?Mathematical formulae have been encoded as MathML and are displayed in this HTML version using MathJax in order to improve their display. Uncheck the box to turn MathJax off. This feature requires Javascript. Click on a formula to zoom.ABSTRACT
Objectives
To identify physiotherapy students’ preferences about their prospective area of practice and the reasons for their choices.
Methods
Tel-Aviv University physiotherapy students participated in a cross-sectional survey and three open-ended questions that comprise the qualitative component of the study. At the very beginning of their studies, and at the end of the first to fourth years, participants were asked about their area of preference, the factors that shaped their choice, and the reasons for prospective changes in their preference.
Results
In total, 289 students filled out the survey. Response rate was 68%. Interest in some areas of practice such as pediatrics remained stable throughout years of physiotherapy studies. In contrast, interest in other areas such as sports declined and interest in others such as rehabilitation increased. The open-ended questions yielded 1,616 codes sorted into five categories that shaped the students’ preferences: “I/Me /My” the largest category, followed by “the physiotherapy studies program” and then the relational focused “physiotherapy practice.” The number of codes for “working conditions” and “work-life balance” increased steeply with the progression of the studies and the age of the students.
Conclusions
The choice for areas of practice of physiotherapy students vary during their professional formation. During their professional development, their preferences are shaped by their personal feelings, interest in and past experience with the specific areas of practice, as well as their practical exposure, experiences in practicums, and theoretical studies. Millennial physiotherapists prefer areas of practice in which personal as well as relational considerations are core.
Introduction
Career choices and attitudes among physiotherapy students are important for understanding prospective professionals’ rationale for choosing their future professional path, as well as for planning the future workforce. Like other health profession studies (Benner, Citation2000), undergraduate physiotherapy studies are a lengthy, formative process that facilitates under-graduates’ personal professional development and preferences as practitioners (Reeve et al., Citation2012; Richardson, Citation1999a). This socialization process allows them to learn formal knowledge, skills, and rules, as well as informal and implicit knowledge, norms, values, and loyalties within the profession (Richardson, Citation1999a). Professional socialization in physiotherapy is a complex process, as in other medical professions (Harman et al., Citation2021). For example, a review of the professional development of nurses identified learning, interaction, development, and adaptation as the major components. Broad educational programs, competent role models, and adequate field experiences were the antecedents of these components and had either positive or negative effects on them (Dinmohammadi, Peyrovi, and Mehrdad, Citation2013). Education programs seek to support professional development. Thus, they should try to link theory and practice to promote the learning that is relevant for the delivery of health services (Kurunsaari, Tynjälä, and Piirainen, Citation2022; Richardson, Citation1999b).
Medical career preferences are influenced by multiple factors. They are also dynamic and may change over time (Querido et al., Citation2016). This process is affected by a combination of one’s personality and environmental factors (Dohn, Citation1996; Hammond, Cross, and Moore, Citation2016). Other factors that affect the choices physiotherapy students make are clinical exposure and experience, interest in a specific area, and the positive impact of a role model, mentor, clinical educator, or university lecturer (Janaudis-Ferreira et al., Citation2016; Marques et al., Citation2019; Reeve et al., Citation2012). For example, among a group of Canadian physiotherapy students, the role models cited most frequently as having a strong impact were the preceptors in clinical placements (Öhman, Solomon, and Finch, Citation2002). Öhman, Solomon, and Finch (Citation2002) reported that the accessibility of jobs or economic benefits were the most frequently indicated reasons for career choice upon graduation. On an aggregate level, the individual career choices of prospective physiotherapists determine the staffing levels of various areas of practice. Studies indicate that areas such as cardiorespiratory physiotherapy lack an adequate numbers of professionals (Marques et al., Citation2019; Reeve et al., Citation2012). Understanding the factors that impact students’ choice of area of practice throughout the socialization process may also help in the improvement of the curriculum for professional development in the area of physiotherapy and in planning the workforce. However, young professionals seeking a work-life balance and intellectual satisfaction continue to assess their choice of career path even after graduation (Cleland et al., Citation2014).
