|Year : 2013 | Volume
| Issue : 2 | Page : 171-177
Quality assurance system in Indian physiotherapy education: A missing link?
Saloni Deorukhkar, SM Khatri, Kristina Kindblom
College of Physiotherapy, Pravara Institute of Medical Sciences, Deemed University, Loni, Taluka: Rahata, District: Ahmednagar, Maharashtra State, India
|Date of Web Publication||13-Dec-2013|
College of Physiotherapy, Pravara Institute of Medical Sciences, Deemed University, Loni, Taluka: Rahata, District: Ahmednagar - 413 736, Maharashtra
Source of Support: None, Conflict of Interest: None
Objectives: To investigate the quality assurance system in Indian physiotherapy education. Design: A cross-sectional survey with mixed method was employed in this research. Participants: Forty two participants were involved in the study and responded to a questionnaire. Seven participants out of the 42 were selected for video interview. Materials and Methods: A questionnaire and an audio or video interview technique were used for the data collection. Descriptive statistics was used to analyze the questionnaire. A qualitative method was analyzed with content analysis. Results: The questionnaire result showed that hardly one-third of participants were aware about quality in general in the physiotherapy education. In the analysis of the interviews, four categories emerged: They indicated that awareness, skills, rating, and requirements related to quality seem to be important in developing quality assurance in physiotherapy. Conclusion: As a small scale study of quality assurance system, this study can contribute to develop an overall awareness of quality system in the Indian physiotherapy education. It can also contribute to the educational and professional life ahead by developing experience and updating the upcoming new physiotherapy researches. However, affirmative effects can also extend physiotherapists in advance.
Keywords: Awareness, accreditation, credentials, professional recognition, students′ educational quality, skills
|How to cite this article:|
Deorukhkar S, Khatri S M, Kindblom K. Quality assurance system in Indian physiotherapy education: A missing link?. Arch Med Health Sci 2013;1:171-7
| Introduction|| |
Quality concept is basically a 20 th century phenomenon that has roots in the industry and management.  The word quality comes from the Latin word qualis meaning -what kind of and with variety of meanings and connotations. It has been referred to as a slippery concept.  The words of Pirsing  have been cited frequently as Quality. You know what it is, yet you don't know what it is. But, that's self-contradictory. Quality shows that some things are better than others, that is, they have more quality. When you try to say what the quality is, apart from the things that have quality, it all goes poof! There is nothing to talk about! If you can't say what quality is, how do you know what it is, or how do you know that it even exists? If no one knows what it is, then for all practical purposes, it doesn't exist at all. But, for all practical purposes, it really does exists. So round and round you go, spinning mental wheels and nowhere finding any place to get traction. What the hell is quality, what is it?
Hierarchy concept of quality involves inspection, quality control, quality assurance, and total quality management.  Quality has few central ideas, around which the whole concept revolves: Quality as absolute, quality as relative, quality as a process, and quality as culture.  The British Standard Institution defines quality as the totality of features and characteristics of a product or service that bear on its ability to satisfy stated or implied needs (BSI, 1991).  Quality may be perceived as required standards, zero defects, customer/client satisfaction, value for money, process etc.  Quality assurance can be done by varieties of way that includes self-evaluation, peer review by experts, analysis of statistical information, surveys of students, employers, graduates, professional bodies, testing knowledge, skill and competencies of students.  Reeves and Bednar (1994)  concluded that the search for an universal definition of quality and a statement of law like relationship has been unsuccessful. Education is recognized as one of the critical elements of the National Development Efforts. Good education is seen as a stepping stone to a high-flying career. It's believed that quality of higher education decides quality of human resources in a country.  Physiotherapy has become an emerging allied health care profession. Today, various universities are offering undergraduate, post-graduate, and post-doctoral physiotherapy programs.  Medical knowledge has no national boundaries, and physiotherapy professionals whom we are training in one country are serving in other country, and for that propose, we have to maintain standards. World over as educational standards placed the need for stepping up programs to a Masters level to enable the profession take a vertical growth, India also developed post-graduate programs, but it needs patients' compliance as a major practice guidelines, which is lacking in India. 
