As per National Commission for Allied and Healthcare Professions
Scope and need for Physiotherapy professionals in the Indian Healthcare system
The quality of medical care has improved tremendously in the last few decades due to the advances in technology, thus creating fresh challenges in the field of healthcare. It is now widely recognized that health service delivery is rapidly shifting to patient centric model with a multi-disciplinary team approach involving both clinicians and non- clinicians. As the country faces an increasing prevalence of chronic diseases, aging population, and rise in the life-style related ailments, the demand for rehabilitative and therapeutic services in surging. Physiotherapists play a crucial role in improving the quality of life for patients and are essential in promoting mobility, pain management, and functional independence, thereby also reducing the burden on medical and surgical treatments.
As the Indian government strives towards Universal Health Coverage and expansion of healthcare infrastructure including hospitals, clinics, wellness centres, academic institutions etc., physiotherapists have a major role to play and their expertise is vital in multi disciplinary healthcare teams across different levels of healthcare delivery system contributing to comprehensive patient care. Many examples assert the need of skilled and competent physiotherapists in the system such as the National guidelines for prevention and management of stroke highlights the that physiotherapists significantly enhance management and early return to normal life for stroke survivors. The increasing awareness about the preventive healthcare and importance of physical well-being further amplifies the demand the Physiotherapy services in rural and urban settings alike. Several other examples include people of all age groups with mobility difficulties, sports persons, pregnant women, persons with soft tissue injuries, post-surgical cases, patients with cardiac and pulmonary ailments, the elderly, cancer patients, patients with chronic conditions such as diabetes people with neuropathic pain and amputees, and those suffering from other lifestyle disorders; the list of people and potential patients who benefit from Physiotherapy is indefinite. Thus, the breadth and scope of the Physiotherapy practice varies from one end to another, including areas of work listed below:
Across the age span of human development from neonate to old age;
With patients having complex and challenging physical dysfunction/ problems resulting from systemic illnesses, diseases, disorders or trauma
Towards health promotion and disease prevention
Assessment, diagnosis, management and evaluation of interventions and protocols for treatment; "Curriculum Handbook of Physiotherapy (Intellectual Property of the National Commission for Allied and Healthcare Professions, Ministry of Health and Family Welfare).”
In a broad range of settings, from a patient's home to community, Healthcare facilities including those in the educational institutions and corporate/industrial set up, primary care centers, to tertiary care settings; and
With an understanding of the healthcare issues associated with diverse socio economies and cultural norms within the society. The detailed scope is mentioned in Chapter 8.
Learning goals and objectives for Physiotherapy professionals The handbook has been designed with a focus on performance-based outcomes pertaining to different levels of education program. The learning goals and objectives of the undergraduate and post-graduate education program will be based on performance expectations. They will be articulated as learning goals (why we teach this) and learning objectives (what the students will learn). Using the framework, students will learn to integrate their knowledge, skills and abilities in a hands-on manner in a professional healthcare setting. These learning goals are divided into nine key areas:
Independent Clinical Practice
Communication
Member of a multidisciplinary health team
Ethics and accountability at all levels (clinical, professional, personal and social)
Commitment to professional excellence 1.3.6. Leadership and mentorship
Social accountability and responsibility
Scientific attitude and scholarship (only at higher level-MPT and PhD)
Lifelong learning
Clinical Practice
Using a patient/family centered approach and best evidence, each student will learn to organize and implement the preventive, investigative and management plans; and will offer appropriate follow-up services. Program objectives should enable the students to:
Apply the principles of basic science and evidence-based practice
Develop competency for autonomous practice of Physiotherapy as first-hand practitioners.
Prescribe and use relevant investigations, therapeutic interventions, assistive devices, home and work place modifications, sup- port systems etc. as needed .
Identify the indications of Physiotherapy for various disease, disorders and trauma and manage them in an appropriate manner with physiotherapeutic modalities. "Curriculum Handbook of Physiotherapy (Intellectual Property of the National Commission for Allied and Healthcare Professions, Ministry of Health and Family Welfare).”
Assessment of patients and identifying the need for appropriate referral to other medical specialties.
