Thesis (PhD)--University of Stellenbosch, 2001. / ENGLISH ABSTRACT: "Quality" has different meanings to different people. Even quality experts do not agree on a single definition: Juran's definition of quality revolves around his concept of "fitness for use", Crosby defines quality in terms of performance that produces "zero defects" and Deming defines quality as a "never ending cycle of continuous improvement". One element, however, that is common to all three approaches is that management must accept and demonstrate leadership if quality is to be achieved. Quality is rarely thought of as others perceive it. What is apparent is that if providers of care wish to maintain leadership in defining quality, they need to - Actively participate in the public debate about quality. Review the way in which they have been defining quality. Question whether their definitions are aligned with what the purchasers of health care define as being important. Develop meaningful measures of quality and data collection systems that will allow them to demonstrate quality and value. - Willingly share data not only on outcomes, and also measures that are specific to individual procedures and service providers. The PhysioFocus practice accreditation programme attempted to achieve the above factors. By realising the goal of the research this was determined. The goal of the research was to evaluate the PhysioFocus practice accreditation programme and to make recommendations on the educational programme for accreditation in private physiotherapy practices. This goal was realised by means of an exploratory and descriptive research design with a qualitative orientation. The evaluation of the PhysioFocus practice accreditation programme was performed by means of a validated evaluation instrument. The group interview revealed components of the PhysioFocus practice accreditation programme that require remediation. Recommendations included professional-ethical issues, business management and legislative issues. The recommendations will be implemented by the PhysioFocus practice accreditation committee. The PhysioFocus practice accreditation learning programme was evaluated by means of a semi-structured questionnaire, containing eleven questions and a section for comments. The general consensus was that the PhysioFocus practice accreditation programme is essential in private physiotherapy practice in South Africa. The implementation of the PhysioFocus practice accreditation programme resulted in the facilitation of quality physiotherapy; professional and personal development; monitoring of quality improvement processes; and the evaluation and remediation of these processes. This supported the central theoretical assumption of the research. Concerns were voiced about the lack of standards, lack of quality improvement skills, the public image of the physiotherapy profession and the lack of basic business management training. The researcher concluded that the implementation of the PhysioFocus practice accreditation programme is essential in private physiotherapy practice in South Africa. At present the current PhysioFocus practice accreditation programme does not address all the needs of private physiotherapy practices. Recommendations based on the research included remediation of the current PhysioFocus practice accreditation programme, formal education included business management, professional-ethical-Iegal issues, standards and scientific methods to analyse process variation and the development of improvement strategies in quality improvement. Other recommendations include informal education, physiotherapy management and structured quality improvement activities. The issue of the image of the professional physiotherapist was also addressed. Topics for future research were identified. The uniqueness of the research lies in the fact that this is the only physiotherapy practice accreditation