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A descriptive study of occupational and physical therapists in British Columbia McGregor, Louise 1975

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A DESCRIPTIVE STUDY OF OCCUPATIONAL AND PHYSICAL THERAPISTS IN BRITISH. COLUMBIA by LOUISE MCGREGOR B.A., The University of British Columbia, 1968 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in. the Faculty of Education We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA August, 1975 In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f the r e q u i r e m e n t s f o r an advanced degree at the U n i v e r s i t y o f B r i t i s h C o lumbia, I agree t h a t the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and stud y . I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y p u rposes may be g r a n t e d by the Head o f my Department o r by h i s r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . Department o f ~C TDUL c <~\T/ c <Q T h e - U n i v e r s i t y o f B r i t i s h Columbia 20 75 Wesbr'ook P l a c e Vancouver, Canada V6T 1W5 Date DtzT- £«id'. I°t >5 ABSTRACT In order to plan appropriate educational a c t i v i t i e s for occupa-tional and physical therapists baseline data are required. For this de-scriptive study a twenty percent random sample of therapists in Br i t i s h Columbia was surveyed. Their demographic, educational, employment and professional characteristics as well as their future educational and employment goals were investigated and compared. Participation i n various types of learning a c t i v i t i e s , formal and informal, and the deterrents to participation in continuing education were considered. A check l i s t of perceived learning needs was categorized and rank ordered. A factor anal-ysis and a mean rating on thirty selected statements of opinion were re-ported. Few significant differences were found between the occupational therapists and the physical therapists. The majority of both resided and worked in the greater Vancouver area and were female between 25 and 29 years of age. Most of the therapists graduated with a diploma and had attended university. The Canadian schools accounted for about 60.0 per-cent of the graduates and the Br i t i s h schools for 25.0 percent. Over 65.0 percent were working in a hospital or rehabilitation center and more than 60.0 percent were dealing with patients who were at the acute or rehabili-tation level of care. Approximately 20.0 percent had been in their present position for over six years. It was found that most available in-service educational a c t i v i t i e s were well attended. Professional literature was frequently cited as an educational resource. Membership in the professional associations was i i i i i reported by the vast majority, however, meetings and congresses conducted by the associations were not frequently attended. On the average a thera-pist had attended at least one continuing education short course every two years. The major deterrents to participation were lack of suitable courses, lack of financial support and family responsibilities. The most highly favored educational method was the short course, but considerable interest was shown in credit courses as many wished to complete a bacca-laureate degree and about 10.0 percent were considering post graduate studies. Approximately one quarter were interested in attending university f u l l time and over one third wanted c l i n i c a l specialty courses. Specific learning needs when categorized and rank ordered showed a significant difference i n interest between occupational and physical therapists on rehabilitative techniques and human relations s k i l l s , but not on the basic sciences or management of specific conditions. The analysis of opinion about working conditions, education, standards of practice and health care showed general agreement between the two professional groups. Significant differences occurred, however, on items concerned with their professional role and work performance. The physical therapists, although they agreed with the occupational therapists, held a wider range of opinion about these items. It was concluded that every therapist in British Columbia should have the opportunity of continuing their learning through post graduate education; continuing education; In service learning a c t i v i t i e s ; s e l f -directed studies as well as degree completion and re-entry programs. The responsibility for providing these opportunities should be shared by iv governments; health care institutions and agencies; universities; profes-sional associations and the therapists. On-going investigation of real learning needs of therapists and evaluation of the effectiveness of further education on the delivery of health care are required in order to plan for change and the professional growth of occupational and physi-cal therapists. TABLE OF CONTENTS Page ABSTRACT i i LIST OF TABLES v i i i LIST OF FIGURES x ACKNOWLEDGMENTS x i CHAPTER I INTRODUCTION 1 NEED FOR THE STUDY 2 PURPOSES OF THE STUDY 2 METHODS AND PROCEDURES 3 PLAN OF THE STUDY 5 I I REVIEW OF THE LITERATURE 7 NEED FOR CONTINUING EDUCATION 7 PATIENT CARE AND CONTINUING EDUCATION 11 RESPONSIBILITY FOR CONTINUING EDUCATION 12 CHARACTERISTICS OF THERAPISTS 13 LEARNING NEEDS 14 BARRIERS TO CONTINUING EDUCATION 17 SUMMARY 19 I I I CHARACTERISTICS OF OCCUPATIONAL AND PHYSICAL THERAPISTS . 22 GEOGRAPHICAL LOCATION 22 DEMOGRAPHIC CHARACTERISTICS 23 EDUCATIONAL CHARACTERISTICS 25 v v i CHAPTER Page EMPLOYMENT 31 MEMBERSHIP IN THE PROFESSIONAL ASSOCIATIONS 36 FUTURE GOALS 38 EMPLOYMENT GOALS . . . 40 SUMMARY 42 IV FURTHER EDUCATION 45 IN-SERVICE EDUCATION 45 PROFESSIONAL ASSOCIATION MEETINGS AND CONGRESSES . . . 48 SELF-DIRECTED EDUCATION 50 CONTINUING EDUCATION 55 BARRIERS TO PARTICIPATION IN CONTINUING EDUCATION . . . 57 PREFERRED EDUCATIONAL METHODS 59 PREFERRED SCHEDULE 62 PREFERRED EDUCATIONAL MATERIALS 62 SUMMARY 64 V ASSESSMENT OF LEARNING NEEDS 67 BASIC SCIENCES 68 CLINICAL CONDITIONS . 70 REHABILITATIVE TECHNIQUES 72 ADMINISTRATIVE SKILLS 74 HUMAN RELATIONS SKILLS 74 HEALTH CARE DELIVERY SYSTEMS . . . . 76 SUMMARY • 76 VI SELECTED STATEMENTS OF OPINION 79 v i i CHAPTER P a 8 e FACTOR ANALYSIS 82 SUMMARY 87 VII SUMMARY 88 THE LITERATURE REVIEW 88 THE FINDINGS 89 IMPLICATIONS 95 CONCLUSION 99 BIBLIOGRAPHY 100 APPENDIXES 1. Interview Questionnaire 106 2. Letters of Transmittal 129 3. Learning Needs 132 LIST OF TABLES TABLE Page I D i s t r i b u t i o n of Therapists by Location 23 I I D i s t r i b u t i o n of Therapists by Sex, M a r i t a l Status and Age . 24 I I I D i s t r i b u t i o n of Therapists by Year of Graduation 28 IV D i s t r i b u t i o n of Therapists by Country of Graduation . . . . 30 V D i s t r i b u t i o n of Therapists by Job T i t l e 31 VI D i s t r i b u t i o n of Therapists by Employment Agency 32 VII D i s t r i b u t i o n of Therapists by Type of Practice and Level of Care with which They are Primarily Concerned 34 VIII D i s t r i b u t i o n of Therapists by the Number of Years Employed i n Present Position i n B r i t i s h Columbia . . . . 35 IX D i s t r i b u t i o n of Therapists by Career Goals 39 X D i s t r i b u t i o n of Therapists by Educational Goals 41 XI D i s t r i b u t i o n of Therapists by Employment Goals 41 XII D i s t r i b u t i o n of Therapists by Attendance at Association Meetings and Congresses 49 XIII D i s t r i b u t i o n of Therapists by Referral to Professional Literature 51 XIV D i s t r i b u t i o n of Therapists by Number of Professional Books Purchased 53 XV D i s t r i b u t i o n of Therapists by Sources of Information Concerning Patient Care 55 XVI D i s t r i b u t i o n of Therapists by Attendance at Continuing Education Courses 56 XVII Rank Order of Perceived Learning Needs i n the Basic Sciences 69 v i i i ix TABLE Page XVIII Rank Order of Perceived Learning Needs for C l i n i c a l Conditions 71 XIX Rank Order of Perceived Learning Needs for Rehabilitative Techniques 73 XX Rank Order of Perceived Learning Needs for Administrative S k i l l s 75 XXI Rank Order of Perceived Learning Needs for Human Relations S k i l l s 76 XXII Rank Order of Perceived Learning Needs for Health Care Delivery Systems 77 LIST OF FIGURES FIGURE Page 1. Professional Education of Therapists . 26 2. Membership i n Professional Associations 37 3. In-service Educational Activities 47 4. Distribution of Therapists by Journals Read 52 5. Learning Needs met by Continuing Education 57 6. Barriers to Participation in Continuing Education 58 7. Interest of Therapists in Specific Educational Methods . . 60 8. Months of Year Preferred by Therapists for Educational Activities 63 9. Interests of Therapists i n Educational Materials 64 10. Mean Rating of Selected Statements of Opinion by Therapists 80 x ACKNOWLEDGMENTS The author wishes to extend a special word of thanks to the occupational and physical therapists who participated i n this study. The encouragement, interest and assistance of the Faculty, School of Rehabilitation Medicine and many friends i s much appreciated and made the completion of this thesis possible. The guid-ance, counselling and optimism of Dr. J. Thornton i s gratefully acknowledged. x i CHAPTER I INTRODUCTION Traditionally the milieu of the majority of therapists has been the hospital and the rehabilitation center and their prime concern has been the care of the institutionalized patient. This w i l l continue to be the case for many; however, in the future i t is l i k e l y that more ther-apists w i l l be involved in the delivery of health care at the community level. Worthingham (71) writes that "the task of the future is not 'med-icine' in the context that i t provides the basic s c i e n t i f i c research and medical care, but 'health' or the preservation of health by a l l available means." This is echoed by Henderson (33) who believes that "the pro-motion of health is far more important than the care of the sick . . .[as] there i s more to be gained by helping everyman learn to be healthy than by preparing the most skilled therapist for service to those in crises." Therapists of today must not only keep abreast of new knowledge and techniques but also adopt new attitudes about their role in the delivery of health care. To keep pace with the educational requirements thus generated necessitates careful planning. McCreary (46) states that: Defining learning needs is acknowledged as the f i r s t step i n planning an educational activity. Its importance is magnified in continuing education by the heterogenity of learners, the com-plexity of the f i e l d and the rapid obsolescence of knowledge and s k i l l s as a result of the rapid growth of new knowledge from re-search. The inadequacies of the present methods of identifying learning needs are also, generally acknowledged. 1 2 NEED FOR THE STUDY Bier and Murphy (8) i n th e i r study of educational needs and career blockages of occupational therapists suggest that baseline data are needed to assess the present status quo before sophisticated pro-jections can be made for future needs. I t i s therefore relevant at this time i n B r i t i s h Columbia to establish objective demographic, educational and employment data on therapists including t h e i r learning a c t i v i t i e s and future aspirations. In considering the learning needs of therapists i t i s important to look at the changing patterns of health care, the needs of the consumers, and the needs of the professions as w e l l as the many other factors that influence continuing education. Furthermore, i t i s useful to know how therapists f e e l toward t h e i r jobs, t h e i r profession, other professionals and the patients. Learning a c t i v i t i e s offered to therapists should provide them with the opportunity to continue t h e i r education systematically so that the a c q u i s i t i o n of new knowledge, techniques and attitudes i s not l e f t to chance. The contributions that therapists are being asked to make i n the health f i e l d depends on the quality of the education available to them, consequently the a v a i l a b i l i t y of post graduate and continuing educa-tion may wel l affect opportunities for advancement, job s a t i s f a c t i o n , as we l l as job a t t r i t i o n rates. PURPOSES OF THE STUDY The purposes of this study have been l i m i t e d to seeking answers to the following questions: 3 1. What is the demographic, educational and employment profile for practicing therapists in British Columbia? 2. To what extent do therapists participate in educational a c t i v i t i e s , and are they satisfied with these? 3. What are the barriers to participation in continuing pro-fessional education? 4. What are the perceived learning needs of practicing therapists? 5. What are the appropriate ways to deliver learning experiences? 6. What implications does the information collected have for the planning of continuing professional education for occupa-tional therapists and physical therapists? METHODS AND PROCEDURES Sample The population studied included a l l qualified occupational thera-pists (OTs) and chartered physical therapists (PTs) practicing f u l l time or part time i n British Columbia as of May 15, 1972. Those therapists employed f u l l time by the School of Rehabilitation Medicine at The Univer-sity of British Columbia were excluded. The PTs were drawn from the membership l i s t of the Association of Physiotherapists and Massage Practitioners (APMP) dated May 1971 and up-dated to May 1972. To be el i g i b l e to practice in British Columbia PTs must register with the APMP with the exception of Government of Canada employees. Deletions were made on the basis of the inactive membership l i s t ; however, a l l therapists leaving the province do not apply for inactive 4 membership and their names may be retained on the active l i s t . The corrected membership l i s t came to a total of 477. The OTs were drawn from the membership l i s t of the British Columbia Society of Occupational Therapists (BCSOT). Although OTs do not have compulsory licensing there was l i t t l e d i f f i c u l t y i n securing an accurate l i s t of the 107 OTs registered as of May 15th, 1972. Therapists employed in a combined capacity (PT and OT) are to be found on both of the above l i s t s . A 20 percent random sample with replacements was selected from both l i s t s . An i n i t i a l sample of 127 PTs was produced, of these 86 were interviewed. Forty-one persons were not interviewed because: they had l e f t British Columbia; they had retired; they were on holidays; they had transferred to occupational therapy; or they could not be located or con-tacted. A total of 25 OTs were interviewed out of the i n i t i a l sample of 33. Eight therapists were not interviewed because they were not practic-ing; they had l e f t the province; they could not be located; or they had been selected on the physical therapy (PT) sample. The f i n a l sample interviewed consisted of 86 PTs which included four combined PT/OTs and 25 OTs including one combined therapist, 18 per-cent and 23 percent respectively of the total populations. Interview An interview with questionnaire was used (see Appendix 1). The questionnaire consisted of three sections: 1. The f i r s t e l i c i t e d the following data: demographic, pro-fessional employment, basic professional education, continuing 5 education, professional a c t i v i t i e s , future goals and barriers to continuing education. 2. The second covered specific learning needs and levels of interest i n each. 3. The third dealt with selected statements of opinion about therapists' professional ac t i v i t i e s and about continuing education. The instrument was revised several times prior to reaching i t s f i n a l form. It was pre-tested on members of the Faculty of the School of Rehabilitation Medicine, The University of British Columbia, and therapists not in the sample. Two assistants were used to conduct the interviews. In the interest of time, distance, and expense, some interviews were completed by mail and telephone. A l l but 15 of the PTs and 4 of the OTs were interviewed personally. The questionnaire was precoded for keypunching. Univariate and bivariate frequency tables were developed using computer programs at The University of British Columbia. Multivariate analysis was used where appropriate. PLAN OF THE STUDY In Chapter II of the study the relevant literature i s reviewed about continuing education for OTs and PTs and the results of specific studies similar in nature to this one are noted. 6 The demographic, educational, employment and p r o f e s s i o n a l character-i s t i c s of OTs and PTs as w e l l as t h e i r future goals are reported i n Chapter I I I and a p r o f i l e of each group i s drawn up. Further education i s the subject of Chapter IV. This covers con-t i n u i n g education i n c l u d i n g the b a r r i e r s to p a r t i c i p a t i o n as w e l l as s e l f - d i r e c t e d education. The learning needs of therapists are dealt with i n Chapter V. These l e a r n i n g needs are considered under sev e r a l major headings such as Basic Sciences, C l i n i c a l Conditions and R e h a b i l i t a t i v e Techniques. In each group s p e c i f i c l e a r n i n g needs are rank ordered. Chapter VI gives the opinions of therapists about p r o f e s s i o n a l and educational a c t i v i t i e s . The f i n a l chapter concludes with a summary of the data and the implications f o r developing continuing p r o f e s s i o n a l education f o r t h e r a p i s t s . CHAPTER II REVIEW OF THE LITERATURE The review of the literature provides an overview of opinions on continuing professional education currently appearing in the occupa-tional and physical therapy journals. Some of the literature i s applicable to a l l levels of professional education, and is drawn from that of other disciplines in the health sciences when appropriate. Canad-ian literature is scant in respect to continuing education for therapists; however, one would anticipate that an increasing number of articles w i l l appear in the next few years as therapists become more active participants in continuing professional education. NEED FOR CONTINUING EDUCATION The American Physical Therapy Association (APTA) (2) states: Regardless of how well prepared a physical therapist is at the time he enters practice, he has an immediate need for continuing education . . . a need that becomes greater with the passage of time. Yesterday's knowledge i s but the base for tomorrow's growth." Current literature reflects the expressed need of health professionals at a l l levels of practice to be involved in continuing education. The necessity to renew knowledge, to acquire new s k i l l s and attitudes, to cope with change and the fear of obsolescence have been discussed at length by many people (14, 27, 30, 50, 51, 59, 61, 65, 68, 69, 72). 7 8 The need for continuing education emerges from the phenomena of change: change in what is known about man and how he functions in health and i l l n e s s ; change in the way in which people meet the challenge to survive in a dynamic age: and change in the objec-tives, organization, and financing of health services. Professional roles are altered as society changes and as new knowledge and tech-nologies emerge. The individual who wishes to avoid obsolescence cannot leave to chance his acquisition of new knowledge or his a b i l i t y to adapt to changing demands. He must meet the challenge of change actively or the world w i l l pass him by. (68) Change has become a common theme in the literature. Burke (11) and Moore (49) see i t as a way of l i f e for OTs and PTs. These professions are i n a process of transition and they are continuously re-examining their roles in the light of changing times and attitudes toward health care (25, 34, 52, 55, 58, 61, 72). One of the major changes for therapists is the shifting of emphasis from the institution to the community and from illness or crises care to maintenance and prevention (11, 25, 39, 40, 67, 70). Goldin (28) in considering the change in the traditional role of the PT, i n particular their function in the community, sees this as an opportunity to explore and to add a new dimension of activity other than just the treatment of patients. How the profession defines i t s role w i l l determine whether such an expansion i s accepted or rejected. Educational program planning and development must not only keep pace with change, but should anticipate i t . As new roles for therapists are identified, education is capable of f a c i l i t a t i n g desired and planned professional change. There are increasing demands for therapists to act as supervisors, administrators, researchers and teachers; to function as independent professionals; to work in a peer relationship with other pro-fessionals; to move into the community and to serve as consultants and counsellors (28, 49). 