Every year, hundreds of students apply to the Department of Physiotherapy in Tel Aviv University, and only less than 100 are accepted. In their admissions interviews, the candidates are asked about their interest in and reasons for applying to study physiotherapy. The desire to engage in sports rehabilitation and to help people are common answers. Harman et al. (Citation2021) also described physiotherapy students as being drawn to the profession because of their altruism and the perceived meaningfulness of making a difference in peoples’ lives. These results are in accordance with studies indicating that the desire to help people affects the preferred choice of career (Fabunmi, Adebajo, and Akinola, Citation2020) among physiotherapy graduates. In addition, their preferred career pathway often focuses on sports medicine and musculoskeletal physiotherapy, with a preference for private practice work (Öhman, Solomon, and Finch, Citation2002; Öhman, Stenlund, and Lars, Citation2001; Reeve et al., Citation2012). In Israel, every physiotherapy graduate can practice in any professional area. Their professional development is based on the physiotherapist’s willingness, and is acquired through clinical experience and post-graduate courses. The purpose of this study is to identify preferences for area(s) of practice and reasons for choosing these areas among physiotherapy students in Israel in various stages of their professional education.
Methods
Study design
A cross-sectional survey was conducted among five graduation cohorts from Tel Aviv University during the 2019 academic year. The survey included quantitative, closed-ended demographic questions, and three open-ended questions. This approach allowed the opportunity to appraise the subjective perspective of the physiotherapy students, a perspective that is seldom studied. These three questions comprised the qualitative component of the study.
Setting
Physiotherapy studies at Tel Aviv University is an undergraduate program that lasts four years, meaning eight semesters, as recommended by World Physiotherapy (Citation2021). This training includes two semesters of guided practicums, usually during the second semester of the third and fourth years. In Israel, a physiotherapist must have a bachelor’s degree and pass a government examination from the Ministry of Health. Upon completion of these requirements, they may start their professional practice.
Participants and procedure
The institutional review board (IRB) for this study was granted by Tel Aviv University’s ethics committee. No funding was received for this study. During 2019, all Tel Aviv University physiotherapy students were invited to participate in this survey. One of the researchers came to their classes at the end of the first, second, third, and fourth years (June 2019) and at the very beginning of the first year (pre-studies, October 2019). The students received an explanation of the study’s objectives and were asked to fill out the pen-and-paper survey questionnaire anonymously. The open-ended questions were: 1) List up to three areas of practice in which you would like to work as a physiotherapist; 2) What made you prefer these areas of practice; and 3)
What might influence your preferences about your areas of practice later in your career path as a student or as a physiotherapist? The voluntarily completed forms were collected later that day.
Data analysis
Descriptive statistics were used to describe the participants. The Kruskal Wallis or tests were used to assess differences in the participants’ demographic characteristics by academic year. The inductive analysis of the open-ended answers was conducted in accordance with conventional content analysis (Hsieh and Shannon, Citation2005). The texts were read and reread by the first two authors (two physiotherapists affiliated with Tel Aviv University’s Physiotherapy Department) to immerse themselves in the data and obtain an overview of it. Then, they reread the answers word-by-word and classified specific words or sections from the texts into preliminary codes. Based on this initial analysis, they created an agreed-upon set of potential categories, each including several codes. These initial categories were refined in a series of peer-debriefing sessions, during which all authors including a qualitative medical and health sociologist researcher with a different affiliation reread the texts from the students from the various classes together. The outcome of these sessions was categories and sub-categories, each containing several codes. This scheme was further elaborated in another series of peer-debriefing sessions, when other texts were assigned to sub-categories. At this point, definitions for each category and sub-category were developed, enabling all authors to categorize the remaining answers independently.
