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Educating Australian physiotherapists: striving for excellence in sport and exercise medicine
  1. Kim Bennell,
  2. Gillian Webb
  1. Centre for Sports Medicine Research and Education School of Physiotherapy, University of Melbourne Parkville, Melbourne, Australia

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    Physiotherapists play a major role in sports medicine delivery and research in Australia, a country renowned for its sporting achievements and sporting culture. Sports medicine in this country is a relatively young specialty which has undergone rapid development particularly since the 1956 Melbourne Olympic Games. Educating physiotherapists in sports and exercise begins in undergraduate training where a large proportion of the physiotherapy course focuses on theoretical knowledge and practical skills in the neuromusculoskeletal area. After graduation, further sports physiotherapy experience can be gained through formal postgraduate university qualifications or a variety of professional development activities.

    The first formal education programme for students in the area of physiotherapy began in Australia at the University of Melbourne in the early 1900s. Initially, registration to practice physiotherapy in Australia was licensed under the Massage Registration Board and the Massage Act. In the 1970s, under the auspices of the Physiotherapy Registration Board, physiotherapists in Australia were granted primary contact practitioner status. This was a first in the world for physiotherapy. The responsibility associated with primary practitioner status had a profound effect on undergraduate education requiring an emphasis on differential diagnosis by way of clinical reasoning and clinical decision making.

    Undergraduate training

    In Australia in the year 2000, seven universities offer physiotherapy undergraduate programmes with about 650 students in total graduating each year. Two more programmes have started and will have graduates in the near future. A further university has advertised for a new chair of physiotherapy, and other universities are considering establishing programmes. This is a clear demonstration of the popularity of physiotherapy as a choice of career for Australian students. In particular, many students are interested in the area of sports physiotherapy. The programmes are very competitive to enter and the students entering the programmes come from the top 2–5% of secondary school leavers. There is also a great demand for places from students who have completed other degrees and wish to enter physiotherapy—for example, science and human movement (physical education). Although each university has its own entry requirements, these would all include English and a variety of biological and physical science subjects. At present, all physiotherapy programmes in Australia are four year bachelor degrees. Plans are in place at a number of universities for entry level masters programmes. Physiotherapy curriculums from all universities must now be accredited by the Australian Council of Physiotherapy Regulating Authorities (ACOPRA). There are no national examination requirements for graduating physiotherapists, as the accreditation process is rigorous covering all aspects of physiotherapy programmes.

    In the environment in which physiotherapists will work in the 21st century, graduates should understand the need and have the desire to be lifelong learners responsible for their own professional development. To continue to strive for excellence, educational programmes need to reflect the demands of the community for health professionals well versed in evidence based practice with the ability to communicate effectively with their stakeholders. With these societal requirements, the emphasis throughout Australian undergraduate physiotherapy educational programmes is a framework of study that focuses on biomedical science subjects integrated with extensive clinical experience and evidence based physiotherapy practice.

    Acknowledging the fact that most Australian physiotherapists work in the area of musculoskeletal and sports physiotherapy, emphasis in the undergraduate programmes is on those subjects particularly relevant to sport and exercise including biomechanics, kinesiology, physiology, and in particular exercise physiology, anatomy and applied anatomy, neuroscience, motor control, and soft tissue pathologies. The understanding of normal structure and function and therefore the ability to analyse abnormal structure and function is a major element of sports physiotherapy practice. Added to this, students develop skills in the management of sporting injuries, exercise prescription, injury prevention, and health promotion. Many undergraduate students gain first aid and sports trainer qualifications in order to further their experience in sports coverage. Such programmes ensure that the graduating physiotherapist is well placed to take a significant role in the discipline of sports medicine.

    Following on from their undergraduate education, there are a number of avenues that graduates can pursue to further their knowledge and skills in sports physiotherapy, including formal postgraduate tertiary qualifications, professional development, continuing education and specialisation within the framework of the Australian Physiotherapy Association (APA).

    University based graduate sports physiotherapy education

    All of the schools of physiotherapy provide postgraduate education specifically for physiotherapists. This encompasses both course work and research streams. In the sports and exercise area, there are a variety of coursework awards including sports physiotherapy, exercise rehabilitation, manual therapy, neuromuscular physiotherapy, and hydrotherapy. Recently professional doctorates have been introduced that will allow clinicians to undertake original research related to their clinical practice as well as advanced clinical work. The multidisciplinary nature of sports medicine in Australia is further supported by other graduate programmes relevant to sports and exercise medicine which are available to a range of suitably qualified health professionals.

