REFLECTING ON OUR CLINICAL EDUCATION EXPERIENCE…. WHAT CAN WE CHANGE?

Exodus of Nigerian trained physiotherapists (Physical therapist) have commenced since the start of physiotherapy training in Nigeria, but “checking out” of Nigerian trained physiotherapist exploded in the 1990s and has continued to get worse. This has been part of “brain drained phenomenon or ethical recruitment” of professional, across Africa, especially from Nigeria, across all walks of life; most especially, the medical industry in Nigeria. Emigration of Physiotherapists to the western world, especially Britain and America, has been very significant. There are many factors that contributed to this “brain drain/ethical recruitment”, and our training in Nigeria, has really us to thrive and succeeded in our respective specialistic disciplines/professional journey. Nigeria invested a great deal in all of us, as we don`t have students’ loan to pay back. I hope that we can give something back to that Nation, by turning the “brain drain phenomenon” to “brain gain”. The birth of International Association of Nigerian Physiotherapists should afford us the opportunity to give back from a stronger collective effort standpoint, regardless of the support we give our alma Matta, individually or in small groups.

Physiotherapy education, like all clinical sciences across the world have the didactic and the clinical component. According to World Confederation of Physical Therapy (WCPT), a minimum of 40% of physiotherapy education is directed to clinical education. Commission for Accreditation of Physical Therapy Education (CAPTE) recommends that physical therapy education program devotes up to 48% of contact/clock hours in curriculum to clinical education experience. Interestingly, due to the organizational set up or structure of our physiotherapy education in Nigeria, (University/Teaching Hospital based), our clinical education covered about 45-60% of our undergraduate physiotherapy education. This aspect of our training is one of the most complex part of our education, the performance and delivery is very critical. It is interesting to note that these programs were Bachelor of Science or Bachelor of Medical Rehabilitation programs, but our clinical confidence was significantly above average, by the time of graduation from these programs.

The settling process and subsequently, the thriving of a clinical professional in the emigrated country/environment is really a daunting challenge3. We all had a good share of our own challenges; but the good news is that, in one form or another we have been successful with our professional career in our “new home”. The educational experiences we had from our “native home”, especially our clinical education experience have contributed significantly to our survival and successes, regardless of our challenges. To this end, I profoundly appreciate all our mentors and teachers that have invested in our professional journey.

These Mentors and teachers/clinicians really guided us to implement principles learnt during didactic education into our clinical education experiences…. Principles like, “you need proximal stability to achieve functional distal mobility”; “Repetition maximum and motor unit recruitment form the bases of muscle strengthening”; “diagonal mobility of multiplanar joints gives effective maximal functional mobility”; “the bigger the base of support, the better the stability” …. to mention a few. Despite the pervasive friction between the “academicians” and the “clinicians” within our institution and profession at home, some of these mentors/teachers/clinicians, continued to be part of our lives…. The likes of Mr. Joshua Obiri (late), Professor V.C.B. Nwuga (late), Professor Joseph Balogun, Professor Victor Obajuluwa, Dr. K.A. Sanni, Dr. Popoola, and many more. Their investments in ensuring a great clinical education experience for their students is greatly appreciated.

Yes, despite the short comings in our country and inadequacies of our system in Nigeria combined with challenges with professionalism amongst physiotherapists in Nigeria; I will say that we got a fairly good deal with our clinical education experience. Definitely, there are rooms for improvement. Some factors have been identified to be critical to quality clinical education experience for Physiotherapists (Physical therapists), namely clinical education framework, clinical education sites, structure of clinical education, assessment in clinical education, and clinical education faculty. These factors will not drive itself without the stakeholders` involvement in planning, execution, evaluation, and accountability with set benchmarks. The Stakeholders will include the professional Association, board/Agency involve in issuing and monitoring of professional licensing, educational accreditation board, hospital/clinical site management and other professional organizations of the profession.

International Association of Nigerian Physical Therapist is a stakeholder, as part of the “other professional organizations”. One of the visions of this organization is ….”to advance the members’ role in improving the functional health and wellness of the Nigerian Nation and….”. It`s high time we all come together to make this organization strong if we are to take our rightful place within the context of ‘brain gain’ for the progress of our profession in our “homeland”. The organization, through its membership and executive/board should put together a plan to take our rightful in the annals of time. “To whom much is given, much is expected.”

The principles of master adaptive learner are not foreign to us as clinical professionals. Growth mind set and resilience are essential non-cognitive characteristic that is second nature to us by now. Self-reflection, along with insight is critical to growth mindset. Insight, the degree of awareness of our own knowledge and performance; and self-reflection, the ability to reflect on one`s own action. when insight and self-reflection is combined, it puts you us in the direction of continuous learning. Hence, self-reflection leads to healthy and constructive change that can enhance performance, positive change, and growth.

