|MEDICINE AND SOCIETY: COMMUNITY AND PHYSIATRIST
|Year : 2014 | Volume
| Issue : 3 | Page : 233-235
Approach of physiotherapy students towards community placement: Perceived obstacles
Anila Paul1, Ruptee Dhaul2
1 Medical Trust Institute of Medical Sciences, College of Physiotherapy, Irimpanam, Kochi, Kerala, India
2 Department of Physiotherapy, Fortis Hospital, Vashi, Navi Mumbai, Maharashtra, India
|Date of Web Publication||27-May-2015|
Medical Trust Institute of Medical Sciences, College of Physiotherapy, Irimpanam (PO), Kochi - 682 309, Kerala
Source of Support: None, Conflict of Interest: None
Context: Challenges on community clinical placements for students from various medical streams has been reported over time. Physiotherapy students are exposed to community clinical placements during graduation course as part of training. This study was conducted to investigate the attitude of Physiotherapy students towards community clinical placements. Aims: To investigate attitude of Physiotherapy students towards community clinical placements. Settings and Design: A cross-sectional survey was conducted among 181 Physiotherapy students (103 final years and 78 interns) from three different Universities in Mumbai using purposive sampling. Materials and Methods: A validated questionnaire was designed to gather information on attitude and perception towards community clinical placements. Statistical analysis used: Data were analyzed using descriptive statistics in SPSS version 16. Results: Sixty-eight percentage of students reported keen interest in community clinical placements in which 78% were motivated by their past experiences in community services. Eighty percent of them reported that community clinical placements play a significant role in Physiotherapy education and training. The obstacles faced during community clinical placements were lack of interest in Physiotherapy among community members (80%), unavailability of local resources (57%), difficulty in communication in local language (48%), and unhygienic environment (33%). Conclusions: Physiotherapy students reported positive attitude towards community clinical placements as a part of curriculum and were keen in community services. However, lack of awareness about Physiotherapy among community pose barriers to this exposure.
Keywords: Attitude, awareness, community placement, perception, physiotherapy
|How to cite this article:|
Paul A, Dhaul R. Approach of physiotherapy students towards community placement: Perceived obstacles. Astrocyte 2014;1:233-5
| Introduction|| |
It is reported that there is an acute shortage of doctors and paramedics in rural areas, in spite of having many medical universities in India.  India, with a population of over 1 billion, with diverse socio-cultural geographical features, has 75% of persons with disabilities (PWDs) living in rural areas. The escalating cost of health care, the increasing economic constraints, and the shortfalls in service provision have all contributed to the difficulty in rehabilitation of the disabled.
Physiotherapists provide valuable contributions to the transformation of the health care delivery system by improving health care quality and outcomes through prevention, treatment, and management of impairments. As essential participants in the health care delivery system, Physiotherapists assume leadership roles in rehabilitation; in prevention, health maintenance, and programs that promote health, wellness, and fitness; and in professional and community organizations. 
Physiotherapy graduation program in India is a 4-year course with mandatory 6 months internship. Community physiotherapy is a subject in 4 th year in physiotherapy graduation course under various health universities in India. This subject is designed to enable students to understand the scope of physiotherapy in the prevention of diseases, health promotion, and education of community-based population. Exposure to this subject enables them to understand various roles of physiotherapists to meet health care needs of rural and urban communities.
Clinical placements are an important link between learning theory and clinical applications.  Clinical training during graduation program augment integration of knowledge, skills, and behavior into professional practice and enable the students to attain sufficient confidence to practice in professional and competent ways.
Clinical training in community physiotherapy subject involves clinical placements of students at various rural and urban community populations. These clinical placements are incorporated in the curriculum to provide an understanding among students about socio-cultural and economic influences on community health.  Community placements enhance the learning process through application of knowledge in real world context which is useful in knowledge retention and to improve motivation of students.
The institutions organize community clinical placements for students in rural or urban community settings under the supervision of institutional educators. Students are exposed to various challenges during community clinical placements. Community exposure during graduation program has influence on willingness and preparedness of students for community services in the future.  Therefore, this study was designed to evaluate attitude and perception of undergraduate physiotherapy students toward community clinical placements.
| Materials and Methods|| |
A cross-sectional study was conducted among 181 physiotherapy students with purposive sampling method. The target population included 103 final year students and 78 interns from three different institutions affiliated to three different universities in Mumbai, Maharashtra. All students recruited for the study had attended community clinical placements as per the schedule instructed by the institute during the final year.
Approval for the study was obtained from Institutional Ethics Committee of School of Physiotherapy, Maharashtra. The questionnaire was designed to assess attitude and perception of students toward community clinical placements. This questionnaire included 4 items related to demographic information with 5 sub items, keenness toward community clinical placements with 17 sub items, perception toward community clinical placements with 4 sub items, and obstacles confronted during community clinical placements with 4 sub items. Questionnaire was designed based on extensive literature searches and suggestions from five experts in the field were obtained as peer reviewers, before application of the questionnaire as research tool in this study.
After seeking approval from the concerned authority, the students were gathered in a classroom, and general instructions on inscribing the questionnaire were provided. Students were given the option to refuse to participate in this study. The response rate was 100%, and the study was conducted from January to March 2014.
