Dissecting the gross anatomy curriculum and pedagogy for South African physiotherapy students

Abstract

Physiotherapists require sound and detailed gross anatomical knowledge to prepare them for safe and competent clinical practice. In South Africa physiotherapy (PT) practitioners are autonomous and provide first line care for patients. In this role they can diagnose a patient’s condition and treat to restore optimal function within the boundaries of their scope of practice. Undergraduate students in this country receive gross anatomy education in the first and/or second year of their PT course. The significance of this research lies in the fact that it addresses the need for a comprehensive perspective on a unified national approach to a gross anatomy curriculum for undergraduate PT students in South Africa. It also identifies the pedagogies best suited for the delivery of such a curriculum to this student body. Studies included in this thesis document facts relating to gross anatomy education for the undergraduate PT student body globally, information from national PT student gross anatomy coordinators and qualified South African physiotherapists and consider the relevance of the relationship between the learning styles of undergraduate PT students and the teaching styles of their gross anatomy lecturers. In South Africa there are eight Health Science Faculties that offer an anatomical grounding to undergraduate PT students as part of baccalaureate courses. They are widely distributed throughout the country. Gross anatomy programmes vary widely in curriculum design and pedagogy used. This thesis brought together global and national perspectives on the topic in order to formulate a unified national approach to gross anatomy education for South African undergraduate PT students. The thesis consisted of four studies that were grouped into Phase 1 (Studies 1 and 2) and Phase 2 (Studies 3 and 4). Four original papers resulted from the findings of Studies 1, 2 and 4. Paper 1 (Appendix 1) of this thesis is a protocol document developed to guide the scoping review process in Study 1. The preparation of the Joanna Briggs institute protocol and charting template ensured that the scoping review that was subsequently carried out followed a systematic, verifiable methodology. Paper 2 (Chapter 3), a scoping review, systematically sourced published or unpublished literature in all languages prior to 20 March 2018, to ascertain the gross anatomical education afforded to undergraduate PT students in the global context. The collation of 1241 sourced documents identified 51 eligible papers for inclusion. Papers were charted into eight categories according to the main focus of the intervention undertaken. Mean sample sizes varied from (216.9 ± 241.3) in the inter-professional category to (55.3 ±30.4) in the ethical, professional and psychological matters category. Overall 26 study samples (51.0%) had input from PT students or PT professionals exclusively in the sample. Key findings emphasised: the relevance of gross anatomy in PT education and how inter-professional education and clinical input in the form of case-base learning factored into this scenario; the increase in computer-assisted learning; the beneficial use of team-based learning and peer teaching; enhancement of professional behaviours during dissection and improved student attitudes to ethics and perceptions of the dignity of human life. These findings were used to compare the global gross anatomy situation with the findings of the national gross anatomy survey undertaken in Paper 3 (Chapter 4). Paper 3 (Chapter 4), a 42-question peer-reviewed online survey established gross anatomy curriculum and pedagogy content for South African undergraduate PT students at all eight relevant Health Science faculties in South Africa. Seven coordinators from six (75%) of the universities responded. Collected data showed that staff qualifications and experience varied widely and high to average staff to student ratios existed between faculties. Total number of weeks in courses per year was 27.6 (± 5.7) varying widely between institutions. Calculable direct contact anatomy hours ranged between 100 and 308 with a mean of 207.6 (±78.1). With the exception of one faculty this is high in comparison to global standards as reported in Paper 2. The main difference noticed between the pedagogy in use globally and locally was that computer-assisted learning was used liberally in the global setting but due to budget constraints only half of the responding faculties used it in South Africa. The findings highlighted disparity between national programmes and therefore confirmed the significance of the study in relation to the identification and formulation of a unified curriculum for the country. The third study (Chapter 5) established what South African physiotherapists in different service delivery spheres, in the Gauteng Province of South Africa, perceived as necessary content for a gross anatomy curriculum and pedagogy for South African PT students. This study used a qualitative grounded theory approach and was conducted using focus group discussions. The sample was PT lecturers, at the University of the Witwatersrand (WITS) and physiotherapists in public hospitals and private practices in Gauteng. Theoretical saturation dictated number of participants and focus groups. Data collection and analysis were simultaneous. Data analysis was inductive to establish themes. Reliability and strength of research factors were implemented. Five focus groups were held (n=32). Overall average age of participants was 29.9 (± 7.8) years and physiotherapy experience was 7.4 (± 7.7) years. The public sector particpants had the lowest mean age of 24.2 (± 2.4) years. Recorded years of experience was highest in the private sector at 12.7 (±7.3). There were more female participants and clinical work areas were diverse in scope of practice. All pedagogies named by participants were in line with the global and national findings (Papers 2 and 3). The suggested anatomy programme content inclusion and exclusion mirrored that suggested in both the global and national perspectives (Papers 2 and 3). The psychological wellbeing of PT students in relation to dissection and coping with ‘anatomy overload’ was raised in the discussions. Seven themes were identified. This study added depth to the overall thesis by incorporating the essential viewpoint of qualified physiotherapists who have the advantage of knowing what is clinically required to ensure effective, professional and competent PT practice post qualification. Paper 4 (Chapter 6) determined the different gross anatomy learning styles utilised by two chronological South African undergraduate PT student cohorts enrolled at WITS and identified the different teaching styles utilised by the gross anatomy instructors, involved in the teaching of those students in the School of Anatomical Sciences at WITS. This study design was cross-sectional and data were collected using the standardised GrashaRiechmann learning style scale (GRLSS) and the Grasha-Riechmann teaching style scale (GRTSS) questionnaires. The key findings from this study offered insight into the type of learning styles PT students use to learn gross anatomy. Student samples were small (Group 1, n=59 and Group 2, n=54) but response rates high (n=39, 66.1% and n= 43, 81.5%) in 2015 and 2016. Mean Likert scores for GRLSS indicated most popular choice for learning style was the Dependent style: 3.81(0.75) for Group 1 and the Independent style: 3.68(0.61) for Group 2. Both gender and age factors influenced the results but no significant differences were recorded in GRLSS scores for the different age groups. Lecturers scored highest in the Expert category of teaching styles. Compatibility between learning and teaching styles was seen in both years when identified GRLSS and GRTSS styles were grouped together into specific cluster categories. One member of staff had ‘accomodated’ to a different teaching style cluster in 2016 more suited to the Independent learning style of student Group 2.These findings may impact on the types of pedagogy chosen to best suit student group learning. However, the increase number of students in anatomy classes as indicated in both the global literature and the national survey and the general diversity of student learning style preference may lead to the conclusion that there is no ‘one size fits all’ strategy that can be implemented to ensure all student learning style needs are met. In conclusion the research strategy undertaken fulfilled the aims and objectives of the project. The addition of a qualitative component in the gathering of the data added a further dimension and depth to the research. Overall there is identification of plausible, beneficial and implementable curricular and pedagogical suggestions that can be presented to relevant tertiary and governmental bodies in order to help facilitate a unified national gross anatomy educational programme for undergraduate PT students in South Africa