Today, number of students opting for higher education in physiotherapy is increasing in India, and even the number of universities has increased to 481 in 2011. The quality issues have started arising due to diversity and focus on access and equity than quality. The University Grants Commission with its statutory powers is expected to maintain quality in Indian higher education institutions as per section 12 of the UGC Act of 1956 and other statutory bodies like NAAC (National Assessment and Accreditation Council), Medical Council of India, Dental Council of India, and many more.  However, there is no regulatory body for physiotherapy profession in India and protection for patients' safety with physiotherapy interventions. In many colleges, same old study is continued all over worldwide and there is no further advance in techniques and research study. People take physiotherapy as a second option of their career, and the intake of students is too less. This profession can be compared to nursing course many times as a paramedic field. Professional standards and malpractices becomes a big challenge in absence of regulatory body, and we believe that training and educational quality is an important factor. Hence, this research study was undertaken to investigate the current status of quality assurance system in Indian physiotherapy education.
| Materials and Methods|| |
Cross-sectional survey designs with mixed (quantitative, qualitative) methods were employed. A questionnaire with audio or video interview techniques was used for the data collection. Mixed methods were also used to analyze the data. Permission to perform the research was obtained from the head of the Institution.
A purposeful selection of 42 participants willing to participate was considered for this study. They were faculty members, post-graduate students, and interns at the College of Physiotherapy [Figure 1], Pravara Institute of Medical Sciences, Loni, Maharashtra State, India - 413 736. Out of the 42 participants who were recruited for this study, 32 (76%) were females and 10 (24%) were males. They had variable professional experience from none to 10 years. The average age of participants was 25.83 ± 7.564 years with a range from 21 to 53 years.
A questionnaire was developed specifically for this study. The questionnaire had close-ended questions with yes and no answers and was constructed to give an idea of quality assurance. A number of background questions and six questions related to quality assurance were included like, have you heard about quality assurance? Do you think quality assurance exists in India? Is quality assurance system necessary? Do you think it can maintain academic standards? And, What are the barriers [Figure 2] for quality assurance, will quality assurance be of any help?
A restricted number of participants were selected for audio or video interview. As per the convenience and willingness of the participants, they could choose interview from either audio or video. The interviews were performed on the same day in a small office at the physiotherapy. The duration was about 5-10 min. The interview was conducted by the investigator and one supervisor. It was formal interviews with five structured questions like what is quality in general? Will quality assurance be of any help in physiotherapy? How could a quality system in Indian physiotherapy develop? Will quality assurance improve our professional skills? Will it improve academic standards and requirements needed to create a quality assurance system? The mixed type of questions in the questionnaire and the interviews were used to receive a broad picture and to know the participants' different opinions and ideas about quality.
The analysis of the questionnaire responses used descriptive statistics. The interview text was analyzed with content analysis.  The process of analysis was constructed in four steps: Meaning unit, condensed meaning unit, coding, and category [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]. Later, the codes with the same ideas were grouped into the different categories. This content is abstracted by only audio\video interview.
Out of a total 50 participants, 13 interns, 11 I st Yr MPTh students, 10 II nd Yr MPTh, and 8 Faculty Members available at COPT on the day of the data collection, 42 participated in this research yielding a response rate of 84% and rest 8 participants were not interested to respond for the study.
It showed that the results of completed Questionnaire revealed that 29.5% of participants heard about the quality assurance in physiotherapy, 11.9% felt that quality assurance exists in physiotherapy, 95.2% felt that quality assurance will be of any help, 97.6% felt that quality assurance is necessary for Indian physiotherapy education, and 92.8% felt that quality assurance will help in maintaining the academic standards. The last question consisted of sub-questions as barriers of quality assurance and response given below:
Structured questionnaire result
Out of 42 participants, only 7 participants agreed for audio\ video interview, of which 5 (12%) agreed for audio interview and 2 (5%) agreed for video interview. The interpretation of the video interview was done as it can be used for other educational purpose. Their responses formed four categories such as Awareness, Skills, Rating, and Requirements given below:
Responses showed that there was unclear idea about the quality assurance and no concentration on quality. General idea suggested that quality was given but not working on quality assurance. The majority response was that participants were unaware about quality assurance. Even barriers of quality were included, by which conductance of quality assurance is not possible.
Responses ensured of basic professional skills competence. Some didn't find any relation between professional skills and quality assurance. It showed that 57% felt that quality assurance can improve our professional skills.
Participants felt that academic standards can be improved by quality assurance to certain extent. The responses indicated that 29% perceived that quality assurance will help in rating academic standards.
