What was the activity?
The initial prompt for this project was the desire by physiotherapy students from black and minority ethnic groups, through their own student testimonies, to be heard by the profession. These testimonies were gathered as part of other research (both staff-led and student-led projects) and used to develop an educational tool to be used by physiotherapists working in practice. The ability to meet the students’ requests to make their student voices ‘heard’ in a meaningful way is considered to be a success in improving awareness and skills to manage racism in physiotherapy practice.
Physiotherapy remains a predominantly white female profession (Bithell, 2007; Hammond, 2009). Current professional demographic information reports that 75% of qualified physiotherapists and 61% of student members are female with only 8% of qualified members describing their ethnicity as from a Black or Minority Ethnic (BAME) population (CSP, 2019), compared to 14% of the general population of England and Wales (GOV.UK, 2018).
Previous work in physiotherapy reflects an attainment gap, prevalent in higher education more broadly (Norris et al 2017), with reports of prejudice towards students from a diverse background within the physiotherapy profession (Hammond et al., 2019, Norris et al., 2020). Due to the most notable imbalance in attainment in practice, this project focused on developing a resource for physiotherapy practice educators to promote awareness and reflection on racism, inequality and unacceptable behaviours within the physiotherapy practice environment which significantly impact students from diverse ethnic groups in attainment, through negative judgement and a reduced sense of belonging (Norris et al., 2017; Hammond et al., 2019). Students have highlighted a desire and a need to be included in developments to challenge current hegemony, particularly in relation to race (Hammond et al., 2019).
This project was funded by Health Education England (HEE) through four Universities: Oxford Brookes University, Brunel University London, St George’s University of London and Buckinghamshire New University. The project started in February 2021 and was completed in October 2022. An initial scoping event (an evening webinar) was held in February 2021 with interested stakeholders to share details of the project and invite contributions and advice.
The training resource was co-produced with a collaborative group of ten individuals (five qualified physiotherapists and five student physiotherapists). A summary of the key steps follows.
- Following ethics committee advice, students were invited to consent for their testimonies from these projects to be shared with the project team. Participants were offered a voucher to recognise their contribution.
- Development of a brief outline and aims for the project.
- Creation and sending of an advertisement for co-creators to join project group via the naitonal journal, Physiotherapy.
- Recruitment of a group to help co-create the training resource, including five physiotherapy students and five practice educators from individuals who self-identify as from a BAME background.
- Five meetings of the co-creators group November 2021 to September 2022 with discussions to consider learning outcomes, content, format, selection of testimonials, self-reflection, interactive aspects and other resources, and reflection on pilot evaluation.
- Video recordings of the selected student testimonials by Tamasha – a theatre company that aims to nurture talent for emerging and established artists from the Global Majority.
- Development and refinement of learning resource materials. The final project included individual video testimonials that presented the students’ voices and gave clinical physiotherapists insight into the lived experience by physiotherapy students from black and minority ethnic populations. Each testimonial was supported by a worksheet offering both group and individual learning and reflective activities to challenge thinking and behaviour with respect to the particular subject matter of the testimonial. The tool is flexible to allow each facilitator to support delivery of a selection of testimonials as is best suited to a particular practice environment.
By October 2022, the training resource had been delivered online and face-to-face to 19 qualified physiotherapists, on two occasions, as part of the pilot. The project evaluation was planned by the project team and implemented to assess impact and covers affect, knowledge and strategies for practice.
How did it impact students?
Pilot data gathered (through pre and post training questionnaires and focus groups ) from physiotherapy educators who completed the pilot training is suggests a positive improvement in awareness and understanding of racism in the workplace, in addition to improved confidence in responding to it. The post-training focus groups captured their key reflections and perceived development related to the training. The responses were coded and developed into three themes as follows.
- Developing an understanding of microaggressions – participants talked about different ways that the training had developed their understanding of microaggressions as compared to overt racism.
- Recognising the impact of racism and microaggressions on students captured descriptions of the impact on the student, particularly in terms of the student’s feelings and sense of belonging.
- The challenges of finding space and time to have conversations about race and knowing what to do reflected the particular nuances of the practice environment that can make it difficult to know what to do. For instance, the student is part of the team, but not employed by the organisation.
These findings highlight the impact of the practice tool in improving awareness and confidence in addressing racism and microaggressions in practice.
This project has allowed student voices to be truly heard. The development of this educational tool, based on experiences as lived by physiotherapy students will enable educators to support marginalised students more adequately. While in recent months, there has been a proliferation of tools and resources for addressing racism (for example, the European Network Against Racism toolkits and The Anti-racism toolkit, University of Leeds), the specific nature of the physiotherapy practice environment requires a response that is specific to this context. This project is a response to that call.
Any advice for others?
Through this project we experienced overwhelming positivity of co creation and working with colleagues and students who have lived experience of racism within physiotherapy. Conversations around racism and allyship are constantly changing and we designed this tool to support team and group working and we do not feel that this is an appropriate resource to be used independently or in isolation. There is ongoing discussion about facilitation of this teaching and the need for expertise in practice education or racism. This educational tool has been developed for physiotherapy practice educators but may be suitable for use in related professional fields.
Any other contextual details?
Widening participation (WP) in higher education has been a strategic objective of the Department for Education and Skills since 2003, supported by the Office for Fair Access (2012). This includes promoting the effective recruitment, retention and progression of students who have historically been under-represented in higher education institutions including those from socio-economically deprived backgrounds, BAME backgrounds and from families with no history of higher education (Connor, Tyres, Modood and Hillage 2004). Such an aspiration has relevance for pre-registration physiotherapy programmes. Following the death of George Floyd, there has been increased global attention on systemic racism. These concerns have been demonstrated within the education of physiotherapy students in the UK.
Bithell, C. (2007) ‘Entry-level physiotherapy education in the United Kingdom: governance and curriculum’, Physical Therapy Reviews, 12(2), pp. 145-55. https://doi.org/10.1179/108331907X175041
Connor, H., Tyres, C., Modood, T and Hillage, J. (2004) Why the difference? A closer look at higher education minority ethnic students and graduates. DfES.
CSP (2019) Annual Quality Review 2017/18 preregistration education. CSP: London.
Department of Education and Skills (2003) The Future of Higher Education. Norwich: DfES.
Hammond, J.A. (2009) ‘Assessment of clinical components of physiotherapy undergraduate education: are there any issues with gender?’ Physiotherapy 95(4), pp. 266-272. https://doi.org/10.1016/j.physio.2009.06.003
Hammond, J.A, Norris, M., Williams, A. and Walker, S. (2019) ‘Working hard to belong: a qualitative study exploring students from black, Asian and minority ethnic backgrounds experiences of pre-registration physiotherapy education’, BMC Medical Education, 19(372). https://doi.org/10.1186/s12909-019-1821-6
Norris, M., Hammond, J.A., Williams, A. Walker, S (2020) ‘Students with specific learning disabilities experiences of pre-registration physiotherapy education: a qualitative study’, BMC Medical Education, 20(2) https://doi:10.1186/s12909-019-1913-3
Norris, M., Hammond, J.A, Williams, A., Grant, R., Naylor, S. and Rozario, C. (2017) ‘Individual student characteristics and attainment in pre-registration physiotherapy: a retrospective multisite cohort study’, Physiotherapy, 104(4), pp. 446-452 https://doi.org/10.1016/j.hysio.2017.10.006