Provide care to patients – efficiently and in a cost-effective way – in a range of settings, and maintain foremost the interests of individual patientsLifelong learning
Identify the influence of biological, psychosocial, economic, and spiritual factors on patients’ well-being and act in an appropriate manner
Incorporate strategies for certain emergency care, health promotion and disease prevention with their patients
Communication
The student will learn how to communicate with patients/clients, care-givers, other health professionals and other members of the community effectively and appropriately. Communication is a fundamental requirement in the provision of Healthcare services. Program objectives should enable the students to:
Provide sufficient information to ensure that the patient/client can participate as actively as possible and respond appropriately to the information
Clearly discuss the diagnosis with the patient, and decide appropriate treatment plans in a sensitive manner that is in the best interests of the patients and the society in general
Explain the proposed healthcare service – its nature, purpose, possible positive and adverse consequences, its limitations, and reasonable alternatives wherever they exist
Use effective communication skills to gather data and share information including attentive listening, open-ended inquiry, empathy and clarification to ensure understanding
Appropriately communicate with, and provide relevant information to, other stakeholders including members of the healthcare team so that the team prioritizes and continuously refines its communication channels creating an environment of general and specific understanding.
Use communication effectively and flexibly in a manner that is appropriate for the reader or listener
Explore and consider the patient’s ideas, beliefs and expectations during interactions with them, along with varying factors such as age, ethnicity, culture and socioeconomic background
Develop efficient methods for all forms of written and verbal communication including accurate and timely record keeping "Curriculum Handbook of Physiotherapy (Intellectual Property of the National Commission for Allied and Healthcare Professions, Ministry of Health and Family Welfare).”
Assess his/her own communication skills, develop self-awareness and be able to improve his/her relationships with others
Possess skills to counsel for lifestyle changes and advocate health promotion
Membership of a multidisciplinary health team
The student will learn to put a high value on effective communication within the team, including transparency about aims, decisions, uncertainty and mistakes. Team-based Healthcare is the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively to accomplish shared goals within and across settings to achieve coordinated, high quality care. Program objectives will aim at making the students learn to:
Recognise, clearly articulate, understand and support shared goals in the team that reflect patient and family priorities
Possess distinct roles within the team; to have clear expectations for each member’s functions, responsibilities, and accountabilities, which in turn optimises the team’s efficiency and makes it possible for them to use division of labor advantageously, and accomplish more than the sum of its parts
Develop mutual trust within the team to create strong norms of reciprocity and greater opportunities for shared achievement
Communicate effectively so that the team prioritises and continuously refines its communication channels creating an environment of general and specific understanding
Recognise measurable processes and outcomes, so that the individual and team can agree on and implement reliable and timely feedback on successes and failures in both the team’s functioning and the achievement of their goals. These can then be used to track and improve performance immediately and over the time.
Ethics and accountability
Students will understand core concepts of clinical ethics and law so that they may apply these to their practice as physicians. Program objectives should enable the students learn to:
Describe and apply the basic concepts of clinical ethics to actual cases and situations
Recognise the need to make Healthcare resources available to patients fairly, equitably and without bias, discrimination or undue influenc
Demonstrate an understanding and application of basic legal concepts to the practice of Physiotherapy "Curriculum Handbook of Physiotherapy (Intellectual Property of the National Commission for Allied and Healthcare Professions, Ministry of Health and Family Welfare).”