9 Senters (61) views physiotherapy as modo.v.itely professionalized and expects professionalization to accelerate in the 70's concomitant with specialization and role refinement and as the demand for physio-therapy services increases. A relationship exists between professionalism and continuing education; however, being a professional does not automati-cally mean an active enthusiastic participant in continuing education (17, 51). Brandenburg (10) in an address to OTs said: In this space age the vocations with status of professions are keenly aware of the need for their members to continue to develop their knowledge and s k i l l s i f they are to stay abreast of recent developments and to be worthy of a profession. Consequently, the gap between educational programs and the practice of the profession must be closed. Continuing education is a means of affecting change as well as coping with i t (17, 27). It must, therefore, "provide for more c l i n i c a l refreshment i f i t i s to help health professionals keep pace with change . . . " (18). It is important that therapists understand and play a role in shaping their own professional destiny for i f they do not assume this responsibility others w i l l do so for them (72). To have a secure future therapists must meet the rapidly changing needs for services (21, 49). They should be prepared to function as a co-worker with the physician and other health professionals (34, 40, 52). They must meet the rising expectations of a knowledgeable public who are demanding the highest quality care at the lowest cost (21, 34, 45, 48, 51, 61). 10 Glass (27) thinks that continuing education must become mandatory for professional personnel, providing for a renewal of training in order to prepare them to meet change. The problems in instituting relicensing procedures are recognized as having great significance for those planning continuing education activities as well as for governments (17, 51, 66). It i s an issue that must be grappled with i n the near future so that de-cisions are not made for the professions but by them. The Committee on the Healing Arts (57) recommended: that a program for ensuring continuing competence be implemented for physiotherapists and that periodically perhaps every five years every physiotherapist in Ontario be required to present . . . a certificate . . . stating that she has maintained a satisfactory level of competence in the practice of physiotherapy. There i s a common concern expressed by Nakamoto (50) , Weimer (65) and Zimmerman (73) that the health industry, which presently ranks third in the United States in terms of the number of people employed, has not yet f u l l y recognized the value of continuing education in developing the s k i l l s needed for the changes expected. Often the programs offered f a i l to achieve the learning and behavioral changes necessary for improved patient care. Continuing education should seek new directions i f existing ac t i v i t i e s are not meeting the needs. Although the case i s not clear, the view i s expressed widely that Continuing Education in the health sciences suffers from a lack of clear purpose, an absence of professional interest and incompetence in the provision and conduct of educational a c t i v i t i e s . There is also a widespread impression that programmes are ad hoc and piece-meal instead of continuing and designed along traditional lines of youth education rather than taking into account that the potential participants are adults (50). 11 Another aspect of continuing education that cannot be ignored is the need for balance between the professional and the l i b e r a l arts courses, required to add meaning, humaneness, perspective and se l f -realization to the lives of every individual (69). A study of the behavior-al sciences can add insight to the understanding of reactions and a t t i -tudes of the patient to health care (51). In discussing the OT of the future Sokolov (62) voices the opinion that a truly educated person w i l l automatically produce a better OT, one who i s concerned with a l l human beings and can find out what the patient needs and desires, and one who w i l l keep on learning. PATIENT CARE AND CONTINUING EDUCATION The ultimate goal of a l l a l l i e d health workers either directly or indirectly i s improved patient care. The patient i s the one central focus of health care covering the total spectrum of services beginning with prevention and ending with rehabilitation or recovery (39, 51). There would then seem to be a need for developing programs in continuing education which centers attention on the patient as well as on procedures and disease (51). Programs for health professionals a l l too frequently have been uniprofessional, primarily concerned with s k i l l s and knowledge, seldom have they been concerned with attitudes toward the patient, col-leagues or other professionals (15, 16, 51). An interprofessional approach i s seen as one means of meeting the needs of the patient and providing quality health care. This approach should be built on the process of inquiry into the nature of patient care 12 i n which the health professionals are j o i n t l y involved. The reactions and attitudes of each profession w i l l be different and together a l t e r the course of treatment. Interprofessional courses may also provide the motivation for each profession to develop and improve i t s own unique q u a l i t i e s (16, 51, 73). RESPONSIBILITY FOR CONTINUING EDUCATION Who bears the r e s p o n s i b i l i t y for continuing professional education? The general opinion i s that i t should be a r e s p o n s i b i l i t y shared between the i n d i v i d u a l , the u n i v e r s i t i e s , the health care i n s t i t u t i o n s as w e l l as the professional associations and the government (31, 35, 50, 65, 68). The in-service education programs of the teaching hospitals must recognize t h e i r r e s p o n s i b i l i t y , e s p e c i a l l y to the new graduate (17, 30). The uni-v e r s i t i e s , having provided a basic education, must be prepared to a s s i s t i n the continued professional growth of the therapist (68). The therapist has a professional and a l e g a l r e s p o n s i b i l i t y to develop her f u l l poten-t i a l and keep up to date (31). I t i s incumbent on the associations, t r a d i t i o n a l l y the source of continuing education through meetings, con-gresses and journals, to expand thei r ro l e beyond these boundaries. The governments, who may demand proof of maintenance of competence, must be prepared to share i n the cost of providing adequate continuing educa-tion (34). 13 CHARACTERISTICS OF THERAPISTS Jantzen's (37) recent study of registered active members of the American Occupational Therapy Association (AOTA) reported data on 6,158 female OTs. Their mean age was 27, with 71.4 percent of the group be-tween 25 and 44 years of age. Flint and Spensley's (26) study of 242 Minnesota OTs found the respondents ranged in age from 23 to 57 with a median age of 32. The median age for those employed was 28. Poole and Kaslow (53) found that the Wisconsin OTs who were employed ranged in age from 21 to 65 with 85 percent between 21 and 45. Predominantly a female profession, the majority of employed OTs were found to be married. Jantzen reported that 96.1 percent were female, while 69.5 percent were married and 25.5 percent were single. Flint and Spensley had similar findings with 96 percent of their sample being female, and 72 percent married. Poole and Kaslow found that 98.3 percent of the OTs employed were women, 66 percent were married and 39 percent were single. Jantzen (38) in her study found that in the 20 to 24 year age group 94.6 percent of the OTs were working while only 49.5 percent of the 35 to 39 year age group were employed. However the median age of employed OTs was found to be 32.4 years of age. Of the single therapists 94.9 percent were working, while 52.9 percent of a l l married OTs were employed. Hightower (34) in a mail survey of 500 active PTs reports that 61 percent were under 35 years of age. The Mountain States (56) study found that two-thirds of the PTs were between 28 and 44 with the average age 14 being about 36. In Ontario most practicing PTs are i n their twenties and thirties (57). Those i n supervisory positions tend to be older. PTs are predominantly female (3). Of the respondents in Hightower's study 30 percent were male. This is a much higher figure than for the Ontario study where the male therapists accounted for approximately 9 percent of the sample. LEARNING NEEDS The key to planning an educational activity i s the identification of learning needs. The APTA (2) sees the determination of subject matter for continuing education programs as a most d i f f i c u l t task and states that "programs should be based for the most part on demonstrated need and wishes of Physical Therapists i n the area." OTs in setting up con-tinuing education programs must take into consideration the process of change occurring within the profession as well as "relationships to other health professionals and to our total society and i t s needs" (72).. Self-determination of one's learning need is important; however, educational need is often determined not by the individual but by the state (51). The nursing profession, with more experience in continuing educa-tion, has not resolved the many d i f f i c u l t i e s that arise when attempting to determine learning needs and set p r i o r i t i e s . However, i t i s essential that this be accomplished. Continuing education is now beginning to be accepted as an equal partner with a l l other levels of education in the lifelong pursuit of professional and personal growth. Some of the factors to be considered in needs' determination are the concern for maintenance J5 of competencies and the problems of relicensure, as well a;.; changes in health care delivery systems, the s h i f t from hospital to the communi ./ type of care, and the increasing emphasis oh prevention. Schweer ({>'>) stresses the need to produce "valid reliable measurement of improved delivery of health services at the patient care level" as indicators; f o r establishing needs and p r i o r i t i e s . She raises a number of " c r i t i c a l issues" in the areas of needs determination. If real needs are to be determined and p r i o r i t i e s established, she emphasizes the necessity for the collection of data from a wide range of sources and the u t i l i z a t i o n of a l l available human resources. McMahon (47) points out the necessity of looking at the needs of the•community and the consumer as well as those of the individual therapist. The voluntary nature of adult learning must be considered as i t leaves the individual with the f i n a l decision about his own learning needs and how to satisfy them. The potential learner must be given the opportunity to indicate the content of the courses he wishes to study (7, 47, 68). On the other hand Bergevin (7) believes that every effort should be made to discover and meet real learning needs, for these "should reveal something necessary that a learner actually lacks and can acquire through a learning experience." Learning needs are largely determined by surveys using a question-naire or interview. Other means include community study, advisory committees, consultation with leaders i n the community, interviewing the consumer, and analyzing c r i t i c a l incidents (8, 47, 54, 68). Interest surveys appear to have "limitations as guides for planning continuing 16 education." Opinion i s only an opinion expressed at one point in time; i t is not a commitment to act (47). Johnson and Ware (41) confirmed this in their follow up study on a 1961 survey of interests carried out for the APTA to ascertain preferences for short courses. It seemed that motivation to study and interest do not necessarily correlate. They con-cluded that "a better method of determining needs of the profession should be developed." In the f i e l d of health care, prediction of future needs whether they be in the area of manpower, technology or professional standards are usually too l i t t l e and too late (41). No published literature on specific need determination for OTs was located and that for PTs is scant. Hightower (34) failed to identify any strong specific learning need for PTs, although "an opportunity to learn specific neurophysiological approaches to treatment represented their greatest perceived educational need." The APTA survey evaluated by Johnson and Ware (41) showed that PTs had an overwhelming preference for continuing education i n the area of the basic sciences principally functional anatomy, neuronatomy, neurophysiology, gross anatomy and physiology, followed by therapeutic exercise. In a pilot study to test the proposition that personnel of PT departments are well prepared for the requirements of their jobs, Heap (32) concluded that there was a need for courses related to teaching, super-vision, administration and interpersonal relationships. The Mountain States (56) study revealed that PTs had an expressed need for courses dealing with rehabilitation, treatment and prevention of heart disease, cancer and stroke in that order. 17 In a study of p r a c t i s i n g OTs i n Kansas, Biers and Murphy (8) found that the one or two week course was rated as being of the greatest importance i n upgrading, followed by the v i s i t i n g c l i n i c a l consultant who exchanged ideas on c l i n i c a l problems. Amongst the PTs of the Mountain States study short term courses, demonstrations, and workshops were highly rated, while the least preferred educational methods were conventions or meetings, and professional books or journals. They i n d i -cated that an increase i n the a v a i l a b i l i t y of educational t e l e v i s i o n and radio, short term trai n i n g programs and programmed i n s t r u c t i o n would be desirable. Hightower (34) found the methods favored, although presently unavailable, were programmed i n s t r u c t i o n , audio tape recordings and records, correspondence courses, motion pictures and t e l e v i s i o n . These methods, when ava i l a b l e , were also selected by nurses (50). Information on i n s t r u c -t i o n a l techniques which appealed to therapists was not found i n the l i t e r a t u r e but nurses wanted lectures, group discussions, f i l m s , handouts, panel discussions and role playing., Physicians preferred the two or three day symposia and rated textbooks and journals as the most valuable means for the transmission of medical information (12). BARRIERS TO CONTINUING EDUCATION Continuing education i s not only costly to the purveyor but comes at a high cost to the p a r t i c i p a n t , who must f o r f e i t some part of his per-sonal l i f e and salary, as w e l l as pay t r a v e l and l i v i n g expenses i n order to attend (34, 56). I t i s therefore apparent that p a r t i c i p a t i o n i n con-tinuing learning a c t i v i t i e s may be enhanced or discouraged by various 18 factors. Hightower (34) found that the barriers for therapists were not significant. The problems, however, of high patient load, no coverage for patient care i n the absence of the therapist, poor timing of educa-tional opportunities and financial loss did present obstacles. Individual problems involved the distance necessary to travel to a course and per-sonal and other family obligations. The Mountain States study ascertained that participation in courses could be enhanced by payment of expenses, no loss in salary, provision for a substitute while absent, programs closer to home, more information about courses and earlier notification of when they were to be scheduled. It was observed, however, that A physical therapist with several additional courses to her credit might possibly improve her eventual chances of promotion but noth-ing is guaranteed. As a result there is l i t t l e incentive to advance and keep up (56). The factors that affect participation in continuing nursing educa-tion programs are the distance to travel, the employment situation, the a v a i l a b i l i t y of counselling and scholarships, the appropriateness of pro-grams and materials, as well as the opportunity to use what is learned. Also cited was an implied criticism that there was a need to learn more. Some nurses f e l t that there was too much emphasis on formal education and that the present day stress on degrees might detract from learning on a continuum. A further factor noted was the conflict in role identity, that is one cannot know what to learn unless one is certain of what one is expected to do. Nakamoto (50) in her extensive review of the nursing literature on continuing education found that family responsibilities were 19 the most important single barrier reported; other factors were time, expense, staff coverage, a v a i l a b i l i t y of courses, distance to travel, and insufficient or inadequate publicity. Barriers to physicians' attendance at continuing education activities in order of frequency were time away from a busy practice, loss of income and travel time. Non-participants, especially surgeons and medical specialists, indicated that they found other sources for getting their information. The general practitioner stated that his primary reason for non-attendance was the amount of time that must be committed to patients (12). SUMMARY A substantial body of literature exists which supports the impor-tance and necessity of continuing education to therapists. It i s seen as a viable method of not only coping with change but in anticipating and affecting change. No evidence was found in the literature to prove whether or not continuing education is necessary for the achievement of better patient care, although that may be implied. The literature stresses the need of therapists for continuing education with some emphasis on courses of an interprofessional nature and those leading to attitudinal change. The recognition and support for continuing education for ther-apists to date has not been overwhelming; the responsibility for changing this i s seen as lying with the universities, governments, health care institutions, professional associations and the individual therapist. 