Curriculum challengers and changers

Research projects within the pre-registration curriculum exist to develop research and critical reasoning skills. While some students choose to focus their final-year research in clinical practice, others use the opportunity to turn the lens inward and review, by critiquing and challenging their own educational experience. And why not? After all, students bring to the table invaluable insight and experience. Who better than the future workforce to investigate these issues and provide recommendations for their universities to act upon. 

In this article, Mark Gould and Steph Berns take a look at some of the outputs from this year’s final year students. The subject matter is diverse, with students focusing on everything from palliative care teaching, treatment of transgender people, race and inclusion, and Covid-19 and its impact on physiotherapy education and the mental health of students. In the words of the students interviewed for this piece – it’s important to encourage students to evaluate and critique practice, their education and the profession. Their research can bring fresh perspectives and different experiences that will not only benefit them, but also the patients and communities they’ll go on to serve.

Mental health

Chloe Low and Kira Doyle, final year MSc students at St George’s, University of London, examined the impact of Covid-19 on student placements and mental health as well as its longer-term impact, in terms of students’ sense of preparedness for a band 5 role. 

Existing research shows levels of depression and anxiety are higher in healthcare workers than the general population.

Building on this, they examined whether there was anything universities could do to prepare students before starting placements, to better equip them for these challenges. Both Chloe and Kira felt their mental health was impacted by the pandemic so this was a topic of personal interest too. 

Their initial findings reveal a proportion of students felt disadvantaged by Covid and have struggled on placement. 

They said:

We believe our research will provide valuable insight into the student experience throughout the pandemic, and hopefully provide future students with strategies to cope with the changes to the academic programme they may face, and how this may better prepare them for a band 5 job role.

Chloe and Kira felt that researching and disseminating their findings proved therapeutic for both themselves and those who contributed. They now plan to use social media to disseminate their findings to maximise its impact and contribute to the growing research on the pandemic’s impact on education. 

‘Doing the literature search there was a clear gap in research, but as time has gone on, more and more is trickling through and we can see the effect Covid has really had for students’, they added. Though keen not to “overstate the impact” of their research, they are hopeful that it can provide useful insights into what students were feeling and experiencing over the past year. 

Race consciousness

Dexter Troy Fernandez, a second year MSc student at Brunel University, says his dissertation on sense of belonging among Black, Asian and Minority Ethnic (BAME) physiotherapy students was inspired by the work of his supervisor, Meriel Norris, and colleagues.

His focus on placements arose from his longstanding interest in contributing to equality diversity and inclusion (EDI) work, as well as from his own first placement where he experienced a sense of “not feeling he belonged” and that he needed to change how he spoke in order to fit in. 

He says feelings of estrangement were compounded by patients making inappropriate statements or asking inappropriate questions.

Talking to other students he found they felt the same way. As there’s limited research in this area he decided to take it on for his dissertation. Dexter recruited eight students from Brunel and elsewhere to take part in a virtual interview with a set of questions about their sense of belonging, how they felt about the profession after their placements, and what effect they perceived their placements had on their clinical assessments in relation to ethnicity.

His findings showed that students want better preparation for their placement surroundings, and also for educators to stand up more for their students, particularly preparing students for the comments or behaviour they might receive from their patients. 

The interviews highlighted the challenge of the first placement – a challenge in general regardless of background, but compounded for BAME students when struggling with a sense of belonging and being able to relate to peers.

Interviewees also spoke of the need for practice educators ‘to be aware of challenges that face BAME students who face racism and micro-aggressions on placement’. 

The research highlighted the power dynamic between students and their practice educator, as well as the power dynamic between the student, practice educator and the university lecturers, which makes it hard for students to voice concerns about possible unfair treatment. 

The research process itself has made Dexter consider a career in clinical research or academia. He also noted that undertaking the research had personal benefits as well: ‘I had my own issues with confidence and sense of belonging, so doing the interviews has empowered me to be a lot more assertive in my future placements and speak up when I feel something is wrong.’

Graduate Lloyd Hanley-Byron was a BSc student at Coventry University when he wrote his 2020 dissertation. Similar to Dexter, Lloyd examined the obstacles BAME physiotherapy students face, including perceptions of being prematurely judged based solely on their ethnic backgrounds, experiences of feeling that they need to alter their behaviour in order to “fit in” with the dominant culture, and dealing with racial micro-aggressions. 

Lloyd says the fact that there were no black lecturers on his degree, only one lecturer who was a person of colour, and very few physiotherapists of colour on his placements, made him aware of under representation within the profession. 

Lloyd spoke about the need for change and the need to disseminate research, ensuring that it reaches those who hold power and can take action.

He said: ‘Since the pandemic you now see so many webinars, online presentations held by people willing to share the latest research or talk about experiences, and along with that create open environments for Q&A sessions and discussion. That’s been a great way to disseminate research. It just needs to reach those people at the top.’

