Two major pedagogical patterns on how anatomy was taught to physiotherapy students emerged from the study: the implicit and explicit teaching of anatomy during the clinical placements. The implicit teaching of anatomy was characterised by informal anatomy teaching strategies and was described by seven anatomy-teachers-for-physiotherapy, while the explicit teaching of anatomy was described by the remaining teacher.
4.5.4.3.1 The implicit teaching of anatomy during clinical placements
The implicit teaching of anatomy during the clinical placements was hallmarked by anatomy teachers assuming that the Clinical Student Placement Supervisors knew what anatomical knowledge and skills to teach, how to teach and evaluate the teaching of physiotherapy students during the clinical placements. There was no established and regular communication between the anatomy-teachers-for-physiotherapy and the Clinical Student Placement
Supervisors.
The anatomy-teachers-for-physiotherapy said that the Clinical Student Placement Supervisors assumed that the students learnt all the required anatomical knowledge by the end of the 1st year.
“They have covered all of their anatomy, generally the anatomy is a really good standard by the end of 1st year” (Vanessa)
“We assume a certain amount of knowledge in year 2, we assume that they have done all of their basic skills and we assume that they know (by the time they start 2nd year)” (Marie)
The experiences in the clinical placements provided practical and clinical opportunities for the students to use the anatomical knowledge and skills learnt during the 1st year and it motivated the students to appreciate the importance of anatomy:
“I think that’s sort of a driver when they get out on to 2nd year, and they normally come back after the placement, really, highly motivated to study even more depth, so yeah, … So they realize they can’t be a good physiotherapist without sound anatomical knowledge” (Vanessa)
There was a desire expressed by three anatomy-teachers-for-physiotherapy that within the implicit teaching there ought to be better sharing of curricular details among anatomy teachers.
“We also need to maintain the awareness of what is going on (in other modules) and you know what the specifics are on other people’s modules” (Marie)
The anatomy teachers also assumed that the Clinical Lecturers and the Clinical Student Placement Supervisors reinforced the anatomical knowledge the students had learnt during the 1st year without verifying it.
“We don’t know for sure that it (reinforcement of anatomical knowledge in 2nd and 3rd year) will be done” (Marie)
“I am not sure off the top of my head whether it is implicit or not, but what I certainly know that when students before they go on clinical placements, they often do revise their anatomy, but it’s not something that I am aware of that is explicitly written in the module” … “I am not sure of the statistics of who does it (revises anatomy in 2nd and 3rd years before going to clinical placements) and who doesn’t” (Keith)
4.5.4.3.2 The explicit teaching of anatomy during clinical placements
The explicit teaching of anatomy during the clinical placements was characterised by an anatomy teaching leadership that promoted greater sharing of curricular information, ideas and expertise for teaching anatomy between the anatomy teachers and the Clinical Student Placement Supervisors.
Only the Plate-Glass-A university lead by the Anatomy Theme Lead, Kelly, had explicit teaching of anatomy during the clinical placements. Kelly led a committed team of anatomy teachers and Clinical Student Placement Supervisors.
“It is good to have a dedicated anatomy team to share ideas.” (Kelly)
The Clinical Student Placement Supervisors made the students realise the importance of learning anatomical knowledge during one-to-one tutoring in the placements and reported back to the Anatomy Lead:
In 2nd year – “They can then realise when they get to a point where they are thinking ‘okay, this person (the student supervisor) is going to ask me about x, y and z anatomical underpinning’, then if they then realise it’s one to one with the clinical educator (student supervisor) , that is when they get it, that’s when I think they really start to step up because they realise that there is no way out. ... It tends to typically happen not in year 1 and I think their mentality is still school and college” (Kelly)
Some of the Clinical Student Placement Supervisors were very good at reinforcing the anatomical knowledge that would have been previously taught by anatomy teachers during the 1st year.
“So, some clinical educators (Clinical Student Placement Supervisors), within the time of clinical placement will ask a lot of underpinning anatomy. … I would encourage clinical educators as well, to be asking questions because some of the clinical educators are great at it and kind of gather as much of the information from the students as possible, so that they see the relevance. Other are a little bit... “ (Kelly)
There were intentional and scheduled meetings between anatomy teachers and the Clinical Student Placement Supervisors to strengthen the learning of anatomy during the clinical student placements.
“Those kind of sessions are good, when we have sessions with the clinical educators” (Kelly)
“Then what I like is when we have kind of debriefing sessions with the clinical educators” (Kelly)
The meetings between anatomy teachers and Clinical Student Placement Supervisors were helpful because they shared information on the anatomy curricula and prevented students from misrepresenting information to Clinical Student Placement Supervisors what they had been taught by the anatomy teachers.
“So it’s quite nice then at various times during the academic year, we invite clinical educators in and talk to them about various things in terms of students education, so that when students go on placements, we send a kind of skills set with them, so that in year 1, they have covered this and this, so that the educator (CSPS) knows that they covered whatever. That’s the difficulty, the students will say ‘oh no no, I have not covered this in my life’, so they know that we have given the information to the clinical educators, so they can’t say that anymore, which is a good thing” (Kelly)
The Anatomy Theme Lead Lecturer saw a greater scope for improving the explicit learning of anatomy and wished for more formal linking and referring of various learning resources of anatomical knowledge to non-anatomy teaching sessions within the three physiotherapy undergraduate degree course, i.e. to all the other physiotherapy modules.
“If I had everything we wanted, I would be linking the anatomy to everything (physiotherapy knowledge) we teach, so that in the ideal world, whether it was done in the anatomy suite (dissection laboratory) or maybe online resource, literally you could just tap into something before you kind of get them to do whatever. So if you are gonna do the ligaments of the knee, ‘let’s refresh it now, let’s see it, let’s look, you know, what those ligaments look like’” (Kelly)
Kelly’s long career of over 20 years at the same school and being given significant power in managing anatomical teaching contributed to the presence of explicit teaching strategies. Kelly had additional roles of being the Anatomy Theme Lead for the BSc Physiotherapy degree and postgraduate anatomy degree specially designed for physiotherapists and the Anatomy Laboratory Link Tutor for physiotherapy.
“I have input across all three of those areas (musculoskeletal, neurology and
respiratory/cardiovascular, which are the core clinical areas of physiotherapy) as an anatomy lecturer” (Kelly)
“We have an anatomy (cadaver laboratory) link tutor, that’s me now, okay so the anatomy (for physiotherapy) tutor role is established. So I think what happened is that the anatomy would be taught by anatomists (initially) and we would
gradually share it and gradually over time that person would come online as an anatomy teacher” (Kelly)
“So basically what we have talked about so far is undergraduate, but the other modules I run include applied clinical anatomy for post-grads and … and there is sort of a post-graduate certificate in anatomy studies that is based here as well” (Kelly)
With the teaching management power Kelly had, she was able to strategise and reflect on the chronological development of anatomical knowledge and skills from 1st year students right, to postgraduate physiotherapy students. In contrast, anatomy teachers in physiotherapy schools with implicit clinical teaching of anatomy were ‘modulated’ and their teaching influence was restricted to the one or two modules with significant anatomical tutorials.