programme implemented in South Africa. It is also the only physiotherapy practice accreditation programme in South Africa that has been evaluated. / AFRIKAANSE OPSOMMING: "Gehalte" het verskillende betekenisse vir verskillende mense. Selfs kenners op die gebied van gehalte stem nie saam met 'n enkele definisie nie. Juran se omvattende definisie is "gebruikswaarde", terwyl Crosby gehalte in terme van produksie, naamlik "zero defek", definieer. Deming definieer gehalte as "'n nimmereindigende siklus van voortdurende verbetering". Die een aspek wat al drie die kenners egter gemeen het, is dat bestuur leierskap moet aanvaar en demonstreer indien gehalte bereik wil word. Geen twee persone ervaar gehalte eenders nie. Indien diensverskaffers leiding wil behou ten opsigte van gehalte-definiëring, sal hulle verplig wees om: aktief deel te neem aan openbare debat oor gehalte; die aanvaarde definisie van gehalte te herevalueer; die aanvaarde definisie van gehalte op te weeg teenoor dié van die mediese hulpfonds-administrasie; gehalte- en data insamelingsisteme te ontwikkel om gehalte en waarde te bewys; en gewillig alle data te deel - nie net uitkomsdata nie, maar ook data wat spesifiek op individuele prosedures en diensverskaffers van toepassing is. Die PhysioFocus praktyk-akkreditasieprogram het gepoog om bogenoemde te bereik. Die navorsing het gerealiseer deurdat die doelstelling bereik is. Die doelstelling van die navorsing was om die PhysioFocus praktykakkreditasieprogram te evalueer en aanbevelings te maak vir 'n leerprogram vir die akkreditasieprogram. Die doelstelling het gerealiseer deur "n verkennende en beskrywende navorsingsontwerp vanuit 'n kwalitatiewe oriëntasie. Die evaluering van die PhysioFocus praktyk-akkreditasieprogram het deur middel van 'n gevalideerde evalueringsinstrument geskied. Die groepsonderhoud het areas van die PhysioFocus praktyk- akkreditasieprogram wat remediëring benodig, geïdentifiseer. Aanbevelings het professionele-etiese aspekte, besigheidsbestuur en wetlike aspekte ingesluit. Die aanbevelings sal deur die PhysioFocus praktykakkreditasiekommitee geïmplementeer word. Die evaluering van die PhysioFocus praktyk-akkreditasieleerprogram het deur middel van 'n semi-gestruktureerde vraelys met 11 oop vrae, tesame met 'n afdeling vir opmerkings, geskied. Die algemene aanname was dat die PhysioFocus praktyk-akkreditasieprogram noodsaaklik is in privaat fisioterapiepraktyk in Suid-Afrika. Die implementering van die PhysioFocus praktyk-akkreditasieprogram het gehalte fisioterapie, professionele en persoonlike ontwikkeling, die monitering van gehalteverbeteringsprosesse, asook evaluering en remediëring van hierdie prosesse, tot gevolg gehad. Dit het die sentraalteoretiese aanname van die navorsing ondersteun. Daar was egter kommer oor die gebrek aan standaarde, die beeld van die fisioterapieprofessie, asook die gebrek aan besigheidsbestuuropleiding. Die navorser het tot die gevolgtrekking gekom dat die implementering van die PhysioFocus praktyk-akkreditasieprogram noodsaaklik is in privaat fisioterapiepraktyk in Suid-Afrika. Die huidige PhysioFocus praktykakkreditasieprogram voldoen nie aan al die vereistes van privaat fisioterapiepraktyk in Suid Afrika nie. Aanbevelings vanuit die navorsing sluit die volgende in: remediëring van die huidige PhysioFocus praktyk-akkreditasieprogram; formele opleiding, insluitende profesionele-etiese-wetlike aspekte; standaarde; wetenskaplike metodes om die praktykprosesveranderinge te analiseer; en die ontwikkeling van 'n gestruktureerde gehalteverbeteringstrategie. Die beeld van die fisioterapieprofessie is ook aangespreek. Onderwerpe vir toekomstige navorsing is geïdentifiseer. Die navorsing is uniek omdat die PhysioFocus praktyk-akkreditasieprogram die enigste akkreditasieprogram vir fisioterapie in Suid Afrika is. Dit is ook die enigste fisioterapie-akkreditasieprogram wat in Suid Afrika geëvalueer is.