Regarding the requirements, some have no idea of requirements; some suggested of clinical practice license, credentials (a documentation and certification), accreditation (grading of students academics), awareness of quality and practice guidelines, regulatory bodies for physiotherapy education are needed, so they can be confident about their knowledge and some proof that no one can replace them. Seventy two percent felt that these are the requirements so as to ensure the quality assurance in physiotherapy education.
The findings of this qualitative pilot study suggested that the current status pertaining to quality assurance system in physiotherapy is probably missing.
The questionnaire had in the beginning a filter question asking if the participant heard of quality assurance system in physiotherapy. One-third of the participants reported an affirmative response to this question, suggesting the greater extent of unawareness about quality assurance system in physiotherapy education. This response is because there is lack of knowledge, time, and lack of awareness.
Since there has been hardly any similar study in India, this topic needs to be highlighted. The results of the study could not be interpreted in the light of previous knowledge.
Secondly, a restricted number of participants reported positive but lower response rate for existence of quality assurance in physiotherapy education, but suggested that they had a vague idea of quality system and its existence.
Thirdly, almost all the participants reported an encouraging response to help in quality assurance in physiotherapy and suggested that development of quality assurance is low and the awareness with its existence is near to the ground.
Fourth, majority of participants reported that there is necessity of quality assurance in physiotherapy and suggested that it should be made necessary for progress of physiotherapy education and increase confidence in their ability in the near future. 
Almost all participants reported confirmatory responses for maintaining academic standards and recommended that by introducing new techniques and some uniform rules could help in maintaining academic standards. The quality assurance can improve theoretical and practical knowledge. It can give greater confidence to students and also some responsibility to their own learning and later can act as facilitators. 
The old techniques will not be further developed if the importance of quality has not been discussed and would follow the same path. Even higher bodies are almost non-existing to regulate physiotherapy. The findings also suggest time constraints related to perceptions of burden, so lack of time is also more in common. 
The former questionnaire consists of structured questionnaire done by interviewing participants. In the interviewing process, many described their clarification about the study:
The comments made more commonly on awareness, skills, rating and important aspects illustrates that participants have a vague idea about quality in general as well as quality assurance as it is self-contradictory word, so participants think that quality assurance is lacking. It describes that there should be improvement in educational point of view and once developed in proper manner, it can provide appropriate learning opportunities and improve their knowledge as well.
Here also, we got affirmative response by participants that introducing new techniques in our theoretical knowledge will improve professional skills and can keep updating our knowledge and implementation of that knowledge or skills and keep the records, which can show quality indeed and quality assurance can help in improvement of skills.
It can be maintained by approaching to students' education, structuring supervisions, structured orientation programs, and increase confidence in their ability of academic knowledge.  For requirement, even regulatory bodies are needed, so that people can get good quality service and also be confident about the quality they are giving to the patients.
Teaching and facilitation of learning are likely to become even more important as physiotherapist adapt to policy changes and adopt a more preventative and educative role in practice.  The questionnaires used in this study were close-ended and structured questionnaire. It is the investigator's design and study. The questionnaire was made simple to comprehend for the participants. In addition, interview was conducted of the participants since it is believed that using more than one method of data collection may be helpful in obtaining a more complete picture of human behavior and experience.  By this help of the questionnaire, even participants got aware of quality assurance and its existence. So, there should be need to study the quality assurance of physiotherapy education in India.
Participants recruited for this study were only interns, post-graduates, and faculty members from only one teaching institute; the number of participants was small, and participants were also selected by their rural or urban background; only one male and one female faculty participated in the video interview, and reliability of producing same response in a qualitative study like this remains dubious. Considering it as pilot study, the generalizations of results becomes difficult at the moment.
| Conclusion|| |
Public interest in accountability is rooted in the growing importance of physiotherapy education and uncertainty concerning its adequacy and affordability. Quality assurance of Indian physiotherapy academic programs is highly perceived as non-existing or missing, and ineffective physiotherapy education effectively serves public and individual priorities.
| Acknowledgement|| |
Authors would like to sincerely appreciate the participants for their valuable time and participation in the research.
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[Figure 1], [Figure 2], [Table 4]
[Table 1], [Table 2], [Table 3], [Table 5], [Table 6], [Table 7]