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Cunningham S.1, Herbel K.2, Jackson R.2
1Radford University, Department of Physical Therapy, Roanoke, United States, 2The Jackson Clinics, Middleburg, United States
Background: In 2012, an 18-month post- graduate orthopaedic manual therapy residency program was introduced in Nairobi, Kenya to provide physiotherapists in Kenya access to current evidence based practice. Residency programs emphasizing clinical reasoning and manual therapy could provide a means to optimize the effects of physiotherapy (minimize pain, normalize movement and maximize function) without the need for or access to expensive equipment. However, if the skills and knowledge gained through post- graduate education programs are not implemented in clinical practice, patient outcomes will not be influenced.
Purpose: The purpose of this qualitative research study was to explore the clinical practice of Kenyan residency graduates one and two years following completion of the program.
Methods: Participants included a sample of convenience of residency graduates from the first and second cohorts on the program (n=18) and their employers (n=7). Interviews occurred in Nairobi, Kenya and the surrounding area over a one-week period in October 2016. A semi-structured interview guide was utilized. In addition, the clinical practice of the graduates and their colleagues was observed. The grounded theory approach was utilized to describe the data. Primary coding was performed by the investigators using the constant comparative method. This will be followed by secondary cycle coding to identify core concepts. To ensure credibility of the concepts, data will also undergo analyst triangulation to avoid selective perception in the interpretive analysis. The core concepts will then be examined to discover a theme that connects the concepts and explains the relationship. Member checks, with the theory that emerges from the data, will be performed through electronic mail in January 2017.
Results: Five preliminary core concepts were discovered. The residency graduates and their employers feel the training not only positively affected the residents clinical practice, but also the clinical practice of their colleagues through the provision of peer mentoring and continuing education. An assessment including a thorough hypo-deductive clinical reasoning process and manual therapy techniques were novel approaches to patient care and are currently utilized most often in the clinic. With integration of these skills, patient outcomes have improved with patients requiring less visits and obtaining optimal function. Initial challenges for implementing the knowledge and skills from the residency included resistance from peers and patients towards the new techniques. However, as patients outcomes improved, the new approach to care was accepted by patients, physiotherapists, and administrators.
Conclusion(s): The residency program has been successful in its mission to positively influence physiotherapy practice in Kenya. The graduates of the program are not only providing effective treatment to their clients, but are sharing the new knowledge and skills gained through the residency education with colleagues resulting in a positive change in overall clinical practice.
Implications: Long term, sustainable, continuing education programs in developing countries have an opportunity to elevate physiotherapy practice resulting in improved patient care.
Funding acknowledgements: This research was supported by the Radford University Waldron College Research Award.
Topic: Education: continuing professional development
Ethics approval: The Kenya Medical Training College Ethics and Research Committee and the Institutional Review Board of Radford University.
All authors, affiliations and abstracts have been published as submitted.
