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Volume 12, Issue 1 (2024)
Health Educ Health Promot 2024, 12(1): 91-104 |
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Received: 2024/01/12 | Accepted: 2024/03/5 | Published: 2024/03/22
Received: 2024/01/12 | Accepted: 2024/03/5 | Published: 2024/03/22
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Rojas J, Fuster-Guillén D, Flores J, Hernandez R. Successful Practices in the Teaching-Learning of Physical Therapy. Health Educ Health Promot 2024; 12 (1) :91-104
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1- Postgraduate School, Cesar Vallejo University, Lima, Perú
2- Faculty of Health Sciences, San Juan Bautista Private University, Lima, Perú
3- Postgraduate School, Continental University, Lima, Perú
4- Research Department, Norbert Wiener Private University, Lima, Perú
2- Faculty of Health Sciences, San Juan Bautista Private University, Lima, Perú
3- Postgraduate School, Continental University, Lima, Perú
4- Research Department, Norbert Wiener Private University, Lima, Perú
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Introduction
This study is focused on identifying successful practices in the teaching-learning of physiotherapy. The practices integral to professional training transcend mere theoretical knowledge and content delivery. They serve as conduits for bridging theory with practice, enabling students to concretely apply competencies, skills, and abilities in real-world scenarios. Students gain firsthand experience in the complexities of patient care, honing their conceptual, methodological, and ethical acumen by engaging in these practices [1, 2]. Active methodologies focused on the learner take precedence over traditional content-centric approaches, challenging long-standing orthodox teaching paradigms in physiotherapy education. This shift redefines the role of the teacher as a mediator, facilitator, and guide, fostering active engagement, collaborative interactions, creativity, critical thinking, and reflective practice. The didactic strategies are tailored to address real-world challenges, encouraging problem-solving and application-oriented learning [3-5]. This approach aligns with a constructivist point of view wherein the learning and evaluation process is viewed as dynamic and contextually situated [6, 7]. Multiple studies have left evidence of implementing such practices.
The advancement of science is in permanent transformation every day, demanding methods that empower students to develop abilities that allow autonomous learning and critical and reflective thinking. However, higher education systems in health disciplines, especially physiotherapy, are still dominated by traditional teacher-centric approaches. These methods typically entail one-way content delivery and rote memorization, relegating students to passive receivers. Therefore, such methodologies fail to equip learners with the necessary tools to navigate the complexities of real-world professional scenarios [7, 8]. Teaching in physiotherapy requires practical engagement with patients to develop professional competencies. While online instruction and simulation can facilitate certain practical skills, they cannot fully substitute direct patient interaction [1, 9]. Therefore, it is essential to resort to active and dynamic methodologies so that the student is the architect of their knowledge and skills development.
This study addresses the different didactic and methodological strategies of a practical and dynamic nature developed in physiotherapy and distributed in 7 thematic blocks. Based on socioconstructivist principles [5], the students' active and collaborative participation takes precedence. They reject rote memorization in favor of developing creativity, critical reflection, and problem-solving skills. Among these methodologies is clinical case resolution, which facilitates skill development, critical thinking, synthesis, and inference-making, preparing students to tackle academic and clinical challenges [3].
In the second order, we consider simulation-based learning, which reproduces real clinical experiences through simulated scenarios, creating a safe environment conducive to enhancing the learners' technical skills and cognitive processes, including information analysis, clinical decision-making, self-efficacy, communication skills, and multidisciplinary development [10, 11]. Moreover, this approach improves professional behavioral competencies, communication, patient assessment, therapeutic analysis and design, intervention, evidence-based practice, and risk management compared to traditional methods [12].
Third, problem-based learning promotes active learning through problem-solving. It is initiated by presenting problems for the students to solve. By investigating potential solution alternatives, students acquire new knowledge that is gradually integrated into their cognitive frameworks, preparing them to address real-life professional challenges [13]. For this reason, PBL contributes to autonomous learning, teamwork, interpersonal skills, and the promotion of values and attitudes [7]. Case-based learning or case studies analysis facilitates learning through dissecting real or simulated cases. It involves interpreting the case, formulating hypotheses, investigating information and data, their comparison to test hypotheses, and proposing possible alternative solutions [7, 14, 15]. Project-based learning empowers students, overcoming their positions as passive recipients of content the teacher develops in the classroom. Through project execution, the learner engages in inquiry processes to resolve identified problems, necessitating acquiring knowledge and skills for planning, designing, organizing, and implementing activities and tasks while gaining new insights [7, 15].
In the fourth order, team-based learning seeks to achieve significant learning for students through collaborative work. Students are organized into teams committed to achieving predefined objectives, where each member holds responsibility for their learning and that of their peers [16-17]. This requires implementing case analysis, group discussion, scientific article review, group and individual assignments, audiovisual materials, participation in forums, and role-playing activities [18].
Fifth, the Inverted Classroom is a model that disrupts the sequence of a traditional class. It requires prior preparation of students through the study and investigation of data autonomously of the contents to be developed, which must be socialized before the class session using printed materials, audiovisual media, and ICT supportive activities. Subsequently, the activities are centered around applying the previously obtained knowledge [19-20].
