Abstract
Background: Best practice in physical therapy education requires good quality and quantity of research based on authentic learning settings and teaching practices. Facilitating large multisite research and large data sets for analysis has the potential to contribute to a strong research base. Clinical research makes use of international and interprofessional consortiums to produce quantity and quality of research outcomes.
Objectives: The paper aimed to investigate international and interprofessional co-authorship in educational research in a single journal and describe two collaborative models. Methods: The paper has two sections. (1) A review of co-authorship in 113 papers published in the Journal of Physical Therapy Education over a three and a half year period (2014 to 2017). (2) Two models of collaboration in educational research are described.
Results: The literature review highlighted a pattern of almost no international collaborations but close to 27% of papers with interprofessional collaborations. Two collaborative models were presented, one an international and intraprofessional model and the second an international and interprofessional research approach.
Conclusions: It is argued that creating consortiums with international and interprofessional health professionals will progress the quality of educational research in physical therapy, assisting with our educational decision-making and further improving on our learning and teaching practices.
Introduction
In 2016, Jenson and colleagues [Citation1] wrote that educational research is the ‘hardest science’ and emphasized the importance of research for best education for physical therapy students and graduates. Physical Therapy programs aspire to advanced competencies for their students, emphasizing the integration of knowledge, skills and attributes required for graduates who can drive best practice for themselves and the health sector. This ambition is complex, demanding and challenging to operationalize. There is a need for a strong evidence-base to support educator decision-making around curriculum development, optimal teaching approaches and strategies to build student confidence and competence within the constraints of time and resources. Educational research in physiotherapy however is lagging behind clinical research. A cursory look at the educational literature highlights studies in single learning settings and findings typically based on student or academic perception of a curriculum intervention as gathered by survey or focus group data, or student performance in single assessment tasks. While these offer very real value in ‘practice wisdom’, there is a need for testing our teaching approaches with rigorous research in multiple sites to inform our educational practice.
While there is pressure for academics to publish on their teaching and learning practices, anecdotal evidence suggests that the common educator experience is to prioritise subject coordination, preparation for teaching, teaching, assessment, provision of feedback, responding to student feedback, and administration tasks all taking priority over education research. Further, limited funding opportunities exist for education research providing limited structural support for academics to take time out of their teaching responsibilities for research. In the Australian and Swedish experience, academics tend to publish in their area of clinical interest rather than on their educational practice. This is compounded with the relative ease of joining research collaborations in areas of clinical interest, drawing time and attention away from educational research.
The objective to learn from and with each other has been increasingly emphasised as essential in health professional education [Citation2–4] and clinical practice [Citation5,6]. Clinical research in physical therapy has a growing tradition of international & interprofessional collaborations, with increasing numbers of Level I and Level II studies establishing a strong evidence base for best physical therapy practice. In this paper we explore if the culture of valuing international and interprofessional collaboration has translated into physical therapy educational research. We argue that building strong international and interprofessional collaborations will build on the quality and quantity of educational research that will improve our practice in educating the new generations of physical therapists and have impact on the quality of lives of our patients and clients, and the health system in general.
The profession globally is tackling the same questions around optimal teaching in physical therapy. Classroom teaching, clinical education, e-learning and best preparation for students to transition to independent practice are a global priority. In this paper, we argue for the need for the development of multiple international consortiums of education researchers, working together to build understanding from multiple research sites, large number of participants, and different and diverse perspectives influencing the analysis of data. Sharing large n data collected from methodologically rigorous research will extend the quality of the physical therapy evidence base.
This paper is written in two sections:
Section (a) explores the current level of international and interprofessional collaborations in physical therapy educational research using a single leading physical therapy education journal. Descriptive analysis was used to explore the levels of collaboration over three and a half years of publication in the Journal of Physical Therapy Education (JOPTE), and
Section (b) presents two models of collaboration that have been effectively implemented to promote educational research. Model 1 is an international and intraprofessional model, while Model 2 is an international and interprofessional model.
These two sections are followed by a discussion on the advantages and challenges of international and interprofessional collaborations to promote quality research in physical therapy education.