To this end, I want you to reflect on this scenario presented below…….

Your comments are welcome on your self-reflection on the scenario presented…

  1. See yourself as the student, reflecting on your experience as the student.
  2. See yourself as the clinician, reflecting on how you have handled this in the past and hopefully what changes could have been suggested.
  3. How can we as a body, a stakeholder, make the clinical education experiences of future physiotherapist, better than what we have experienced, considering our “brain gain”.

References…

  1. Oyeyemi AY, Oyeyemi AL, Maduagwu SM, Rufai AA, Aliyu SU. Professional Satisfaction and Desire to Emigrate among Nigerian Physiotherapists. Physiother Can. 2012;64(3):225-232
  2. Scott ML, Whelan A, Dewdney J, et al. “Brain drain” or ethical recruitment? Med j.Aust. 2004;180(4):174–6. Medline:14960139. [PubMed] [Google Scholar]
  3. Stillwell B, Diallo K, Zurn P, et al. Developing evidenced-based ethical policy on the migration of health workers: conceptual and practical challenges. [cited 2007 Sep];Hum Resour Health [Internet] 2003 Nov;1(18)
  4. World Confederation of Physical Therapist (2011): WCPT guideline for the clinical education component of physical therapist professional entry level education guidelines. http://www.aefi.net/Portals/1/Repository/Guideline_clinical_education_complete.fc394285-ed32-42d0-987ae814e72eedfe.pdf
  5. WCPT guideline for physical therapist professional entry level education. http://www.aefi.net/Portals/1/Repository/Guideline_PTEducation_complete.1481e4b7-e059-464a-9ac4-cadf8021d594.pdf.
  6. Commission on accreditation in Physical Therapy education. 2012-2013 fact sheet. http://www.capteonline.org/uploadfiles/CAPTEorg/About_CAPTE/Resources/AggregateProgramData/PTprogram.
  7. Nigeria Society of Physiotherapy (2012): History of Physiotherapy in Nigeria. http://www.nigeriaphysiotherapynigeria.html
  8. Medical Rehabilitation Therapists (Registration) Board of Nigeria. Harmonized curriculum of studies for the Bachelor of Physiotherapy (B.PT) degree programme in Nigerian universities. 2009. [27]. http://www.mrtbnigeria.org/docs/curr/BPTCurriculum.pdf.
  9. Obajuluwa VA. Unity as compass and pathfinder to professional growth of physiotherapy. www.nigeriaphysio.org/media/archive1/documents/Unity as compass and pathfinder to professional growth of physiotherapy. (2013)
  10. Balogun JA. Professionalism in Physiotherapy. www.nigeriaphysio.net/media/archive1/docs/Balogun2015_Professionalization_Lecture.pdf
  11. McCallum CA, Mosher PD, Jacobson PJ, Gallivan SP, Giuffre SM. Quality in Physical Therapist clinical education: A Systematic Review. Phys Ther. 2013;93(10):1298-1311. https://doi.org/10.2522/ptj.20120410
  12. Recker-Hughes C, Wetherbee E, Buccieri KM, FitzpatrickTimmerberg J, Stolfi AM. Essential characteristics of quality clinical education experiences: Standards to facilitate student learning. J Phys Ther Educ. 2014; 28:48-55.
  13. A vision for excellence in Physical Therapy education, Journal of Physical Therapy Education: December 2021 – Volume 35 – Issue Supplement 1 – p 1-35 doi: 10.1097/JTE.0000000000000216
  14. Cutrer WB, Miller B, Pusic MV, et al. Fostering the development of master adaptive learners: A conceptual model to guide skill acquisition in medical education. Acad Med. 2017;92(1):70-75.
  15. Jayatilleke N, Mackie A. Reflection as part of continuous professional development for public health professionals: a literature review. J Public Health . 2012;35(2):308-312.

Dr. Ayodeji Famuyide, M.Ed.; DPT; FAAOMPT
C.O.O
Greater Baton Rouge Physical Therapy
3676 Harding Blvd. #B
Baton Rouge, LA. 70807

Scenario:
You were assigned second year physiotherapy students for their first clinical experience. The head of department from the school informed your institution/hospital that these students will be starting next week. The students will be bringing along with them a clinical log manual for their clinical hours to be initialed and signed by you. Areas of expected clinical experience was outlined in the logbook. This will be a 4-week clinical experience. The logbook will be the evaluation tool for the student`s clinical experience. Your clinical director informed you that you should not let the students` addition to your workload affect your productivity. It is assumed that as a clinician, you should be able to teach students clinical skills, no matter their level of didactic and clinical education.

How can a clinician give a clinical physiotherapy student, a great clinical education experience when the clinician, might not understand the principles of teaching and impacting clinical experience?

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