Sixth, interprofessional education (IPE) positively impacts communication skills and cooperative work, as it facilitates the clinical application of theoretical knowledge [21]. IPE facilitates the development of professional values [22] and favors communication, leadership, patient-centered care, role clarification, teamwork, and conflict resolution [23].
Finally, we have service-learning (A+S), which is rooted in community action and involves applying knowledge and skills (such as communication, leadership, patient-centered care, role clarification, teamwork, and resolution of disagreements) to address [24]. It generates motivation to obtain new knowledge and skills while also contributing to developing civic values among students, such as a sense of community, solidarity, and civic responsibility [7].
This study aimed to explain how successful practices contribute to the teaching and learning of physiotherapy.
Information and Methods
This study used a literature review methodology involving a systematic process to minimize biases and random errors. Its objectives were to synthesize the most relevant recent scientific knowledge on a topic, seek high methodological standards in its development, incorporate primary or original studies on the same topic, and seek to consolidate current knowledge [25-26]. As an essential point, this study corresponds to a qualitative approach characterized by its capacity to comprehend unique realities that are difficult to understand through a singular perspective. It serves as an interdisciplinary and transdisciplinary field, employing methods that involve the interrelation between the researcher and the research subjects for data collection, analysis, and validation [27]. In this research, 80 articles were analyzed in the literature concerning successful practices contributing to the teaching and learning of physical therapy between 2014-2022. Following the conclusion of the information search, a validation and reliability assessment was conducted to ensure the suitability and relevance of the selected material to the research problem (Figure 1).
The references encompassed both national and international literature. To comprehensively explore the subject matter, multiple databases were utilized, including Scopus (n=10), SciELO (n=9), ResearchGate (n=2), Latindex (n=4), Google Scholar (n=4), Dialnet (n=4), ClinicalKey (n=2), Springer (n=2), DOAJ (n=2), Redalyc (n=2), ERIC (n=2), OJS (n=2), Elsevier (n=1), PubMed (n=1), IDUNN (n=1), and TORROSA (n=1). The search strategies used to compile the information were by author, subject, keywords, bibliographic references, search tricks, and Boolean operators such as AND and OR. Regarding the geographic scope of the selected research, they originate from different countries.
![src=./files/hehp/images/HTML_Publish/73382/73382-F_1.png]()
Figure 1. Prisma diagram
Findings
The analysis result of 49 documents were presented in Table 1.
Active methodologies
Learning is gaining knowledge through active engagement, participation, and collaborative interaction between learners and teachers. The subject matter to be learned, the context, teaching methodologies, educational environment, and assessment strategies collectively control the learning approach adopted by the learner [3]. Active methodologies prioritize the learner as an active participant in the teaching-learning process. This pedagogical conception is constructivist, as it involves constructing knowledge based on the student's experience [5]. Among them are resolving clinical cases, inverted classrooms, role-playing, service-learning, and peer tutoring [5]. Throughout the training process, several elements were identified as facilitators of learning, including encouraging dialogue in the classroom, incorporating active pauses for students, providing various tools (in addition to clinical cases), telling stories and different clinical experiences, utilizing imagery to generate emotions and facilitating the enjoyment for both students and teachers [5]. Physical therapy education requires implementing learning and teaching methods to foster skills, critical thinking processes, synthesis, and making inferences. Examining learning approaches is critical to preparing physical therapy educators to meet academic and clinical challenges [3]. There is a marked improvement in motivation, metacognition, context mastery, inquiry and choice, and learning strategies and approaches [28]. Learners who perceive classroom sessions as more interactive and dynamic and incorporate diverse strategies tend to have a more positive perception of their learning experience [16]. During the clinical years, teaching methods often involve clinical and community-based learning. This includes clinical-based learning with practice on patients in real situations to learn new skills. The basic knowledge acquired in the preclinical years is applied to medical conditions during the clinical years. In the clinical phase, more emphasis is placed on the problem-based learning method, which plays a pivotal role in developing deep learning. The deep learning process enhances critical thinking and promotes personal development among students.
Deep processing of knowledge and skills is essential in the clinical phase to formulate rational hypotheses and patient management plans [2-3]. Receiving timely feedback regarding learners' understanding of a particular topic equips them with tools. It fosters incremental learning of concepts, clarifying fundamental aspects essential for grasping corresponding practices and contributing to acquiring professional competencies in physical therapy [28]. During the clinical phase, teaching methods primarily encompass clinical and community-based learning. It includes case-based learning with practice on patients in real situations to learn new skills. There is a significant emphasis on the Problem-Based Learning Method, which primarily fosters deep learning. The deep learning process enhances critical thinking and personal development among learners through analytical observation, novel problem-solving, or teamwork. This deep processing of knowledge and skills is essential in the clinical phase, enabling students to formulate rational hypotheses and develop patient management plans [29-32, 3].
