schools of physiotherapy to further
effective educational research and practice. It is suggested that key stakeholders in
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Ch 9: Strategic directions to enhance learning and teaching
physiotherapy education consider mechanisms to facilitate these collaborative

processes.
9.2 Dissemination of web-based physiotherapy course information

The project team recognises that many schools of physiotherapy have developed
attractive, informative websites. It suggests that schools of physiotherapy continue to
review their websites to ensure that they:
• identify and define the unique qualities and characteristics of a
physiotherapist;
• provide current and prospective students with clearer descriptors of the
learning outcomes they can expect from participating in the course; and
• explain and provide the rationale for their curriculum design and educational
philosophy, highlighting ways in which the curriculum prepares students for
the profession.
The project team affirms the value of the APA Website in providing the community
with ready access to information about physiotherapy, as well as links to all the
schools of physiotherapy in Australia.
We suggest that schools of physiotherapy regularly review information about their

courses that is provided by other agencies, such as DEST and the Tertiary Admission
Centres. Schools could consider setting up data-bases that utilise web service and
content management technology to provide outside agencies with flexible access to up
to date information about their courses.
9.3 Staff and student understandings of physiotherapy learning

outcomes
There would be merit in schools of physiotherapy developing consistent school wide
approaches to nomenclature related to learning outcomes. The meaning and value of
these learning outcomes should be communicated to students to enhance the quality of
their learning.
9.4 Employer satisfaction with physiotherapy graduates

Despite the high level of satisfaction expressed by employers, some private
practitioners identified the need for improved preparation of graduates for private
practice. Schools of physiotherapy are advised to consider greater involvement of
private practitioners in curriculum planning and delivery.
9.5 Professional and industry involvement in university education

Collaboration between universities and the profession is important at all levels of
curriculum development and delivery. More could be done by schools of
physiotherapy to consult with and provide opportunities for professional and industry
involvement in physiotherapy education.
69
Ch 10: Conclusions
10 CONCLUSIONS
_____________________________________________________________________
The project team considers that the current state of physiotherapy education in
Australia is sound with many positive findings arising from the study. Whilst
fulfilling the core requirements of accreditation, there is a healthy diversity of
educational pedagogies, enabling students to learn within the particular context of
their own university. There are a variety of different physiotherapy courses with
different purposes such as rural/regional education, graduate entry and double
degrees. It is both desirable and inevitable that curriculum designs and goals of these
courses will vary and schools are encouraged to retain their own priorities and
curriculum content, approaches and learning outcomes in addition to these core
expectations. Other contextual factors will inevitably affect curricula. These include
the resourcing of the schools of physiotherapy and the different forms of management,
the sizes of the student cohorts and the geographical locations of the universities and
their specific agendas.
10.1 Student learning in a research based academic and clinical

environment
All schools demonstrate a student centred approach in both the design and delivery of
curricula. The incorporation of research evidence in preparing for practice and the
development of clinical reasoning are universal. Research literature is accessed by
students from the early years at university and research led teaching is demonstrated
by courses in ‘Evidence based practice’ and ‘Research methods’. Students are given
the opportunities to learn in context with problem based learning and case based
scenarios. The academic staff and clinical educators are highly committed to student
learning. Graduates cite the critical importance of their clinical learning experiences
in their development for professional practice.
Students progress through their courses as strongly bonded cohort groups and they
describe and celebrate a strong and positive student experience. As determined from
discussion with students and, more particularly with graduates and their employers,
there is an outstanding and very strong commitment to lifelong learning and ongoing
professional development.
10.2 Current challenges in university education

Nevertheless, there are significant challenges to the maintenance of existing
physiotherapy courses and the introduction of planned new courses. These challenges
include those common to all disciplines, such as students’ transition to university, the
increasing personal costs of education, including for some students the payment of
full fees and, aligned with this, a greater demand to work whilst studying. Academic
staff are being asked to undertake more educational activities with less funding; there
are imperatives to evaluate and review curricula; to maintain and increase research
activity and funding; and to continue their own professional development as teachers.
The increasing diversity of the student body increases the demands on staff and the
development of generic skills and attributes is expected of both students and staff. A
number of these challenges present additional difficulties in physiotherapy.
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Ch 10: Conclusions
10.3 Selected challenges in physiotherapy education
10.3.1 Funding and resourcing physiotherapy entry level courses