Data were analyzed using descriptive statistics in Statistical Package for the Social Sciences 16 version.
| Results|| |
One hundred and eighty-one physiotherapy students from three educational institutions each affiliated to three different universities were recruited for the current study. Of 181 students, 170 were females and 11 were males. The subjects included 103 final year physiotherapy students and 78 interns who were exposed to community clinical placements as part of clinical training.
The results revealed that 68% of students have a keen interest in community clinical placements [Figure 1]. It was reported that 78% of students who expressed keen interest in had previous exposure to community services. Eighty-nine percent of them attended medical camps in past years, 24% reported that their parents, relatives, or friends were actively involved in community services and 10% had participated as a team member in natural disaster management in past.
Eighty percent students agreed to the key role of community clinical placements in improving clinical training at community health care level [Figure 2]. The students reported a range of reasons for community clinical placements based on experiences. Ninety percent of students opined that community clinical placements augment the awareness about physiotherapy among community. It was reported that community clinical placements improve accessibility to physiotherapy services at community (59%) and enhance clinical skills of students (42%).
Students reported various obstacles for community clinical placements [Figure 3]. Lack of awareness about physiotherapy among community was reported as a major obstacle by the students (37%).
| Discussion|| |
The attitude of physiotherapy students toward community clinical placements was found positive with 68% expressed keen interest in community service. Previous experience in medical camps and natural disaster management was found to have influenced the students. Family members and friends who are dedicated to community services had greatly influenced the students in developing positive attitude toward community clinical placements. Such previous experiences motivated students to involve themselves in community services.  This is directing toward the need for inclusion of mandatory community service during pre-graduation period, which can motivate and enhance the attitude of students toward community clinical placements after joining graduation course.
India has diverse socio-cultural geographical features and 75% of PWDs live in rural areas. It is reported that in spite of having many medical universities, medical resources at rural community areas are still underdeveloped. There is an urgent need to build up innovative methods to improve the accessibility and availability of medical and allied health resources to all community population.  It is reported that community clinical placements of students during graduation program has an impact on their intention to work in community set ups. , Physiotherapy curriculum need to stress on mandatory clinical exposure at all community levels at rural and urban settings including primary health centers.
In the current study, students strongly agreed that community clinical placements had a significant role in understanding application of theory learned in classrooms and improved their clinical skills. Community placements provide opportunities to develop problem solving skills and ability to work autonomously among students. , Furthermore, students perceived that community placements improved awareness about scope of physiotherapy among community. Community clinical placements during graduation will enable the students to acquire knowledge and skills to practice at community level.  Furthermore, this enables students to take up physiotherapy professional roles toward diverse health needs of different community population.
Students reported lack of awareness about physiotherapy among community as a major challenge during community clinical placements. It is reported that public awareness about physiotherapy is considerably less resulting in misunderstanding about role of physiotherapists with other health care professionals.  Issues related to communication in local language and unhygienic environment found to be other obstacles confronted by students. Measures to improve patient interaction and to practice clinical skills need to be considered. Supervision and guidance by faculty members encourage the students during community clinical postings. ,
The current study revealed positive attitude of physiotherapy students toward community clinical placements. However, the barriers like lack of awareness about physiotherapy among community need serious interventions.
| Acknowledgment|| |
Experts in the area of community physiotherapy who were actively involved in validation of the questionnaire are acknowledged.
| References|| |
Johnsey T. Awareness of physiotherapy among the Anganwadi workers in Dakshina Kannada. Muller J Med Sci Res 2013;4:57.
WHO/WKC, Tech. Ser./04.2, Aging and Health Technical Report Vol. 5. Available from: http://www.who.int/kobe_centre/ageing/ahp_vol5_glossary.pdf [Last accessed on Sept 2014]
Frantz JM, Rhoda AJ. Assessing clinical placements in B Sc. Physiotherapy program. The Internet J Allied Health Sci Pract 2007;5:3.
Vrushali P, Hadiya P. Perception of community based rehabilitation as a postgraduate specialty subject among physiotherapy students.
Indian J Physiother Occup Ther 2012;6:142.
Brockwell D, Wielandt T, Clark M. Four years after graduation: occupational therapists' work destinations and perceptions of preparedness for practice. Aust J Rural Health 2009;17:71-6.
Lee S, Mackenzie L. Starting out in rural New South Wales: the experiences of new graduate occupational therapists. Aust J Rural Health 2003;11:36-43
Devine S. Perception of occupational therapists practicing in rural Australia: a graduate perspective. Aust Occup Ther J 2006;53:205-10.
Russel M, Clark M, Bamey T. Changes in attitudes and skills among occupational therapy students attending a rural fieldwork unit. Aust Occup Ther J 1996;43:72-8.
Hall AA, Kirkby RJ. Community knowledge of physiotherapy in a rural Victorian town. Aust J Physiother 1979;25:23-5.
Ramli A, Joseph L, Lee SW. Learning pathways during clinical placement of physiotherapy students: A Malaysian experience of using learning contracts and reflective diaries. J Educ Eval Health Prof 2013;10:6.
[Figure 1], [Figure 2], [Figure 3]