Simulation in physiotherapy
The simulation-based learning model aims to reproduce real clinical experiences through simulated scenarios by creating a safe environment that facilitates learners to increase technical skills and cognitive processes, also known as non-technical skills, including information analysis, clinical decision-making, self-efficacy, communication skills, and multidisciplinary development [10-11]. Studies have demonstrated that simulation improves professional behavioral competencies, communication, patient assessment, therapeutic analysis and design, intervention, evidence-based practice, and risk management compared to traditional methods [12]. Therefore, simulated practice in physiotherapy involves two phases: a planning phase and an execution phase. During these phases, physiotherapeutic care is provided, incorporating factors such as anamnesis, application of the test and measurements, explanation of the evaluation, physiotherapeutic diagnosis, prognosis, and treatment planning [33]. This approach enhances knowledge retention and skill acquisition compared to traditional methods.
Simulation practice has demonstrated its effectiveness in enhancing high-level skills across several areas, such as clinical skills, self-confidence, performance, safety, and decision-making during the professional reasoning process in clinical practice [11, 34-35].
Table 1. The research attributes of the studied articles
![src=./files/hehp/images/HTML_Publish/73382/73382-T_1A.png]()
![src=./files/hehp/images/HTML_Publish/73382/73382-T_1B.png]()
![src=./files/hehp/images/HTML_Publish/73382/73382-T_1C.png]()
![src=./files/hehp/images/HTML_Publish/73382/73382-T_1D.png]()
![src=./files/hehp/images/HTML_Publish/73382/73382-T_1E.png]()
![src=./files/hehp/images/HTML_Publish/73382/73382-T_1F.png]()
![src=./files/hehp/images/HTML_Publish/73382/73382-T_1_G.png]()
![src=./files/hehp/images/HTML_Publish/73382/73382-T_1G.png]()
![src=./files/hehp/images/HTML_Publish/73382/73382-T_1H.png]()
![src=./files/hehp/images/HTML_Publish/73382/73382-T_1I.png]()
Problem-Based Learning
Problem-based learning (PBL) is a learner-centric method emphasizing autonomous learning and teamwork. It involves small groups of five to eight learners, facilitating effective conflict management. PBL enables the integration of different academic disciplines, requiring students to conduct research, combine theory and practice, devise practical solutions to a defined problem, and apply their knowledge and skills. It enables students to synthesize their learning into a cohesive whole [36, 38-40]. PBL helps students to acquire basic knowledge and essential competencies for their professional practice. It fosters the development of analytical and synthetic skills, encourages self-critique and critical evaluation of peers, and enhances oral and written communication abilities [37]. The transversal competencies are identical to different disciplines, including teamwork, communication, leadership, interdisciplinary environment, self-directed learning, lifelong learning, professional growth, and social responsibility [38]. PBL facilitates reflection, research, and group discussion around a problematic situation the teacher-tutor presents. Rather than simply transmitting knowledge, the teacher-tutor encourages learning. The teacher does not seek to solve problems but, on the contrary, uses them to determine learning goals [39]. Applied to physiotherapy, PBL facilitates the acquisition of skills necessary for conducting a comprehensive functional diagnosis, selecting appropriate treatment, engaging in effective peer discussion, promoting metacognition, and taking ownership of learning. Clinical cases utilized in PBL should be open-ended, with difficulty tailored to the student's proficiency, fostering active participation in their learning process [13]. Organizing debates and discussions as part of the learning process strengthens communication skills, promotes knowledge exchange, and facilitates the use of professional vocabulary. A shared language is a powerful tool that facilitates the assimilation of the disciplines addressed and develops the objectives of essential professional knowledge [38, 13]. This innovative methodology enhances skills and strengths, aiding in the reconstruction of the scientific method. Since the students are responsible for their learning process, they demonstrate greater involvement and commitment [41]. For its effective application, it is essential to analyze the context of the problem, brainstorm solutions, make a list of known information and what is needed, solve and define the problem, and finally obtain information [39]. The objectives of PBL in health sciences are to foster reasoning, problem-solving skills, self-directed learning, communication skills, and an in-depth understanding of the concepts. Principles in the curriculum create a more positive attitude among students and improve metacognitive awareness and critical thinking skills compared to lecture-based methods [40-41]. Creating conditions allowing trial and error is essential since reflecting on mistakes often leads to the most profound learning experiences. By empowering learners to take ownership of their learning and structure their knowledge, PBL fosters depth, impact, and lasting understanding [38]. PBL generates positive values, appreciation, and affective moods. It positively influences the achievement of attitudinal competencies [39]. PBL is a pedagogical practice conducive to fostering a more human and critical formation, particularly when implemented as an active teaching method per established guidelines outlined in the literature [43]. The teacher-student relationship within PBL should balance the necessary closeness to build trust and provide mentorship while maintaining appropriate distance to prevent psychological dynamics [38]. Including clinical cases as an educational tool in physical therapy has yielded numerous benefits such as improvements in patient assessment, greater capacity for comprehensive functional diagnosis, goal setting, and choice of appropriate treatment. In addition, utilizing clinical cases improves communication skills and fosters critical thinking, which encompasses self-regulated reflection on emotions, knowledge, behaviors, and the environment in which the individual develops. This reflective process involves skills such as analysis, inference, evaluation, and evidence-based practice. Additionally, clinical cases promote clinical judgment through students' critical reflection; all focused on problem-solving. These various aspects converge to promoting clinical reasoning, improving behavior and teamwork, acquiring clinical skills, and achieving better patient results [13, 42]. It allows students to interpret data and design strategies to be applied in their professional practice [13].
