Preparing physiotherapists for the future: the development and evaluation of an innovative curriculum | BMC Medical Education

Participants

In total 82 first year students (44,6%) of cohort 2021–2022 and 36 teachers (60%) from six different CoP’s completed the questionnaire. Table 3 shows participant features. Interviews were conducted with 12 students, two from each CoP. The focus groups consisted of 12 teachers.

Questionnaire

Looking at the summary of the questionnaire results (Table 4), students and teachers agree on the implementation of the guiding principles. Overall, students and teachers score high (median of 4 or 5 on a scale of 1 to 5) on the underlying items per guiding principle. Table 5 shows the complete questionnaire. In four of the 22 items the median score was 3. Regarding the first principle, flexible and varied, students were significantly less convinced than teachers.

National progress test

Table 6 shows that mean test scores of the HAN university students are satisfactory compared to other universities. The one-way ANOVA showed a statistically significant difference between groups, F(3,786) = 88.06, p < 0.001. A Tukey post hoc test revealed that the mean total scores of HAN university students (51,30 ± 8,48) was significantly higher than mean total scores of students from university three and four (37,66 ± 10,69, p < 0,001 and 39,26 ± 12,05, p < 0,001 respectively) (see Table 7). Chrohbach’s alpha for internal consistency was 0,81.

In-depth interviews and focus groups

Thematic analysis of interviews and focus groups resulted in three themes and nine subthemes as presented in Table 8. Each theme and subtheme is described and illustrated with quotes from students and/or teachers.

Theme 1. Navigating personalized learning

Embracing ownership

The flexible program structure allowed students to personalize their learning paths, choosing which classes and activities to attend and which ones to skip for the benefit of other learning activities that better match their learning needs and preferences. This autonomy fosters a sense of ownership over the learning process.

S3: “That you can choose, like this class isn’t very relevant to me, I already know a lot about it, so I choose to do something else […], that works well for me.”

T11: “I notice that students are becoming more comfortable with planning what, when, and where they want to learn, and what they need from me, today or tomorrow, and they can easily switch between them.”

However, some students question if the curriculum contributes to deep learning and critical thinking skills. Students and teachers mentioned the risk of a superficial approach to learning.

S5: “Yes, it [SDL] has its advantages and disadvantages, I think when it’s so varied, you can learn a bit of everything, but if there’s too much, you might lose the opportunity to really dive deep into a particular subject. Of course, I can steer my own learning, but I also want to study all the cases.”

S10: “Because you have so much freedom of choice, it can sometimes be difficult to truly immerse yourself in the material. You might feel like, well, I’ll just learn the basics, and that’s enough,’ and then you move on.”

Adapting teaching practices

While the flexible curriculum encourages innovation, some teachers found it challenging to depart from traditional pre-structured curriculum content and pre-defined teaching methods, often reverting to familiar approaches. To align with student’s learning needs and preferences, flexibility and creativity is needed. Teachers highlighted the need for ongoing professional development and critical reflection on current teaching practices.

T2: “In terms of didactic methods, I try to vary, although I don’t always succeed in doing so. I tend to choose methods that feel most comfortable for me. I really must consciously remember to vary, there is room for improvement for me.”

T10: “I believe that we are all still learning to vary our approaches and to make learning more challenging and stimulating. Besides offering different content or contexts as we have done, we need to think about how we can shape it didactically in different ways.”

Bridging the culture gap

The program aims to develop students’ SDL skills, enabling them to set personal goals, create learning strategies, and reflect on their progress, ask for feedback and decide on the next step. Successful students transition from extrinsically motivated tasks to intrinsically driven learning, e.g. from completing pre-defined assignments and asking for general feedback to completing self-chosen assignments and asking for personalized feedback. For many students, particularly those transitioning from a more structured high school environment, the shift to a self-directed learning approach was challenging. They reported feeling overwhelmed and needed additional support to navigate the curriculum.

