Time to address the act of undressing

If you time-travelled back to the origins of physiotherapy you would likely find (mostly) young women in a state of undress learning anatomy and physiotherapeutic skills using each other’s bodies. It’s easy to see why the approach was, and still is, used. 

Anatomy comes to life, students experience ‘normal’ and can safely practise their handling skills, gaining immediate feedback before ever meeting patients. There’s also an argument that experiencing encourages reflection and empathy for patients also in a vulnerable state of undress.

So, if it works, why question it? 

Reena notes that while there are benefits ‘that doesn’t necessarily mean that we should accept the status quo. We should continually challenge ourselves and be supportive of students.’ 

I remember in my first anatomy lecture being told that I needed to buy a sports bra and pants to take part in practical sessions and that I’d need to expose my body to strangers as part of my training. I was terrified by the prospect

I went along with it until a point where it became normal, and I became part of the culture. I feel really passionate about this – if I’ve been perpetuating this culture, I wonder how many more are doing the same because we’re just so desensitised to it.’

Claire recalls a similar early memory of watching a fellow student’s gluteal region being exposed in front of the class. She adds that her drive to rethink practical sessions was also inspired by working as a clinician in Leicester with communities whose religious or cultural beliefs differed from her own. 

Meanwhile, Aisha and Kate are both open about making conscious decisions to be comfortable with something that is inherently uncomfortable. While Aisha shares her insights as a Muslim student and Kate shares her experience of anxiety, everyone interviewed is keen to stress that inclusion is about valuing everyone. And Claire reflects that, with an increasingly diverse set of students, a focus on this issue is a welcome step. 

All the contributors remind me that there are many reasons for being uncomfortable undressing. From different types of bodies – cisgender or trans, menstruation, scars, hidden or visible conditions, past abuse, trauma or simply that a state of undress can cause embarrassment. 

As Aisha reflects:

When I went to my first practical, I had only known these people for a week and suddenly you’re exposing your legs and your arms for others to use you as a model.

The group also point out that modesty and body image issues, irrespective of different genders mixing, aren’t just about culture or religion and that the issue affects both men and women. Over a third of the UK population have issues with their bodies¹, it’s likely that this applies within the physiotherapy classroom too.

Things are changing; I’m curious about what’s enabling this. Claire believes wider societal change is helping students more comfortably articulate boundaries. Kate adds that lecturers are

moving away from telling students to‘ get comfortable with being uncomfortable’ to ‘what can we do to make it more comfortable?

Claire agrees and recognises that it takes strength to raise issues with those in a position of power. She says: ‘Educators need to switch from thinking ‘we’re accommodating you’ to recognising that the students are actually the ones doing the accommodating.’ A sentiment which Aisha shares. 

So how do you create a safe and inclusive environment? 

Claire describes simple yet impactful changes they’ve introduced at Keele University, including setting up practical sessions so that they are inclusive from the start, ensuring that screens are always out – meaning no student needs to feel different, that screens are high enough to fully protect, or having the option to work in threes. She talks of being open and intentional with students, offering alternatives from day one and repeating this message continually, but says the key is being upfront that there are options. She is keen their new guidance offers choice based on body area and the gender of the tutor.

Reena notes that in at least one other university other-gendered colleagues ask permission to come behind screens. 

This chimes strongly with Aisha, who reflects that as a Muslim woman, ‘if I want to see a physiotherapist, I can request a woman. It makes sense that lecturers recognise that, for a growing number of us, this is an issue’. 

On the topic of religion and modesty, Claire talks about working with local Iman’s and Saudi Arabian physio schools to understand what’s permissible. 

We need to start asking whether there are other ways to teach. Do students really need to be exposed, and for how long?

Claire also reflects that during the Covid-19 pandemic, when windows were wide open for ventilation, students were covered to stay warm, only exposing for a brief time whatever part of the body they were working with and yet they weren’t disadvantaged. She talks about thinking differently about the kit students wear, even exploring full tracksuits that can be zipped/unzipped to expose specific body parts.

What’s been welcome throughout this conversation is that everyone approached it with a spirit of improvement, wanting this discussion to include the full education community and student body. 

So, for educators reading this, the challenge is simple…what can you do to make physiotherapy education a wholly inclusive experience? See the boxes for ideas.

¹How does body image affect mental health?