Collaborative or Team-Based Learning
Team-based learning (TBL) is a versatile teaching method based on the socio-constructivist and learner-centered paradigms. Originating in the United States, Larry Michaelsen introduced TBL as an innovative departure from conventional teaching methodologies [21]. It cultivates a collaborative atmosphere aimed at realizing objectives designed by team members alongside educational objectives promoted by the teacher. Despite the integration of technological tools, ABE focuses more on learning contents and concepts, often manifesting in problem-solving scenarios mirroring real-world or daily life challenges [17]. It has been shown to promote significant student learning outcomes, engendering a highlighted active attitude [44]. This is favored in correspondence to the execution of case analysis, group discussion, review of scientific articles, group, and individual papers, use of audiovisual material, participation in forums, and role-playing [18]. Critical thinking plays a pivotal role in structuring reasoned experiences and critically analyzing the cases situated within authentic contexts based on scientific principles [45]. Rivera et al. [46] revealed that groups outperformed individuals, enhanced the integration of skills, and had a high level of group cohesion. Collaborative endeavors foster the sharing of information, knowledge, and solutions. Thereby promoting collaborative relationships among students. This collaborative dynamic fosters a strong peer commitment, favoring mutual learning [47]. The TBL approach catalyzes increased student engagement, encouraging active participation in pre-class reading during lessons. The preparation phase enables teachers to address and focus on learning gaps, while teamwork promotes peer interaction and active participation [48]. Teachers must possess skills such as learning team activities, inspiring discussions within and outside the team, and specializing in the role of the facilitator. They should also provide continuous and timely feedback, focusing on designing team application exercises, modeling collaborative teaching, and facilitating the clinical application of theoretical knowledge [21, 44]. The cultivation of autonomy, critical thinking, and solidarity are encouraged in constructing knowledge and fostering ongoing dialogue among group members.
Inverted classroom
The inverted classroom model represents a pedagogical strategy that redefines the learning processes by shifting a portion of the learning activities outside the classroom. During class sessions, the focus is on leveraging teaching expertise to facilitate and enhance various knowledge acquisition and practical application processes. The transformation of the classroom environment aims to create an interactive and dynamic learning space in which the teacher guides students through practical exercises using questioning techniques and case studies to encourage the inquiry and application of ideas through pre-class video materials. This approach promotes creative participation in the course content [19, 20]. The application of the inverted classroom pedagogical model has been shown to enhance academic performance by providing students with contextualized learning experiences aligned with the demands of their future professions [50]. Therefore, it is essential to integrate healthcare practices based on user-centered clinical reasoning within the context of the prevailing health model. Likewise, these teaching-learning strategies facilitate the development of student autonomy, communication skills, and ethical and humanistic responsibility [51]. In this regard, the flipped classroom approach aims to contextualize the students for the challenges they will face in their future careers. Its influence on learning patterns and techniques of the Proprioceptive Neuromuscular Facilitation-PNF concept supported by short video clips is similar to the traditional methods [51]. It also improves the quality of students' work [50]. Utilizing concise video lectures watched outside the classroom liberates more in-class time for active learning, offering the advantage of easy availability and repeated viewings, considering that students' learning speed may vary [51, 52].
Interprofessional Learning
Interprofessional education (IPE) and collaborative practice can play a pivotal role in moderating various challenges facing healthcare systems worldwide. These initiatives generate greater coordination and continuity of patient care, increase patient satisfaction, and promote collaborative decision-making processes. IPE positively impacts communication skills and cooperative work, facilitating the translation of theoretical knowledge into clinical practice. It provides an important platform for undergraduate students to explore and develop their professional values [22], gaining knowledge and competencies (communication, leadership, patient-centered care, role clarification, teamwork, and disagreement resolution) for teamwork with active patient participation [23]. Team efforts consistently outperform individual efforts. Both current and past attendance is important to team performance, consistent with an IPE program where subsequent sessions build on and extend content presented in previous ones [53]. Students valued their interactions with other students from different professional backgrounds, citing the opportunity to problem solve, receive peer support, and gain insights from various perspectives on patient cases [21-22]. Ideally, IPE should begin early in the trainee's professional career [23]. Most new physical therapy graduates demonstrate confidence in communicating with professionals from diverse backgrounds and understanding their roles, but they often exhibit low self-efficacy levels when faced with interprofessional conflict resolution and when providing feedback to peers [54]. It is recommended that future curricula incorporate IPE to familiarize students with communication, role recognition, and conflict resolution before professional practice [54]. Learning is not a natural or spontaneous process; it requires intentionality, planning, and methodological rigor [55]. The interdisciplinary dialogue within healthcare professions fosters innovative pedagogical practices among teachers. Students appreciate the diversity of professional backgrounds and knowledge among their peers. Their awareness drives students to actively seek out and acquire specific knowledge from disciplines they have not yet encountered [22]. In this perspective, students and faculty collaborate to develop integrated products each semester, which materialize from the partnership established with the unit's Health Team [55].