Section (a)
To examine the level of collaboration in physiotherapy educational research, the Journal of Physical Therapy Education (JOPTE) was selected as one of the primary journals recognised by the global physical therapy community as one of the leading voices on research relevant to physical therapy education. Its vision statement, written in 2007 is available on its website (https://aptaeducation.org/members/jopte/JOPTE-MissionVisionStatement.pdf). This statement highlights that the journal ‘will be recognized both internationally and interprofessionally as the premier forum for disseminating scholarly works in physical therapy educational theory and practice; it will be easily accessible to a wide audience of healthcare practitioners for use in making evidence–based educational decisions to enhance the efficacy of academic and clinical education’. This statement emphasized the Journal’s aspiration to be part of the global conversation in physical therapy education and made clear its valuing of international and interprofessional audience. Although not explicitly speaking of international and interprofessional collaboration in research, the authors read this statement as implicitly valuing both international and interprofessional knowledge exchange. Additionally, JOPTE was selected for review as likely to be familiar to readers of this paper and one that contributes to the culture of research practices in physical therapy education globally.
The primary aim of this review was to reflect on common patterns of educational research published within the last three years and specifically asked the following questions.
| (a) | What is the extent of international collaboration as measured by the authorship in papers accepted for publication in the JOPTE? | ||||
| (b) | What is the extent of interprofessional collaboration as measured by authorship in papers accepted for publication in the JOPTE? | ||||
Method
A review of all articles published between 2014, 28 (1) and 2017, 32 (2) was completed to address these two questions. The decision-making regarding inclusion, exclusion criteria and analysis were established by the two authors. All articles, other than editorials, letter to the editors, invited lectures, expert opinions, and commentaries on other articles and forums were excluded from the analysis. This was on the grounds that they would not be likely to reflect collaborative authorship. All research reports, case reports, method/model presentations, literature reviews and position papers were reviewed. Position papers were included as they were likely to reflect collaborations and it was of interest if these included international and interprofessional collaborations. The first authors (LR) reviewed all papers on two separate occasions to confirm accuracy of data and researched country of location of institutions when this was in doubt. The following variables were recorded:
| (i) | Number of authors | ||||
| (ii) | Number of PT and non-PT authors | ||||
| (iii) | Institutions identified by authors | ||||
| (iv) | Number of institutions represented by the authors | ||||
| (v) | Type of article as identified by the journal | ||||
Descriptive statistics were used for analysis. Frequency of number of authors and number of PT and non-PT authors provided insight into the number of papers with interprofessional collaboration. Frequency of countries represented and number of institutions represented per paper provided information on international and cross-institutional collaborations. Although not a direct question of this review, the types of article as classified by the journal were included in the Table to provide insight into the type of educational articles being published. In instances where articles were described as research papers, they were categorised under research reports.
Findings
The paper titles and data on each of the 113 articles reviewed can be found in Supplemental material. The frequency data findings are summarised in Table . Of the 113 papers reviewed, the majority were research reports (46%), followed by method/model presentations (21%), position statements (18%), case reports (14%) and with only one literature review (.9%). Number of authors ranged from 1 to 10 per paper with the vast majority with 2 or 3 authors (40%) followed by 4 or 5 authors (35%), indicating that authors did engage with collaborative practice. Only 10 of the papers (.9%) were written by single authors.
Table 1 Frequency data of 113 papers review
There was only one example of international collaboration (one author from Australia in a group of 7 authors) and 30 examples (27%) of interprofessional collaboration found in the 113 articles published over the three and a half years. The evidence of collaboration with other disciplines, ranged from 1 to 7 other professions (Supplemental material) and were in most instances from the same University (Table ). (It should be noted that it was not always possible to identify the profession of authors who were not PTs from the authors listing or the details of their position within institutions). In most instances the interprofessional collaborators were statisticians and other health professionals, and in 15 of the30 cases from the same institution. There was strong evidence of collaborations within and across institutions and importantly between universities, hospitals and physical therapy practices. Notable were the 54 examples (48%) of cross-institutional collaborations, however all but four papers were written by authors working at American academic institutions and physical therapy practices. The four articles from authors from non-American institutions were from Australia, Belgium, Canada and Scotland (Table ).