There were two stages to this independent categorization process. First, all three authors categorized the same texts. To ensure consistency between their independent classifications, which were discussed and reviewed, further clarifying the definitions of the categories. Then, each author analyzed the categorization of the remaining texts, followed by its debriefing to the research group. This codification process was handled using Excel spreadsheets which allowed the count of the different codes. Differences between academic years in each sub-category codes were assessed using the test.
Results
Two hundred and eighty-nine students filled out the questionnaire. The response rate was 68%. The median age of the participants was 26 years old [ranging from 20 to 44]. There was a significant difference in the age distribution based on the point at which the students were in their academic studies (p < .01). A post-hoc analysis indicated that students in later years of their academic studies were significantly older. There was no significant difference in the gender distribution of the students by academic year. As indicates, 96 of the participants were male (32.9%). For most participants, physiotherapy studies were their first university-level studies. For 33 (11%) of them, it was their second bachelor’s degree.
Table 1. Participants’ demographic characteristics by academic year.
presents the relative distribution of the “preferred area of practice” by academic year. When entering the program, most students indicated a preference for sports and pediatrics as their areas of interest for future practice. While pediatrics remained a preferred area of practice throughout the years, interest in the area of sports declined. In contrast, by the fourth year, there was a sharp increase in the preference for rehabilitation.
Figure 1. The distribution of “area of internet” by academic year (percent of year), sequence by year of studying each area.
The study’s categories
The students were asked about their area of interest (question #1), the factors that shaped them (question #2), and the reasons for possible changes in their interests (question #3). In their open-ended answers, they provided details about their preferences and their rationale, yielding 1,616 codes. These codes were categorized in five main themes: I/Me/My, the physiotherapy studies program, the practice of physiotherapy, the working conditions of physiotherapists, and work/life balance. present the categories and sub-categories. The tables indicate the number of codes by year of study, the number of students who mentioned the topic, and an example of each (translated from Hebrew). Details are also provided regarding answers about the reasons for changing their preferences about their area of practice (question #3).
Table 2. I/Me/My sub-categories codes by year.
Table 3. The physiotherapy studies program sub-category codes by year of study.
Table 4. Physiotherapy practice sub-category codes by year.
I/Me/My
This was the largest category of all in each year of study. It included the following sub-categories: feelings or sensations about a specific area of preference (272), interest in, knowledge of and understanding in a specific area (193), students’ own concrete experiences (130), such as having engaged in competitive sports, and the students’ own holistic experiences (80), such as being the sibling of a person who underwent physical rehabilitation. The sub-category of “Feelings/ Sensations” as the reason for choosing an area of interest figured more prominently among fourth-year students than among those in other academic years. In contrast the sub-category of “Interest/ Knowledge/Understanding” was more frequent in the first year than in other academic years ().
The physiotherapy studies program
There were three aspects that affected the students’ preferences about an area of interest: its content, mode, and breadth. Specifically, 104 students cited the theoretical aspects. One hundred and fifty-four students cited the compulsory practicum, 102 of them in the third and fourth years. One hundred and eleven students wrote about their encounters with and observations of patients and the physiotherapy practices’ settings. Finally, 50 students noted the impact of people such as course instructors and practicing physiotherapists, whom they described as “inspiring.”
The physiotherapy practice
Students pointed to the characteristics of the physiotherapy intervention (133), such as the preference for long-term interventions; the patients’ characteristics (47), such as a preferred age group or level of function; the aspects of care in physiotherapy practice (70) including the desire to help and support their future patients; and the prospects for professional development (42) as reasons for choosing their prospective areas of practice.
Working conditions of physiotherapists
Students cited economic considerations (77), such as a fair salary; the work setting itself (63), including its overall climate, the opportunities for advancement, and the richness of the cases; and teamwork (25). Working in a team was not a consideration for students in years 0–2, before their experiencing it.