Service Learning Training Practice
Formative Practice (FP) is where the students link the knowledge, abilities, and skills obtained in the elementary level of training with the experiences acquired in practice through the different areas of professional training [24]. It is focused on facilitating learning and enhancing professional competencies, where practical aspects are prepared using techniques that effectively connect theory with practice, thereby becoming a crucial component of professional development. The evaluation of the Practicum emphasizes the assessment of the practical phase, integrating considerations of both human and ethical competencies [39]. Among the essential qualities assuming responsibility, demons
This study is focused on identifying successful practices in the teaching-learning of physiotherapy. The practices integral to professional training transcend mere theoretical knowledge and content delivery. They serve as conduits for bridging theory with practice, enabling students to concretely apply competencies, skills, and abilities in real-world scenarios. Students gain firsthand experience in the complexities of patient care, honing their conceptual, methodological, and ethical acumen by engaging in these practices [1, 2]. Active methodologies focused on the learner take precedence over traditional content-centric approaches, challenging long-standing orthodox teaching paradigms in physiotherapy education. This shift redefines the role of the teacher as a mediator, facilitator, and guide, fostering active engagement, collaborative interactions, creativity, critical thinking, and reflective practice. The didactic strategies are tailored to address real-world challenges, encouraging problem-solving and application-oriented learning [3-5]. This approach aligns with a constructivist point of view wherein the learning and evaluation process is viewed as dynamic and contextually situated [6, 7]. Multiple studies have left evidence of implementing such practices.
The advancement of science is in permanent transformation every day, demanding methods that empower students to develop abilities that allow autonomous learning and critical and reflective thinking. However, higher education systems in health disciplines, especially physiotherapy, are still dominated by traditional teacher-centric approaches. These methods typically entail one-way content delivery and rote memorization, relegating students to passive receivers. Therefore, such methodologies fail to equip learners with the necessary tools to navigate the complexities of real-world professional scenarios [7, 8]. Teaching in physiotherapy requires practical engagement with patients to develop professional competencies. While online instruction and simulation can facilitate certain practical skills, they cannot fully substitute direct patient interaction [1, 9]. Therefore, it is essential to resort to active and dynamic methodologies so that the student is the architect of their knowledge and skills development.
This study addresses the different didactic and methodological strategies of a practical and dynamic nature developed in physiotherapy and distributed in 7 thematic blocks. Based on socioconstructivist principles [5], the students' active and collaborative participation takes precedence. They reject rote memorization in favor of developing creativity, critical reflection, and problem-solving skills. Among these methodologies is clinical case resolution, which facilitates skill development, critical thinking, synthesis, and inference-making, preparing students to tackle academic and clinical challenges [3].
In the second order, we consider simulation-based learning, which reproduces real clinical experiences through simulated scenarios, creating a safe environment conducive to enhancing the learners' technical skills and cognitive processes, including information analysis, clinical decision-making, self-efficacy, communication skills, and multidisciplinary development [10, 11]. Moreover, this approach improves professional behavioral competencies, communication, patient assessment, therapeutic analysis and design, intervention, evidence-based practice, and risk management compared to traditional methods [12].
Third, problem-based learning promotes active learning through problem-solving. It is initiated by presenting problems for the students to solve. By investigating potential solution alternatives, students acquire new knowledge that is gradually integrated into their cognitive frameworks, preparing them to address real-life professional challenges [13]. For this reason, PBL contributes to autonomous learning, teamwork, interpersonal skills, and the promotion of values and attitudes [7]. Case-based learning or case studies analysis facilitates learning through dissecting real or simulated cases. It involves interpreting the case, formulating hypotheses, investigating information and data, their comparison to test hypotheses, and proposing possible alternative solutions [7, 14, 15]. Project-based learning empowers students, overcoming their positions as passive recipients of content the teacher develops in the classroom. Through project execution, the learner engages in inquiry processes to resolve identified problems, necessitating acquiring knowledge and skills for planning, designing, organizing, and implementing activities and tasks while gaining new insights [7, 15].
In the fourth order, team-based learning seeks to achieve significant learning for students through collaborative work. Students are organized into teams committed to achieving predefined objectives, where each member holds responsibility for their learning and that of their peers [16-17]. This requires implementing case analysis, group discussion, scientific article review, group and individual assignments, audiovisual materials, participation in forums, and role-playing activities [18].
Fifth, the Inverted Classroom is a model that disrupts the sequence of a traditional class. It requires prior preparation of students through the study and investigation of data autonomously of the contents to be developed, which must be socialized before the class session using printed materials, audiovisual media, and ICT supportive activities. Subsequently, the activities are centered around applying the previously obtained knowledge [19-20].