published_or_final_version / Education / Doctoral / Doctor of Philosophy

The use of critical thinking is called for in the practise of physiotherapy and has been cited as a learning outcome in the design of the physiotherapy curriculum. Further, the South African Draft White Paper on Higher Education (July,1997) is committed to endow graduates with skills that build the foundation for lifelong learning and included in such skills is that of critical thinking. Although welcomed by the profession, the introduction of critical thinking within the programmes may be premature because of the lack of debate and subsequent understanding about the critical thinking skills necessary for the practise of physiotherapy. Hence critical thinking remains implicit within the context of physiotherapy. Physiotherapy educators are assessing the skill implicitly within the process of clinical reasoning and decision making, without articulating what critical thinking really is, in the context of physiotherapy clinical reasoning. Further one needs to identify the repertoire of component skills that one should possess, in order to be an accomplished critical thinker. Data obtained from interviews with level co-ordinators, and an examination of the course plans within one department at one institution, provided an insight into how critical thinking is understood within the profession. Further, it identified if, and how, critical thinking was currently incorporated into the physiotherapy curriculum. In an attempt to develop a deeper understanding and a guiding framework for critical thinking in Physiotherapy, a workshop was conducted amongst qualified physiotherapists. They were required to model the clinical reasoning and decision making processes that they employ in the clinical area, in the process of working through the clinical problem that was presented. The data that emerged was qualitatively analysed and categorised. This was for the purpose of generating meaning, and for the development of a framework of critical thinking skills, that may be used in conjunction with the process of clinical reasoning to enhance one's clinical judgement. Critical factors emerged from analysis of the data. These included the preponderance of the product over the process method for teaching and assessing, the implicit nature of teaching and assessing for critical thinking in physiotherapy, and the similarities and differences in perception and conception about the meaning of critical thinking and its associated skills. The findings of this study contribute to the understanding and development of critical thinking within the specific context of physiotherapy and inform the development of the physiotherapy curriculum towards the realisation of its intended goals. / Thesis (M.Ed.)-University of Natal, Durban, 2000.

The purposes for this study were: (a) to establish benchmark metrics for selected variables related to characteristics of physical therapy education programs; and (b) to determine how well a subset of the variables predicted group membership based on first-time pass rates (FTPRs) on the National Physical Therapy Examination (NPTE). The population was defined as all physical therapy programs in the United States and Puerto Rico accredited by the Commission on Accreditation in Physical Therapy Education. Questionnaires soliciting data related to the variables were mailed to the entire population (N = 177). Fifty-eight (32.8%) of the programs returned the questionnaire, with 51 (29%) having provided enough information for inclusion in the study. Characteristics of the sample were compared to known population characteristics in order to determine the extent to which the sample represented the population. Pearson product-moment correlation resulted in a coefficient of .993, indicating that the two groups were similar. Descriptive statistics were calculated. Values for the variables were tabulated in various ways, based on the nature of sponsoring institution, regional location, degree offered, and grouping based on FTPRs, in order to facilitate comparisons. A single institution was selected and comparisons made to demonstrate the utilization of benchmark metrics. Chi-squared tests were conducted to study the relationship between curriculum model, degree offered, and grouping. The resulting values of c 2 indicated that these variables were independent of each other. Classification accuracy was determined through discriminant analysis. Results indicated 80% accuracy for this sample; however, the accuracy was only 47% on cross-validation. Structure coefficients were calculated to determine the relative contribution of each variable to the prediction. The findings demonstrate the usefulness of benchmark metrics for facilitating quality improvement in physical therapy education programs. There is, however, need for improvement in the process, and further research should be conducted to develop a realistic model for predicting group membership based on FTPRs.

