The fundamental role of ontology, epistemology, and ethics is widely recognised across the healthcare professions. Yet what is less known in physiotherapy is how ontology and epistemology potentially undermine the ethical intentions of our theories and practices. In this article, we draw on the work of 20th-century philosopher Emmanuel Levinas to highlight this problematic. Particularly Levinas’s ethical critique of ontology and the associated notion of thematisation enable us to highlight a violence that takes place in the philosophical foundations of physiotherapy. Using the overarching aims of physiotherapy, the theory and practice of diagnosis, and the notion and enforcing of professional identities as examples, we additionally show how this violence consequently pervades physiotherapy theory and practice. By exploring a range of critical and practical implications, we finally show how an application of Levinas’s critique of ontology additionally opens toward an otherwise physiotherapy grounded in a renewed understanding of self, other, and their relation. With this, we hope to highlight the core value and critical need for a deeper engagement with the work of Levinas in relation to physiotherapy, and particularly its understanding and implementation of ethics that is so fundamental to its practice.
Abstract: In this editorial we argue that ‘critical’ thinking, research and scholarship are essential to understanding and practicing rehabilitation, and yet are under-represented in the existing rehabilitation literature. By using the term critical, we are referring to research and scholarship that draw from social theory to examine pervasive taken-for-granted practices, assumptions, and principles in any field, including health care. Thus, critical work offers opportunities to enact more ethical and socially just rehabilitation practices. In what follows we call for rehabilitation journals to recognise, welcome, seek out and publish submissions in this exciting area of research, and thereby lead the field in promoting a new understanding of rehabilitation’s purpose, goals, practices, and outcomes.
Abstract: About 200 years ago the invention of the steam engine triggered a wave of unprecedented development and growth in human social and economic systems, whereby human labour was supplanted by machines. The recent emergence of artificially intelligent machines has seen human cognitive capacity augmented by computational agents that are able to recognise previously hidden patterns within massive data sets. The characteristics of this technological advance are already influencing all aspects of society, creating the conditions for disruption to our social, economic, education, health, legal and moral systems, and which will likely to have a more significant impact on human progress than the steam engine. As AI-based technology becomes increasingly embedded within devices, people and systems, the fundamental nature of clinical practice will evolve, resulting in a healthcare system requiring profound changes to physiotherapy education. Clinicians in the near future will find themselves working with information networks on a scale well beyond the capacity of human beings to grasp, thereby necessitating the use of artificial intelligence to analyse and interpret the complex interactions of data, patients and the newly-constituted care teams that will emerge. This paper describes some of the possible influences of AI-based technologies on physiotherapy practice, and the subsequent ways in which physiotherapy education will need to change in order to graduate professionals who are fit for practice in a 21st-century health system.
Background: Hong Kong is at the cross-road between Eastern and Western cultures. Increasing globalisation allows students to gather experiences from various educational contexts. While internationalisation has been promoted in higher education worldwide, the focus was often put on students from Chinese cultures integrating into Westernised education systems. Not much is known about how students from Chinese background with exposures to Western cultures, reintegrate into a Hong Kong university, characterised by a highly competitive system that potentially affects students’ well-being. Aim: To identify learning preferences by Hong Kong physiotherapy students who have been exposed to educational contexts in the USA, Australia or Canada, and to explore their subjective experiences regarding different educational approaches during their studies. Methods: Ten students participated in this phenomenological study. Semi-structured interviews were conducted in English, transcribed ‘ad verbatim’ and analysed using qualitative content analysis. Findings: Three themes emerged from the data: (1) Interaction between students and teachers, (2) past experiences that help with future dreams, and (3) obstacles and opportunities in learning. Conclusion: Physiotherapy students with globalised experience rely on their past educational exposure to give meaning to their future. They believe that a student-centred approach is crucial for learning. Their experiences shed light on consideration factors for optimally internationalising the physiotherapy curriculum.
Background: Communication is fundamental in collaborative physiotherapy practice. Students develop understandings of what constitutes ‘good’ communication through the formal, informal and hidden curricula. Understanding how students understand communication and how this is influenced by the curricula can help educators consider how best to enhance communication knowledge and skills. Aim: This study explored how physiotherapy students conceptualised clinical communication. Methods: This study was underpinned by a social constructionist epistemology. Data consisted of fifteen assignments, completed by students as part of their coursework. Assignments were analysed using the Listening Guide which prompted attention to how the different ways students understood communication and how these understandings were constructed. Results: Communication was understood as uni-dimensional. It was presented as an act done to the patient by the physiotherapist, with little attention to the patient’s communication and involvement in the interaction. Through communication, physiotherapists demonstrated and reinforced their expertise while simultaneously positioning the patient as the recipient of care and knowledge. Conclusion: Understandings of communication reflect broader constructions of physiotherapy and the role of the physiotherapist. These also reflect tensions in the curricula. Enhancing communication in student education requires all parties to understand, value and critically reflect on how communication is constructed and enacted.
Abstract: Physiotherapy education cannot occur without resources. A pragmatic approach to education design is required, with explicit consideration for the cost of our teaching and learning practices. In this editorial, we explore the concept of cost-conscious educational design in the context of physiotherapy education.