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Horobin H.1
1University of Brighton, School of Health Professions, Brighton, United Kingdom
Background: There is a global movement of health care workers around the world, mainly from less well-resourced countries to better resourced parts of the globe. Professional education exists alongside this diaspora, and there is little understanding of the impact of transnational professional education on those undertaking it. The meanings and cultural understandings ascribed to being a physiotherapist can be explored through the construct of professional identities and these were used in this research to consider the impact of a Master's physiotherapy course on Indian students. Social science development from the 1970s (post modernism) generated views of identities that accept that they are contextually, historically and socially bound, that is issues of structure, as well as individually performed (Bourdieu, 1977). This latter aspect of personal control can be referred to as agency and manifests itself in notions of autonomy in physiotherapy practice. The research exposed structural differences between the cultures of practice in India and the UK as well as the individual creativity necessary to achieve greater levels of autonomy.
Purpose: This presentation offers a perspective on the culture of practice through an appreciation of the structural constraints and individual responses to them manifest in different geographical locations. These considerations were used to understand the potential relevance and applicability of Indian student's learning of UK practices.
Methods: Six physiotherapy students studying a postgraduate MSc were interviewed in a qualitative study to understand how participants shaped their experiences into ideas about future practice. An interpretative grounded theory approach was used to highlight various aspects of professional identity demonstrated by the participants. This exposed the structural and agentic nature of clinical decision making and, through ideas of what is right and possible in treatment, the shifting and subtle boundaries of professional autonomy were revealed.
Results: Levels of autonomy vary between and within therapy interactions in both countries, on structural grounds, not solely related to national regulatory contexts, but also to the demands of patients and the position of other professionals within the care arena. Increasing autonomy through the avoidance of medical interference was a notable aim of participants returning to India to work.
Conclusion(s): The disparate cultural contexts of the UK and India result in physiotherapy practice taking very different forms. Structural issues found in different countries can be seen to strongly influence practice. Individual agency in physiotherapy practice in India is considered to be advanced through relationship building with patients and the avoidance of a medical gaze. On return home, Indian physiotherapists looked for locations of practice where medical interference would be limited.
Implications: Structural boundaries within healthcare (political, departmental, state funded or private) affect the relative autonomy and agency of all physiotherapists. Irrespective of location, practice can be seen as a process of agency management and enhancement within these boundaries.
Funding acknowledgements: This research formed part of an Ed.D. supported by Sheffield Hallam University, University of Brighton and a UKIERI travel grant.
Topic: Globalisation: health systems, policies & strategies
Ethics approval: The research was granted ethical permission by the Research Ethics Committee of Sheffield Hallam University.
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