Discussion
This review found very limited evidence of international collaboration in physical therapy educational research as published in a single but well recognised and representative journal in Physical Therapy education, suggesting that international collaborations are not the norm in educational research. In contrast, interprofessional practice contributed to about a quarter of the published papers and there was good evidence of cross institutional collaborations both between physical therapists across a range of institutions and between physical therapists and other health professionals. While inter-institutional collaborations in the USA are thriving, there is clearly room for extending collaborations internationally both intraprofessionally and interprofessionally.
International collaborative behaviour has previously been explored in other areas within medicine, and the findings are convincing about the value of international collaboration. During the years 2013–2015 three separate reviews were published [Citation8–10] analysing the impact of international collaboration in medical research. They all came to the same conclusion that studies with authors from different countries were more cited, and thereby have the potential to have more impact.
While there are grounds to critique our narrow review of a single journal in physiotherapy as the basis for our conclusion, we believe that it is a useful base to promote a further conversation on our need to extend our research collaboration. A more extensive analysis beyond three and a half years with a larger range of journals and using more detailed analysis would be of value. For example, examining references for authorship from outside the USA would indicate the extent of reading of non-USA literature to inform practice, which in itself is a form of collaborative practice. While this review was not completed with the agenda to critique level of research published in a single journal, this level of analysis could be the basis for driving a more thorough analysis of research quality in publications in physical therapy education. It was noted that the majority of studies were research reports which were based on student perspectives garnered between surveys and focus groups; student performance in examinations; and faculty, educator or supervisor perceptions of outcomes of educational initiatives. While data was not formally collected on the outcome of the studies for this review, it was clear that the majority of work was Level III or IV evidence (https://www.health.qld.gov.au/__data/assets/pdf_file/0022/435703/lvl-of-evidence.pdf). It was rare to have large n and multi site data that would have added to the rigour of the research published.
It could be argued that larger interprofessional and international physical therapy educational research are being published in other education journals such as Medical Education or Advances in Health Science Education. This raises the question of why physical therapy journals are not being selected for publications of these works or are not publishing these works. Further consideration needs to be given to how we can bring our educational work up to the standard of our clinical research. In the following section, we present two models to promote further collaboration as a method of improving the quality of our research.
Section (b)
Two models of international collaboration are presented in this section. Model 1 is an international, intra-professional research collaboration approach and Model 2 is an international and inter-professional research collaboration approach.
Model 1: international, intra-professional research collaboration
This model is based on an international consortium of researchers from the same profession using the same methodology to collect data in their own practice settings. This multi-site design builds a massive database in similar educational settings from different parts of the world. Unique to this model is that the teams of researchers may have different questions or hypotheses of interest and therefore choose to examine different variables in their analysis of the same data-set. The massive data-set is therefore the basis for multiple research projects, enriching the understanding of educational practices within a selected learning and teaching context.
This model in practice
Developed by Professor David Clarke of the University of Melbourne (https://www.slrc.org.au/david-clarke/), this model was initially set up as a 12 country study of maths educators researching their teaching practice in Year 9 maths classrooms. Video cameras were set up in the classrooms and captured instructional and learning practices, peer teaching and verbal reasoning related to maths. This consortium of researchers have collaborated for more than 10 years, involves more than 20 countries and has produced over 200 outcomes including books, journal articles and conference presentations.
To extrapolate this example to a physiotherapy context, a consortium of physiotherapy educators from around the world could identify an area of shared interest such as teaching practical skills prior to students entering clinics placements. The consortium would refine an appropriate methodology such as setting up video cameras/or microphones in practical classrooms to capture interactions between students and instructors. All data would be shared, ensuring strong de-identification practices and security of data sharing to satisfy ethics requirements. Each cohort of researchers can then ask their own questions of the data-set. For example one physiotherapy team might examine the questions students ask the instructor during the practical classes building a taxonomy of questions, while another team might examine the ratio of teacher to student engagement relative to student to student engagement during the classes, and yet another team might examine the strategies used by instructors to promote clinical reasoning during practical classes.
Model 2: international, inter-professional research collaboration
This model is a collaboration of both international and interprofessional researchers and is a well-established approach in clinical research. It typically focuses on a single research question completed at multiple sites, such as we see in randomised controlled trials. Shifting this approach into the education space allows both qualitative and quantitative research to be completed in multiple settings within the same institution as well as across different institutions in multiple countries, producing a massive data-set while ensuring methodological rigour.