Funding is a major factor in the context of physiotherapy professional entry programs,
with recent trends reflecting progressive decreases in government funding for
coursework and increasing pressures on schools of physiotherapy to obtain external
funding through full fee paying students, research funding and consultancy
opportunities. Demand for physiotherapy courses is high. The recent development of
graduate entry programs has, in some universities, been opportunistic. The necessity
for income from local and international fee-paying students to supplement core
funding has been a driver for universities to increase the number of these students
with high entrance scores in a discipline of high demand. The increased diversity of
the student body enrolled in physiotherapy courses is potentially a positive influence
on the internationalisation of universities and in preparing students to work globally.
Despite the additional income, there is generally inadequate funding allocated to
physiotherapy budgets and significant work pressures are being experienced by
academic and administrative staff within the schools and by clinical educators in the
(predominantly public) clinical environment. This funding shortfall warrants
recognition and the reclassification of physiotherapy as a clinically based medical
science for funding purposes. There is also competition for fee-paying students which
potentially mitigates against cooperative development, as universities desire to
maintain a ‘leading edge’ in attracting students.
Many of these full fee paying students are meeting the costs of courses themselves
and are endeavouring to work and study simultaneously. Furthermore the personal
costs of education are increased for all physiotherapy students as a result of clinical
requirements. In order to help redress the lack of health professionals in rural and
regional Australia, all schools of physiotherapy endeavour to provide rural and
metropolitan clinical experiences for their students. Students are required to fund their
own travel and accommodation costs when required to live away from their primary
semester residence for a period to undertake clinical experience in a different
geographic location. Unlike the significant funding support provided for medical
students for this purpose, there is little available for physiotherapy students.
10.3.2 Multiple transitions for students

Physiotherapy students undergo several demanding transitions. As well as the change
for those who are school leavers in moving from school to university, all students
experience a transition into the clinical environment. Physiotherapy academic staff
prepare students for this by the development of communication and professional skills
and understanding of psychological, sociological and cultural issues, but the raw
experiences of patients’ trauma, disability and death are profound learning
environments. On entering the workforce there is a further transition to independent
practice which requires further mentoring and explicit support.
10.3.3 Staffing issues

Academic staff in physiotherapy are predominantly female and the project team
perceived that these staff members take on a nurturing role for students above and
beyond that observed in less female environments. Whilst students value this
additional consideration, there is some risk of students failing to develop
independence. On the other hand, with the profound life experiences of the clinical
71
Ch 10: Conclusions
environment, additional counselling of students is frequently required and assisting

the transition stages is a role that falls predominantly to staff.
The physiotherapy academic staff were perceived by the project team to be

hardworking, dedicated individuals pushed to the limits in their current roles. Their
innovative educational ideas were often difficult to implement due to the lack of time
or the requirement for additional funding. There is an urgent need to evaluate and
systematically test the innovations already in place for their educational and cost
effectiveness. Furthermore, competitive research funding with an emphasis on
collaborative activities would promote the necessary multidisciplinary and
physiotherapy research into educational practice in academic and clinical
environments.
10.3.4 Addressing diverse student needs in clinical settings

The increasing diversity of the student body imposes additional challenges in
developing the students’ sense of professional identity and in enabling all students to
integrate into a highly dynamic clinical environment. Clinical educators are deeply
concerned at the additional demands on their time posed by increased student
numbers and by students from different cultural backgrounds.
10.3.5 Collaboration with clinical educators

In all schools, academic staff spend significant time in consultation with clinical
educators. Clinicians request even further consultation and there is the added
challenge of engaging private practitioners in the education process. This will be
essential to alleviate the crisis looming in clinical education in the public system. As
new approaches to clinical education are considered, parallel rigorous evaluative
processes must be undertaken.
10.3.6 Physiotherapy in changing contexts

There are also external changes which impact on physiotherapy entry level education.
These include increasing access to health information by members of the community:
graduates need further skills to advise on the information available. The role of
physiotherapists as primary contact practitioners and as members of multidisciplinary
health care teams are constantly evolving and curricula require frequent evaluation,
review and revision to ensure graduates are well prepared for a future in which the
only certainty is change. The graduates’ preparedness for continued learning and their
clear demonstration of enthusiastic commitment to continuing professional education
and formal postgraduate learning augur well for the future.
In conclusion, there is strong evidence from this study that employers are satisfied
that core learning outcomes have been achieved at the national level among existing
schools of physiotherapy. Consultation with academic staff and students throughout
the study confirms the fact that physiotherapy curricula are facilitating a range of
learning experiences relevant to institutional contexts and student needs. The schools
of physiotherapy and ACOPRA are aligned in their goals to produce competent,
relevant and appropriate physiotherapy graduates for the good of the community.
72
Ch 11: References
11 REFERENCES
_____________________________________________________________________
The Australian Council of Physiotherapy Regulating Authorities Limited, (2002a)

Australian physiotherapy competency standards. ACOPRA Inc, Brisbane.
The Australian Council of Physiotherapy Regulating Authorities Limited, (2002b)

The complete procedures and guideline for accreditation of new physiotherapy
programs. ACOPRA Inc, Brisbane.
The Australian Council of Physiotherapy Regulating Authorities Limited (2004).