Employ professional accountability for the initiation, maintenance and termination of patient-care provider relationships
Demonstrate respect for each patient's individual rights of autonomy, privacy, and confidentiality
Commitment to professional excellence
The student will execute professionalism to reflect in his/her thought and action through a range of attributes and characteristics that include professional competence, appearance, image, confidence level, empathy, compassion, understanding, patience, manners, verbal and non-verbal communication, an anti-discriminatory and non-judgmental attitude, and appropriate physical contact to ensure safe, effective and expected delivery of healthcare. Program objectives will aim at making the students learn to:
Demonstrate distinctive, meritorious and high-quality practice that leads to excellence and that depicts commitment to competence, standards, ethical principles and values, within the scope/legal boundaries of practice
Demonstrate the quality of being answerable for all actions and omissions to all, including service users, peers, employers, standard-setting/regulatory bodies or oneself
Demonstrate humanity in the course of everyday practice by virtue of having respect (and dignity), compassion, empathy, honour and integrity
Ensure that self-interest does not influence actions or omissions, and demonstrate regards for service-users and colleagues
Leadership and mentorship
The student must learn to take on a leadership role where needed in order to ensure clinical outcomes and patient satisfaction. They must be able to respond in an autonomous and confident manner to predicted and unpredicted situations, and should be able to manage them- selves and with other team members effectively. They must create and maximise opportunities for the improvement of the health seeking experience and delivery of healthcare services. Program objectives should enable the students learn to:
Act as agents of change and be leaders in quality improvement and service development, so that they contribute and enhance peoples' wellbeing and their healthcare experience
Systematically evaluate care; ensure the use of these findings to help improve peoples’ experience and care outcomes, and to shape clinical treatment protocols and services
Identify priorities and effectively manage time and resources to ensure the maintenance or enhancement of the quality of care "Curriculum Handbook of Physiotherapy (Intellectual Property of the National Commission for Allied and Healthcare Professions, Ministry of Health and Family Welfare).”
Recognise and be self-aware of the effect their own values, principles and assumptions may have on their practice. They must take charge of their own personal and professional development and should learn from experience (through supervision, feedback, reflection and evaluation)
Facilitate themselves and others in the development of their competence, by using a range of professional and personal development skills
Work independently and in teams. They must be able to take a leadership role to coordinate, delegate and supervise physiotherapeutic healthcare safely, manage risk and remain accountable for the care given; actively involve and respect others’ contributions to integrated person-centered care; yet work in an effective manner across professional and agency boundaries. They must know when and how to communicate with patients, care givers and if needed, refer them to other professionals and agencies, to respect the choices of service users and others, to promote shared decision-making, to deliver positive outcomes, and to coordinate smooth and effective transition within and between services and agencies.
Social Accountability and Responsibility
The students will recognise that the healthcare professionals need to be advocates within the Healthcare system, to judiciously manage resources and to acknowledge their social accountability6. They have a mandate to serve the community, region and the nation and will hence direct all research and service activities towards addressing their priority health concerns. Program objectives should enable the students learn to:
Demonstrate knowledge of the determinants of health at local, regional and national levels and respond to the population’ health needs
Establish and promote innovative practice patterns by providing evidence-based care and testing new models of practice that will translate the results of research into practice, and thus will meet individual and community needs in a more effective manner
Develop a shared vision of an evolving and sustainable Healthcare system for the future by working in collaboration with and reinforcing partnerships with other stakeholders, including academic health centres, governments, communities and other relevant professional and non-professional organisations.
Advocate for the services and resources needed for optimal patient care "Curriculum Handbook of Physiotherapy (Intellectual Property of the National Commission for Allied and Healthcare Professions, Ministry of Health and Family Welfare).”
Scientific attitude and Scholarship
The student will utilise sound scientific and/or scholarly principles during interactions with patients and peers, educational endeavors, research activities and in all other aspects of their professional lives. Program objectives should enable the students to:
Engage in ongoing self-assessment and structure their continuing professional education to address the specific needs of the population
Practice evidence-based practice by applying principles of scientific methods
Takes responsibility for their educational experiences 1.3.8.4. Acquire basic skills such as presentation skills, giving feedback, patient education and the design & dissemination of research knowledge; for their application to teaching encounters.
Develop a research question and be familiar with basic, clinical and translational research in its application to patient care
Lifelong learning
The student will learn to be committed to continuous improvement in skills and knowledge while harnessing modern tools and technology. Program objectives will aim at making the students being able to:
Perform objective self-assessments of their knowledge and skills; learn and refine existing skills; and acquire new skills
Apply newly gained knowledge or skills to patient care
Enhance their personal and professional growth and learning by constant introspection, mentor’s guidance and by utilizing experiences
Search (including through electronic means), and critically evaluate medical literature to enable its application to patient care
Identify and select an appropriate, professionally rewarding and personally fulfilling career pathway.