Sixth, interprofessional education (IPE) positively impacts communication skills and cooperative work, as it facilitates the clinical application of theoretical knowledge [21]. IPE facilitates the development of professional values [22] and favors communication, leadership, patient-centered care, role clarification, teamwork, and conflict resolution [23].
Finally, we have service-learning (A+S), which is rooted in community action and involves applying knowledge and skills (such as communication, leadership, patient-centered care, role clarification, teamwork, and resolution of disagreements) to address [24]. It generates motivation to obtain new knowledge and skills while also contributing to developing civic values among students, such as a sense of community, solidarity, and civic responsibility [7].
This study aimed to explain how successful practices contribute to the teaching and learning of physiotherapy.
Information and Methods
This study used a literature review methodology involving a systematic process to minimize biases and random errors. Its objectives were to synthesize the most relevant recent scientific knowledge on a topic, seek high methodological standards in its development, incorporate primary or original studies on the same topic, and seek to consolidate current knowledge [25-26]. As an essential point, this study corresponds to a qualitative approach characterized by its capacity to comprehend unique realities that are difficult to understand through a singular perspective. It serves as an interdisciplinary and transdisciplinary field, employing methods that involve the interrelation between the researcher and the research subjects for data collection, analysis, and validation [27]. In this research, 80 articles were analyzed in the literature concerning successful practices contributing to the teaching and learning of physical therapy between 2014-2022. Following the conclusion of the information search, a validation and reliability assessment was conducted to ensure the suitability and relevance of the selected material to the research problem (Figure 1).
The references encompassed both national and international literature. To comprehensively explore the subject matter, multiple databases were utilized, including Scopus (n=10), SciELO (n=9), ResearchGate (n=2), Latindex (n=4), Google Scholar (n=4), Dialnet (n=4), ClinicalKey (n=2), Springer (n=2), DOAJ (n=2), Redalyc (n=2), ERIC (n=2), OJS (n=2), Elsevier (n=1), PubMed (n=1), IDUNN (n=1), and TORROSA (n=1). The search strategies used to compile the information were by author, subject, keywords, bibliographic references, search tricks, and Boolean operators such as AND and OR. Regarding the geographic scope of the selected research, they originate from different countries.
Figure 1. Prisma diagram
Findings
The analysis result of 49 documents were presented in Table 1.
Active methodologies
Learning is gaining knowledge through active engagement, participation, and collaborative interaction between learners and teachers. The subject matter to be learned, the context, teaching methodologies, educational environment, and assessment strategies collectively control the learning approach adopted by the learner [3]. Active methodologies prioritize the learner as an active participant in the teaching-learning process. This pedagogical conception is constructivist, as it involves constructing knowledge based on the student's experience [5]. Among them are resolving clinical cases, inverted classrooms, role-playing, service-learning, and peer tutoring [5]. Throughout the training process, several elements were identified as facilitators of learning, including encouraging dialogue in the classroom, incorporating active pauses for students, providing various tools (in addition to clinical cases), telling stories and different clinical experiences, utilizing imagery to generate emotions and facilitating the enjoyment for both students and teachers [5]. Physical therapy education requires implementing learning and teaching methods to foster skills, critical thinking processes, synthesis, and making inferences. Examining learning approaches is critical to preparing physical therapy educators to meet academic and clinical challenges [3]. There is a marked improvement in motivation, metacognition, context mastery, inquiry and choice, and learning strategies and approaches [28]. Learners who perceive classroom sessions as more interactive and dynamic and incorporate diverse strategies tend to have a more positive perception of their learning experience [16]. During the clinical years, teaching methods often involve clinical and community-based learning. This includes clinical-based learning with practice on patients in real situations to learn new skills. The basic knowledge acquired in the preclinical years is applied to medical conditions during the clinical years. In the clinical phase, more emphasis is placed on the problem-based learning method, which plays a pivotal role in developing deep learning. The deep learning process enhances critical thinking and promotes personal development among students.
Deep processing of knowledge and skills is essential in the clinical phase to formulate rational hypotheses and patient management plans [2-3]. Receiving timely feedback regarding learners' understanding of a particular topic equips them with tools. It fosters incremental learning of concepts, clarifying fundamental aspects essential for grasping corresponding practices and contributing to acquiring professional competencies in physical therapy [28]. During the clinical phase, teaching methods primarily encompass clinical and community-based learning. It includes case-based learning with practice on patients in real situations to learn new skills. There is a significant emphasis on the Problem-Based Learning Method, which primarily fosters deep learning. The deep learning process enhances critical thinking and personal development among learners through analytical observation, novel problem-solving, or teamwork. This deep processing of knowledge and skills is essential in the clinical phase, enabling students to formulate rational hypotheses and develop patient management plans [29-32, 3].