This model in practice
The Universitas 21 is a consortium of research-intensive universities that meet annually to promote best practice through research. Within this large consortium, there is a Health Professional Educator community that meets to discuss health professional education. There is an opportunity within this large consortium to form smaller groupings around areas of shared educational interest. Below is an example of one of these mini-consortiums who have worked together to address educational research questions of shared interest across health professions and countries.
In 2013, the SoMe (social media) group was initiated and led by two medical educators, Professor Kendall Ho from the University of British Columbia and Professor Damian Last from University College Dublin, who were interested in the use of social media in health education and wanted to build an evidence base to understand this phenomena (http://u21health.org/social-media-project/). They invited an academic and a student from six professions and six countries (8 institutions) with an interest in social media use in education to join the research team. The professions were medicine, dentistry, nursing, pharmacy, physiotherapy and public health and the countries were Canada, United Kingdom (Birmingham, Nottingham & Ireland), Australia, China, Hong Kong and Mexico (Table ). With an academic and a student representing a team from each institution, there were initially 16 members of the consortium. Outcome from the consortium led to a large survey study (2014 and 2015) with more than 1,528 participants, allowing an advanced understanding of student and academic shared practices in the use of Social media for learning. In addition to building networks and knowledge of how to advance and effectively use social media, this collaboration has resulted in 12 publications and conference presentations with others in press.
Table 2 Countries, institutions and professions involved in the U21 SoMe consortium in Model 2
It would be relatively simple to translate this model into the physical therapy educational research, as it currently operates with clinical research. As with Model 1, a shared methodology and rigour of research design would be the basis for collecting data from multiple sites to build a large n database. Innovative ways of collecting data such as online survey tools, virtual focus groups [Citation7], learning analytics and video recall interviews, can also be used to support research collaboration at a global level.
Discussion
Both models described would promote best practice physical therapy education and research. Both these models collate large data sets in authentic settings that permit extensive analysis and sharing of research findings to an extended audience of health education researchers. The establishment of networks of researchers with shared interests builds communities of learners and experts, all of which directly builds on the knowledge and skills of the physical therapy profession. While the educator in a single institution does the same amount of research activity as they would if they were researching and writing up their own case study; being part of a consortium multiples the output of this activity considerably. Further, the value of having pressure to contribute to an international consortium with set deadlines has a positive effect on prioritisation of workload and of accelerating research activity. The obvious advantage of these approaches include building a rigorous evidence base for our practice, contributing to the quality of teaching practices as well as the personal benefits of improving knowledge and skill.
There are multiple advantages at the personal and professional level for the physical therapy educators working in an education research consortium. Determining if your ideas are generalizable outside your classroom and cultural context has value. Learning about other cultures of education and the opportunity to learn from different researchers improves our practice. It reduces our habits of teaching practice and challenges our routines, stopping us from becoming formulaic in our teaching practice. Establishing networks with other physical therapists and in the case of Model 2, with other health professional educators is a powerful opportunity to learn from other educators and have a critical eye on our own habitual practice. The additional advantage of educating other professions about physical therapy practice and learning more about the culture and practices of other professions globally also provides a powerful lens to examine our own practice.
The standard reason for failure to research and publish in education is workload with educators pointing to the time demands with student issues taking priority over research. While data collection is not necessarily difficult, the need to manage ethics, refine methodology, collect and analyze data and write papers up are all steps that can challenge the educator with competing priorities of educational activity and seeing their families occasionally. From experience, preparing for global teleconference is a positive way to prioritize research activity. Working with others with the same passion in education in the health professions cannot be underestimated, especially as research on clinical science can dominate the physiotherapy research culture and educational research can be seen as a soft approach to science.
Becoming part of a consortium requires initiative and active networking at conferences and professional meetings. Understanding the interests of colleagues and making clear your own educational interest and passion is a useful way to build collaborations. Networking at professional and interprofessional conferences also provides strong opportunities to join or build a team of education researchers. Educators who are already researching on their own practice can seek others working in the same areas. Writing to authors who have published in your area of interest can also be an effective strategy, or even starting your own consortium by putting out a message to colleagues across the globe and in other professions is an option.
