should we dream the impossible dream?
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letters Should We Dream the Impossible Dream? MADAM - I read with interest the commentary on Quality assurance in occupational therapy and physio- therapy fieldwork placements by Hilary Lawley and Catherine Wells (Physiotherapy, May, pages
As I spent three years co-ordinating clinical placements for physiotherapy students at the University of Southampton, I should like to offer some thoughts on this subject. Whereas I applaud Lawler and Wells both for their article and for the pub- lished standards, I would like to advocate a note of caution before such standards are adopted too enthusiastically.
A key question concerns the pri- mary purpose of setting these (\or indeed any) standards. Should they be set at the highest level achievable (ie as gold standards), or at a level achievable by all (ie as minimum standards), or somewhere in between? At one time I was involved in the writing of standards for physio- therapy departments in a chain of private hospitals, and became some- what disillusioned on being informed that some standards would have to be omitted because not everyone would be able to achieve them.
Lawler and Wells state that none of the placements achieved all the stan- dards - is this to be interpreted as standards being set too high, or placements being inadequate? Stan- dards are useful only if they can be audited, and if the audit results in appropriate changes in practice. Everyone involved in the training of occupational therapy and physiother- apy students is well aware that schools are chronically short of clini- cal placements, and are grateful for any placements offered. If place- ments fail to meet standards (eg standards 6 and 7), what will be the outcome? Will schools really decide not to use them? Is responsibility for change seen as an educational prob- lem or a clinical problem?
In addition, although the majority of students may be placed within the suggested timeframes (standard 2
points 4 and 5 , standard 8 point 1) in my experience there is always a sig- nificant minority for whom placements are still being sought until a few weeks (or even days) before their start date. If standards can only be met some of the time, what is their value?
As they stand, these standards are primarily concerned with the process of clinical placement provi- sion and not with the true test of any placement, which must surely be the quality of the learning experience pro- vided. This is understandable as the former is generally easier to measure
and audit. The authors admit that implementing the standards requires considerable administrative support, but do not demonstrate who will ben- efit, and how.
In conclusion, while I appreciate the good intentions behind setting these (and other) standards, I am uncertain as to the consequences of failing to meet them. If there are no such con- sequences, then surely they become simply a wish list, designed to impress external agencies rather than improve clinical education, and will not be taken particularly seriously by those directly involved in training stu- dents.
Anne Bruton MA MCSP University of Southampton
Physiotherapy in GP Practices MADAM - In response to the recent letter (May, page 245) regarding our article Musculoskeletal physiotherapy in GP fundholding practices (Febru- ary 1998, pages 84-92) we would like to thank Lorraine Wareing and Sue Chrisene for their interest in this research. However, we would also like to make the following points.
We reported the results of a small piece of qualitative research. We would have expected that it would be by now well understood that the results of such a study would not be generalised. As stated in the article the views expressed by the small group of physiotherapists interviewed were never intended to be represen- tative of wider opinion.
As the letter by Wareing and Chrisene points out, and as we also said in the paper, more research in this area is needed to demonstrate the extent to which these issues are generalisable for the physiotherapy profession. This research is now being carried out and is seemingly endorsing issues raised in the article.
We would also like to emphasise that the article was not stating that GP/health centre physiotherapy is something to be feared by the phys- iotherapy profession. The paper highlighted positive views and advan- tages for this area of practice as well as reporting some disadvantages and concerns experienced by the participants (as the discussion and conclusions clearly state).
We would also like to refute the claim that we obviously feel threat- ened and undervalued with the point that we were reporting research find- ings and not, as the authors of the above letter seem to assume, our own opinions.
The articles aim was to identify and describe issues for wider debate and exploration. The letter from Wareing and Chrisene, plus direct feedback from other centres wholly endorsing the views in the article, has demon- strated that this is happening, and so was most welcome. Catherine Minns MSc BSc MSCP Christine Bithell MA MCSP DipTP
Why Not Join In? Letters to the Journal are welcome on any professional topics. Please send them to the Journal editor, CSP, 14 Bedford Row, London WCI R r 4ED, or fax 0171 306 6667.
Physiotherapy, July 1997, vol84, no 7
Should We Dream the Impossible Dream?