He’s also using his research to bring about change at a local level, leading in-service training for band 5 physios and occupational therapists at his trust. As part of this, he plans to present his dissertation findings as a means to share his experiences and start conversations.   

Trans awareness

Katie Watts, a second year MSc student at St Mary’s University, Twickenham, examined the treatment of transgender patients. As a gay woman, and member of the LGBTQIA+ community she recognised the need to advocate for others in the community that might not have such a platform.

Her research, using a questionnaire based on the CSP framework for treating trans patients, included questions on personal pronouns, confidentiality and removal of clothing. The latter, she says, is a key issue when for example someone transitioning from female to male might wear chest bindings. 

The research questions focused on students’ self-reported confidence and knowledge in treating trans patients and found that the most confident gained knowledge from sources external to their degree programme. They included broadcasts, blogs, social media, previous EDI training or from within the LGBTQIA+ community. These findings confirmed Katie’s initial hypothesis ‘that education in these areas is really important and needs to be implemented into physio curriculums’.

Some 94 per cent of respondents reported that they wanted more teaching about trans healthcare on their degree programmes. Katie says her research has led to direct changes and given her a taste for more research work. 

‘My supervisor is also my programme director, which is really handy. When I submitted my proposal they said this was something they want to implement. They also want to include the CSP guidelines on transgender health into one of their professional practice modules, which is really promising.’

Teaching palliative care 

David Cabrini Back, a final year BSc student at Bournemouth University, undertook a literature review looking at palliative care education and the attitudes and beliefs students hold about its teaching. 

David chose this topic following a personal experience of a bereavement which he says he “didn’t deal with very well”, but also because it was an area of physiotherapy that he was interested in. ‘The nice thing about a literature review is it gives you the chance to work on something you are passionate about,’ he says. ‘It’s an opportunity to explore topics that are of interest.’

His key recommendation supported the European Commission and the European Association of Palliative Care’s recommendation that palliative care teaching is essential and would better equip students.

David’s educators and university were keen to hear his conclusions. Encouraged by his professor, he presented at his university’s annual undergraduate research conference. As president of Bournemouth’s physiotherapy society, he also arranged a palliative care specialist to give a talk on the topic. Through these activities, he offered a sample of the palliative care education he hopes will feature more prominently in the future.

Research and dissemination tips

Katie, Dexter and David recommend using social media to call for interviewees, network and publicising research findings.

• Dexter recommends tagging prominent names in physiotherapy support networks who are usually more than happy to share research and disseminate it. He also suggests networking with tutors who specialise in topics akin to what you want to do as they will be able to advise and introduce you to networks of their own.
• Katie contacted other universities and organisations to highlight the importance of her work. ‘As soon as other students realised what I was doing they pushed their peers to engage as well – so it had a massive knock on effect and everyone got on board,’ she said.
• David advises exploring the possibility of getting research published in a reputable journal. ‘My lecturer Carol Clark was very supportive of the idea so I sent my paper off to Physical Therapy Reviews with a view to getting it published,’ he added.

Disseminate

As Lloyd mentioned, presenting at events is a great way to share your findings. The opportunity to discuss your work can also help you to make improvements, develop new ideas, instigate a collaboration or inspire others. If you can, try to go to some events beforehand to get a feel for what makes a good presentation. If you are then accepted to present, be sure to check what funding is available to you. The CSP’s Charitable Trust awards funding to members every year. 

Dissemination can also mean sharing your work with key individuals or organisations, those who can put your words into action.

Look into who is best to approach and how to tailor and summarise your findings so that the reader can see its value and relevance.  

The CSP’s many networks are a great place to find an audience for your work, whether it is one of the iCSP interactive forums or a CSP professional network. Check out the Influencers network iCSP for tips and advice.

Be creative 

Publishing your research helps to ensure that future researchers can find it and build on what you’ve learnt. It is also a great way to develop and demonstrate your skills in writing, research literacy and critical thinking. 

Discuss with your supervisor or peers the focus of your article. Once decided, note down the key messages you want the article to communicate. Keep these to hand (and in mind) when writing the article and selecting the journals to approach.

For ideas and access to relevant publications, visit the CSP’s library 

However, journals are not the only way to share your findings. Consider what communication channels your target audience uses and what methods they respond to. This could be podcasts, blogs, videos or infographics. If sharing on social media, be sure to tag in relevant accounts and tailor your content. Think creatively and think bitesize too.

Recognising the value of research

Reflecting on this snapshot of recent research projects, CSP education adviser Nina Paterson said: ‘Not only is it fantastic to see students so engaged in developing their research skills, it’s been valuable to hear the takeaways from their research. 

‘That there needs to be more understanding of the impact on student wellbeing as a result of the pandemic, more support for BAME students, more understanding of trans issues, and more palliative care teaching within the pre-registration programme, are issues that we’ve been actively discussing with the education community. That students are adding to the growing body of evidence in these areas is fantastic. Their findings add weight to the discussions and the impetus for change.’