As could be expected the challenges to both models are multiple. The success of both models are based on the outstanding skills of project managers with intelligence, passion and organizational, communication and problem solving skills. Depending on the size of the research and the ambitions of the consortium, funding and time costs needs to be secured. At its simplest level, each research group can be responsible for funding the research in their own setting and finding the time to complete their data collection and analysis. Teams may be able to apply for larger grants for educational research to contribute to a project officer and time out to prioritise meetings, research design, ethics, data collection and analysis. These models can operate modestly or at a very ambitious scale depending on funding and support.
A major challenge to a global consortium is the coordination of meetings. While free to set up meetings via skype or zoom or other forms of international communication, finding times for busy academics to meet across different timelines may not be straightforward. Difference in geographical timelines and the variability of the quality of the internet in some countries can add difficulty. A face to face symposium with all research groups is ideal but costly and often competes with conferences in areas of clinical expertise. In both models, scheduling a meeting with an established popular conference has worked well. The researchers can present their finding at the conference as well as having face to face meetings with their research consortium to optimises the research opportunities at these meetings.
The most embedded and potentially most problematic issue is an understanding of the culture and language of other countries and other professions. Priorities in terms of publication, seniority of participant and its implications, epistemology, pedagogy, and culture of teaching can all vary between professions and countries and these cultures need to be respected, learnt about and negotiated. While a potential strength, this can become a risk if we are not careful to ensure we understand each other’s values and priorities. It is important to understand that there is a need to spend time getting to know the team and discussing these issues explicitly. Researchers from some countries may be less confident in their research skills and in their English language skills. Research culture may vary in different countries, with some communities emerging in the research space while others are more experienced and established. Ethics procedures vary and ethics committees might have different approaches to reseach on education. It is essential that the ethics of any project is well designed and discussed thoroughly for completion in all contexts to insure a consistency in data collection and data sharing. While the two models described in this paper both operated in English, it is important to recognise that language use can also differ across countries. One issue that must be made explicit early is the publication culture and authorship rules. In some countries and publications there is a resistance to authorship with large numbers, considering the risk that not all authors have contributed to the intellectual work or analysis. Researchers may be surprised at approaches to authorships in other countries and may chose to prioritize other areas of research if they find their time wasted on projects in which they are not acknowledged as authors.
The opportunity to increase the visibility of the physiotherapy profession in interprofessional consortiums cannot be underestimated. In some countries where physical therapy is just developing, the more advanced scope of practice of physical therapists can be a surprise and educational for other professions. One can also hope for the potential for more respect for the physical therapy profession in some other practice contexts. The opportunity to ensure that methodology suits the physiotherapy context and has relevance to physiotherapy educational practices and outcomes of education are also important.
Conclusion
In this paper we argue for the creation of international and interprofessional consortia to build on the quality and quantity of physical therapy educational research. If international, multi-centre clinical research is possible in complex, highly variable clinical settings, it must be feasible in physical therapy education research and it is important that we actively work towards this objective. This review of three and a half years of publication from a key physical therapy education journal found that while physical therapists collaborate effectively in their research for publication practice, and are building on their interprofessional collaboration, there is still a long way to go with international collaborations. We have presented a model of international research: one an intraprofessional and one an interprofessional model of research and discussed the value and challenges of these two models. We argue that global and interprofessional collaborations have the potential to enrich the depth and breadth of our research in physical therapy education and subsequently provide us with genuinely evidence-informed practice to meet our students’ educational needs and their subsequent service to the community.
Disclosure statement
No potential conflict of interest was reported by the authors.
Notes on contributors
Louisa Remedios is an Associate Professor and Director of Teaching and Learning in the Department of Physiotherapy at the University of Melbourne. She was the Coordinator of the DPT program at the University and is now the Development Coordinator of the Post Graduate Rehabilitation Science and Sports Medicine programs at the University of Melbourne.
Christina Gummesson is an Associate Professor with a background in Physiotherapy. Currently she is the Director at the Centre for Teaching and Learning at the Faculty of Medicine, Lund University, Sweden.
Supplemental data
The supplementary material for this article can be accessed at http://10.1080/10833196.2018.1449792.
Supplementary_Material.docx
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