20 Published demographic data on therapists in Canada is not ex-tensive. In general the American studies have found therapists in the labor force to be predominantly female, married, and relatively young. There appears to be an increasing tendency for therapists to remain in the work force after marriage. The perceived learning needs of therapists generally have been ascertained by means of the survey, a method with numerous limitations. Therapists appear to favor short courses. The subject matter of most interest to PTs is the basic sciences and therapeutic exercise. No specific "needs assessment" for OTs have been published. The literature however focuses attention on the need for problem oriented course content centered around the patient. The present and real needs of therapists are s t i l l to be determined, consequently a plan of continuing education for therapists has yet to be developed. Such planning "must consider and act upon current thinking and future trends in our profession, i t s relationship to other health professions, and to our total society and i t s needs" (72). The deterrents to participation in continuing education by thera-pists were not found to be that different from those for other health pro-fessionals. Essentially time, patient coverage, distance, location of the course, cost, family responsibilities, unsuitability of courses and lack of incentive are most commonly cited. There is no doubt that there is a need for continuing education for therapists and that i t should be on-going and offer the opportunity to 2 1 enhance and expand professional and personal growth. There is less certainty as to what i t should consist of and who should be responsible for providing i t . More extensive research, especially in the areas of needs determination and the evaluation of continuing education in light of improved patient care and in maintenance of health is required. CHAPTER III CHARACTERISTICS OF OCCUPATIONAL THERAPISTS AND PHYSICAL THERAPISTS The planning of educational programs for therapists requires a data base from which to work. In this chapter, the geographical location, demographic, educational, employment and professional characteristics of PTs and OTs are discussed. . A profile for each of the two professional groups i s outlined. Reference w i l l be made to findings in other studies and some comparisons made as the data is presented. GEOGRAPHICAL LOCATION Of the 86 PTs and the 25 OTs included i n this study most were located in or near the large urban areas of the province, in particular Vancouver (65.8%) and Victoria/Vancouver Island (18.9%) (Table I). The distribution of therapists may be accounted for in several ways. The larger teaching hospitals and rehabilitation centers which attract and employ many therapists are located in these two urban centers. Therapists, in particular the new graduates, are reluctant to move away from the centers where they consider the best experience may be gained. . Those who choose to work in a small hospital outside of the larger cit i e s do tend to become isolated professionally and personally. The real problem, how-ever, may not be so much a matter of distribution but one of inadequate manpower for there i s a chronic shortage of therapists in the metropolitan areas. 22 23 TABLE I DISTRIBUTION OF THERAPISTS BY LOCATION Location Physical Therapists No. % Occupational Therapists No. % A l l Therapists No. % Victoria; Vancouver Island Vancouver; Lower Mainland Okanagan; Southern Interior Prince George; Northern B.C. TOTAL 15 17.4 55 64.0 9 10.5 7 8.1 6 24.0 18 . 72.0 1 4.0 0 0.0 21 18.9 73 65.8 10 9.0 7 6.3 86 100.0 25 100.0 111 100.0 The small number of OTs working outside of the urban centers (4.0%) may be related to job opportunity, but is more l i k e l y to be a lack of funds to employ an OT or a shortage of OTs to f i l l the positions. DEMOGRAPHIC CHARACTERISTICS Sex The random sample for this study included no male OTs. Amongst the PTs the males accounted for 14.0 percent of the sample (Table II). Traditionally both professions have been predominantly female but with expansion of roles and job opportunities more males are entering both fie l d s , in particular physiotherapy. Marital Status There appears to be a tendency for PTs to remain i n the labor force after marriage, as 59.3 percent of the PTs were married. As for 24 TABLE I I DISTRIBUTION OF THERAPISTS BY SEX, MARITAL STATUS AND AGE Physical Therapists Occupational Therapists A l l Therapists No. % No. % No. % SEX Female 74 86.0 25 100.0 99 89.2 Male 12 14.0 0 0.0 12 10.8 TOTAL 86 100.0 25 100.0 111 100.0 MARITAL STATUS Single 29 33.7 11 44.0 40 36.0 Married 51 59.3 11 44.0 62 55.9 ' Widowed, Divorced, Separated 6 7.0 3 12.0 9 8.1 TOTAL 86 100.0 25 100.0 111 100.0 AGE 20 to 24 years 12 14.0 4 16.0 16 14.4 25 to 29 years 32 37.2 12 48.0 44 39.6 30 to 34 years 8 9.3 3 12.0 11 9.9 35 to 39 years 7 8.1 2 8.0 5 4.5 40 to 44 years 4 4.7 1 4.0 10 9.0 45 to 49 years 9 10.5 1 4.0 5 4.5 50 to 54 years 5 5.7 0 0.0 5 4.5 55 and over 5 5.7 0 0.0 5 4.5 No response 4 4.7 2 8.0 6 5.4 TOTAL 86 99.9* 25 100.0 111 99.9* * The percentages throughout this study have been rounded off to the nearest decimal point; hence the t o t a l s may not equal 100 percent. 25 the OTs an equal number are married as are single (44.0%) (Table II, p. 24). Age Therapists in the work force tend to be young with 51.2 percent of the PTs and 64.0 percent of the OTs being 29 years of age or younger (Table II, p. 24). These figures are similar to the findings of Jantzen (37, 38) and Flint and Spensley (26). On a further analysis of Table II (p. 24) i t is seen that by far the greater percentage of PTs (37.2%) and OTs (48.0%) f a l l into the 25-29 age bracket. This reflects the fact that therapists do not enter the labor force at a very early age and once qualified are inclined to remain in i t for a number of years. There is a marked drop in the number employed in the over 30 age group, especially amongst the OTs, with a relatively even distribution for the PTs. Of the PTs 21.9 percent are 45 years of age or over as compared to 4.0 percent of the OTs, (Table II, p. 24). This might indicate that more PTs than OTs returned to practise or remained in the f i e l d . It i s not surprising to find the majority of therapists in the younger age bracket as most of those surveyed in this study graduated in the period 1963-1972 (Table III, p. 28). EDUCATIONAL CHARACTERISTICS Professional Education In Canada and the United States therapists receive their basic professional education at a university; however, u n t i l recently Canadian graduates were awarded a diploma rather than a baccalaureate degree. In 26 other countries, hospital based diploma programs are the general rule. In Great B r i t a i n the OTs often graduate from a college program with a diploma. In view of the above, the results of this study are not very surprising. The majority of PTs (69.8%) and OTs (88.0%) attended a university but only 23.3 percent of the PTs and 44.0 percent of the OTs graduated with a baccalaureate degree as shown i n Figure 1. This means Physical Therapists School: IM'lospital. '30.'2'%'.'•'• University 69.8% 3 C e r t i f i c a -t i o n Diploma 76.7% Occupational Therapists Baccalaureate Hospital School '• 12, Q%---' University/College 88.0% C e r t i f i c a -t i o n Diploma 56.0% V//// ffe,gWM• 0% 7-7-7 Baccalaureate Figure 1. Professional Education of Therapists that 46.5 percent of the PTs and 44.0 percent of the OTs were awarded a diploma on graduation from University. This s i t u a t i o n w i l l gradually change as more university programs upgrade to a baccalaureate degree. The number of diploma graduates indicate an educational need for a degree completion program. This assumes added importance when i t i s considered that by the 1980's the professional associations w i l l require new members to be graduates of baccalaureate programs. I t i s d i f f i c u l t to compare educational standards from one country to another. However, i n the United States i n 1970 75.1 percent of the OTs 27 had graduated with a degree, 17.8 percent with a certificate and 7.1 percent with a diploma; the latter primarily received in a foreign country (37). Since graduation relatively few therapists have upgraded their academic qualifications. One PT (1.1%) and three OTs (12.0%) have earned a degree in addition to their diploma and eight PTs (9.3%) have some university credits to add to their diploma. There were no post graduate degrees in the sample. The low level of interest in academic pursuits may be due to the lack of specific opportunities for the diploma graduate to upgrade. It i s also well recognized that therapists have generally been more inter-ested i n improving their technical s k i l l s , specifically related to patient care. In Canada, graduate programs for OTs and PTs in their own discipline are non-existent. In the United States graduate programs available to OTs in their own discipline increased from five in the early 1960's to 10 in 1971. By 1970 8.8 percent of female OTs had been awarded a graduate degree and 31.5 percent of those with a master's degree had majored in occupational therapy. It was found that those who completed graduate studies in occupational therapy were more likely to remain in the f i e l d (37). In 1972, Hightower (34) found that 11.0 percent of her sample of PTs held a master's degree. Year of Graduation In this study more of the employed therapists had graduated in the period 1963-1967 than in any other similar period (Table III). In the 28 years from 1963 to 1972, a t o t a l of 62.8 percent of the PTs and 68.0 percent of the OTs graduated. This may be accounted for by the fact that the School of Rehabilitation Medicine, The University of B r i t i s h Columbia, graduated i t s f i r s t students i n 1964. The 20.9 percent of' the PTs and 16.0 percent of the OTs who graduated p r i o r to 1952 (Table I I I ) suggest that a number of therapists do remain i n the work force or return to i t . As already discussed (Table I I , p. 24), the age of therapists concurs with the above findings. TABLE I I I DISTRIBUTION OF THERAPISTS BY THE YEAR OF GRADUATION Year Physical Therapists Occupational Therapists A l l Therapists No. % No. % No. % 1968-1972 20 23.3 7 28.0 27 24.3 1963-1967 34 39.5 10 40.0 44 39.7 1958-1962 5 5.8 3 12.0 8 7.2 1953-1957 9 10.5 1 4.0 10 9.0 P r i o r to 1952 18 20.9 4 16.0 22 19.8 TOTAL 86 100.0 25 100.0 111 100.0 Country of Graduation Canadian schools currently account for over half of the PTs (57.0%) and OTs (60.0%) i n the province. Great B r i t a i n contributes 25.5 percent of the PTs and 24.0 percent of the OTs. The remaining PTs (17.5%) graduated from schools i n A u s t r a l i a , New Zealand, Europe, United States of 29 America, India and South Africa. American schools accounted for 12.0 percent of the OTs and European schools for the f i n a l 4.0 percent (Table IV). There i s considerable similarity between this study and the data compiled in 1970 by the Ontario Board of Directors of Physiotherapy (9). In that study i t was found that 60.0 percent graduated from Canadian schools, 25.4 percent from schools in Great Britain and 14.6 percent from other countries. The data suggest that there continues to be a reliance on graduates from Great Britain (57). As demands for service increase and manpower shortages continue to exist there w i l l probably be l i t t l e change in the overall picture for some years either for PT or OT. Graduates from Canadian Schools In this sample of 111 therapists, 64 graduated from Canadian schools. An almost equal number of PTs graduated from The University of Br i t i s h Columbia (28.6%), the University of Toronto (26.6%), and the University of Alberta (20.4%). A total of 53.3 percent of the OTs graduated from The University of British Columbia while McGill and the University of Toronto graduated 20.0 percent and 13.3 percent respectively (Table IV). Of the Canadian graduates, 49.0 percent of the PTs and 66.7 percent of the OTs were from a combined program, accounted for by the fact that The University of British Columbia and u n t i l recently the University of Tor-onto have offered such a program. 30 TABLE IV DISTRIBUTION OF THERAPISTS BY COUNTRY OF GRADUATION Physical Therapists Occupational Therapists A l l Therapists No. % No. % No. % COUNTRY Great B r i t a i n 22 25.5 6 24.0 28 25.2 A u s t r a l i a , New Zealand 7 8.1 0 0.0 7 6.3 Europe 5 5.8 1 4.0 6 5.4 United States 1 1.2 3 12.0 4 3.6 India 1 1.2 0 0.0 1 0.9 South A f r i c a 1 1.2 0 0.0 1 0.9 Canada 49 57.0 15 60.0 64 57.7 TOTAL 86 100.0 25 100.0 111 100.0 CANADA The University of B r i t i s h Columbia 14 28.6 8 53.3 22 34.4 University of Alberta 10 20.4 1 6.7 11 17.2 University of Saskatch-ewan 1 2.0 0 0.0 1 0.9 University of Manitoba 5 10.2 1 6.7 6 9.4 University of Toronto 13 26.6 2 13.3 15 23.4 McGill University 5 10.2 3 20.0 8 12.5 University of Western Ontario 1 2.0 0 0.0 1 1.5 TOTAL 49 100.0 15 100.0 64 100.0 31 EMPLOYMENT Job T i t l e Over 50.0 percent of a l l therapists c l a s s i f y themselves as a s t a f f therapist and 18.0 percent as department supervisor. T r a d i t i o n a l l y there has been l i t t l e by way of a graded scale of advancement for therapists. This presumably s t i l l holds true for this study shows only 3.5 percent of the PTs and 4.0 percent of the OTs as assistant supervisors, and 4.6 per-cent of the PTs and 4.0 percent of the OTs as senior therapists. There were no private practitioners amongst the OTs but they make up 9.3 percent of the PTs. Consultants are r e l a t i v e l y uncommon and no c l i n i c a l super-visors were found i n the sample (Table V). TABLE V DISTRIBUTION OF THERAPISTS BY JOB TITLE Physical Occupational A l l Job T i t l e Therapists Therapists Therapists No. % No. % No. % Staff Therapist 48 55.8 13 52.0 61 55.0 Senior Therapist 4 4.6 1 4.0 5 4.5 Assistant Supervisor 3 3.5 1 4.0 4 3.6 Department Supervisor 13 15.1 7 28.0 20 18.0 Consultant 3 3.5 0 0.0 3 2.7 Private P r a c t i t i o n e r 8 9.3 0 0.0 8 7.2 Other* 7 8.2 3 12.0 10 9.0 TOTAL 86 100.0 25 100.0 111 100.0 *0ther - Research and Education Co-ordinator, C h i l d b i r t h Educa-t i o n , and Sole Charge. 32 Agency of Employment The general hospitals i n B r i t i s h Columbia employ 46.5 percent of the PTs, r e h a b i l i t a t i o n centers 13.9 percent and the Canadian A r t h r i t i s and Rheumatism Society (C.A.R.S.) 11.6 percent. There are 10.4 percent i n private practice which includes s t a f f therapists employed by a private p r a c t i t i o n e r . The OTs are employed about equally between the psychiatric hospitals (28.0%), the r e h a b i l i t a t i o n centers (24.0%) and the general hospitals (24.0%) (Table VI). TABLE VI DISTRIBUTION OF THERAPISTS BY EMPLOYMENT AGENCY Agency Physical Therapists Occupational Therapists A l l Therapists No. % No. % No. % General Hospital 40 46.5 6 24.0 46 41.4 Children's Hospital 4 4.6 0 0.0 4 3.6 Psychiatric Hospital 0 0.0 7 28.0 7 6.3 Extended Care F a c i l i t y 1 1.2 1 4.0 2 1.8 Rehabilitation Center 12 13.9 6 24.0 18 16.2 Private Practice 9 10.4 0 0.0 9 8.1 C.A.R.S. 10 11.6 2 8.0 12 10.8 Home Care* 4 4.6 1 4.0 5 4.5 Children's School and Treatment Center 2 2.4 1 4.0 3 2.7 Other** 4 4.8 1 4.0 5 4.5 TOTAL 86 100.0 25 100.0 111 100.0 * Victorian Order of Nurses, Public Health. ** University Health Service, Family Practice, C h i l d b i r t h Associa-t i o n , Multiple Sclerosis Society, or a combination of Private Practice and General Hospital. 33 P r i o r to 1968, approximately 90 percent of a l l active members of the APTA were employed i n hospitals; by 1969 the number was closer to 79 percent. Hightower (34) found that nearly half of her sample worked i n general hospitals, 14 percent i n r e h a b i l i t a t i o n centers and 2 percent i n f u l l - t i m e education. Senters (61) reported that 35 percent of the PTs worked i n h o s p i t a l , 8 percent i n r e h a b i l i t a t i o n centers, 4 percent in public health and 17 percent i n an o f f i c e or c l i n i c . She also found that 46 percent worked i n more than one agency. In this study the results are s i m i l a r to Hightowers, especially i f the general and children's hospitals are considered together. In Ontario (5 7) 11.6 percent of the PTs are self-employed, s l i g h t l y higher than the.9.3 percent i n this study. Payment patterns and the type of health care system that develops deter-mine to a large extent the number of therapists who go into private practice. Type of Practice and Level of Care I t was d i f f i c u l t for many therapists to decide what type of practice and l e v e l of care they were primarily involved with, as these tended to vary from day-to-day. The PTs prac t i c i n g i n the i n s t i t u t i o n (76.7%) divided their time almost equally between in-patients and out-patients. Very few therapists spend the greater part of th e i r time on administration and supervision (Table VII). Most therapists worked with patients who were either at the acute or r e h a b i l i t a t i o n l e v e l of care. The PTs were equally involved with both, while the OTs were more involved at the r e h a b i l i t a t i o n stage. This was 34 TABLE VII DISTRIBUTION OF THERAPISTS BY TYPE OF PRACTICE AND LEVEL OF CARE WITH WHICH THEY ARE PRIMARILY CONCERNED Physical Therapists 1 Occupational Therapists A l l Therapists No. % No. % No. % TYPE OF PRACTICE I n s t i t u t i o n based 66 76.7 19 76.0 85 76.5 Home V i s i t i n g 5 5.8 1 4.0 6 5.4 Private Practice 6 7.0 0 0.0 6 5.4 Consultation 4 4.6 0 0.0 4 3.6 Supervision & Adminis-tr a t i o n 2 2.3 3 12.0 5 4.5 Other* 3 3.5 2 8.0 5 4.5 TOTAL 86 99.9 25 100.0 111 99.9 LEVEL t Acute Care 27 31.4 5 20.0 32 28.8 Rehabilitation 27 31.4 11 44.0 38 34.2 Activation 5 5.7 2 8.0 7 6.3 Combined Acute/Rehabili-tation/Activation 22 25.5 3 12.0 25 22.5 Extended Care 1 1.2 3 12.0 4 3.6 Chronic Care 2 2.4 0 0.0 2 1.8 Other** 2 2.4 1 4.0 3 2.7 TOTAL 86 .100.0 25 100.0 111 99.9 * C l i n i c a l research, Day Care Hospital, Teaching, Administration plus out-patients. ** Uninvolved with patient care, no response. 