Work/life balance
This category was a relatively small one. Similar to the “Working conditions of physiotherapy,” the number of codes increased steeply with the progression of the studies and the age of the students (2-4-6-5-30 codes respectively).
Miscellaneous
This category included 18 different codes that did not fit with any of the other groupings and did not form a category by themselves. Examples include “the future of the profession” and “upcoming opportunities.”
describe the number of codes noted for each sub-category. They also provide the number of codes noted for each sub-category on the third question about the factors that could change their decisions and their frequencies. As the tables indicate, there were two main categories: 1) “The Physiotherapy Studies Program”; and 2) “Working Conditions of Physio-therapy” that were distributed significantly differently depending on the academic year (). In the category: “The Physiotherapy Studies Program” there were significant differences by academic year in each sub-category (p < .01). Fourth year students were the least likely to cite theoretical aspects as a reason for choosing an area of interest. They noted training with experiential components most frequently in their preferences for an area of practice. Third year students indicated the practicum in the 3rd and 4th years most frequently as a reason for their preference. Finally, first year students were more likely than students in any year to cite observations of patients and practice (p < .01).
Fourth year students were more likely than students in any other year to note the importance of the “Working Conditions of Physiotherapy” and all of its sub-categories as the reason for choosing an area of interest. The same trend was evident for the “Work/Life Balance” category ().
Table 5. Working conditions of PT and The Work/Life balance sub-category codes by year.
Discussion
The aim of this study was to identify physiotherapy students’ preferences for their area of practice and the reasons for their choices. Changes in these preferences throughout the years of study were also mapped. Our findings regarding the socialization process of physiotherapy students are in line with data from other health related professions (Dinmohammadi, Peyrovi, and Mehrdad, Citation2013). These findings underscore the importance of the content of the specific education program as well as its teaching style and methods. In light of their early socialization prior to their professional studies (Harman et al., Citation2021), physiotherapy students undergo lengthy, intensive professional training, also in academic institutions. During this socialization process, they are exposed to theoretical and practical aspects of the profession and weigh them vis-a-vis their own experiences, values, and preferences. These elements, combined with factors related to the professional environment such as available jobs and salaries, affect their career choices upon graduation.
Our findings indicate that in all academic years, physiotherapy students underscored their personal considerations in their preferences about their career choices. Interest in some areas such as pediatrics remained stable throughout the students’ academic studies. Interest in some areas such as sports declined, whereas interest in others such as rehabilitation increased. Changes in their preferences about prospective areas of practice coincided with exposure to theory and practice in the field. For example, second year students expressed a stronger interest in orthopedics after taking courses in it. Similarly, the practicum in rehabilitation increased interest in this area.
Students indicated that the reasons for their preferences were their positive personal feelings about, interest in and past experience with the specific area(s) of practice, as well as their practical exposure through their practicum and theoretical studies throughout their education (Barradell, Peseta, and Barrie, Citation2018; Fabunmi, Adebajo, and Akinola, Citation2020). Third and especially fourth year students added factors related to the professional environment as reasons for their preferred area of practice. These findings are in line with the literature regarding generational reasons for the choices of young, prospective health-related professionals (Burgess, Van Diggele, and Mellis, Citation2018; Twenge, Citation2009). Moreover, the reasons categorized under the overarching theme of “me” were the most prevalent among the participants. This finding exemplifies the emphasis of millennials on individual and self-focused perspectives compared to older generations (Ng, Schweitzer, and Lyons, Citation2010; Twenge, Campbell, Hoffman, and Lance, Citation2010).
