INTERPUESTO POR AUSBANC

Physiotherapy practice expressed as a negotiation between therapist, the environment and service user generates acts, both in what the therapist does for the service users and what service users do for themselves (or potentially the therapist). In this model of practice, cultural issues diminish, leaving only contexts and responses to those contexts. This position is echoed by Mitchell (1995) when he states that ‘there’s no such thing as culture’, and whilst I empathise with this position to a degree, cultural views have a role. They can usefully be seen to exist, lying within the shared and socially constructed understandings around how one responds to different contexts. However one does need to be careful to include structure when viewing cultured worlds and not locate culture, as it so often has been, as an isolated aspect of social living.

It is within this limited view of the cultural that attempts to internationalise the programme were made. For example there has been an increased recognition of the different meanings attached to functional activities on which so much physiotherapy practice relates. The act of getting in and out of bed or moving from sitting to upright depends on what constitutes a bed, or on what people sit. Is a bed a mattress on the floor, or a hammock? Do people sit on chairs, or on the floor? These differences inevitably involve new thinking about how the person might best be facilitated to move and this requires a combination of tacit and knowledge-skills which are unique to every situation. In the directly clinical modules, movement analysis and rehabilitation thinking has expanded to include case studies and class discussions of multi-culturally inclusive environmental settings, equipment, postures and movements, such as going from kneeling and bowing to standing, as observed by some cultures in forms of prayer. While this embraces difference, it still focusses on cultural, rather than structural, issues and in this way the underlying rationale for practices remain hidden and treatment constructs whilst loosened, continue to be presented in the binary of ‘right’ and ‘wrong’, which are unhelpful in addressing approaches in different contexts.

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The course situation offers another demonstration of the importance of local practices when considering global issues (Tong & Cheung, 2011). And this is where the research conclusions around cultural dominance in teaching become meaningful in any context, as the challenge for educational programmes working in a cross cultural situation is to generate a programme that is culturally flexible, is suitable for more than one place of working and generates a culturally sensitive practitioner. This challenges physiotherapy education to explain and expose its cultural practices, since these aspects are particularly important to those who enter from outside. They are, of course, difficult to determine, mainly because practitioners are generally unaware of their own cultural understandings and values, which form subconscious views and characteristics of themselves and assumed of others (Friedman & Antal, 2005).

Given the difficulties in addressing all the cultural nuances of practice in this area, a facilitative approach to teaching and learning is therefore to maximise student engagement with their own cultural awareness. This results in reflective opportunities having high importance to allow students to incorporate new thinking into their practice contexts. Thus the MSc course requires tutors and academic advisors capable of promoting and guiding student reflection. The collation of feedback and reflections on learning by students into portfolios (which is already part of the curriculum) could help the link between professional requirements in different locations and assist in generating a body of evidence of students’ academic and professional development. Portfolios are a professional requirement for self-regulation and professional auditing is expected of health professionals in many better resourced countries. It supports continuing development awareness for students, even if they ultimately live and work in a location where registration (and professional recognition) is not required at present. Reflecting on this for a moment, it appears that I have here developed a stronger rationale for the professionalism module that I had when I delivered the course. It shows that there was, in fact, some recognition of structural issues, but, at its inception, there was real belief that English physiotherapy was empowering and autonomous, demonstrating some of its limitations.

International issues must be supported by staff who are committed to listening to and also who are culturally respectful of students (Ryan & Viete, 2009). The need for this activity is enhanced at a time when staff are under increasing pressure, time for professional and curriculum development is reduced and reward for undertaking such activities (or penalties for not) are unclear. Not isolating business development from the student experience will ensure that the courses offered are supportive of diversity. This will require an allocation of resources and efforts to learning and teaching, rather than directing strategic attention towards marketing and recruitment. Supporting these changes to involve the timely, integrated and culturally aware input between both course staff and centrally organised services is essential in assisting the student’s development in an effective manner (Carroll & Ryan, 2007; Palfreyman & McBride, 2007).

Greater diversity in the classroom, or even outside of the classroom, for both students and tutors would lessen the dominance of English practice and open up discussion around how and why treatments are different. The barriers to participation extend beyond the cultural value placed on English practices: the Masters course on which the participants studied is designed for mainly international students, which only adds to their sense of isolation. Outside the course English nationals are often unwilling to engage with the international students on campus, possibly intimidated by their linguistic capabilities and limited trans-cultural capability which, ironically, restrict opportunities for them to extend these skills while in England.

6.4 Chapter Conclusion

In this chapter I have considered teaching conceptualisations and the innate repression which suffuses the course, a situation that runs directly contrary to the freedom the participants outline themselves in relation to it. There is little evidence to understand the impact of studying overseas in the long term on practitioners. To deem a course neo-imperialist may seem harsh, when tutors clearly show concern for students, but English physiotherapy education is challenged to explain and expose its cultural practices, since these aspects are

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particularly important to those who enter from outside. They are, of course, difficult to determine, mainly because practitioners are generally unaware of their own cultural understandings and values, which form subconscious views and characteristics of themselves and assumed of others (Friedman & Antal, 2005).

The results point to a need to disrupt normalised practices, and call for change. Recognising the relevance of cultural sensitivity results in internationalisation being the only response to a globalising world (Haigh, 2002). Greater opportunity to relate to other perspectives would benefit home students as well, as globalisation processes challenge establish world orders.