Accreditation. (Accessed 11 Jan 05).http://www.acopra.com.au/accreditation
Eizenberg,N., Briggs,C., Barker, P.,and Grkovic,I., (1999) an@tomedia A new

approach to Medical Education: Developments in Anatomy. Publisher: anaotmedia
Pty Ltd. http://www.anatomedia.com/approach.shtml
Bell, T., Cockburn, A., McKenzie, B., and Vargo, J., (2001). Digital Lectures: If You
Make Them, Will Students Use Them? Constraints on Effective Delivery of Flexible
Learning Systems. Interactive Multimedia Electronic Journal of Computer-Enhanced
Learning, 3(2).
Carroll, S., and McMeeken, J.M., (2000) Establishing the value of rural clinical
placements during undergraduate allied health education. Research report for the Co-
ordinating unit for rural health education in Victoria. 122 pages.
Chipchase, L., Dalton, M., Williams, M. and Scutter, S., (2004). Is education immune
from evidence-based scrutiny? Australian Journal of Physiotherapy 50: 133-135.
Crosbie, J., Gass, E., Jull, G., Morris, M., Rivett, D., Ruston, S., Sheppard, L.,
Sullivan, J., Vujnovich, A., Webb, G. and Wright, A., (2002). Sustainable
undergraduate education and professional competency. Australian Journal of
Physiotherapy 48: 5-7.
Higgs, J., (1993). Physiotherapy, professionalism and self-directed learning. Journal

of the Singapore Physiotherapy Association 14: 8-11.
Higher Education Council Education, National Board of Employment, Education and

Training (NBEET), (1996) Professional and Credentialism, Australian Government
Publishing Service, Canberra.
Vendrely, A,. (2003). Using the internet to supplement clinical education experiences.
Paper presented at the World Confederation for Physical Therapy Congress,
Barcelona.
73
APPENDICES
74
Appendix A: Glossary of terms used in the report
A. GLOSSARY OF TERMS USED IN THE REPORT

_____________________________________________________________________
Clinical educator: a physiotherapy clinical practitioner who teaches the students in

the clinical education component of the course conducted in a clinical practice setting.
It includes both formally designated positions and informal positions.
Clinical viva: an examination using a live patient
Course: A degree program or course taught at a university
Graduate entry Master of Physiotherapy: a pre-registration degree to prepare

entry-level physiotherapists. In all cases students must have completed as a minimum
a bachelor degree with specified prerequisite subjects. These prerequisite subjects are
normally in the areas of human anatomy, human physiology, behavioural sciences and
research methodology or statistics.
Learning outcomes: the demonstrable knowledge, skills and attributes of a student

following a period of learning and teaching. Learning outcomes focus on what a
student learns. Competencies delineated in the Australian Physiotherapy Competency
Standards and used by the Australian Council of Physiotherapy Regulating
Authorities are considered to be learning outcomes
Preceptor: a mentor to learners in the clinical environment. There is a sense of care

and commitment within the role
Professional entry level course: Bachelor of Physiotherapy, Bachelor of Science

(Physiotherapy), Bachelor of Applied Science (Physiotherapy), Master of
Physiotherapy, Master of Physiotherapy Studies
School of Physiotherapy: the academic unit which has responsibility for the
discipline of physiotherapy.
Subject: an assessed component of the course. Courses are comprised of such

subjects (courses), modules or units
75
Appendix B: Abbreviations
B. ABBREVIATIONS
_____________________________________________________________________
ACOPRA Australian Council of Physiotherapy Regulating Authorities

AHMAC Australian Health Ministers Advisory Council
AIHW Australian Institute of Health and Welfare
APA Australian Physiotherapy Association
APCS Australian Physiotherapy Competency Standards
ASCED Australian Standard Classification of Education
AUQA Australian Universities Quality Audit
AUTC Australian University Teaching Committee
CELT Centre for Education Learning and Teaching
CEQ Course Experience Questionnaire
DEST Department of Education, Science and Training
GCCA Graduate Careers Council of Australia
ICT Information and communication technology
NESB Non-English Speaking Background
PBA Physiotherapists Business Association
PBL Problem-based learning
PCRC Physiotherapy Curriculum Review Committee
SES Socio-economic status
76
Appendix C: Entry level physiotherapy courses
C. ENTRY LEVEL PHYSIOTHERAPY COURSES