35 not an unexpected finding i n view of the d i f f e r i n g roles of the OT and PT. At least 25.5 percent of the PTs work at a variety of l e v e l s , usually a combination of acute, r e h a b i l i t a t i o n and activation care. In the smaller hospitals the therapists tend to be generalists, while the larger hospitals and many agencies offer the therapist opportunity for s p e c i a l i z a t i o n . Years of Employment Therapists have a reputation for being a mobile group (3, 57). This assumption would appear to be borne out by this survey which found that 25.6 percent of the PTs and 36.0 percent of the OTs had been i n t h e i r present position for less than one year (Table VIII). About 52 per-cent of the OTs and PTs had been i n t h e i r present job from one to f i v e years while about 22.1 percent of the PTs and 12.0 percent of OTs had TABLE VIII DISTRIBUTION OF THERAPISTS BY THE NUMBER OF YEARS EMPLOYED IN PRESENT POSITION IN BRITISH COLUMBIA Years i n Present Position Physical Therapists Occupational Therapists A l l Therapists No. % No. % No. % Less than one year 22 25.6 9 36.0 31 27.9 One to f i v e years 45 52.3 13 52.0 58 52.3 Six to ten years 12 13.9 3 12.0 15 13.5 Eleven to f i f t e e n years 6 7.0 0 0.0 6 5.4 Sixteen to twenty years 1 1.2 0 0.0 1 0.9 TOTAL 86 100.0 25 100.0 111 100.0 36 been in the same place of employment for six years or more. Profession-all y i t has been considered wise to seek varying experience and the new graduate especially is encouraged to broaden her background before choosing one particular area of expertise. It i s not surprising to find that 75.6 percent of the PTs and 88.0 percent of the OTs had practiced in British Columbia for nine years or less, and that 55.8 percent of the PTs and 48.0 percent of the OTs had been here for four years or less. Annual turnover rate in Canada for PTs and OTs was just over 40.0 percent in 1968 (23). The number of years of professional experience for PTs ranged from less than one year to f i f t y years with an average of 10.5 years which was the same as the Mountain States study (56). Hightower (34) reported an average of six years or less professional experience for PTs. The range for OTs was from less than one year to twenty-two years pro-fessional experience with an average of seven point six years. This i s higher than that found by the Flint and Spensley (26) study where the median number of years of experience was three. More therapists work f u l l time than part time, for PTs the ratio i s approximately eight to one point five and for OTs nine to one. MEMBERSHIP IN THE PROFESSIONAL ASSOCIATIONS Over 95 percent of the PTs and 84 percent of the OTs indicated that they belonged to the CPA and the CAOT respectively. As Figure 2 shows, a number of therapists hold membership in more than one professional association, a result of being graduates of a combined program or having 37 Association Canadian PT Physiotherapy Association OT \////////7777777, 32.0% 95.4% Chartered PT Society of Physio- OT therapy 4.0% 25.6% Canadian PT Association of Occupa- OT tional Therapy 5.8% 84.0% B.C. PT Society of Occupa- OT tional Therapy 0.0% 48.0% Other PT or PT OT Profes-sional Associations 0T 4.7% Other* PT 0T ' 2.3% 4.0% Figure 2. Membership in Professional Associations * North American Academy of Manual Therapy Arthritis Foundation (Allied Health Professionals) 38 graduated in another country. The figures for PTs are similar to the CPA sta t i s t i c s for British Columbia and similar to those for the Mountain States (57). The Flint and Spensley (26) studies, reported 73.0 percent of their sample belonged to the AOTA. Attitudes to professional associations range from highly positive to highly negative. Goldin (28) reported a more negative (61.0%) than a positive (29.0%) feeling. He did ascertain that nine out of ten of those who were positive to their association also expressed feelings of professional adequacy and security, while more than half of those with no positive feeling f e l t professionally inadequate. FUTURE GOALS Career Goals On analyzing the career goals of therapists (Table IX) a surpris-ingly large number were undecided about their goals (23.3% of the PTs and 44.0% of the OTs). It cannot be stated at this time whether this is indica-tive of lack of opportunity for educational or professional advancement or merely a normal response in a relatively young female population. It is likely that the young age range of a predominantly female profession would have marriage as a competing goal. There may also be an element of dis-satisfaction with career opportunities within the professions. It i s noted however that of the 48 staff PTs and 13 staff OTs in the study (Table V, p. 31) only 18 PTs and 3 OTs wish to remain at this level. Some 20.9 per-cent of the PTs and 12.0 percent of the OTs respectively seem reluctant to move out of their primary role in patient care. 39 TABLE IX DISTRIBUTION OF THERAPISTS BY CAREER GOALS Career Goals Physical Therapists No. % Occupational Therapists No. % A l l Therapists No. % Staff Therapist 18 20.9 3 12.0 21 18.9 Senior Therapist 2 2.3 0 0.0 2 1.8 Cl i n i c a l Supervisor 7 8.0 2 8.0 9 8.1 Administration and Supervision 10 11.6 1 4.0 11 9.9 Sole Charge 3 3.5 0 0.0 3 2.7 Community Practice 5 5.8 3 12.0 8 7.2 Teaching 3 3.5 0 0.0 3 2.7 Research 4 4.6 2 8.0 6 5.4 Private Practice 5 5.8 0 0.0 5 4.5 Another Profession 1 1.2 1 4.0 2 1.8 Other* 5 5.9 2 8.0 7 6.3 Undecided 20 23.3 11 44.0 31 27.9 No plans (retirement) 3 3.5 0 0.0 3 2.7 TOTAL 86 99.9 ' 25 100.0 111 99.9 * Raise a family, work in underdeveloped areas, education for childbirth. 40 There is an unfortunate lack of interest in teaching as a career with no OTs and only 3.5 percent of the PTs looking to this in the future. Jantzen (38) considers this to be due to the fact that the basic profes-sional education focuses on preparation for c l i n i c a l practice and not teaching. A more popular choice of goal is that of c l i n i c a l supervisor which was selected by 8.0 percent of both PTs and OTs respectively. Educational Goals In the six months following this study 23.3 percent of the PTs and 16.0 percent of the OTs planned to attend a professional educational event. The therapists expressed some concern about the insufficient advance notice of educational events. Many PTs (50.0%) and OTs (32.0%) have plans for continuing their academic education. In respect to the academic courses 17.4 percent of the PTs and 8.0 percent of the OTs expressed interest i n taking credit courses and 15.1 percent of the PTs and 16.1 percent of the .OTs were con-sidering a baccalaureate degree. A masters degree is the goal of 10.5 per-cent of the PTs and 8.0 percent of the OTs (Table X). The lack of interest in training in a specialty was rather surprising as therapists generally give the impression that they are c l i n i c a l l y rather than academically oriented. EMPLOYMENT GOALS The data (Table XI) in this study suggest that a limited number of therapists plan to remain i n the work force indefinitely (38.3% of the 41 TABLE X DISTRIBUTION OF THERAPISTS BY EDUCATIONAL GOALS Physical Occupational A l l Educational Goals Therapists Therapists Therapists No. % No. % No. % Some credit courses 15 17.4 2 8.0 17 15.3 A diploma i n a specialty 1 1.2 0 0.0 1 0.9 Baccalaureate degree 13 15.1 4 16.0 17 15.3 Masters degree 9 10.5 2 8.0 11 9.9 Specialty Training techniques 4 4.6 0 0.0 4 3.6 Train for another profession 1 1.2 0 0.0 1 0.9 No plans 43 50.0 17 68.0 60 54.1 TOTAL 86 100.0 25 100.0 111 100.0 TABLE XI DISTRIBUTION OF THERAPISTS BY EMPLOYMENT GOALS Physical Occupational A l l Employment Goals Therapists Therapists Therapists No. % No. % . No. % Work i n d e f i n i t e l y 33 38.3 7 28.0 40 36.0 Stop work permanently 1 1.2 0 0.0 1 0.9 Interrupt work for a time 16 18.6 10 40.0 26 23.4 Work part time 17 19.8 3 12.0 20 18.0 Undecided 16 18.6 4 16.0 20 18.0 Retirement/no plans 3 3.5 1 4.0 4 3.6 TOTAL 86 100.0 25 100.0 111 99.9 42 PTs and 28.0% of the OTs). From a manpower point of view i t is interest-ing to note that only 1.2 percent of the PTs and none of the OTs plan to discontinue working permanently, although a number remain undecided (18.6% of the PTs and 16.0% of the OTs). This provides some indication that therapists may anticipate leaving the work force for a time, but plan to re-enter at a later date. This is borne out by the fact that 40.0 per-cent of the OTs and 18.6 percent of the PTs said they planned to interrupt their professional career for a time at some period in their lives. The findings in this study are not dissimilar to those of Fli n t and Spensley (26) who reported that 78.0 percent of the OTs in their study expected to continue working in the foreseeable future, and those who did not gave "family" as the reason for retiring. Canadian s t a t i s t i c s show that PTs tend to change their jobs and i f they leave the profession plan to return to work after a few years (3, 23). SUMMARY Physical Therapists Of the PTs working in British Columbia women outnumber men in the profession approximately six to one. The average PT is l i k e l y to be married, between 20 and 29 years of age and working in Vancouver or the Lower Mainland. The greater number of PTs had graduated since 1963 and with a diploma. The majority had graduated from a Canadian University (52%) most l i k e l y The University of British Columbia or the University of Toronto. Of the Canadian graduates 49 percent had a combined training. 43 Over half of the PTs (55.8%) surveyed are c l a s s i f i e d as s t a f f therapists and 46.5 percent work i n a general hospital. Their average length of professional experience i s 10.5 years. Three-quarters of them have been i n t h e i r present position for f i v e years or l e s s , almost a l l of them work f u l l time, primarily with in-patients and out-patients. Most of the patients they treat are at the acute or r e h a b i l i t a t i v e l e v e l of care, and the pathological conditions most frequently encountered are orthopaedic or neurological. Membership i n the CPA i s excellent (95.4%). Two-thirds of the PTs aspire to a variety of career goals within the profession and 50 per-cent have s p e c i f i c educational goals. Few of them have plans to d i s -continue working on a permanent basis. Occupational Therapy The majority of the OTs work f u l l - t i m e i n Vancouver or the Lower Mainland. There were no males i n the sample. The age range was from 20 to 49 with the majority being under 29. The same number were married as were single. Just over one-half graduated with a diploma and almost two-thirds have graduated since 1963. Canadian schools accounted for 60 percent of the graduates and of these, two-thirds had combined tr a i n i n g i n OT and PT and over half of the graduates were from The Univer-s i t y of B r i t i s h Columbia. Over one-half of the OTs are c l a s s i f i e d as s t a f f therapists and are employed i n equal numbers i n the general, psychiatric and r e h a b i l i t a -tion i n s t i t u t i o n s . Three-quarters work i n an i n s t i t u t i o n where the 44 majority of their time i s spent with in-patients. More than three-quarters of them have been in their present position for five years or less. They have an average of 7.6 years of professional experience and the pathological conditions most frequently encountered by the OTs can be categorized as orthopaedic, neurological or psychiatric. More than twice as many OTs work with patients at the rehabilitation level as with the acute patient. The greater majority (84.0%) belong to their professional associa-tion. The OTs (44.0%) in this study had a limited variety of career goals within the profession, 32.0 percent had specific educational goals and none planned to stop working on a permanent basis. CHAPTER IV FURTHER EDUCATION Therapists are prepared for c l i n i c a l practice by a sound basic professional education. Thereafter the i r ongoing professional learning needs are s a t i s f i e d i n a number of ways: by in-service education; by the professional associations through meetings, special interest groups, and congresses; by se l f - d i r e c t e d education; by continuing education and postgraduate studies. To date post graduate opportunities i n the pro-fession have been non-existent.and systematic continuing education for therapists i n B r i t i s h Columbia has not been extensive. This chapter w i l l look at therapist's p a r t i c i p a t i o n i n a variety of educational a c t i v i t i e s and w i l l include what therapists perceive to be barriers to continuing education. The methods, scheduling and materials considered by therapists to be most appropriate for t h e i r educational needs are also covered. IN-SERVICE EDUCATION Structured in-service educational a c t i v i t i e s take a variety of forms and may be unique to a pa r t i c u l a r setting. Therapists are selective as they must consider the content and i t s relevance to them, as w e l l as the time involved. Six common in-service a c t i v i t i e s with an educational component were looked at; f i r s t to ascertain i f they were available to the therapist and second to determine what the p a r t i c i p a t i o n rates were of 46 therapists i n those a c t i v i t i e s when available. Staff meetings with educational input were i d e n t i f i e d as being available to most therapists (Figure 3) and were attended regularly by 58.1 percent of the PTs and 84.0 percent of the OTs. Interprofessional a c t i v i t i e s ranked second i n a v a i l a b i l i t y and t o t a l p a r t i c i p a t i o n . Among the OTs 52.0 percent attended these regularly and 20.0 percent occasionally, while 24.4 percent of the PTs attended regularly and 31.4 percent occasion-a l l y . In-service nursing a c t i v i t i e s were available to 58.1 percent of the PTs and about 52.3 percent attended regularly or occasionally. The OTs seemingly found in-service nursing education less useful for although i t was available to 52.0 percent of them, only 24.0 percent attended regularly or occasionally. Rounds were not readily available on a regular basis to PTs and OTs but when available were w e l l attended. Therapists find these a worthwhile learning experience because of th e i r direct bearing on patient care. Short courses planned by the i n s t i t u t i o n or agency were available to approximately 50.0 percent of the therapists (Figure 3) and were regularly attended by 20.0 percent of the OTs and 11.6 percent of the PTs. These short courses are not necessarily designed to meet s p e c i f i c learning needs of therapists and are often m u l t i d i s c i p l i n a r y i n nature. In-service educational a c t i v i t i e s are not generally available to therapists i n private practice. There are li m i t e d offerings for those working i n the community or i n small hospitals, however agencies such as C.A.R.S. have an excellent record for providing in-service a c t i v i t i e s for their s t a f f . Staff Meetings Grand Rounds Ward/Doctors Rounds Nursing In-service Interpro-fessional Short Courses PARTICIPATION REGULAR PT PT OT PT OT PT OT PT OT PT OT AVAILABLE OCCASIONAL NOT AVAILABLE NEVER W^^^^^^^r^W^^^W^- / //77s X V VN / S N A / i l l . 6% \/////// YZZ.-r^.n 23..2% vvvc .q •20. 0%., - . . . , . ! l 2 . Q % ( w r - - ^ — IS? 2 2 . 0 % /////////// •1/ ///.18.6% //// 4 .8% '.^ r^ -SfeSS-SS.^  44.0% ////, 1.0%,- 8 . 0 % K ; i 6 . 33 '36.0%' 8% 2 8 . 0 % 24.4% ^ r j / 7 . 'ItiMllllh • 5 2 . 0 / 777TTTT7 11.6% 8 . 1 % 2 0 . 0 % . / ,' .-' / y /j 1 6 . 0 % / 1 6 . 0 % / ,> : '> ~ % / 1 2 . 0 % N z\s v x . \ y v y . 0% X / / V - - 7 6 4 . 0 % N y y A / X; \/ v ~N . V X X54.7%> ^4pyo%xxxx XXX-^ 1.9% X- v X :<>A/\ / 4 8 . 0 % \V y v \ :•-3.4% \ • .\ ,40.7% 2 8 . 0 % XXX\X3%\XvX\V y\>AW 48.0%yy\\ XXX* Figure 3. In-Service Educational Activities 48 Other a c t i v i t i e s of a more at y p i c a l nature that therapists re-ported p a r t i c i p a t i n g i n were: monthly noon hour educational meetings for a l l therapists, f i l m s , journal clubs, c l i n i c conferences and team meetings. PROFESSIONAL ASSOCIATION MEETINGS AND CONGRESSES I t i s assumed that the majority of professional meetings and a l l congresses have a large educational component. In this study 30.2 percent of the PTs and 24.0 percent of the OTs had not attended any professional meeting i n the past year (Table X I I ) . This does indicate a considerable better attendance l e v e l for OTs than the F l i n t and Spensley (26) study which reported that 63.0 percent of the OTs had never been to a professional meeting. Table XII shows that 28.0 percent of the OTs and 16.3 percent of the PTs had attended seven or more meetings during the previous year. In terms of costs incurred, attendance at national congresses i s an expensive luxury. I n s t i t u t i o n a l budgets and schedules do not usually allow for more than one member of a small s t a f f to attend the yearly event and junior members would have no p r i o r i t y . In view of the number of s t a f f therapists, who are young and recently graduated the attendance at one congress i n the past f i v e years by 30.2 percent of the PTs and 36.0 percent of the OTs i s to be understood. I t i s regrettable, however, to find that 61.6 percent of the PTs and 56.0 percent of the OTs had to date never had the opportunity to attend a national conference (Table XII). At some time i n thei r career over half the PTs (5 7.0%) and OTs (52.0%) had held o f f i c e or served on a committee for their respective 49 TABLE XII DISTRIBUTION OF THERAPISTS BY ATTENDANCE AT ASSOCIATION MEETINGS AND CONGRESSES Physical Therapists Occupational Therapists A l l Therapists No. % No. % No. ATTENDANCE AT. PROFESSIONAL MEETINGS LAST YEAR None 26 30.2 6 24.0 32 28.8 One or two 26 30.2 9 36.0 35 31.5 Three or four 16 18.6 1 4.0 17 15.3 Five or s i x 4 4.6 2 8.0 6 5.4 Seven or more 14 16.3 7 28.0 21 18.9 TOTAL 86 100.0 25 100.0 111 100.0 ATTENDANCE AT CONGRESSES IN PAST FIVE YEARS None 53 61.6 14 56.0 67 60.4 One or two 26 30.2 9 36.0 35 31.5 Three or four 4 4.7 2 8.0 6 5.4 Five or more 3 3.5 0 0.0 3 2.7 TOTAL 86 100.0 25 100.0 111 100.0 50 professional association. In the past two years, 31.4 percent of the PTs and 36.0 percent of the OTs had been involved i n these a c t i v i t i e s , which although not i n the true sense an educational a c t i v i t y do keep therapists up-to-date on many professional matters. Although p a r t i c i p a t i o n i s not exceptional the findings i n this study indicate more interest i n association a c t i v i t i e s than reported by the committee on the Healing Arts (57). SELF-DIRECTED EDUCATION Reading Therapists use professional l i t e r a t u r e as a source of information for s e l f - d i r e c t e d learning. Only 3.5 percent of the PTs and 12.0 percent of the OTs had not referred to any professional l i t e r a t u r e i n the previous working month. As Table XIII indicates the incidence of use i s quite high with 23.2 percent of the PTs and 24.0 percent of the OTs having occasion to refer to professional l i t e r a t u r e approximately twice a week. Other studies have found reading to be a method of s e l f - d i r e c t e d education favored by physicians and other health professionals (16, 51)., The results of this survey would suggest that the f a c i l i t i e s of the professional associations are used very l i t t l e as a resource for borrowing or purchasing l i t e r a t u r e . Reasons for this non-use could be u n s u i t a b i l i t y of the material, the time, e f f o r t and expense involved i n securing i t , lack of knowledge about i t s existence or the increasing a v a i l a b i l i t y of information l o c a l l y . A large portion of the l i t e r a t u r e published by the associations i s possibly of more value to supervisors because of i t s administrative content. 51 TABLE XIII DISTRIBUTION OF THERAPISTS BY REFERRAL TO PROFESSIONAL LITERATURE Number of Occasions i n Previous Month Physical Therapists Occupational Therapists A l l Therapists No. % No. % No. % Never 3 3.5 3 12.0 6 5.4 Once or twice 24 27.9 5 20.0 29 26.1 Three or four times 29 33.7 8 32.0 37 33.3 Five or s i x times 10 11.7 3 12.0 13 11.7 Seven times or more 20 23.2 6 24.0 26 23.4 TOTAL 86 100.0 25 100.0 111 100.0 Professional Journals Membership i n professional associations usually includes a sub-s c r i p t i o n to a journal which suggests why the CPA and the CA0T journals were the most frequently read (Figure 4). Physiotherapy, the Journal of the Chartered Society of Physiotherapy ( B r i t i s h ) was also popular with the PTs, 61.6 percent having read at least one a r t i c l e i n i t during the previous month. Physical Therapy, the Journal of the APTA was read by 30.2 percent. These were infrequently consulted by the OTs. The OTs read the American Journal of Occupational Therapy and the British Journal of Occupational Therapy more frequently than the PTs. Physical and occupational therapy journals from countries other than those already mentioned were also referred to by therapists. Both the PTs and the OTs Journal Journal of the Canadian Physiotherapy Association Physical Therapy, Journal of the American PT Association Physiotherapy, The Journal of the Chartered Society of Physiotherapy Canadian Journal of Occupational Therapy The American Journal of Occupational Therapy British Journal of Occupational Therapy Other National Physiotherapy or Occupational Therapy Journals Other Medical Journals Other Nursing Journals Other Administration Journals Figure 4. D i s t r i b u t i o n PT OT PT OT i limn i illinium WW*. 30.2% 0% 198.8% 177777777 16.0% 17.4% 111II11II111111111 iT 5.8% 'llllllllllllllllllllllllllh 9.3% \lllllllllllllllil PT OT PT OT PT OT PT OT PT OT PT OT PT OT PT OT of Therapists by Journals Read 61.6% 6 4 . 0 % 36.0% . 7.9% /7j 4.0% Wiiiiiiimiuiim 49.8% 48.0% 29.1% Vllllllllllllllh 32.0% . 4.6% I !Ik 8.0% 8 4 . 0 % 53 read medical and nursing journals. The medical journals included those on orthopaedics, physical medicine and other s p e c i a l t i e s . Journals covering psychology, prosthetics, paraplegia, sports medicine, osteopathy, r e h a b i l i t a t i o n , speech and administration are also referred to. Books Purchased In the year previous to th i s study, 50.0 percent of the PTs and 40.0 percent of the OTs had not purchased any books that would be of value to them i n the i r work (Table XIV). This undoubtedly relates to TABLE XIV DISTRIBUTION OF THERAPISTS BY NUMBER OF PROFESSIONAL BOOKS PURCHASED Books Purchased i n Previous Year Physical Therapists Occupational Therapists A l l Therapists No. % No. % No. % None 43 50.0 10 40.0 53 47.8 One 13 15.1 5 20.0 18 16.2 Two 13 15.1 6 24.0 19 17.1 Three 5 5.8 1 4.0 6 5.4 Four 4 4.7 0 0.0 4 3.6 Five or more 8 9.3 3 12.0 11 9.9 TOTAL 86 100.0 25 100.0 111 . 