Notwithstanding these generational aspects, the emphasis on individual concerns does not conflict with altruistic factors. Many of the students also cited the reasons categorized under the theme of “care and patients and treatment characteristics” as guiding their area of choice. These reasons resonate with the motives that physiotherapy students expressed in their admissions interviews (Fabunmi, Adebajo, and Akinola, Citation2020; Fuente-Vidal et al.,Citation2021; Harman et al., Citation2021). Moreover, the theme “the physiotherapy practice” that includes care, patients and treatment characteristics indicates that these students not only valued the interpersonal aspects of their prospective practice very highly (Mulcahy, Jones, Strauss, and Cooper, Citation2010) but also reflect prominent professional values of the profession (American Physical Therapy Association, Citation2021). Thus, the characterization of these millennial professionals seems to be more complex than is often depicted (Cogin, Citation2012; Ng, Schweitzer, and Lyons, Citation2010).
Areas of practice highlighted during socialization also seem to have an impact on the students’ choice of preferences. As trivial as it may sound, students often gravitated to the areas that were emphasized in their training (Fabunmi, Adebajo, and Akinola, Citation2020; Kurunsaari, Tynjälä, and Piirainen, Citation2022) with the concomitant implications for the planning of the future physiotherapy workforce. Highlighting an area of practice is reflected in its proportion in the curriculum. Thus, the students often preferred areas of study in which they had hands-on, real-life, first-hand experiences, inspiring teachers and mentors from the area, a well-developed practicum, and opportunities for supervision and/or mentorship (Hall et al., Citation2021; Kurunsaari, Tynjälä, and Piirainen, Citation2022; Reeve et al., Citation2012; Torres Sánchez et al., Citation2019). Pedagogically it seems that teaching methods must focus on having inspiring professionals provide more engagement in specific areas in order to influence this generation, which expects meaningful experiences in its education (Aaron and Levenberg, Citation2018; Burgess, Van Diggele, and Mellis, Citation2018; Cleland et al., Citation2014; Shields, Bruder, Taylor, and Angelo, Citation2013). Workplaces that want to attract these prospective professionals need to consider hosting physiotherapy students and providing attractive mentorships that can offer inspiring, hands-on experiences (Forbes et al., Citation2020; Marques et al., Citation2019; Mulcahy, Jones, Strauss, and Cooper, Citation2010; Torres Sánchez et al., Citation2019). Prospective workplaces must also grant working conditions aligned with young physiotherapists’ preferences, including economic considerations, an enriching work setting with professional development opportunities and a variety of clinical cases, a team to be part of and a work/life balance (Ng, Schweitzer, and Lyons, Citation2010; Roskell and Cross, Citation2003). Similar to our findings, Forbes and colleagues identified the desire for self-determination and the importance of mentorship as methods for supporting the transition of new graduate physiotherapists into the practice setting (Forbes et al., Citation2020).
Further research is needed to determine the role of other personal characteristics such as gender, age (in view of the increasing number of students retraining in mid-life), as well as type of socialization (i.e. academic vs. non-academic) in the choice of areas in which to practice. These studies should investigate not only the trajectories of prospective professionals’ preferences but also the dynamics in these preferences throughout their years in practice. Qualitative studies may be instrumental in helping identify the context-related career decisions of young cohorts of physiotherapists.
Limitations
Our study is limited by the fact that it was a cross-sectional study, not a longitudinal one. Conducting a longitudinal study would allow us to detect changes in the dynamics of change among specific individuals. However, the five different cohorts in our survey included a large sample of participants. In addition, it was free of the selection bias resulting from the withdrawal of participants over time that is associated with longitudinal studies. Thus, we feel confident that insights from our study could be relevant to other undergraduate physiotherapy programs.
Conclusions
The choice for areas of practice of physiotherapy students vary during their professional formation. Their preferences may be stable throughout their socialization, indicating that their formal studies have little impact on this choice. In contrast, interest in some areas may increase or decrease, in part due to the match between the students’ expectations about experiential learning, and the teaching and prospective employment modalities. Millennial physiotherapists prefer areas of practice in which personal as well as relational aspects are core considerations. These preferences should guide the development of the physiotherapy curriculum. Prospective employers need to take these considerations into account, offering working conditions that support a work/life balance.
Disclosure statement
No potential conflict of interest was reported by the author(s).
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Funding
References
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