    The research pathway is through masters and doctoral programmes. These require the student to undertake substantial supervised original research, which is examined through a major thesis. The students' topics reflect the research strengths of the individual institutions and may include basic science or clinically based projects. Australian sports physiotherapy research has been published internationally, and topics include lumbar stabilisation exercises, prevention and treatment of hamstring injuries, shoulder rehabilitation programmes, risk factors for stress fractures in athletes, effects of external ankle supports, proprioception and ankle sprains, postoperative rehabilitation of anterior cruciate ligament reconstructions, and pathophysiology of patellar tendinosis.

    Continuing education through a national body

    A variety of sources provide continuing education in the area of sports and exercise medicine to the practicing physiotherapist. The major provider of this education is the APA, which was formed in 1940 and today represents more than 80% of registered physiotherapists. A primary focus of the APA is to ensure the maintenance of standards of practice of physiotherapy in Australia. The APA facilitates this in a number of ways. In 1999, it introduced a mandatory continuing education programme to promote excellence in physiotherapy practice and an understanding of the need for lifelong learning. This is a competency based model which is very broad in its scope and requires members to be responsible for their own continuing professional development in a framework of continuing education. The APA has also accepted in principle a Charter of Educational standards. This document facilitates the APA to work with universities and national special groups to promote and support appropriate standards for the training of physiotherapists in areas of clinical specialty such as sports physiotherapy. The APA Charter of Educational Standards is based on the relation between course outcomes and defined levels of competency. This strong link between the professional association and the universities acknowledges that both sectors provide different ongoing educational opportunities that allow physiotherapists to be constantly enhancing their practice.

    Sports physiotherapy was one of the first specialty areas developed within the APA during the 1960s. It is currently one of the largest clinical areas in the association representing practitioners working in all sectors including private practice, sporting clubs, the national and state sports institutes, public hospitals, and community centres. Members of the National Sports Physiotherapy Group have access to continuing education in the form of lectures, seminars, workshops, and sports courses. They are encouraged to participate in organised sports coverage and are required to maintain current first aid certificates.

    The APA is in the midst of developing a process of specialisation, which will encourage and enable their members to continue to develop their expertise in their areas of interest. This specialisation process will be multilevel and will reflect formal postgraduate qualifications as well as continuing education. The APA Sports Physiotherapist title is awarded to physiotherapists who attain a nationally recognised academic and clinical standard paving the way for entry into the specialisation process. Criteria include involvement with sporting teams, coverage of sports events, continuing professional education in sports physiotherapy, teaching in the area, and promotion of the discipline through research, publications, community service, and community education in sports injury prevention and management. APA sports physiotherapists maintain their title through a mandatory continuing professional development scheme. Benefits of achieving the title include raised public awareness of sports physiotherapy and the specific skills that title holders possess, enhanced marketing opportunities, recognition of the title by outside agencies, and greater opportunities for employment in the sports and exercise medicine setting.

    Participation in other activities

    In Australia, the multidisciplinary nature of sports medicine has been facilitated by the establishment of Sports Medicine Australia (SMA). This organisation is Australia's peak authority on all issues relating to sports medicine, sports science, and exercise for the physically active. It is a national umbrella body representing a membership base of health professionals, sporting organisations, and individual participants at both the grass roots and the elite level. Physiotherapists show a commitment to excellence in sports medicine by their level of participation in SMA. For example, membership (of the 3340 members in SMA, 22% are physiotherapists), committee participation, and organisation of and attendance at the annual scientific conference. In the past six years, three physiotherapists have been recipients of the Young Investigator Award for outstanding research at the SMA conference. Many other physiotherapists also present their research at this forum.

    Conclusion

    Educating physiotherapists in sports and exercise science continues to develop as new knowledge and evidence based research is made available. There is a strong ethos in physiotherapy for continuing education and professional development. The commitment by the APA and universities to continue to develop programmes that strive for excellence ensures that Australian physiotherapists are at the forefront of sports medicine practice and research.

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