100.0 the a v a i l a b i l i t y of a medical l i b r a r y . The supervisor of the department usually includes a sum for the purchase of books i n the departmental budget i f a medical l i b r a r y i s not readily available to the therapists. A 54 therapist working i n private practice or i n any position of i s o l a t i o n may tend to buy more professional books than one working i n a large i n s t i t u t i o n . Professional Consultation Sources consulted by a therapist about patient problems depend to a large extent on the nature of the problem and the set t i n g i n which the therapist works. The persons most frequently consulted were the physician, another therapist i n the same i n s t i t u t i o n or the supervisor (Table XV). These data indicate a r e l a t i v e l y strong tendency for ther-apists to learn from t h e i r peers. The physician i s however the prime source of information and could be a means of imparting considerable knowledge to the therapist. When therapists are searching for information on recent develop-ments i n patient care there are two main resources: departmental reference material was used by 41.9 percent of the PTs and 68.0 percent of the OTs, and a medical l i b r a r y was used by 39.5 percent of the PTs and 24.0 per-cent of the OTs (Table XV). Private practitioners and those therapists working on t h e i r own or at some distance from a medical l i b r a r y f a c i l i t y w i l l have to r e l y on thei r own reference material. CONTINUING EDUCATION In this study 31.4 percent of the PTs and 32.0 percent of the OTs had attended one continuing education course i n the previous two-year period, and a further 27.9 percent and 20.0 percent respectively 55 TABLE XV DISTRIBUTION OF THERAPISTS BY SOURCE OF INFORMATION CONCERNING PATIENT CARE Physical Therapists No. % Occupational Therapists No. % A l l Therapists No. % CONSULTANT Supervisor 20 23.3 3 12.0 23 20.7 Therapists i n same i n s t i t u t i o n 22 25.6 10 40.0 32 28.8 Therapists outside of the same i n s t i t u t i o n 3 3.5 1 . 4.0 4 3.6 A physician 39 45.2 9 36.0 48 43.2 A nurse ,or team member 1 1.2 2 8.0 3 2.7 Organization executive TOTAL 1 1.2 0 0.0 1 0.9 86 100.0 25 100.0 111 100.0 RESOURCE A medical l i b r a r y 34 39.5 6 24.0 40 36.0 Professional associations 4 4.7 2 8.0 6 5.4 School of Rehabilitation Medicine 3 3.5 0 0.0 3 2.7 Department reference l i b r a r y 36 41.9 17 68.0 53 47.8 Own reference l i b r a r y 7 8.1 0 0.0 7 6.3 Personal contact 2 2.3 0 0.0 2 1.8 TOTAL 86 100.0 25 . 100.0 111 100.0 56 had attended two courses i n the same time (Table XVI). The mean number of short courses attended by a l l therapists was found to be one per year, however 19.8 percent of a l l therapists had not been to a course i n the previous two years. TABLE XVI DISTRIBUTION OF THERAPISTS BY ATTENDANCE AT CONTINUING EDUCATION Courses Attended (Past Two Years) Physical Therapists Occupational Therapists A l l Therapists No. % No. % No. % None 16 18.6 6 24.0 22 19.8 One 27 31.4 8 32.0 35 31.5 Two 24 27.9 5 20.0 29 26.1 Three 13 15.1 3 12.0 16 14.4 Four 4 4.7 2 8.0 6 5.4 Five or more 2 2.3 1 4.0 3 2.7 TOTAL 86 100.0 25 100.0 111 100.0 In considering the data i n Table XVI i t must be kept i n mind that the f i n a n c i a l as well as the manpower si t u a t i o n i n most departments would l i m i t the number of courses a therapist would be free to attend during the year. To date short courses have been offered infrequently and are unlikely to be relevant to every therapist. Most are held i n the Vancouver area which i s a deterrent to attendance for therapists working outside of the urban area. 57 BARRIERS TO PARTICIPATION IN CONTINUING EDUCATION Organized professional continuing education courses at the time of this study were meeting the needs of only 20.0 percent of the OTs and 26.7 percent of the PTs (Figure 5). The needs of 44.0 percent of OTs and 34.9 percent of the PTs were not being met and a further 36.0 percent and 38.4 percent were undecided. Figure 5 suggests that OTs are somewhat less satisfied than the PTs. Therapists who were undecided did not know what the continuing education p o s s i b i l i t i e s could be; furthermore they were not necessarily dissatisfied with what had been offered but were dissatisfied with the lack of courses to select from. YES NO UNDECIDED Physical Therapists Occupational Therapists 38.4% y////////m///////M 36.0% Figure 5. Learning Needs Met by Continuing Education Barriers to participation are displayed in Figure 6 and i t is immediately obvious that "lack of suitable courses" i s the major deterrent, which applies more to the OTs (73.0%) than to the PTs (54.6%). Family responsibilities were more of a barrier to the PTs (46.5%) than the OTs (16.0%). Lack of financial support was a restraint for 41.9 percent of the PTs and 24.0 percent of the OTs. 58 B a r r i e r L a c k o f f i n a n c i a l PT s u p p o r t Q T W//////M 2 4 . 0 % 4 1 . 9 % L a c k o f s u i t a b l e PT c o u r s e s Q^. 5 4 . 6 % MM Hllllliil •lilt/fltlll. 22 7 3 . 0 % F a m i l y r e s p o n -s i b i l i t i e s PT OT '/////, 1 6 . 0 % 4 6 . 5 % A t t i t u d e o f s u p e r v i s o r s PT OT 9.3% 1 6 . 0 % U n s a t i s f a c t o r y e d u c a t i o n a l e x p e r i e n c e PT OT 5 . 8 % 8 . 0 % L a c k o f c o u n s e l l i n g PT OT tzzz 1 6 . 3 % 8 . 0 % No i n t e r e s t PT OT zzza 1 3 . 9 % 1 2 . 0 % O t h e r * PT 0T I////////////V 29- 0% 3 2 . 0 % F i g u r e 6 . B a r r i e r s t o P a r t i c i p a t i o n i n C o n t i n u i n g E d u c a t i o n * D i s t a n c e , t i m e - o f f t o a t t e n d , n o n - p r o f e s s i o n a l i n t e r e s t s . 59 Continuing education was of no interest to 12.0 percent of the OTs and 13.9 percent of the PTs, generally these therapists were looking forward to retirement in the near future. Additional barriers to continuing education were distance required to travel to a course, the d i f f i c u l t y i n getting time off from work, particularly for those who work alone, and the cost of attending a course not located in one's own d i s t r i c t . Sole charge therapists and private practitioners had d i f f i c u l t y finding suitable locums and no means for replacement of lost income was available. These findings pinpoint deterrents similar to those in other studies (50, 12). Physicians i n non-metropolitan areas find distance required to travel to a course more of a deterrent than loss of income. Nurses give family responsibilities as having the most influence on their participation; they also l i s t time, expense and staff coverage. PREFERRED EDUCATIONAL METHODS The question of whether or not certain educational methods would meet the needs of therapists produced the results outlined in Figure 7. The method favored by 75.6 percent of the PTs and 92.0 percent of the OTs was the short course, institute or workshop. Physicians also consider the two or three day symposia the most valuable method for the trans-mission of medical information (12). The extension course for credit was considered by 47.7 percent of the PTs and 56.0 percent of the OTs to be a good method, offering therapists an opportunity to work toward a degree on a part time basis. Correspondence courses for credit were seen as a 60 Educational Method Extension courses, credit PT OT 47.7% w/////////////////mm/A 56.0% Extension courses, non-credit PT OT W/////////////////M 38.4% 40.0% Correspondenceprj, credit OT 31.4% 24.0% Correspondencep,j, non-credit OT 17.4% 8.0% In s t i t u t e s / work shops, PT short course O T 75.6% \/////////////////////////////////////7777\ 92.0% Independent ^ study, credit 0T 33.7% V/////////////////A 40.0% Independent study, non-credit 0T /////////////m 33.7% 36.0% University f u l l time PT OT mum 26.6% 16.0% Hospital, c l i n i c a l specialty courses PT OT 34.9% A 40.0% Figure 7. Interest of Therapists i n Spe c i f i c Educational Methods 61 viable method by 31.4 percent of PTs and 24.0 percent of OTs. Few were interested i f no credit was given. Independent study through programmed learning or other means was an unfamiliar idea to most; however, 33.7 percent of the PTs and 40.0 percent of the OTs were interested i n this method for credit-Most of the therapists expressed doubts about their a b i l i t y to become independent learners. Twenty-six point s i x percent of the PTs and 16.0 percent of the OTs were interested i n returning f u l l time to university. Specialty courses involving i n s t r u c t i o n by an expert i n a c l i n i c a l area within the hos p i t a l setting were of interest to 34.9 percent of PTs and 40.0 percent of OTs. These data would suggest that there i s s u f f i c i e n t i n t e r e s t i n methods other than the short course to warrant using a variety of pro-gramming methods. Other studies also indicate the need to make increasing use of correspondence courses, programmed i n s t r u c t i o n , s e l f - l e a r n i n g packages and extension courses for credit. Alternative methods that were suggested by the respondents i n this survey included the following: 1. An i n s t i t u t i o n a l exchange program for therapists 2. Educational leave 3. Travelling consultants 4. Development of c l i n i c a l research 5. Evening courses 6. Short courses i n a specialty conducted by an expert for a l i m i t e d number of participants. 62 7. Refresher courses combining academic work and c l i n i c a l experience 8. A general plea for greater exchange of knowledge at a l l levels between therapists and other professionals. PREFERRED SCHEDULE This survey disclosed that the preferred time of year for educa-t i o n a l a c t i v i t i e s , i n p a r t i c u l a r short courses, would be i n the f i r s t three calendar months of the year for 34.9 percent of the PTs and 56.0 percent of the OTs (Figure 8). A p r i l , May and June were preferred next followed by October, November and December. Therapists would l i k e courses scheduled during the week as i t was found that only 20.9 percent of the PTs and 16.0 percent of the OTs would, select the weekend. Those i n favor of the weekends are usually therapists i n private practice, i n sole charge or outside of the larger metropolitan areas. PREFERRED EDUCATIONAL MATERIALS There was considerable i n t e r e s t i n a variety of learning materials, video tapes appealed to 60.5 percent of the PTs and 72.0 percent of the OTs, while programmed learning materials attracted 54.6 percent of the PTs and 68.0 percent of the OTs (Figure 9). This l e v e l of i n t e r e s t i n d i -cates the need for the development of i n s t r u c t i o n a l materials which could be made available to therapists throughout the province. Figure 8. Months of Year Preferred by Therapists for Educational Activities 64 Educational Material Programmed Learning Materials PT OT 54.6% X/////////////////////////////A 68.0, Slide f i l e s PT 37.2% OT V///////////////A 40. OX Video tapes PT OT 60.5% 72.0% Slide tapes PT OT mmmmmmm 57.0% 48.0% Figure 9. Interest of Therapists i n Educational Materials SUMMARY This chapter investigated educational a c t i v i t i e s for therapists from the point of a v a i l a b i l i t y and p a r t i c i p a t i o n . Both unstructured and structured a c t i v i t i e s were studied as i t was considered that some con-tinuing learning needs could be met outside of the formal educational setting. Barriers to continuing education were also considered. An attempt was made to determine what therapists perceived to be the methods that would meet th e i r educational needs and how these might best be scheduled. The results suggest that of the in-service a c t i v i t i e s available the educational s t a f f meeting i s the most often attended. Interprofessional 65 activities and rounds respectively would rank next, in av a i l a b i l i t y and are rated high in usage by therapists. The meetings and congresses of the professional associations are used in a limited way by therapists for continuing education. Although 70.0 percent of a l l therapists attended one or more meetings in the past year less than 20.0 percent attended on a regular basis. National con-gresses are attended by relatively few therapists unless the event occurs locally. Many therapists read to further their own education and pro-fessional literature i s frequently referred to. Only 6.0 percent of a l l therapists admitted to not having done so in the month previous to the interview. Professional journals particularly those published i n Canada are read by the majority of therapists and many others are referred to at frequent intervals. However, less than one-half of the therapists buy any professional books and these would li k e l y purchase only one or two a year. Therapists would usually consult a medical library or the reference materials in their own department and for further information on matters such as patient care they would consult with a physician or a colleague. Approximately 80.0 percent of a l l therapists attended one or more continuing education courses in the previous two years. The lack of suitable courses was given as the major deterrent to attending continuing educa-tional a c t i v i t i e s . The majority of therapists indicated that their needs were not being met by the short courses presently being offered. More therapists showed an interest in the short course than any other method. There was also considerable interest in extension courses 66 for credit and in independent learning courses such as those offered through correspondence. The preferred months for courses were from January to June and weekdays were favored over weekends. Interest was shown in having video tapes, slide tapes as well as programmed learning materials more available. CHAPTER V ASSESSMENT OF LEARNING NEEDS The determination of learning needs was done by an interest assessment check l i s t covering six general categories (see Appendix A). The check l i s t ascertains the f e l t learning needs of individual therapists at a particular moment in time, therefore i s subject to many interven-ing variables. No attempt was made to ascertain the degree of motivation for taking a course to satisfy these needs. The interviewer suggested that although one could be "interested" in many subjects, they should indicate "no interest" i f they thought that they would never be inclined to take a course or attend a seminar or workshop centered around that particular item. Therapists were asked to indicate their level of interest by checking either "Recent Advances" or "Greater Depth" in order to try and determine the level of need (see Appendix C for detailed findings). These headings were in agreement with categories established by the APTA (2) study of continuing education. Learning needs within each of the categories were then rank ordered on the basis of expressed interest versus no interest. A Spearman rank order correlation coefficient was done for each to assess the degree of relationship between OTs and PTs. As was anticipated OTs and PTs have a high level of agreement on most of the topics but do show a disparity in interest on some items. 67 6 8 BASIC SCIENCES The basic sciences are the foundations upon which physical and occupational therapy are based. They provide the knowledge for under-standing the why, what, when, and how of therapeutic assessment, tre a t -ment and evaluation. A thorough knowledge of the basic sciences and t h e i r functional application prepare therapists to make t h e i r unique contribution to health care. The OTs and PTs surveyed demonstrated a high l e v e l of i n t e r e s t i n some of the twenty-five topics itemized under basic sciences. An interest i n drugs that act on the nervous, muscular and cardiovascular systems ranked f i r s t with both groups. Biochemistry, histology and epidemiology were of l i t t l e i n t e r e st to either group. The PTs place neuroanatomy, neurophysiology and neuropathology second, t h i r d , and fourth respectively. The physiology, pathology and functional anatomy of the musculoskeletal system are f i f t h , seventh and ninth respectively (Table XVII). Biomechanics and kinesiology ranked s i x t h . The PTs had very l i t t l e i nterest i n psychopathology and physio-l o g i c a l psychology. After drugs and psychosocial growth and development the OTs ranked together anatomy of the musculo-skeletal system, psychopathology, psy-chology, physical growth and development. Neuroanatomy, neurophysiology and physiological psychology were ranked the same, followed by neuro-pathology and musculo-skeletal pathology. 69 TABLE XVII RANK ORDER OF PERCEIVED LEARNING NEEDS IN THE BASIC SCIENCES Physical Occupational Learning Need Therapists Therapists (Rank Order) (Rank Order) Musculo-skeletal Anatomy 9 4.5 Respiratory Anatomy 18 20.5 Cardiovascular Anatomy 17 18 Neuroanatomy 2 8 Musculo-skeletal Physiology 5 10 Respiratory Physiology 10 22 Cardiovascular Physiology 11 16 Neurophysiology 3 8 Musculo-skeletal Pathology 7 11.5 Respiratory Pathology 13 18 Cardiovascular Pathology 15 18 Neuropathology 4 11.5 Psychopathology 22 4.5 Psychology 13 4.5 Physical Growth and Development 13 4.5 Psychosocial Growth and Development 16 2 Physiological Psychology 21 8 Biomechanics and Kinesiology 6 13 Biochemistry 24 25 Histology 25 23.5 Radiology 20.5 20.5 Genetics 20.5 14.5 Epidemiology 23 23.5 Drugs 1 1 Laboratory Procedures 8 14.5 . r = 0.4882; one t a i l e d significance <.01 70 The items on which there was the greatest difference i n ranking by the OTs and PTs were psychopathology, psychosocial growth and develop-ment, physiological psychology and physiology of the respiratory system (Table XVII, p. 69). There was a positive relationship between the interests of the OTs and PTs and a one t a i l e d significance l e v e l of greater than .01 was reached. CLINICAL CONDITIONS C l i n i c a l conditions i n th i s study imply the management of s p e c i f i c c l i n i c a l e n t i t i e s . On three of the sixteen items there was a consider-able difference i n p r i o r i t y of interest between the OTs and PTs. These were sports i n j u r i e s , deaf and b l i n d , and psychiatric conditions (Table XVII) . These findings were not unexpected, as by the very nature of th e i r t r a i n i n g psychiatry and work with the deaf and bl i n d have f a l l e n into the domain of the OTs, while sports i n j u r i e s have been dealt with by PTs. Sports i n j u r i e s are not covered to any extent i n many undergraduate pro-grams and presently are of increasing interest to PTs. The PTs give f i r s t place to musculo-skeletal and orthopaedic conditions, followed by traumatic and neurological conditions (Table XVIII) . The OTs ranked neurological conditions f i r s t , followed by orthopaedic, musculo-skeletal and equally ranked are psy c h i a t r i c , neuro-surgical and traumatic. This r e f l e c t s the types of conditions most frequently treated by the majority of therapists. There was an o v e r a l l lack of interest i n infectious diseases and those pertaining to n u t r i t i o n a l , metabolic or endocrine disorders as well 71 TABLE XVIII RANK ORDER OF PERCEIVED LEARNING NEEDS FOR CLINICAL CONDITIONS Learning Need Physical Therapis ts (Rank Order) Occupational Therapists (Rank Order) Cardiovascular 8 10.5 Respiratory 7 12.5 Psychiatric 11 5 Infectious 14 15 Musculo-skeletal 1.5 3 Neurological 4 1 Neurosurgical 5.5 5 Traumatic 3 5 Orthopaedic •1.5 2 Sports Injuries 5.5 14 Obs tetrics/Gynecology 12 16 Paediatrics 9 7.5 Geriatrics 10 10.5 Mental Retardation 14 9 N u t r i t i o n a l , Metabolic, Endocrinal 14 12.5 Deaf/Blind 16 7.5 r = 0.589; one t a i l e d significance <.05 7 2 as obstetrics and gynecology. Mental retardation and g e r i a t r i c s were of great interest to a few therapists but did not rank high o v e r a l l (Appendix C, Table C2). The p o