TRANSFORMATIVE LEARNING AND DEVELOPING SOCIAL ACCOUNTABILITY: A SOUTH AFRICAN CASE STUDY IN PHYSIOTHERAPY

M. Unger¹, D. Ernszten², A. Titus², S. Statham²

¹Stellenbosch University, Rehabilitation and Health Sciences, Cape Town, South Africa, ²Stellenbosch University, Rehabilitation and Health Sciences, Cape Town, South Africa

Background: There is an impetus to transform Higher Education to facilitate the development of social accountability and produce critically conscious graduates capable of identifying social ills, reflecting on and initiating actions for change. Leadership and advocacy competencies however are often written as broad philosophical statements in curricula. How these translate across the four-year physiotherapy programs and are enacted is less clear. The relationship between the curriculum intent and lecturers’ perspectives regarding the pedagogical underpinnings of- and practical application within responsive curricula, is critical and important to inform further curriculum development and renewal initiatives.

Purpose: The aim of this study was therefore to explore the range of understandings that physiotherapy lecturers have as they interpret the principles underpinning the Physiotherapy curriculum which is intended to deliver future physiotherapy professionals capable of effecting change and advancing health for all.

Methods: This study has emerged from work conducted as part of the Responsive Curriculum Project which is a South African based multi-institutional project led by the Centre for Health Professions Education at the Faculty of Medicine and Health Sciences, Stellenbosch University. A qualitative descriptive case study with an interpretivist paradigm was conducted at one physiotherapy department in South Africa. Ten lecturers who fulfilled the roles of programme- and/or module coordinator participated in one of two focus group discussions, followed by nine semi-structured individual interviews, ensuring a variety of perspectives and triangulation of the data. The eleven transcripts were uploaded to AtlasTi® qualitative data analysis software (V9) for further management and analysis. Member checking of transcripts was also done to ensure trustworthiness of the data. Transformative learning theory and the theory of social accountability was used to develop a conceptual framework for deductive thematic analysis of the data. This was supported by independent inductive thematic analysis.

Results: Participants understood social accountability to be a complex construct made up of different components and that the curriculum extends beyond the degree to preparing students for citizenship. Professional accountability, recognition of health inequities and understanding your boundaries, the importance of inter- and trans professional engagement and innovative problem solving, advocacy, leadership and scholarship where the main themes identified. Lecturers utilised a variety of pedagogies that underpin social accountability and transformation including immersive /contextual learning, role modelling, discursive pedagogy and reflection being most reported. Challenges for applying these however were also identified.

Conclusions: Physiotherapy lecturers recognise their roles in developing social accountability. The study identifies strengths and weakness including the need to seek a balance between developing clinical competence and critical citizenship. Integrated experiential learning and reflective practice are deemed essential to foster social accountability and social justice, however, the extent to which undergraduate students can enact on complex ethical issues and injustices needs to be further explored.

Implications: This study identified strengths, gaps and challenges in curriculum structure and methods of teaching and learning useful to inform future curriculum development initiatives. Developing a strong professional identity begins day one of year one and careful attention in how these building blocks are imbedded and scaffolded throughout the curriculum is recommended.

Funding acknowledgements: Self-funded

Keywords:
Transformative learning
Social accountability
Responsive curriculum

Topics:
Education
Education: methods of teaching & learning
Education: clinical

Did this work require ethics approval? Yes

Institution: Stellenbosch University

Committee: Health Ethics Committee

Ethics number: Humanities Project no: 8838