This study aimed to identify student perceptions regarding changes implemented after review by the State Board of Education of Alagoas in the course of physical therapy in 2009. An evaluation process is often unpleasant, always creates insecurity, fears, dissatisfactions, conflicts and suspicions regarding the authenticity or listed demands. On the other hand, generates knowledge that enables plan actions aimed at overcoming difficulties. This is a correlational study and comparison participants, they were considered two main sets of variables: background (student perception) and consequent (didactic and pedagogical organization, faculty, and infrastructure). Participants were 159 students from a public university of Maceió-AL, 27 (17%) men and 132 (83%) women, aged between 17 and 38 years (M = 21.86, SD = 3.54 . The participants answered a structured questionnaire that measures the degree of student perceptions regarding changes implemented; and provide their sociodemographic characteristics. Revealed a low student perception of the changes implemented by university in surveyed dimensions: pedagogical-didactic organization (mean = 2.80), faculty (mean = 3.27) and infra-structure (mean = 1.97), resulting in low level of satisfaction. This reality demonstrates the necessity of establishing deploy a disclosure policyand student awareness to the changes implemented in the course. / Este estudo teve como objetivo identificar a percepção discente quanto às mudanças implementadas após avaliação do curso de fisioterapia pelo Conselho Estadual de Educação de Alagoas em 2009. Passar por um processo avaliativo é, muitas vezes, desagradável, sempre gera insegurança, receios, insatisfações, conflitos e desconfianças em relação à autenticidade ou demandas elencadas. Por outro lado, gera conhecimentos, que possibilitam planejar ações destinadas à superação das dificuldades. Trata-se de um estudo correlacional e de comparação entre participantes, em que foram considerados dois conjuntos principais de variáveis: antecedentes (percepção discente) e conseqüentes (organização didático-pedagógica, corpo docente, e infra-estrutura). Participaram deste estudo 159 discentes de fisioterapia de uma IES pública de Maceió-AL, sendo 27 (17%) homens e 132 (83%) mulheres, com idade variando entre 17 e 38 anos (M= 21,86; DP=3,54). Os participantes responderam um questionário estruturado que aferia seu grau de percepção quanto às mudanças implementadas no curso e coletados dados sociodemográficos. Evidenciou-se baixa percepção discente das mudanças implementadas pelas IES nas dimensões pesquisadas: organização didático-pedagógica (média=2,80), corpo docente (média=3,27) e infra-estruturar (média=1,97), resultando em baixo nível de satisfação sobre o curso. Esta realidade demonstra a necessidade da instituição implantar uma política de divulgação e sensibilização discente, frente às mudanças implementadas no curso.

Thesis (MPhil (Curriculum Studies))--University of Stellenbosch, 2006. / Clinical education in health sciences is an important and distinct part of health care education. In clinical education situations, students learn to integrate the knowledge, skills, attitudes and values of the profession. The attainment of clinical competence is one of the main outcomes of the Clinical Physiotherapy module for physiotherapy students at Stellenbosch University (SU). In its Strategy for Teaching and Learning (2001:3), SU embraces a student-centered approach to teaching. In a student-centered approach towards teaching, the focus is on the quality and quantity of student learning. In the current changing context of higher education, all spheres of education need to be assessed to determine the meaning of student-centeredness and to establish whether it is achieved. The above-mentioned approach may lead to quality management in teaching and learning.

Physiotherapy student practice education, the focus of this thesis, is a highly valued, yet scarcely researched component of pre-registration physiotherapy education. Moreover, the student voice is largely absent from existing research. In this study, 14 physiotherapy students’ perspectives of practice education were gained through email communications (n=13) and face-to-face interviews (n=12). To provide an in-depth and provocative view, physiotherapy student practice education was analysed as a type of activity system, employing concepts borrowed from cultural-historical activity theory (CHAT). Interacting activity systems, objects, players, rules, norms, divisions of labour, mediating artefacts, intra- and inter-systemic contradictions were explored and identified. The findings show that assessment skewed students’ object motives. Practice educators were positioned as powerful gatekeeper/assessor gift-holders. Physiotherapy students enacted ‘learning practice’ norms, such as extensive reading, and adopted the position of practice educator-pleaser. Students sometimes refrained from speaking when they wanted to, for example, to challenge unprofessional staff behaviour. Students were reluctant to show themselves as learners, feeling instead that they needed to present themselves as knowledgeable, able practitioners. However, students did not easily recognise themselves as able contributors to practice. For students, knowledge for practice was focussed on patient assessment and treatment, but the level, depth and volume of knowledge required was perceived differently across distinctive practice areas. Intra- and inter-systemic contradictions, such as the skewing of student object motives towards assessment, and away from whole-patient-centred care, are highlighted. The study findings therefore have implications for patient care as well as for the object of physiotherapy student practice education, student learning and assessment and workplace learning. A cross-profession review of the object of physiotherapy student practice education, to include the voice of service users, students, practice educators, HEIs and service providers, is recommended. A review of physiotherapy student practice-placement assessment, which seemed to be at the core of PSPE dynamics and conditions, is recommended, to take account of the extent to which assessment can influence students’ PSPE object motives, PE/student dynamics and student/patient interactions. Developmental Work Research is proposed as a way forward for future research in this area.