s i t i v e c o r r e l a t i o n between OTs and PTs interests i n th i s category was at the .05 l e v e l of significance on a one t a i l e d test. REHABILITATIVE TECHNIQUES The 19 items i n th i s group refer to s p e c i f i c s k i l l s and techniques that make up the repertoire used by OTs and PTs (Table XIX). Therapists generally are becoming more specialized, therefore, one would expect to fin d a high l e v e l of interest i n an in d i v i d u a l f i e l d of expertise. Differences i n ranking between OTs and PTs were found on those items where there has been t r a d i t i o n a l l y l i t t l e overlap of roles. Among these are those considered e s s e n t i a l l y to be the domain of the OTs, vocational assessment, homemaking, sheltered workshops and creative a c t i v i t i e s , and those generally considered i n the sphere of the PTs, therapeutic exercises, manipulation, and i c e . Electrodiagnosis and electrotherapy were of l i t t l e i n t e r e s t to therapists i n general. There was no s i g n i f i c a n t c o r r e l a t i o n between the interests of PTs and OTs i n r e h a b i l i t a t i v e techniques. As far as rank order of i n t e r e s t , PTs place physical and functional assessment, remedial exercises, perceptual assessment, transfers and s p l i n t i n g , at the top. The OTs give top and equal ranking to vocational assessment, perceptual assessment, homemaking, functional independence and sheltered workshops. Creative workshops come next for OTs followed 73 TABLE XIX RANK ORDER OF PERCEIVED LEARNING NEEDS FOR REHABILITATIVE TECHNIQUES Learning Need Physical Therapis ts (Rank Order) Occupational Therapists (Rank Order) Physical Functional Assessment 1 8 Perceptual Assessment 3 3 Psychological Assessment 10 8 Vocational Assessment 13.5 3 Electrodiagnosis 15 15.5 Therapeutic Exercises 2 14 Prosthetics 11.5 13 Electrotherapy 13.5 18.5 Homemaking 19 3 Functional Independence 9 3 Creative A c t i v i t i e s 18 6 Recreational and So c i a l A c t i v i t i e s 17 10.5 Sheltered Workshops 16 3 Transfers, Equipment and Methods 4.5 10.5 Sp l i n t i n g and Devices 4.5 8 Manipulation 6 15.5 Special Equipment 8 12 Ice 7 18.5 Hydrotherapy 11.5 17 r = -0.2241; n.s. 74 by physical and functional assessment, psychological assessment and s p l i n t i n g with equal rank. There appears to be an overlap of interests between OTs and PTs (Table XIX, p. 73) especially i n the areas of perceptual assessment, o r t h o t i c s , and physical and functional assessment. The necessity for sound assessment i s now w e l l recognized as a basis for establishing aims and methods of treatment and on-going evaluation. S k i l l i n s p e c i f i c assessment techniques i s an important part of the role of the therapist. ADMINISTRATIVE SKILLS Not a great deal of interest was shown by PTs or OTs i n adminis-t r a t i o n and supervision (Table XX). Medical l e g a l problems, program planning and evaluation, learning and i n s t r u c t i o n , and audio v i s u a l aids were the only topics i n which more than 50.0 percent of the therapists indicated an i n t e r e s t . As a rather small number of therapists aspire to supervisory positions, the l e v e l of i n t e r e s t , however, could be con-sidered r e l a t i v e l y encouraging. Table XX gives d e t a i l s of the rank order of i n t e r e s t which would be considered when designing a course i n admin-i s t r a t i v e matters. As indicated by the Spearman correlation c o e f f i c i e n t t e s t , interests of PTs and OTs are s i m i l a r , s i g n i f i c a n t at a <.01 l e v e l . HUMAN RELATIONS SKILLS A l l therapists (80% of the OTs and over 50% of the PTs) were interested i n the f i v e items i n t h i s category (Appendix C Table C5). The PTs are primarily interested i n therapist-patient and interprofessional 75 TABLE XX RANK ORDERING OF PERCEIVED LEARNING NEEDS FOR ADMINISTRATIVE SKILLS Learning Need. Physical Therapists (Rank Order) Occupational Therapists (Rank Order) Office Management and Procedures . 9 6.5 Economics of Health Care 5 8.5 Personnel Management and Supervision 6 4.5 Medical Legal Problems 1.5 4.5 Program Planning and Evaluation 1.5 2 Learning and Instruction 3.5 2 Audio Visual Aids 3.5 2 Research Design 7 4.5 Computer i n the Health Sciences 10 10 S t a t i s t i c s i n the Health Sciences 8 8.5 r g = 0.7713; one t a i l e d significance <.01 relationships while the OTs rank together therapist-patient r e l a t i o n -ships, communication s k i l l s , and counselling as being of most interest (Table XXI). Therapists are increasingly aware of the importance of human relationships, and although OTs and perhaps to a lesser degree PTs have some s k i l l s i n this area they are conscious of the heed to improve them. There was however no s i g n i f i c a n t c o r r e l a t i o n between the l e v e l of interests of PTs and OTs i n human relations s k i l l s . 76 TABLE XXI RANK ORDER OF PERCEIVED LEARNING NEEDS FOR FOR HUMAN RELATIONS SKILLS Learning Need Physical Therapists (Rank Order) Occupational Therapists (Rank Order) Staff relationships 4 4 Therapist-patient relationships 1.5 2 Interprofessional relationships 1.5 5 Communication s k i l l s verbal and non-verbal 3 2 Counselling/interviewing 5 2 r = -0.1250; n.s. s HEALTH CARE DELIVERY SYSTEMS Over 50.0 percent of the therapists had an interest i n pursuing the items l i s t e d under health care delivery systems; they were p a r t i c u l a r l y interested i n the more recent changes i n these areas (Appendix C, Table C6). Occupational Therapists ranked interest i n community health care ahead of prevention, the opposite was the case for the PTs (Table XXII). SUMMARY I t i s recognized that an interest survey, because of i t s very nature, cannot be used as a measure of intent toward taking a course i n the future; i t can nevertheless give some ind i c a t i o n of what therapists perceive as their learning needs and how they are l i k e l y to respond. In 77 TABLE XXII RANK ORDER OF PERCEIVED LEARNING NEEDS FOR HEALTH CARE DELIVERY SYSTEMS Learning Need. Physical Therapists (Rank Order) Occupational Therapists (Rank Order) Health Education and Preventative Medicine 1 2 Community Health Care 2 1 I n s t i t u t i o n a l Care 3 3 r = 0.5; n.s. s th i s survey the term interest was meant to indicate an intent to pursue the subject further. The most surprising outcome of the survey was the overwhelming int e r e s t i n drugs which ranked f i r s t , for both OTs and PTs, i n i t s own category as w e l l as when a l l 80 items were ranked. Other items of common in t e r e s t to OTs and PTs were perceptual assessment and neurological conditions. In ranking a l l items i t was found that the OTs were equally interested i n homemaking, functional independence and sheltered workshops, vocational assessment as with drugs and perceptual assessment. Inter-professional r e l a t i o n s h i p s , verbal and non-verbal communication s k i l l s , counselling and interviewing were next i n in t e r e s t followed by s t a f f r e l a t i o n s h i p s , creative a c t i v i t i e s , psychosocial growth and development and neurological conditions. The PTs were most interested a f t e r drugs i n physical and functional.assessment, orthopaedic and musculo-skeletal conditions, remedial exercises and traumatic conditions, neurological 78 conditions, perceptual assessment, neuroanatomy, neurophysiology and transfers and ortho t i c s , manipulation, sports i n j u r i e s , neuropathology and neurosurgery. These findings should be of p a r t i c u l a r importance when considering future programs for continuing education. I t was found that except for r e h a b i l i t a t i v e techniques and human re l a t i o n s k i l l s when items were ranked i n each category there was a considerable degree of correlation between the interests of OTs and PTs. This i s not, an unexpected finding as i t i s i n these two areas that the s p e c i f i c expertise of OTs and PTs are to be found. This indicates the need for planning a certain number of s p e c i f i c educational a c t i v i t i e s for each group. CHAPTER VI SELECTED STATEMENTS OF OPINION Thirty selected statements of opinion, gleaned from the literature and frequently heard comments, covering working conditions, education, interpersonal relationships, standards of practice and health care were presented to the therapists in the study. They were asked to indicate their feelings about each statement as i t applied to their profession on a six point scale from strongly agree to strongly disagree (Figure 10). On the majority of the thirty items, using the standard formula for the t test, OTs and PTs show a high level of agreement. There was, however, a significant difference of opinion on eight of the statements, underlined in Figure 10. On a l l of these statements the difference could be accounted for by the greater divergence of opinion among the PTs while the OTs were more convergent in their opinion, that is the standard deviation for these statements was greater for the PTs than the OTs. OTs are more i n agreement on such things as the degree of involve-ment of the therapist in total health care, the responsibility of the therapist to communicate with the patient on his treatment and i t s eventual outcome; and the sensitivity required when dealing with other professionals. These opinions are i n keeping with their high interest i n human relations s k i l l s dealt with in Chapter V. 79 STATEMENT 0 No. 1. T h o r n p i H t s h a v e t o s p e n d t o o much t i m e i n k e e p i n g r e c o r d s a n d o t h e r c l e r i c a l t a s k s 2. T h e r a p i s t s a r c e d u c a t o r s a n d t e a c h e r s n t a l l l e v e l s o f p r a c t i c e . 3. T h e r a p i s t s t e n d t o t r e a t a c o n d i t i o n r a t h e r t h a n a p a t i e n t . .A, T h e r a p i s t s s h o u l d b o l e s s I n v o l v e d i n t o t a l h e a l t h c a r e * 5. T h e r a p i s t s f e e l t h a t t h e y a r e i n a d e a d e n d j o b w i t h l i m i t e d o p p o r t u n i t y f o r p r o f e s s i o n a l a d v a n c e m e n t . 6. T h e r a p i s t s a s h e a l t h p r o f e s s i o n a l s a r e e x c e e d i n g l y r i g i d i n t h e i r s t a n d a r d s o f p r a c t i c e . 7. T h e r a p i s t s h a v e a r e s p o n s i b i l i t y c o t e l l t h e p a t i e n t w h a t t h e r a p e u t i c t r e a t m e n t i s b e i n g p l a n n e d ... er.d r e s u l t * * 8. T h e r a p i s t s d o n o t h a v e a g o o d c o n c e p t o f t h e i n t e r -p r o f e s s i o n a l a p p r o a c h t o h e a l t h c a r e . 9. T h e r a p i s t s a r e a l l o w e d t o u s e t h e i r own i n i t i a t i v e . 1 0 . T h e r a p i s t s s h o u l d e n g a g e i n c o m n u n i t y a c t i v i t i e s i n c o n n e c t i o n w i t h t h e i r p r o f e s s i o n a l r o l e . 1 1 . T h e r a p i s t s f r e q u e n t l y w a s t e t i m e p e r f o r m i n g t a s k s t h a t  c o u l d be d o n e a d e q u a t e l y b y t r a i n e d a i d e s . 12. T h e r a p i s t s m u s t h a v e a m a s t e r ' s d e g r e e i n t h e i r p r o f e s s i o n a v a i l a b l e t o them. 1 3 . T h e r a p i s t s o f t e n p u t t h e p a t i e n t s e c o n d a r y t o t h e i r r o u t i n e s . 14. T h e r a p i s t s w i t h c o n t i n u i n g e d u c a t i o n c o u l d f u n c t i o n a s  ^ ' d o c t o r ' s a s s i s t a n t " i n F a m i l y P r a c t i c e o r c o m m u n i t y tned. 15. T h e r a p i s t s t o - d a y s e e m more c o n c e r n e d w i t h wages a n d h o u r s t h a n w i t h p a t i e n t c a r e . 1 6 . T h e t h e r a p i s t ' s p r o f e s s i o n a l r o l e i s u n d e r s t o o d b y m o s t d o c t o r s . 1 7 . T h e r a p i s t s h a v e a r i g h t t o s p e n d some o f t h e i r o n d u t y t i m e  r e a d i n g t o k e e p a b r e a s t o f a d v a n c e s i n t h e p r o f e s s i o n . * 1 8 . T h e r a p i s t s tu-^e a r i g h t t o e x p e c t t h e n u r s e s t o make c h a n g e s o n t h e w a r d t o s u i t t h e n e e d s o f t h e p a t i e n t . 1 9 . T h e r a p i s t s s h o u l d h a v e a r e g u l a r e v a l u a t i o n o f t h e i r  work, p e r f o r m a n c e . * 20 . T h e r a p i s t s h a v e a r e s p o n s i b i l i t y t o q u e s t i o n t r e a t m e n t s o r d e r e d b y t h e d o c t o r s . 2 1 . T h e r a p i s t s s h o u l d b e g i v e n a j o b d e s c r i p t i o n f o r e a c h p o s i t i o n t h e y f i l l . 2 2 . T h e r a p i s t s r e c e i v e r e f e r r a l s f o r a l l p a t i e n t s who w o u l d b e n e f i t f r o m t h e r a p e u t i c t r e a t m e n t . 2 3 . T h e r a p i s t s must b e p r e p a r e d t o u p g r a d e t h e m s e l v e s a c a d e m i c a l l y . 2 4 . T h e r a p i s t s w i t h e x p e r i e n c e s h o u l d h a v e t h e f r e e d o m t o c h o o s e t h e t h e r a p e u t i c t r e a t m e n t b e s t s u i t e d t o t h e p a t i e n t . 2 5 . T h e r a p i s t s e n t e r t h e p r o f e s s i o n s e e k i n g p e r s o n a l s a t i s f a c t i o n . T h e r a p i s t s t n he r e l l c o n s e d s h o u l d be r e q u 1 r c 4 t,o p a r t Ic l p . i t r- I n c o n t i n u i n g I'duc.t t ! nn_ I n rc-h.ih i 111 a t l»n. * 27. T h c r a p l H t n ' k n o w l e d g e a n d s k i l l s a r e e f f e c t i v e l y u s e d , 28 . T h e r a p i s t f i h a v e t h e t i m e t o a d e q u a t e l y n n n e s f i a n d p j an t r c n t i n c n t o . 29. I?1':/:']'_!;" ' " » ' - ' ' t d e v e l o p m M i s l t t v H y t o o t h e r pryl/.'MjMon-iJji, * 30. T h o r n p t nt ti h a v e n n i M p o m i I b I 111 y t o c o n s i d e r t h o f l i u n u l / i l Imp I I i-«t ItMitl '»»" ( c c ' i l ir'-ni, t <» l.h<* p . i t l o n t . ** ri t y,n t f 1 c n n l nt . O'j 1 e v e l ch'.'ted St M c m i ' M L d <if ( i p l n l I 9 * i i l g n l I U:nnt nt .01 1 <• v.; 1 Fl KU I f III. M.-im K;il Inn .if b y T l i . - n i | 81 OTs f e e l more strongly than PTs that some of thei r tasks could be undertaken by trained aides. The other statements where there was a s i g n i f i c a n t difference concerned working practices. Physical Therapists are not i n complete agreement on the following: that they can function independently; that they should be allowed to read professional material on the job; that t h e i r work performance should be evaluated or that continuing education should be required for relicensure. Therapists are quite united otherwise i n t h e i r b e l i e f s . They a l l f e e l that too much time must be spent on c l e r i c a l tasks. They agree that they are teachers and that they treat the patient rather than the condition. They disagree s l i g h t l y i n t h e i r opinion that they are i n a dead-end job. They only s l i g h t l y agree that they are r i g i d i n t h e i r standards of practice. A strong dedication to the interests of the patient comes through as well as the importance of the interprofessional nature of health care and involvement i n community a f f a i r s . There i s a po s i t i v e approach to educational a c t i v i t i e s . Therapists do f e e l hampered to a degree by lack of time to assess and evaluate. They consider that they are free to take a moderate degree of i n i t i a t i v e and have potential for expanding t h e i r role. They f e e l that t h e i r role i s not yet completely understood by doctors and that they do not always receive r e f e r r a l s for patients that would benefit from their treatment. They f e e l quite strongly that they must question doctor's orders and that they should have freedom of choice when i t comes to treatment. 82 The results suggest a positive a t t i t u d e , although a d e f i n i t e f e e l i n g comes through that the i r role i s not yet c l e a r l y understood and they have not reached the i r f u l l p o t e n t i a l as a therapist and a member of the health care team. FACTOR ANALYSIS The t h i r t y statements (Appendix A) for a l l 111 therapists were factor analyzed i n order to ascertain i f a few basic concepts would emerge. Seven factors were extracted from the 24 items, however, s i x items did not appear i n any factor. These were: Item No. 2 Therapists are educators and teachers at a l l levels of practice. Item No. 4 Therapists should be less involved i n t o t a l health care. Item No. 6 Therapists as health professionals are exceedingly r i g i d i n t h e i r standards of practice. Item No. 18 Therapists have a right to expect nurses to make changes on the ward that would better s u i t the needs of the patient. Item No. 20 Therapists have a r e s p o n s i b i l i t y to question treatments ordered by doctors. Item No. 21 Therapists with experience should have the freedom to choose the therapeutic treatment best suited to the patient. Each of these s i x items accounts for 4.17 percent or less of the t o t a l variance and together they account for 49.8 percent of the t o t a l variance. 83 Factor I: Professional P r i o r i t i e s Item Statement Factor Loading 17 Therapists have a right to spend some of their on duty time reading to keep abreast of advances i n the i r profession. - 0.5423 29 Therapists must develop a s e n s i t i v i t y to other professionals. 0.5858 30 Therapists i n planning treatment pro-grams have a r e s p o n s i b i l i t y to con-sider the f i n a n c i a l implications to the patient. 0.6811 Proportion of t o t a l variance explained: 13.67 percent The f i r s t factor extracted accounts for a greater percentage of the t o t a l variance than any other. This factor does indicate that ther-apists do place consideration for the patient f i r s t amongst th e i r p r i o r i t i e s along with the need to be sensitive to other professionals. Care of the patient today i s not a matter for one member of the team alone. Factor I I : Patient Care Item Statement Factor Loading 3 Therapists tend to treat a condition rather than the t o t a l patient. - 0.6625 8 Therapists do not have a good concept of the interprofessional approach to health care. - 0.5820 15 Therapists today seem more concerned with wages and hours than with patient care. - 0.5031 Proportion of t o t a l variance explained: 7.57 percent 84 This factor i s comprised of three items. I t appears from the analysis that therapists are concerned with t o t a l patient care, with the patient as an i n d i v i d u a l and they see this as being achieved best through an interprofessional approach. Factor I I I : Role Responsibility Item Statement Factor Loading 1 Therapists have to spend too much time i n keeping records and other c l e r i c a l tasks. 0.5256 11 Therapists frequently waste time performing tasks that could be done adequately by w e l l -trained aides. 0.5927 16. The therapist's professional role i s understood by most doctors - 0.5218 27 Therapist's knowledge and s k i l l s are e f f e c t i v e l y used. - 0.5483 28 Therapists have the time to adequately assess and plan treatments. - 0.7166 Proportion of t o t a l variance explained: 7.21 percent Role R e s p o n s i b i l i t i e s take i n f i v e items. Many tasks therapists are called upon to perform do not r e f l e c t the l e v e l of th e i r professional t r a i n i n g , taking time that they could use to better advantage. Ther-apists' s k i l l s and knowledge may be poorly u t i l i z e d i n part due to a lack of understanding of t h e i r professional roles. 