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Cunningham S.1, Litwin B.2, Fernandez-Fernandez A.2, Canbek J.2
1Radford University, Department of Physical Therapy, Roanoke, United States, 2NOVA Southeastern, Physical Therapy, Fort Lauderdale, United States
Background: In the year 2000, it was estimated that there were 234 million moderately or severely disabled people living in developing countries. Although there are limited numbers of physical therapists available to provide services in these countries, there is an opportunity to maximize the potential of physical therapy that is available for the benefit of those in need. To assist with clinical reasoning development and skill advancement, a residency program has been introduced in Nairobi Kenya. However, without the ability to implement the training received in the clinic, clinical practice will not be positively influenced by the additional education provided.
Purpose: The purpose of this study was to explore from participant's perspectives; the residency program's ability to foster the use of new skills in the clinical environment and barriers to integrating concepts and skills gained during the residency program into their clinical practice.
Methods: A sample of convenience was utilized. Participants were residents in the third and fourth cohorts of the residency program in Nairobi, Kenya (n=27). One on one interviews were performed in October 2016. All interviews were recorded and transcribed by an independent transcriptionist to ensure accuracy. The descriptive phenomenology 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 patterns and themes. In addition, the data will undergo analyst triangulation.
Results: Preliminary themes include the following barriers to implementing new knowledge and skills into clinical practice. Patients have been accustomed to receiving modalities such as hot packs and ultrasound exclusively for their musculoskeletal complaints and require education to accept new treatments such as manual therapy and exercise. Colleagues in the clinic become self-protective when patients refuse to see physiotherapists without specialty training based on their perception of improved outcomes. Time constraints, imposed by a large number of patients requiring care, limits the ability of the physiotherapist to perform a thorough evaluation in an initial visit. However, these barriers were balanced by facilitators as the physiotherapists progressed through the residency program. Patients new to physiotherapy were accepting of manual techniques based on unfamiliarity with customary modalities provided for pain control. Residents provided continuing education to colleagues following each module to promote the utilization of manual therapy and exercise techniques in the clinic, which resulted in improved outcomes. Many colleagues joined subsequent residency cohorts for formal training. As the number of residency trained physiotherapists increased in a given clinic and patient outcomes improved, additional support from administration has been provided resulting in increased time for patient care.
Conclusion(s): Initial barriers to implementing a thorough assessment process, manual therapy, and exercise in the clinical setting were transformed to facilitators as residents shared the new skills with colleagues and patient outcomes improved.
Implications: Understanding the facilitators and barriers that affect the utilization of new skills and knowledge in the clinic may assist future programs in meeting the challenges of positively influencing patient care in developing countries through provision continuing education to physiotherapists.
Funding acknowledgements: Not applicable.
Topic: Education: continuing professional development
Ethics approval: Kenya Medical Training College Ethics and Research Committee, Institutional Review Board of Radford University, Nova Southeastern University Institutional Review Board
All authors, affiliations and abstracts have been published as submitted.