_____________________________________________________________________
Table 5: Entry level physiotherapy courses in Australia
University Entry level courses in physiotherapy *
University of Master of Physiotherapy (graduate entry)

Canberra
Charles Sturt Bachelor of Physiotherapy with/without honours

University
Curtin University Bachelor of Science (Physiotherapy) with/without honours

of Technology Bachelor of Science (Physiotherapy) degree conversion (on-
shore)
Bachelor Physiotherapy (off-shore)
Master of Physiotherapy (graduate entry)
Griffith University Bachelor of Physiotherapy / Bachelor of Exercise Science

(double degree)
Master of Physiotherapy (graduate entry)
La Trobe Bachelor of Physiotherapy with/without honours

University Bachelor of Physiotherapy / Bachelor of Ergonomics (double
degree)
The University of Bachelor of Physiotherapy with/without honours

Melbourne
The University Bachelor of Physiotherapy with/without honours

Notre Dame

Newcastle

Queensland Master of Physiotherapy Studies (graduate entry)
University of South Bachelor of Physiotherapy with/without honours

Australia Master of Physiotherapy (graduate entry)
The University of Bachelor of Applied Science (Physiotherapy)

Sydney Master of Physiotherapy (graduate entry)
* This table reflects data available in December 2004
Two new entry level courses are beginning in January 2005 at Monash University and
James Cook University. Two further courses are proposed at two additional
universities in future.
77

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LEARNING OUTCOMES AND

Joan McMeeken, Gillian Webb, Kerri-Lee Krause,

The University of Melbourne

A PROJECT FUNDED BY THE

Demographic data for physiotherapy students shows similar patterns of diversity to

In order to contextualise this review of curriculum processes in physiotherapy, the

Employers of recent physiotherapy graduates are generally highly satisfied with

areas of clinical practice that employers perceive to be somewhat lacking among

Recent graduates’ satisfaction with physiotherapy courses is evaluated through the

The project team found considerable evidence of assessment and monitoring of

Concerns were expressed at the increasing amount of content required to be included

The project team recommends the following:

Physiotherapy education research

Physiotherapy learning outcomes

Accreditation and quality assurance for physiotherapy education in Australia

2 Study design and method ....................................................................................6

3 National consistency and specification of learning outcomes in

4 Staff and student understandings of physiotherapy learning outcomes.......24

4.2 Clarifying terms ............................................................................................24

5 Curriculum design, delivery, assessment and review, in physiotherapy

6 Clinical education and stakeholder involvement in curriculum....................43

7 Employer satisfaction with physiotherapy graduates ....................................51

7.5 Challenges of supervising recent graduates ...............................................59

8 Quality of learning and teaching in entry level physiotherapy......................64

9 Strategic directions to enhance learning and teaching...................................68

Table 1 Numbers of participants in focus groups ..........................................................8

1.1 Aims and structure of report

Chapter 1 contextualises the study. It provides an overview of broad changes in the

Chapter 4 provides evidence of staff and student understandings of learning outcomes

In light of the critical role of employers we sought information on their levels of

national dissemination of these good practices among the physiotherapy higher

A number of recommendations emerged from our wide consultation with employers,

1.2 Physiotherapy in changing contexts

Physiotherapy Competency Standards (APCS) were finalised and adopted following

1.3 The changing nature of the student body

1.4 Resource implications of a feminised workforce

Maternity leave costs place a disproportionate financial burden on university

1.5 Requirements for clinical education

Do the APCS reflect contemporary practice? The competencies were reviewed in

However, the continuing provision of a comprehensive clinical education experience

1.6 Relationships between physiotherapy and other health sciences

1.7 Increasing role of technology and influence of globalisation

Australian universities without exception have recognised the value of information

To what extent do physiotherapy courses, curricula and clinical education experiences

2 STUDY DESIGN AND METHOD

2.1 Methods used in the project

The data sources that we used were:

2.2 Review of the literature

2.3 Analysis of Course Experience Questionnaire responses

2.4 An analysis of school of physiotherapy websites

2.5 Focus groups

Table 1: Numbers of participants in focus groups

School of Physiotherapy Students Graduates Staff Employers

2.5.1 Current student focus groups

2.5.2 Recent graduate focus groups

2.5.3 Staff focus groups

2.5.4 Employer focus groups

2.6 Discussions with heads of schools of physiotherapy

2.7 National surveys to address curriculum issues