85 Factor IV: Professional Status Item Statement Factor Loading 10 Therapists should engage i n community a c t i v i t i e s i n connection with their professional role. 0.7262 12 Therapists must have a master's degree i n t h e i r profession available to them. 0.6956 22 Therapists receive r e f e r r a l s for a l l patients who would benefit from therapeutic treatment. - 0.5368 Proportion of t o t a l variance explained: 5.80 percent Of the three items that make up this factor, Item 22 should measure the opposite of Items 10 and 12. Therapists are generally considered to be oriented toward patient care. Involvement i n community a c t i v i t i e s and i n pursuing post graduate education could be i n c o n f l i c t with t h i s i n t e r e s t . I t would take them away from what they consider to be th e i r primary role. Factor V: Maintenance of Competence Item Statement Factor Loading 19 Therapists should have a regular evaluation of t h e i r work performance. - 0.6508 21 Therapists should be given a job des-c r i p t i o n of each position they f i l l . r 0.6313 23 Therapists must be prepared to upgrade themselves academically. - 0.6313 26 Therapists to be relicensed should be required to participate i n continuing education i n r e h a b i l i t a t i o n . - 0.6719 Proportion of t o t a l variance explained: 5.63 percent This factor i s made up of four items which denote therapists' awareness and r e s p o n s i b i l i t y for t h e i r own accountability. I t recognize the need for some means of measuring and maintaining professional s k i l l s and knowledge. Factor VI: Job S a t i s f a c t i o n Item Statement Factor Loading 5 Therapists f e e l that they are i n a dead end job with l i m i t e d opportunity for professional advancement. 0.5082 7 Therapists have a r e s p o n s i b i l i t y to t e l l the patient what therapeutic treatment i s being planned, the length of the treatment and what can be expected as the end result 0.6274 14 Therapists with continuing education could function as "doctor's assistants" i n Fam-i l y Practice or Community Medicine. 0.6890 25 Therapists enter the profession seeking personal s a t i s f a c t i o n . 0.5848 Proportion of t o t a l variance explained: 5. 25 percent The four items extracted to make up t h i s factor are i n d i c a -t i o n that therapists do indeed f e e l that greater job s a t i s f a c t i o n could be achieved by an expansion of t h e i r roles. Factor VII: I n i t i a t i v e Item Statement Factor Loading 9 Therapists are allowed to use their own i n i t i a t i v e . 0.7298 13 Therapists often put the patient secondary to their routines. - 0.5667 Proportion of t o t a l variance explained: 5. 06 percent 87 The f i n a l factor extracted includes only two items. On analysis it.would appear that i f therapists were not allowed to use th e i r own i n i t i a t i v e t h e i r jobs would become more routine and subsequently re s u l t i n i n d i f f e r e n t patient care. SUMMARY Thirty statements of opinion were selected on the basis of t h e i r frequency of occurrence i n the l i t e r a t u r e and t h e i r usage by therapists. These were presented to the therapists i n the survey to rate on a s i x point scale. This was done i n order to ascertain some of the views held by them and to attempt to determine any s i g n i f i c a n t differences. On eight statements there was a s i g n i f i c a n t difference of opinion between OTs and PTs, due i n most instances to the greater concurrence of opinion amongst the OTs than the PTs. On the whole there was general agreement between them. A factor analysis produced seven factors using the 24 items and accounted for 50.1 percent of the t o t a l variance. These factors dealt with professional p r i o r i t i e s , patient care, role r e s p o n s i b i l i t y , pro-fessional status, maintenance of competence, job s a t i s f a c t i o n and i n i t i a t i v e . The analysis carried out i n this chapter i s one step that could be used as a basis for further investigation and the eventual development of an a t t i t u d i n a l scale for therapists. CHAPTER VII SUMMARY This descriptive study was based on data collected from 86 PTs and 25 OTs practicing i n B r i t i s h Columbia. The interview questionnaire sought demographic, employment and educational data from them, as w e l l as the deterrents to thei r p a r t i c i p a t i o n i n continuing education and their perceived learning needs. The attitudes they held about working conditions, patient care, continuing education and professional roles were explored. Limitations of the study were the size of the sample, although i t was a 20 percent random sample of the population of therapists i n B r i t i s h Columbia, and that i t was not possible to determine therapists' r e a l needs seen from the point of the consumer and the employer. The analysis did not include correlations between perceived learning needs of therapists and data about t h e i r geographic l o c a t i o n , age, conditions of employment or educational background. THE LITERATURE REVIEW In reviewing the l i t e r a t u r e about the education of therapists the following points are found to be discussed most frequently: the necessity for continuing education and the need for i t to be a part of the continuum of education; the part education plays i n advancing pro-fe s s i o n a l i z a t i o n and i n f a c i l i t a t i n g change. I t i s repeatedly stated i n the l i t e r a t u r e that therapists have the r e s p o n s i b i l i t y for shaping th e i r 88 89 own professional future and for defining t h e i r role i n the health care delivery system. Therapists should also be prepared to determine how t h e i r performance i s to be evaluated. Further, there was limited evidence of r e a l commitment to the idea of continuous learning, nor i s continuing education as yet recognized as essential to the professional development of therapists by those responsible for i t s delivery. The impact of continuing education on patient care has not yet been undertaken. Resources allocated to con-tinuing education, both f i n a n c i a l and i n terms of trained educators, must be substantially increased. The major barriers to continuing education are securing a replace-ment, distance to t r a v e l for courses, family r e s p o n s i b i l i t i e s and appro-priate offerings. The studies on continuing education i n r e h a b i l i t a t i o n are generally descriptive i n nature and report mainly socio-demographic and other base-l i n e data. The survey method was used i n most cases. THE FINDINGS Demographic The majority of therapists were found to reside i n the larger urban areas, only 18.6 percent of the PTs and 4.0 percent of the OTs l i v e d outside of Vancouver, Lower Mainland and the V i c t o r i a , Vancouver Island d i s t r i c t s . Occupational therapy was found to be t o t a l l y female dominated, and of the PTs surveyed only 14.0 percent were male. There were more married PTs than OTs, 59.3 percent and 44.0 percent respectively. 90 The age distribution for the two groups was somewhat different with 64.0 percent of the OTs and 51.2 percent of the PTs being i n the 20-29 age bracket. There were more practicing PTs over the age of 40 than OTs. Professional Education The professional educational data showed that 88.0 percent of the OTs and 79.8 percent of the PTs graduated from a university program and 44.0 percent and 23.3 percent respectively received a baccalaureate degree, while the remainder had received a diploma. The majority of therapists had graduated since 1963 and 19.7 percent were from Canadian schools. Of these The University of British .Columbia accounted for 53.3 percent of the OTs and 28.6 percent of the PTs. Great Britain supplied approximately one-quarter of a l l therapists in the work force in British Columbia. Approximately 15.0 percent of a l l therapists planned to go on to a baccalaureate degree and 10.0 percent to a Masters. However, 50.0 per-cent of the PTs and 68.0 percent of the OTs had no academic educational goals. Very few therapists were interested in pursuing a specialty (4.6% of the PTs and no OTs). Employment It was found that by far the greater number of PTs (77.9%) and OTs (88.0%) had worked in their present position in British Columbia for five years or less. Over 50.0 percent of a l l therapists were in staff positions and 76.5 percent practice in an institution. The PTs were more l i k e l y to be employed i n a general hospital than OTs (46.5% against 24.0%), however, 28.0 percent of the OTs and only 13.0 percent 91 of the PTs work in a rehabilitation center. Psychiatric hospitals employed 28.0 percent of the OTs and no PTs. Private practice accounted for 9.3 percent of the PTs and no OTs. A total of 18.6 percent of the PTs and 16.0 percent of the OTs were undecided as to future employment plans. The remainder intended to keep working f u l l time, part time or to return to work following a break. Over one-half of the OTs (56.0%) and PTs (33.9%) had no definite plans about their future within the profession. Some interest was shown in administration and c l i n i c a l supervision, but very l i t t l e in teaching and research. The most common levels of care provided by PTs were acute, re-habilitation or a combination of acute, rehabilitation and activation. OTs were to be found more frequently practicing at the rehabilitation, acute, extended care or a combination of acute, rehabilitation and activation levels. In-service Education The study revealed that therapists participate extensively in those in-service a c t i v i t i e s available to them, especially staff meetings with educational content, ward rounds, interprofessional a c t i v i t i e s , and in-service programs in nursing. Professional Activities The survey found that membership i n the Canadian Physiotherapy Association and the Canadian Association of Occupational Therapy was excellent, 95.4 percent and 84.0 percent respectively. During the year prior to the survey, however, 30.2 percent of the PTs and 24.0 percent of 92 the OTs had never attended a meeting, while 30.2 percent of the PTs and 36.0 percent of the OTs had attended only one or two meetings i n that time. Congresses were attended by very few therapists, except when held i n their immediate v i c i n i t y . Self-directed Education Reading professional journals was ci t e d frequently as an inde-pendent learning a c t i v i t y . Although books were infrequently purchased by therapists, l i b r a r i e s were extensively used. Other learning resources used on an ad hoc basis were the physicians, professional colleagues and the supervisor. Continuing Education In the two years previous to the study 27.9 percent of the PTs and 20.0 percent of the OTs had attended continuing education non-credit short courses at the rate of two per year. Only 22.1 percent of the PTs and 24.0 percent of the OTs had attended more frequently. This study revealed that i n the previous two years some of the PTs (18.6%) and OTs (24.0%) had not attended any such courses. At the time of the study only 27.7 percent of the PTs and 20.0 percent of the OTs could p o s i t i v e l y say that the i r needs for continuing education were being met. Although no one barri e r was found to be a major deterrent to attendance at continuing education courses, the three main r e s t r a i n t s were lack of suitable courses, family r e s p o n s i b i l i t i e s and lack of finan-c i a l support. Other factors l i m i t i n g p a r t i c i p a t i o n were distance from locale of a course and getting time off to attend. 93 Preferred Educational Methods and Scheduling The short course (workshop seminar, etc.), interested 92.0 per-cent of the OTs and 75.6 percent of the PTs. In spite of the fact that qualifying for a specialty was not a highly regarded educational goal, 34.9 percent of the PTs and 40.0 percent of the OTs indicated interest in taking a hospital or institutionally based c l i n i c a l specialty course. The other methods in order of interest were extension courses (credit or non-credit), independent study (credit or non-credit), and correspon-dence courses (credit). F u l l time university attendance and correspondence courses for non-credit were of interest to only a few of the therapists in the study. Therapists preferred January, February, March followed by A p r i l , May and June as the best times of year to schedule courses. Most therapists favoured weekdays over weekends. Considerable interest was expressed in educational materials, particularly those that were audio visual. Learning Needs Specific areas of perceived learning needs were identified for both PTs and OTs. The OTs expressed particular interest in drugs, especially those acting on the nervous, musculo-skeletal, respiratory and cardio-vascular systems. They were also interested in perceptual assessment, homemaking, functional independence, sheltered workshops, vocational assessment, interprofessional relationships, verbal and non-verbal communication s k i l l s and counselling and interviewing. 94 The PTs were particularly interested in drugs, physical and functional assessments, orthopaedic and musculo-skeletal conditions, perceptual assessment, neuroanatomy and neurophysiology. There was a significant correlation between the rank order of learning needs for PTs and OTs in the basic sciences, c l i n i c a l conditions, and administrative s k i l l s but not for rehabilitative techniques and human relation s k i l l s . Opinions Thirty statements of opinion were presented to the therapists in the survey. On analysis of the results for a l l therapists seven factors were identified: professional p r i o r i t i e s ; patient care; role responsi-b i l i t i e s ; professional status; maintenance of competence and job satis-faction and i n i t i a t i v e . On further analysis of the statements the OTs and PTs were found to be in close agreement on twenty-two of them. On the remaining eight the standard deviations for the PTs were greater than for the OTs. The OTs be-lieve they should be more involved i n total health care; take more respon-s i b i l i t y for explaining the treatment plan and end results to the patient and be more sensitive to other professionals than the PTs. The OTs are more in agreement that they should have their work performance evaluated, be required to participate in continuing education for relicensure, and be allowed to spend some time on professional reading while on duty than the PTs. OTs more than PTs consider they waste time performing tasks that could be done by aides and are more united i n their opinion about their a b i l i t y to function in the community in an expanded role. 95 IMPLICATIONS Educational Admission to the professional associations for therapists i s apt to become an end rather than a means to further education, while continuous learning is an educational concept s t i l l to be f u l l y under-stood and accepted. Therapists have the capability for professional and personal growth, however they must become committed to these ideas i f their professional knowledge and s k i l l s are to be f u l l y u t i l i z e d . In order to provide motivation to participate in continuous learning, good learning experiences must meet the needs of the therapists. In order to do this, educational a c t i v i t i e s should be provided on a variety of levels: continuing education; in-service education; s e l f -directed education; degree completion programs; re-entry and post graduate education. The scope of this study did not permit study of degree completion, re-entry and post graduate programs, however, the necessity for a degree completion program in Br i t i s h Columbia was made evident by the number of therapists with only a diploma. Furthermore, the professional associa-tion's recommendations that their future members would require a degree is subtle motivation for acquiring one. There i s , of course, the advantage that a degree program provides entry to post graduate studies. Since this study began The School of Rehabilitation Medicine, The University of British Columbia, has developed a degree completion program. 96 A post graduate program should be available within the profession for those presently holding a baccalaureate degree. I t i s u n l i k e l y , u n t i l t h i s i s so, that there w i l l be any major emphasis on research. While degree completion and post graduate programs are the r e s p o n s i b i l i t y of the u n i v e r s i t i e s , re-entry programs should be the prime r e s p o n s i b i l i t y of the associations. A re-entry course i s presently being developed for PTs i n B r i t i s h Columbia. Continuing Education Continuing Education should be w e l l planned so that i t meets the needs of the therapists whether they are new graduates or experienced therapists and wherever they may work. Although the short course i s highly favoured, other methods of providing continuing education should be explored. This w i l l require not only adequate f i n a n c i a l resources, but educators with experience i n continuing education programming. The determination of needs should not be confined to therapists' interests only, but should also take into account the t r a i n i n g required for expanding t h e i r r o l e s , for changing the delivery system of health care to consumers i n their communities, and for taking a more active role i n preventive medicine. The detailed check l i s t used i n this study has already proved useful for course planning, however, perceived needs change over time and with increased educational opportunities. In the near future the relationship between continuing education and the maintenance of competencies for relicensure must be determined. The provision of continuing education should be shared responsi-b i l i t y . The hospitals and agencies by giving quality care provide an i d e a l 97 c l i n i c a l setting for continuing education; the university can provide the academic background, research f a c i l i t i e s and foster education on a variety of levels. The professional associations should co-operate with these i n -stitutions as well as the licensing bodies to assess the needs of their membership, provide manpower to design and implement programs and allocate appropriate funding. The governments should be committed to support continuing education as a means of maintaining competence and of delivering exemplary health care. Above a l l , therapists must recognize the relevance of continuing education to their own professional and personal self-fulfillment. Since this study began the interest of therapists in continuing their education in one or more directions has increased. The establish-ment of a Division of Continuing Education in Rehabilitation by the School of Rehabilitation Medicine at The University of British Columbia has given recognition to the necessity for more educational opportunities for therapists. In-service Education Although in-service education is available to most therapists, i t i s imperative that learning experiences are designed to meet specific c l i n i c a l needs. The results of in-service education on patient care should be evaluated. The opportunity to set standards of care and to u t i l i z e records for c l i n i c a l evaluation could be used as a basis for determining educational objectives. 