Simulation in physiotherapy
The simulation-based learning model aims to reproduce real clinical experiences through simulated scenarios by creating a safe environment that facilitates learners to increase technical skills and cognitive processes, also known as non-technical skills, including information analysis, clinical decision-making, self-efficacy, communication skills, and multidisciplinary development [10-11]. Studies have demonstrated that simulation improves professional behavioral competencies, communication, patient assessment, therapeutic analysis and design, intervention, evidence-based practice, and risk management compared to traditional methods [12]. Therefore, simulated practice in physiotherapy involves two phases: a planning phase and an execution phase. During these phases, physiotherapeutic care is provided, incorporating factors such as anamnesis, application of the test and measurements, explanation of the evaluation, physiotherapeutic diagnosis, prognosis, and treatment planning [33]. This approach enhances knowledge retention and skill acquisition compared to traditional methods.
Simulation practice has demonstrated its effectiveness in enhancing high-level skills across several areas, such as clinical skills, self-confidence, performance, safety, and decision-making during the professional reasoning process in clinical practice [11, 34-35].
Table 1. The research attributes of the studied articles
Problem-Based Learning
Problem-based learning (PBL) is a learner-centric method emphasizing autonomous learning and teamwork. It involves small groups of five to eight learners, facilitating effective conflict management. PBL enables the integration of different academic disciplines, requiring students to conduct research, combine theory and practice, devise practical solutions to a defined problem, and apply their knowledge and skills. It enables students to synthesize their learning into a cohesive whole [36, 38-40]. PBL helps students to acquire basic knowledge and essential competencies for their professional practice. It fosters the development of analytical and synthetic skills, encourages self-critique and critical evaluation of peers, and enhances oral and written communication abilities [37]. The transversal competencies are identical to different disciplines, including teamwork, communication, leadership, interdisciplinary environment, self-directed learning, lifelong learning, professional growth, and social responsibility [38]. PBL facilitates reflection, research, and group discussion around a problematic situation the teacher-tutor presents. Rather than simply transmitting knowledge, the teacher-tutor encourages learning. The teacher does not seek to solve problems but, on the contrary, uses them to determine learning goals [39]. Applied to physiotherapy, PBL facilitates the acquisition of skills necessary for conducting a comprehensive functional diagnosis, selecting appropriate treatment, engaging in effective peer discussion, promoting metacognition, and taking ownership of learning. Clinical cases utilized in PBL should be open-ended, with difficulty tailored to the student's proficiency, fostering active participation in their learning process [13]. Organizing debates and discussions as part of the learning process strengthens communication skills, promotes knowledge exchange, and facilitates the use of professional vocabulary. A shared language is a powerful tool that facilitates the assimilation of the disciplines addressed and develops the objectives of essential professional knowledge [38, 13]. This innovative methodology enhances skills and strengths, aiding in the reconstruction of the scientific method. Since the students are responsible for their learning process, they demonstrate greater involvement and commitment [41]. For its effective application, it is essential to analyze the context of the problem, brainstorm solutions, make a list of known information and what is needed, solve and define the problem, and finally obtain information [39]. The objectives of PBL in health sciences are to foster reasoning, problem-solving skills, self-directed learning, communication skills, and an in-depth understanding of the concepts. Principles in the curriculum create a more positive attitude among students and improve metacognitive awareness and critical thinking skills compared to lecture-based methods [40-41]. Creating conditions allowing trial and error is essential since reflecting on mistakes often leads to the most profound learning experiences. By empowering learners to take ownership of their learning and structure their knowledge, PBL fosters depth, impact, and lasting understanding [38]. PBL generates positive values, appreciation, and affective moods. It positively influences the achievement of attitudinal competencies [39]. PBL is a pedagogical practice conducive to fostering a more human and critical formation, particularly when implemented as an active teaching method per established guidelines outlined in the literature [43]. The teacher-student relationship within PBL should balance the necessary closeness to build trust and provide mentorship while maintaining appropriate distance to prevent psychological dynamics [38]. Including clinical cases as an educational tool in physical therapy has yielded numerous benefits such as improvements in patient assessment, greater capacity for comprehensive functional diagnosis, goal setting, and choice of appropriate treatment. In addition, utilizing clinical cases improves communication skills and fosters critical thinking, which encompasses self-regulated reflection on emotions, knowledge, behaviors, and the environment in which the individual develops. This reflective process involves skills such as analysis, inference, evaluation, and evidence-based practice. Additionally, clinical cases promote clinical judgment through students' critical reflection; all focused on problem-solving. These various aspects converge to promoting clinical reasoning, improving behavior and teamwork, acquiring clinical skills, and achieving better patient results [13, 42]. It allows students to interpret data and design strategies to be applied in their professional practice [13].