S5: “In the beginning, I needed to get used to it. The freedom and flexibility felt like a culture shock. I really had to get used to it.”

S6: “At first, I didn’t know what to do, and there was no guidance. But now that we understand it better, it’s motivating. It really encourages you to work from your own motivation.”

S4: “Last year, I was focused on completing video cases [problem tasks], just to fulfill requirements. This year, I’m more centered around identifying my own needs and desires in the process.”

Theme 2: Caring and sharing

Fostering peer learning

Second-year students expressed a sense of responsibility and enjoyment in helping first-year students. This peer tutoring not only aids the juniors but also reinforces the tutors’ own understanding and skills where junior students profited from role modeling opportunities.

S3: “It’s rewarding to help first-year students in their process, while simultaneously strengthening my own knowledge.”

S5: “I find it fantastic to help first-year students. Collaborating across different academic years is great because you can always learn from each other.”

Building confidence

Teachers observed that students’ confidence and self-efficacy beliefs grew significantly through vertical collaboration, where senior students mentor junior students. This process helps students progress through Miller’s pyramid of clinical competence, moving from ‘knowing’ to ‘showing how.’

T4: “The growth in self-confidence is evident. Students who struggled in their first year are now starting to shine, showcasing their increased knowledge and ability to articulate concepts.”

S2: “Assisting first-year students provides reassurance, affirming that I already know quite a lot. With third years, it’s like a benchmark; am I on the right track?”

Sustaining engagement

While collaboration within the Community of Practice (CoP) is beneficial, maintaining engagement among senior students is challenging due to their reduced presence on campus for internships or minors [out of campus programs]. This lack of interaction limits the exchange of experiences across different academic years.

T12: “Collaboration among first- and second-year students is smooth, but engaging senior students is challenging. Although they initially participate during onboarding [introduction of a learning period], sustaining this involvement is difficult as time progresses.”

S10: “Obtaining [online] feedback from senior year students [on written products or video-recorded performances] is no problem; however, their physical presence is limited.”

Theme 3: Shaping professional identity

Life-long learning

Students’ and teachers’ experiences show that PACE contributes to the development of life-long learning skills such as, dealing with uncertainty and navigating complex real-world situations, that future physiotherapist need to respond to the increasing complexity of help requests in clinical practice.

S12: “It is beneficial that I learned how to plan and structure my own learning path. These are skills that I need as a physiotherapist but also in daily life. I am confident to use these skills in the future.”

T7: “I think the current education is future-oriented because students learn to handle different things like chaos, complexity, making their own choices, which is very important as a physiotherapist. Students are being prepared for the ‘real world’.”

Embracing spontaneous learning

What both teachers and students see as an advantage of a flexible program is that the curriculum is not overloaded with prescheduled classes. Instead, there is room for alternative, spontaneous learning activities organized by students. By bringing real-life experiences into the classroom, students took the lead in bridging the gap between theory and practice, strengthening their engagement with the learning content.

S2: “[…] Last week, a girl from my handball team got injured, and I took her to school the next day. Her problem didn’t fit into the program, but all the teachers were super enthusiastic, and that’s when you learn the most.”

T2: “As a teacher I also feel the flexibility in education. Students were working on a clinical case on a hip disorder, when a student said; “my grandmother has hip osteoarthritis and a lot of difficult questions [that I couldn’t answer].” So, the next week we had a grandmother in the classroom.”

Envisioning the future

The program’s flexibility allows students to explore various physiotherapy specializations and work settings. From the first year, students are encouraged to envision their future as a physiotherapist, to anticipate their future role in society in order to build a realistic image of the profession and a personal, professional identity.

S4: “Teachers share their experiences from different physiotherapy settings. They are interested in what I want to do after graduation and offer guidance on finding the most suitable career path.”

T8: “We encourage students to take their own path and help them become the physiotherapist they want to be. The focus is more on discovering what kind of physiotherapist they want to become and how they will achieve that.”