Searching our mindset – looking at places and spaces in education

Why do we design our physiotherapy programmes the way we do? What is on the research agenda relevant to physiotherapy education? Are we about to make shifts in our mindset on how to approach education? Where may the profession benefit from advancement in education? What is the current state of places and spaces for meaningful and authentic learning? How can we as an international profession identify shared opportunities for lifelong learning? Those questions and many more offer us, as educators, opportunities to develop the education within our profession. Education, based on research both in content and form.

As educators, we are responsible for embedding the culture of researching our practice and translating evidence into practice with our students. We can celebrate that physical therapy research is thriving, with high-quality research available to enrich our clinical practice. This clinical evidence is often based on international and interprofessional collaborations and these alliances are enriching for our clinical practice. It is therefore somewhat ironic that there is a dearth of strong evidence to inform teaching and learning practices. We have yet to build a rich repository of research that addresses learning in multiple authentic settings, which is effective for diverse learners. A large proportion of our educational reports appear to be descriptive of our practice with outcomes measured by student or staff perception of value of our approaches. We also commonly use outcomes in examinations as an outcome measure, treating assessment outcomes as valid and reliable measures of the success of our teaching approaches. The importance and challenges of good educational research has been highlighted [1,2]. If we are able to complete research in the clinical context with its multiple extraneous variables and complex settings, we would argue that we need to be working towards this standard also in educational research. Given our roles in influencing student learning and therefore patients’ health experience and outcomes, we need to ensure that we work actively on improving and broadening the perspectives of our research in education.

We believe that we can move towards excellence in educational research by engaging in international and interprofessional collaborations. Our profession has always acknowledged the value of learning from, with and about other professions and from physical therapists across the globe. It is important that this translates into educational research. In an effort to promote active listening to and learning from our colleagues, we have devoted this special issue to learning about innovative practices and ways of thinking that have emerged from collaborations between educators in different countries and health professions. The papers compiled in this issue give us the opportunity to reflect on our own mindset and habits of practice, examine our places and spaces of teaching and giving thought to our professional development. These are all issues that need further exploration and would benefit from further collaborative research.

In a review of articles published in Physical Therapy Education during the last three and a half years, it was clear that there are limited international educational research collaborations, and while interprofessional collaborations existed, these were often within single institutions, suggesting that we mainly look at local practice [3]. Research from other fields has consistently shown the benefits of international collaboration as measured in citations and thereby impact. While this does not necessarily tell us about translation, it does tell us that more people are learning from collaborative work.

Searching our mindset

We have started this issue by inviting educators from other professions to provide insights into one of the most challenging aspects of education i.e. that of assessment and how we create and communicate the culture of assessment. It is well established that assessment drives learning and we must acknowledge that assessments can lead to unproductive and unprofessional behaviour that may actually conflict with our ambition to produce well-educated graduates with a range of knowledge, skills and attributes.

Dawson and Fox [4] question if assessment can be counterproductive and reinforce a problematic mindset among students. From this starting point, the authors go on to describe an innovative programme approach to assessment successful implemented at a Dental school. Implicitly their work also raises the question about the mindset we have as educators. Do we have the same mindset as the students and would we benefit from adjustment of our mindset in our approach to and design of assessments in our programmes?

Another review of assessment and how to influence positive student learning behaviour comes from medical education. To guide us in reviewing important aspects for the milestones we may call assessment, Cecilio-Fernandez et al [5] reviewed the literature to create ten tips to guide us on the practicalities of designing our assessment tasks. An important tip is the reminder that we should pay attention to how much time we can realistically expect our students to spend on learning activities and preparation for assessment tasks. We need to consider risk of cognitive overload and what else the students need to juggle to live healthy lives and be healthy learners in a lifelong perspective.

Places for learning (about and with each other)

We refer to ‘places’ as physical contexts where we work to engage students in learning activities. We have started to venture outside our traditional teaching places of lecture theatres, practical classrooms and clinical setting, suspecting that only keeping the traditional places may reinforce unhelpful established habits and routines of learning activities (as outlined in the two paper on assessment) and promoting less useful earning behaviours. In this special issue, we have insights from authors looking to use places differently. Interestingly, these explorations of different places are the result of interprofessional collaborations; as different ways of seeing the learning context space they work in.

