altphysio curriculum physiotherapy

altPhysio | Background of the school

This is the first of a series of posts on a vision for what a new school of physiotherapy might look like if it was designed from scratch; what it could be if we left behind the legacy systems that almost all new programmes are built around. I’ve written the series as an interview set in 2025, a few years after the school has opened, just as a different way of trying to get some of these ideas out of my head and onto the page. Much of what I present here is untested and is simply informed by my own research, my conversations with colleagues and students, and my own thinking, rather than on any real world examples. I would love to hear any thoughts on the ideas in these posts. And with that, here is the interview.

We’re going to be spending a few weeks in conversation with a lecturer at altPhysio, described as a next generation school of physiotherapy, in order to get a better understanding of the underlying rationale behind the very different approach to education taken by the founders. Over the next month or so we’ll delve into different aspects of the curriculum, going into the details behind the changes and asking why they were necessary. For now though, let’s establish the context for the rest of the discussion.

Q: Tell us a little bit about altPhysio; when and why it started.

altPhysio started as a private physiotherapy school in 2020, after we realised that our more traditional programmes were not graduating physiotherapists with the competencies and attitudes towards practice that we said we valued. From our own experiences in practice we could see that we needed to do more if we wanted a new generation of clinical professionals who could work and thrive within the complex health systems of the 21st century.

Q: Was there anyone else who recognised these problems? How did you know that it wasn’t just your own programme?

Between 2010 and 2015 there were a few publications that came out, articulating the problems that we were experiencing first hand. The main ones were the Lancet commission’s report on Health professionals for a new century and the WHO Transforming and Scaling up Health Professions Education. There were others but these two really highlighted some of the challenges with allied health professions education, making strong recommendations around the institutional and educational reforms that were necessary. One of the primary concerns raised in the Lancet report was that professional education had not kept up with contemporary health challenges “largely because of fragmented, outdated curricula and static pedagogy that produced ill-equipped graduates.” There were several other systemic problems that were also highlighted, many of which we could see in our own curriculum.

The report recommendations included calls for the promotion of transformative education and interdependence among institutions, greater integration of information technology, deeper links with the health system and a more critical, inquiry-focused learner. These changes would have required significant changes to the higher education system, mostly supported by deeply held beliefs that would have been very difficult and time consuming to change. We decided that it would be easier to simply start again by asking what it was that we wanted to develop within our students and then working backwards to design the environments we would need to achieve those outcomes.

Q: And what about the decision to design something so radically different to what has come before? What was wrong with the traditional system?

Like most other institutions at the time we were used to a process of gradual and incremental changes to the curriculum, where we evolved slowly over time. But we soon realised that small scale iteration will only produce evolutionary change at a pace and scale that we decided was unacceptable for changes we wanted to see. The only realistic way to implement the recommendations of the Lancet Commission and WHO reports was to start over, beginning with taking a serious look at our curriculum. It was a difficult – but liberating – experience, seeing that a lot of what we were doing in the curriculum had very little evidence to support it.

“The first step to thinking clearly is to question what we think we know about the past.” – Peter Thiel, Zero to One

We decided that the only way to truly innovate in this space was to begin with a blank slate. We asked what changes we should make considering the world we actually live in, as opposed to designing a programme based on the world as it existed 500 years ago. Traditional universities started at about that time and, besides a few changes aimed at increasing efficiencies in the system, the general structure is pretty much the same. We asked which parts of that system actually improved learning and which parts should go. And it didn’t take long to realise that a lot of what is currently encoded into a university is not aimed at enhancing learning.

altPhysio is a next generation physiotherapy school that began by questioning the assumptions we accept as being fundamental to the curriculum. Think of it as rewriting the code that we base our curricular thinking on.

Instead of relying on legacy systems that the research says is flawed why not start again, except this time using what we know to create a more equitable, socially just, student-centred classroom? Research pushes back the boundaries of knowledge to create new spaces into which practices should move. But higher education institutions are large, old and risk averse – people are set in their ways and reluctant to move into the new spaces that we create through our inquiries into the world. It seemed to make sense that, instead of investing our limited resources in the small, incremental changes that a traditional institution would find palatable, we should just begin afresh. So in 2020, after 4 years of planning, we opened altPhysio; a re-imagined vision of physiotherapy education for the 21st century.

By Michael Rowe

I'm a lecturer in the Department of Physiotherapy at the University of the Western Cape in Cape Town, South Africa. I'm interested in technology, education and healthcare and look for places where these things meet.

2 replies on “altPhysio | Background of the school”

Hi Dirk. Thanks for your thoughts. I agree with you that the curriculum should be centred on competencies and that the assessment of those competencies is an important factor to design around. I think that many curricula are currently centred on what can only be called “content”, where lecturers spend more time thinking about what content to cover than whether or not they are developing within students the competencies they say they value. For example, we all say that we want our students to be creative problem solvers but have a hard time showing where in the curriculum we actually give them opportunities to truly develop creative solutions to difficult problems.

I enjoyed your letter that you shared in the link and like the idea of the different professional roles you describe. I think that this would be a useful place to start any conversation about the “type” of student we want to graduate.

Hi Michael, great creative post! I feel we need an international consensus on what competencies an entry-level physiotherapist should have acquired.(1) Next, we can start thinking about how these competencies can be assessed. Only then we can design a program that offers the best opportunities for physiotherapy students to acquire these competencies. Hereby, we should take into account that in real life, a physiotherapist needs to be able to concurrently use different sets of competencies.
It would be a great challenge to create such a program from scratch, not confined to the conventional approach to education, tailored for international students and designed to prepare the next generation of physiotherapists to make a difference in a contemporary world.

(1)Vissers et al. Competency-based physiotherapy education: need for a European view? Medical Teacher 04/2013; 35(4):337-338.

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