Collaborative or Team-Based Learning
Team-based learning (TBL) is a versatile teaching method based on the socio-constructivist and learner-centered paradigms. Originating in the United States, Larry Michaelsen introduced TBL as an innovative departure from conventional teaching methodologies [21]. It cultivates a collaborative atmosphere aimed at realizing objectives designed by team members alongside educational objectives promoted by the teacher. Despite the integration of technological tools, ABE focuses more on learning contents and concepts, often manifesting in problem-solving scenarios mirroring real-world or daily life challenges [17]. It has been shown to promote significant student learning outcomes, engendering a highlighted active attitude [44]. This is favored in correspondence to the execution of case analysis, group discussion, review of scientific articles, group, and individual papers, use of audiovisual material, participation in forums, and role-playing [18]. Critical thinking plays a pivotal role in structuring reasoned experiences and critically analyzing the cases situated within authentic contexts based on scientific principles [45]. Rivera et al. [46] revealed that groups outperformed individuals, enhanced the integration of skills, and had a high level of group cohesion. Collaborative endeavors foster the sharing of information, knowledge, and solutions. Thereby promoting collaborative relationships among students. This collaborative dynamic fosters a strong peer commitment, favoring mutual learning [47]. The TBL approach catalyzes increased student engagement, encouraging active participation in pre-class reading during lessons. The preparation phase enables teachers to address and focus on learning gaps, while teamwork promotes peer interaction and active participation [48]. Teachers must possess skills such as learning team activities, inspiring discussions within and outside the team, and specializing in the role of the facilitator. They should also provide continuous and timely feedback, focusing on designing team application exercises, modeling collaborative teaching, and facilitating the clinical application of theoretical knowledge [21, 44]. The cultivation of autonomy, critical thinking, and solidarity are encouraged in constructing knowledge and fostering ongoing dialogue among group members.
Inverted classroom
The inverted classroom model represents a pedagogical strategy that redefines the learning processes by shifting a portion of the learning activities outside the classroom. During class sessions, the focus is on leveraging teaching expertise to facilitate and enhance various knowledge acquisition and practical application processes. The transformation of the classroom environment aims to create an interactive and dynamic learning space in which the teacher guides students through practical exercises using questioning techniques and case studies to encourage the inquiry and application of ideas through pre-class video materials. This approach promotes creative participation in the course content [19, 20]. The application of the inverted classroom pedagogical model has been shown to enhance academic performance by providing students with contextualized learning experiences aligned with the demands of their future professions [50]. Therefore, it is essential to integrate healthcare practices based on user-centered clinical reasoning within the context of the prevailing health model. Likewise, these teaching-learning strategies facilitate the development of student autonomy, communication skills, and ethical and humanistic responsibility [51]. In this regard, the flipped classroom approach aims to contextualize the students for the challenges they will face in their future careers. Its influence on learning patterns and techniques of the Proprioceptive Neuromuscular Facilitation-PNF concept supported by short video clips is similar to the traditional methods [51]. It also improves the quality of students' work [50]. Utilizing concise video lectures watched outside the classroom liberates more in-class time for active learning, offering the advantage of easy availability and repeated viewings, considering that students' learning speed may vary [51, 52].
Interprofessional Learning
Interprofessional education (IPE) and collaborative practice can play a pivotal role in moderating various challenges facing healthcare systems worldwide. These initiatives generate greater coordination and continuity of patient care, increase patient satisfaction, and promote collaborative decision-making processes. IPE positively impacts communication skills and cooperative work, facilitating the translation of theoretical knowledge into clinical practice. It provides an important platform for undergraduate students to explore and develop their professional values [22], gaining knowledge and competencies (communication, leadership, patient-centered care, role clarification, teamwork, and disagreement resolution) for teamwork with active patient participation [23]. Team efforts consistently outperform individual efforts. Both current and past attendance is important to team performance, consistent with an IPE program where subsequent sessions build on and extend content presented in previous ones [53]. Students valued their interactions with other students from different professional backgrounds, citing the opportunity to problem solve, receive peer support, and gain insights from various perspectives on patient cases [21-22]. Ideally, IPE should begin early in the trainee's professional career [23]. Most new physical therapy graduates demonstrate confidence in communicating with professionals from diverse backgrounds and understanding their roles, but they often exhibit low self-efficacy levels when faced with interprofessional conflict resolution and when providing feedback to peers [54]. It is recommended that future curricula incorporate IPE to familiarize students with communication, role recognition, and conflict resolution before professional practice [54]. Learning is not a natural or spontaneous process; it requires intentionality, planning, and methodological rigor [55]. The interdisciplinary dialogue within healthcare professions fosters innovative pedagogical practices among teachers. Students appreciate the diversity of professional backgrounds and knowledge among their peers. Their awareness drives students to actively seek out and acquire specific knowledge from disciplines they have not yet encountered [22]. In this perspective, students and faculty collaborate to develop integrated products each semester, which materialize from the partnership established with the unit's Health Team [55].
Service Learning Training Practice
Formative Practice (FP) is where the students link the knowledge, abilities, and skills obtained in the elementary level of training with the experiences acquired in practice through the different areas of professional training [24]. It is focused on facilitating learning and enhancing professional competencies, where practical aspects are prepared using techniques that effectively connect theory with practice, thereby becoming a crucial component of professional development. The evaluation of the Practicum emphasizes the assessment of the practical phase, integrating considerations of both human and ethical competencies [39]. Among the essential qualities assuming responsibility, demons