The paper by Kelly, Thuong and colleagues [6] is collaboration between physical therapy educators and computer engineers, and uses augmented reality and gaming technology to devise ways of helping students to learn functional anatomy (https://www.ngv.vic.gov.au/exhibition_post/augmented-studio/). While the lesson can be conducted in a standard practical classroom, the physical place is significantly altered by technology, and shifts the dynamic of teaching from static dissections and prosections to learning anatomy on a moving human. While this innovation is in its early days of development as an educational tool, the potential of augmented reality in physical therapy promises exciting collaborations and student learning opportunities into the future. We wish to add a word of caution here – innovation without thoughtful and considered use of pedagogy may risk the extraordinary potential that lies ahead of us.

A study about clinical reasoning as a conceptual model for interprofessional learning looked at between physical therapy and nursing department [7], the place for information collection and creation of the learning activities are taken outside campus into the authentic clinical setting. While the learning activities occurred on campus, the communication is with the health care workers from the clinical context. This approach uses small group active learning, and clinical reasoning to drive the conversation. Again the interprofessional nature of this collaboration extends the conversation outside the typical leaning places.

Bolton (physical therapist) and Andrews (social worker) share their early experiences from student learning about Indigenous health, by stepping out from the university and entering a museum designed and managed by Indigenous community, creating a site of history and evolving culture [8]. Disrupting students’ expectations of learning places to engage with history as a key determinant of health encourage students to deconstruct their experience more readily. Could this concept serve as a possible model to transfer to other learning objectives? In 2001, Bardes [9] and colleagues wrote about using art galleries have been used to teach observation skills to medical students and for orientation of physical therapy students and there are undoubtedly many opportunities for us to explore learning about ourselves and our patients in public spaces, previously not considered in physical therapy education. Bolton and Andrews noted profound student insights from the opportunity to step outside the classroom experiences. Additional public places may be worth further exploration for understanding the humanity of engagement.

Increasingly, ‘clinical’ placements in developing countries are seen as sites for service learning, with students developing essential attributes of communication and cultural competence while practising their clinical reasoning and practice skills. There has been some critique that these visits are of value to the visiting student but are of less value to the host country and that outcomes are temporary at best. Lee & Webb (both physical therapists) have investigated the literature as a foundation for designing a global placement [10]. Important here is the essential step of examining the evidence and seeking to understand best model frameworks before launching into projects with good intentions. Having theory around practice is essential as a step into research-based education.

These initiatives may facilitate learners to grasp concepts more rapidly or to understand the lived experience of others. We hope to inspire thinking of the placement as one aspect that can be altered to improve learning – the gradual increase in shift of environment is shown by different examples.

Spaces for relevant and authentic learning

Another way to shift our way of looking at educational development is to consider different spaces for learning, including various online spaces. Unge et al [11] raises the question if e-learning actually could be expressed as learning where the ‘e’ stands for the space we create for the learning activity. While the space itself cannot make up evidence informed learning environment, they moved on to investigate if and how the intended learning in ‘e’ spaces were explicitly based on learning theories or arguments for how the intended learning was anticipated to be facilitated. One lesson for us to drive the research forward may be to make the implicit explicit. Which problems are we trying to solve by using new spaces? Are we lacking relevant research on learning to build on?

The virtual spaces offer some unique features that Tarrant [12] uses and carefully studied to further understand aspects of the use of social media to facilitate learning. Social media is so often associated with poor behaviour, that is a delight to see it used for promoting ethical professional behaviour in the health context. In addition to the increased student engagement, Tarrant also demonstrates the use of systematic data collection to examine her teaching choices, providing some insights into how we can use analytics made available by social media to examine our teaching practices. There is an opportunity for physiotherapy education to examine the use of social media in educational practices.

View to lifelong learning

And finally, we complete the issue with a two-country examination of post-professional education, drawing our attention to what is actually on offer to our graduates. While it is a common goal of pre-professional physical therapy education to embed a commitment and passion for lifelong learning in our students, formal post-qualification programmes need to be available to facilitate this. Thanks to Westervelt and colleagues [13], we have an international collaboration between the US and Australian authors that review what formal programmes are on offer in the two counties. More importantly, they reflect on the gaps in what is on offer, provoking us to consider if we are meeting the needs of the population. Reflecting on the cultural and funding factors that shape what is on offer and how we as a profession can advocate to shape what is available to meet the needs of the community should be an important outcome of this work.

As for now, we hope that this special issue may bring you inspiration to develop education by research in collaboration with your colleagues across professions, institutions and countries, across places and spaces, challenging our present mindsets. We encourage you to contact the authors of these papers and to extend the collaboration and conversation. We hope for ripples from this work to impact our practice, benefit our students and influence positively the health experience of individuals at a local and global level.