Therapies for shuttered minds

Ngaio Crequer talks to four academics about how the National Health Service reforms are affecting their daily work of training students, and finds them largely enthusiastic about the links between practice and higher education.

They did not look down upon us. But we needed to ensure that they did not look down upon us." That is how Heather Coates, director of studies for physiotherapy described the relationship between her and her academic colleagues at the University of Hertfordshire.

She and four colleagues joined the university in 1991/92 charged with drawing up a new undergraduate degree course in physiotherapy.

She had moved from Coventry Polytechnic, as it then was, and had spent 20 years in education and the health service as a physiotherapist.

"The development of a new course was exciting and we were in the privileged position of starting with a clean piece of paper. The university was very supportive, but I was moving to an institution which knew nothing about physiotherapy education."

"We had to deal with academic colleagues who did not know what our requirements were. We had to instill into our senior colleagues the understanding that their perceptions were inaccurate. We needed to use our negotiating skills."

What she had to do was to change their perceptions of what her students should be taught. For example, lecturers in the bio-sciences assumed that they would be able to provide a lot of the teaching but Mrs Coates told them the subject would only be a small portion of the course. "They were looking at us sideways to ensure we were of the same calibre as they were. We had to sell physiotherapy as a good academic subject in its own right. Because the subject is vocationally-orientated we had to ensure it was recognised and valued by them, in the same way we recognised it ourselves."

The course is very innovative and taught around themes, rather than subjects. Students take 30 modules over three years, and nine of these are undertaken in clinical placements, in hospitals or in the community. The course is the most highly sought after in the university. Some 1,500 candidates chased 40 places this year. This certainly helps to impress Mrs Coates's colleagues.

She says that physiotherapy is having to change. There is a move from the acute, high-tech sector, into the community. More physiotherapy is now being undertaken in people's homes, and the course has to reflect that in practice. The biggest problem is finding clinical placements for her students.

She says: "Managers of trusts have to be money-conscious. We have to pay units to take our students, it is the market economy.

"A physiotherapy manager has to meet his or her own contract requirements and this means they must consider their throughput of students.

"A student will take longer to treat a patient than a qualified member of staff and some managers have to justify this to their own line managers.

"Some may say, 'what is there in it for us?' This is a problem for us as an education provider.

"We have to work very hard to find placements. Yet they must see that we are trying to educate the workforce for the future. If they do not invest, they are damaging their own profession. Ask anyone in the physiotherapy world what their biggest worry is, and they will say it is the provision of clinical placements."

In 1996, regional health authorities will disappear and Mrs Coates is concerned about the future commissioning of education and training.

"I would like to see para-medical subjects funded by the funding councils. This would make everything much more straightforward.

"There should not be this delineation between categories of students. Nor should we have to negotiate contracts for different lengths of time. In the long-term this would make everything much more stable."