98 Professional Associations Professionally therapists must re-examine their roles and plan for change. They must build a body of knowledge based on accepted research and assume responsibility for rational judgement in expanding their role. The professional associations should lead the way by establish-ing policies that further lifelong professional and personal growth and ensure excellence of health care. Self-directed Education Therapists, like other health professionals, seek to satisfy their own educational needs in a variety of ways: professional literature; programmed texts; audio visual materials; observational v i s i t s ; and attendance at professional meetings and congresses. These w i l l vary with time, experience and location. In order to enhance self-learning, more time and effort should go into researching and producing appropriate learning materials. Medical library f a c i l i t i e s available for the use of a l l therapists throughout the province are necessary to the development of self-directed education. Research The need for research that w i l l provide a proven body of c l i n i c a l knowledge related to the practice of physical and occupational therapy i s long overdue. In order to develop research programs therapists require knowledge of research methods and s t a t i s t i c a l analysis as well as practical experience. Financial assistance from the government and private agencies is needed to develop and support on-going projects. The support and continuing interest of knowledgeable researchers in the basic sciences and 99 other c l i n i c a l areas of the Health Sciences Section would be required. Some of the operational research would need to be structured on an i n t e r -professional basis. CONCLUSION This study has described the physical and occupational therapists i n B r i t i s h Columbia, thei r present educational status and perceived learn-ing needs. The data developed provides assistance i n determining t h e i r o v e r a l l professional educational requirements and objectives. Further investigation of r e a l needs and methods of evaluating the results of continuing education are indicated. I t i s apparent that i f the l i f e l o n g educational needs of OTs and PTs are to be met, the r e s p o n s i b i l i t y must be shared by government, the u n i v e r s i t y and professional associations as w e l l as therapists themselves. Bibliography American Occupational Therapy Association, "Occupational Therapy: I t s D e f i n i t i o n and Functions," The American Journal cf Occupa-tional Therapy. Vol. 26, No. 4 (May-June, 1972), 204-205. American Physical Therapy Association, Committee on Continuing Education. "Guidelines for Continuing Education for Components of the American Physical Therapy Association," Journal of the American Physical Therapy Association. Vol. 52, No. 4, ( A p r i l , 1972), 405-407. Azi z , Jawed. "The Supply of and Requirements for Physiotherapists i n Canada." Health Manpower Planning D i v i s i o n , Dept. of National Health and Welfare, March, 1972. (Mimeographed) Background Data for Improved Medical Communications and Continuing Medical Education: A Survey of Texas Physicians. Baylor Univer-s i t y College of Medicine, December 20, 1968. Baumgart, A l i c e J. " I d e n t i f i c a t i o n of Learning Needs of P r a c t i c i n g Medical Surgical Nurses." A Progress Report to the Annual Meeting, Registered Nurse's Association of B r i t i s h Columbia. May, 1971. (Mimeographed) Baumgart, A.J. and M.J. Neylan. "A Study to Determine the Character-i s t i c s and Perceived Learning Needs of Staff Nurses Giving Direct Care to Sick Adults i n Acute General Hospital Units i n B r i t i s h Columbia." (Unpublished) Bergevin, Paul. A Philosophy for Adult Education. The Scabury Press, New York. 1967. Biers, L., and J.F. Murphy. "A Descriptive Study of Educational Needs and Career Blockages," American Journal of Occupational Therapy. Vol. 24, No. 3, ( A p r i l , 1970), 196-200. Board of Directors of Physiotherapy, Province of Ontario, O f f i c i a l "* Register, February 28th, 1971. "1971 Study i n the Delivery of Physiotherapy i n Ontario," A Manpower Survey. (Mimeographed) Brandenburg, Earnest. "Building Toward Professionalism," Proceedings of Workshop on Graduate Education in Occupational Tficrapy. Wash-ington University, St. Louis, Missouri. A p r i l , 1963. 100 101 11. Burke, Richard D. "Occupational Therapy and Rehabilitation Natural A l l i e s , " Rehabilitation Record. (May-June, 1967), 10-12. 12. C a l i f o r n i a Medical Association. A Survey of Continuing Medical Education for Physicians Part I and II. Conducted by the Bureau of Research and Planning, San Francisco: The Association, 1969. 13. Canadian Physiotherapy Association. "Submission to the Royal Commission of the State of Women." A resolution by The Canadian Physiotherapy Association. May, 1967. (Mimeographed) 14. Canadian Physiotherapy Association, Ontario Branch. "Submission to the Sub Committee on Education of the Health Sciences." Ontario Council of Health. (February 1967). (Mimeographed) 15. Chase, Helen C. "Some Current Research for the A l l i e d Health Professions," Journal of the American Physical Therapy Association. Vol. 51, No. 7. (July, 1971), 771-776. 16. "Continuing Education for the Health Professions." Excerpted from the Report of an Interprofessional Task Force on Continuing Education. Center for the Study of Medical Education, University of I l l i n o i s , College of Medicine.. Journal of the American Physical Therapy Association. Vol. 47, No. 5, (May, 1967), 418-424. 17. Copeland, Harlan. "Change and Continuing Education," Ends and Means. The National Conference on Continuing Education in Nursing, 1970. Edited by Ruth W. McHenry, Syracuse University (May, 1971). 18. Crichton, Anne. "The Continuing Education Respo n s i b i l i t i e s of Health Science Centres." Association of Canadian Medical Colleges News-l e t t e r , January-February, 1972. 19. Crichton, Anne and Marion Crawford. Disappointed Expectations. Report on a Survey of Professional and Technical Sta f f i n the Hospital Service i n Wales, 1963, Welsh Hospital Board. 20; Department of Labour, Canada. Women in the Labour Force, 1970, Facts and Figures. 21. Deschler, Marlene. "Physical Therapy Future i n Community Health.,'" Your Future in Physical Therapy, Conference Program Proceedings. i970 Annual Meeting Ohio Chapter American Physical Therapy Association, May, 1970. 22. Dickinson, Gary. A Survey of the Need for Programs to Prepare Members of the Health Professions as Specialists in Continuing Education. Adult Education Research Center and D i v i s i o n of Continuing Education i n the Health Sciences. W.K. Kellogg Foundation Project Report No. 1. 102 23. Dominion Bureau of Statistics. Health Manpower in Hospitals, Physio-Oocupational Therapists, 1961-68. Information Canada, Ottawa. 24. Ernest, Marilyn. "Continuing Education in Rehabilitation Medicine," The Journal of Education, of the Faculty of Education, Vancouver, No. 18, Winter, 1971. 25. Finn, Geraldine, L. "The Occupational Therapist in Prevention Pro-grams," The American Journal of Occupational Therapy. Vol. 26, No. 2, (March, 1972), 59-66. 26. F l i n t , R.T. and K.C. Spensley. "Career Patterns of Minnesota O.T.'s," American Journal of Occupational Therapy. Vol. 22, No. 1, (Jan.-Feb., 1968), 30-34. 27. Glass, Bentley. "Educational Obsolescence," Journal of the American Physical Therapy Association. Vol. 51, No. 9 (September, 1971), 1017-1018. 28. Goldin, George J. "Community Aspects of the Role of the Physical Therapist." Journal of the American Physical Therapy Associa-tion. Vol. 46, No. 3, (March, 1966), 259-263. 29. Hamburg, J. "Future Trends in Professional Education," American Journal of Occupational Therapy. Vol. 24, No. 7, (October, 1970), 488-489. 30. Hammond, M.J. "Changing Patterns in Physiotherapy Education in South Australia," Australian Journal of Physiotherapy. XVII, March, 1971. 31. Hayter, Jean. "Individual Responsibility for Continuing Education." Journal of Continuing Education in Nursing. Vol. 3, No. 6 (November-December, 1972), 31-38. 32. Heap, M.F. "The Need for Effective Selection of Personnel in Physical Therapy Departments," Journal of the American Physical Therapy Association. Vol. 49, No. 1, (January, 1969), 7-14. 33. Henderson, Virginia A. "Health is Everybody's Business," The Canadian Nurse. (March, 1971), 31-34. 34. Hightower, Ann B. "Continuing Education in Physical Therapy/' Journal of the American Physical Therapy Association. Vol. 53, No. 1, (January, 1973) , 19-24. 35. Hornback, May S. "Continuing Education—Whose Responsibility," Journal of Continuing Education in Nursing. Vol. 2, No. 4, (July-August, 1971), 9-13. 103 36. Houle, Cyril 0. "The Comparative Study of Continuing Professional Education," Journal of Continuing Education in Nursing. Vol. 3, No. 3, (May-June, 1972), 4-11. 37. Jantzen, Alice C. "Some Characteristics of Female Occupational Therapists, Part I Descriptive Study," American Journal of Occupational Therapy. Vol. 26, No. 1, (Jan-Feb., 1972), 19-26. 38. Jantzen, Alice C. "Some Characteristice of Female Occupational Therapists, Part II, Employment Patterns of Female Occupational Therapists, 1970," American Journal of Occupational Therapy. Vol. 26, No. 2, (March, 1972), 67-77. 39. Johnson, Geneva R. "Wither Goest Thou, Friend?" Your Future in Physical Therapy. Conference Program Proceedings, 1970 Annual Meeting, Ohio Chapter American Physical Therapy Association, May, 1970. 40. Johnson, Geneva. "What's the Answer?" Journal of the American Physical Therapy Association. Vol. 52, No. 4, (April, 1972), 447-449. 41. Johnson, M.W., and C.B. Ware. "Assessment of Continuing Education," Journal of the American Physical Therapy Association. Vol. 47, No. 10, (October, 1967), 962-970. 42. Kendall, M.G. and B. Babington Smith. Tables of Random Sampling Numbers. Cambridge University Press, 1951. 43. Labour, Canada. Women's Bureau, 1971. 44. Lewis, Eloise. Nursing Education—Creative, Continuing, Experimental. National League for Nursing, 1966, New York. 45. McCreary, J.F. "Summing Up," F i r s t National Health Manpower Con-ference, Department of National Health and Welfare and The Association of Universities and Colleges of Canada. October, 1969. 46. McCreary, J.F. Continuing Education in the Health Sciences, Annual Reports 1970-1971. The Health Sciences Centre, The University of British Columbia. 47. McMahon, Ernest E. Needs—of People and Their Communities—and the Adult Educator. Adult Education Association of the U.S.A., Washington, D.C. 48. Michels, Eugene. "Your Future in the American Physical Therapy Association," Your ^Future in Physical Therapy. Conference Program Proceedings, 1970, Annual Meeting, Ohio Chapter American Physical Therapy Association, May, 1970. 104 49. Moore, Margaret L. "The Fallacy of Peaceful Change," Journal of the American Physical Therapy Association. Vol. 49, No. 2, (February, 1969), 133-138. 50. Nakamoto, June and Coolie Verner. Continuing Education in Nursing, A Review of North American Literature, 1960-1970. W.K. Kellogg Project Report No. 4, Adult Education Research Centre and Div-i s i o n of Continuing Education i n the Health Sciences, The Univer-s i t y of B r i t i s h Columbia, 1972. 51. Pascascio, Anne. "Continuing Education for Quality Health Care," Journal of the American Physical Therapy Association. Vol. 49, No. 3, (March, 1969), 257-264. 52. Perry, Jacquelin. "The Contribution of the Physical Therapist to Medicine," Journal of the American Physical Therapy Association. Vol. 45, No. 11, (November, 1965), 1033-1041. 53. Poole, M.A. and S. Kassalow. "Manpower Survey Report, Wisconsin Occupational Therapy Association," American Journal of Occupational Therapy. Vol. 22, No. 4, (July-August, 1968), 304-306. 54. P r i c e , E.M. Learning Needs for Registered Nurses. Columbia Uni-v e r s i t y : Teachers College Press, Teachers College, 1967. -55. Ramsden, Elsa L. " A u t h o r i t y — P r o f e s s i o n a l Responsibility," Journal of the American Physical Therapy Association. Vol. 51, No. 4, ( A p r i l , 1971), 418-421. 56. Report of a Survey on Continuing Education Needs for Health Pro-fessionals. Mountain States Regional Medical Programs. Boulder, Colorado: WICHE, 1969. 57. Report of The Committee on the Healing Arts. Vol. 2, Queen's P r i n t e r , Ottawa, 1970. 58. Robbens, J.W. "Why Management for Change," Physiotherapy. Vol. 58, No. 5, (May, 1972), 154-155. 59. Robertson, H.R. "Education for Health Manpower: Old Problems and New Objectives," Second National Conference on Health Manpower. Health and Welfare, October, 1971, Canada. 60. Schweer, Jean E. " C r i t i c a l Issues i n Continuing Education i n Nursing: Determining Needs and P r i o r i t i e s , " Journal of Continuing Education in Nursing. Vol. 2, No. 14, (July-August, 1971), 14-20. 61. Senters, Jo M. "Professionalization i n a Health Occupation: Physical Therapy," Journal of the American Physical Therapy Association. Vol. 52, No. 4, ( A p r i l , 1972), 385-391. 105 Sokolov, J. "The O.T. of the Future." American Journal of Occupa-tional Therapy. Vol. 19, No. 1, (Jan. Feb. 1965), 1-4. Storey, P a t r i c k B. Continuing Medical Education A New Emphasis. D i v i s i o n of S c i e n t i f i c A c t i v i t i e s , American Medical Association, Chicago, I l l i n o i s , 1968. Ward, Nancy. "Factors Influencing Physical Therapy Education." Imple-mentation of the Evaluation Process in Physical Therapy Education. APTA-VRA I n s t i t u t e , 1967. Weimer, Ed. W. "Prepare Now for Tomorrow." Journal of the American Physical Therapy Association. Vol. 50, No. 8, (August, 1970), 1145-1146. 66. Wells, Thomas L. Guiding Principles for the Regulation and the Education of the Health Disciplines. Government of Ontario, January, 1971. 67. West, Wilma L. "Professional Responsibility i n Time of Change," American Journal of Occupational Therapy. Vol. 22, No.1(January, February, 1968), 9-15. 68. Western Interstate Commission for Higher Education. Continuing Education in Nursing. Boulder, Colorado, November, 1969. 69. White, Thurman and J.E. Burkett. "A Philosophy of Continuing Education," Journal of the American Physical Therapy Association. Vol. 46, No. 1, (January, 1966), 28-33. 70. Wiemer, Ruth Brunyate. "Some Concepts of Prevention as an Aspect of Community Health." American Journal of Occupational Therapy. Vol. 26, No. 1, (January-February, 1972), 1-9. 71. Worthingham,'C. "What i s the Future of Physical Therapy Education?" Journal of the American Physical Therapy Association. Vol. 43, No. 9, (September, 1963), 645-649. 72. Zamir, L e i l a . "Perspectives i n Occupational Therapy Education," American Journal of Occupational Therapy. ' Vol. 24, No. 3, ( A p r i l , 1970), 192-195. 73. Zimmerman, T.D. "Laddering and L a t t i c i n g : Trends i n A l l i e d Health," American Journal of Occupational Therapy. Vol. 24, No. 2, (March, 1970), 102-105. 62. 63. 64. 65. A P P E N D I X A INTERVIEW QUESTIONNAIRE 106 S.R.M./U.B.C./72. Respondent's Number PHYSIOTHERAPIST and OCCUPATIONAL THERAPIST INTERVIEW SCHEDULE Respondent'8 Name: Home Address: Work Address: Telephone Numbers: Home: Work : Date Interviewed: Interviewer: R e s p o n d e n t ' s N u m b e r . D a t a C a r d N u m b e r . O c c u p a t i o n o f t h e r e s p o n d e n t a t t h e p r e s e n t t i m e : 1 . P h y s i o t h e r a p i s t 2 . O c c u p a t i o n a l T h e r a p i s t 3 . C o m b i n e d P h y s i o t h e r a p i s t / O c c u p a t i o n a l T h e r a p i s t G e o g r a p h i c a l D i s t r i c t : 1 . V a n c o u v e r - L o w e r M a i n l a n d 2 . V a n c o u v e r I s l a n d 3 . O k a n o g a n - S o u t h e r n I n t e r i o r B r i t i s h C o l u m b i a 4 . P r i n c e G e o r g e - N o r t h e r n B r i t i s h C o l u m b i a I n s t i t u t i o n / a g e n c y w h e r e t h e r e s p o n d e n t i s w o r k i n g : 1 . G e n e r a l H o s p i t a l 2 . C h i l d r e n ' s H o s p i t a l 3 . P s y c h i a t r i c H o s p i t a l 4 . E x t e n d e d C a r e H o s p i t a l 5 . R e h a b i l i t a t i o n C e n t r e 6 . P r i v a t e P r a c t i c e 7 . O t h e r ( s p e c i f y ) : H o w m a n y y e a r s h a v e y o u w o r k e d 1 . O n e y e a r o r l e s s 2 . 1 t o 5 y e a r s 3 . 6 t o 1 0 y e a r s 4 . 1 1 t o 1 5 y e a r s 5 . 1 6 t o 2 0 y e a r s 6 . 2 1 y e a r s o r m o r e i n t h e a b o v e i n s t i t u t i o n ? S e x : 1 . M a l e 2 . F e m a l e W h a t i s y o u r m a r i t a l s t a t u s ? 1 . S i n g l e 2 . M a r r i e d 3 . W i d o w e d , d i v o r c e d , s e p a r a t e d 2. 109 7. What i s your age: 13,14. 1. 25 and under 15. 1, 2. 26 to 30 * 2.' 3. 31 to -5 3. 4. 36 to 40 i>\ 5. 41 to 45 s 5.' 6. 46 to 50 - 6^  7. 51 to 55 7] 8. 56 to 60 3 ] 9. 61 to 65 q* 8. What i s your job t i t l e ? 1. Staff therapist 16. 1. 2. Senior therapist 2. 3. Assistant supervisor 3. 4. Supervisor 5. C l i n i c a l supervisor 5. 6. Sole charge 6. 7. Consultant 7. 8. Private practitioner 8. 9. Other (specify): 9« 9. How i s the greater percentage, of your working time spent? 1. "In patient" care 17. 1. 2. "Out patient" care 2« 3. Home v i s i t i n g 3. 4. Private practice ^* 5. Consultation 5. 6. Supervision/administration 6. 7. Other (specify): ^. f you do not deal directly with patient care, proceed to Question 13. 0. If you deal directly with patients, with which type of care are you primarily concerned? 1. Acute 13. 1. 2. Rehabilitation 2. 3. Activation 3. 4. Extended care 4. 5. Combination 5. 6. Other (specify): 6« 1. If you deal directly with patients, into which one or two main categories do the majority of your patients f a l l ? 1. Orthopaedic 19. 1. 2 2. Neurological/neurosurgical ^ 20. 3. 4 3. Respiratory ' 21. 5. 6 4. Cardiovascular 2 ^2* 7. 8 5. Other medical * 23. 9. A 6. Psychiatric/behaviour problems 24. B. C 7. Other (specify): 25. D. E 3 2 . I n w h a t c o u n t r y d i d y o u t a k e y o u r b a s i c p r o f e s s i o n a l e d u c a t i o n ? ^ ® 1 . C a n a d a 2 6 . 1 . 2 . G r e a t B r i t a i n 2 . 3 . A u s t r a l i a , N e w Z e a l a n d 3 . 4 . E u r o p e 4 . 5 . U n i t e d S t a t e s 5 . 6 . O t h e r ( s p e c i f y ) : 6 . 3. I f y o u a r e a C a n a d i a n G r a d u a t e , f r o m w h a t U n i v e r s i t y d i d y o u g r a d u a t e : 1 . U n i v e r s i t y o f B r i t i s h C o l u m b i a 2 7 . 1 . 2 . U n i v e r s i t y o f A l b e r t a 2 . 3 . U n i v e r s i t y o f S a s k a t c h e w a n , 3 . 4 . U n i v e r s i t y o f M a n i t o b a 4 . 5 . U n i v e r s i t y o f T o r o n t o 5 . 6 . U n i v e r s i t y o f W e s t e r n O n t a r i o 6 . 7 . Q u e e n s U n i v e r s i t y 7 . 8 . M c G i l l U n i v e r s i t y 8 . 9 . U n i v e r s i t y o f M o n t r e a l 9 -1 0 . L a v a l U n i v e r s i t y A . 1 1 . D a l h o u s i e U n i v e r s i t y B * 1 2 . C . A . O . T . S p e c i a l C o u r s e ( K i n g s t o n ) c « I f a C a n a d i a n G r a d u a t e , w h a t p r o g r a m d i d y o u t a k e ? 1 . P h y s i o t h e r a p y 2 8 . 1 . 2 . O c c u p a t i o n a l T h e r a p y 2 . 3 . C o m b i n e d P h y s i o t h e r a p y / O c c u p a t i o n a l T h e r a p y 3 . . I n w h a t y e a r d i d y o u g r a d u a t e : 3 0 , 3 1 . 1 . 0 t o 4 y e a r s a g o 3 2 . 1 . 2 . 5 t o 9 y e a r s a g o 2 . 3 . 1 0 t o 1 4 y e a r s a g o 3 . 4 . 1 5 t o 19 y e a r s a g o 4 . 5 . 2 0 o r m o r e y e a r s a g o 5 . . F r o m w h a t t y p e o f b a s i c p r o f e s s i o n a l e d u c a t i o n a l p r o g r a m d i d y o u g r a d u a t e ? 1 . H o s p i t a l b a s e d - d i p l o m a / c e r t i f i c a t e 3 3 . 1 . 2 . U n i v e r s i t y b a s e d - d i p l o m a / c e r t i f i c a t e 2 . 3 . U n i v e r s i t y b a s e d - d e g r e e 3 . . W h a t i s y o u r h i g h e s t a c a d e m i c q u a l i f i c a t i o n ? 1 . D i p l o m a / c e r t i f i c a t e 3 4 . 1 . 2 . D i p l o m a / c e r t i f i c a t e a n d o n e o r m o r e U n i v e r s i t y c r e d i t s 2 . 3 . B a c c a l a u r e a t e d e g r e e 3 . 4 . M a s t e r s d e g r e e 4 . 4* 111 L8. How many years have you been employed? 35,36. 1. As a physiotherapist 37,38. 2. As an occupational therapist 39,40. 3. As a combined therapist 41,42. L9. How many years have you practiced i n British Columbia? 1. 4 years and under 1. 2. 5 to 9 years 2. 3. 10 to 14 years 3. 4. 15 to 19 years 4. 5. 20 or more years 5. 50, Are you presently working f u l l time or part time? 1. F u l l time 2. Part time (17 hours per week or less) 44. 1. 2. 11. What "in-service" educational opportunities exist i n your institution? Yes 1. Staff meetings with educational input 2. Grand Rounds (your specialty) 3. Ward/doctors rounds (on your wards) 4. Nursing "in-service" educational a c t i v i t y _ 5. Interprofessional educational a c t i v i t y 6. "In-service" short courses 7. Other (specify): No 45. 46. 47. 48. 49. 50. 51. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 12. How often do you attend the following "in-service" educational programs? Attend Regularly Occasionally Never 1. Staff meetings (ed. input) 52. 1. 2. 3. 2. Grand Rounds 53. 1. 2. 3. 3. Ward/doctors rounds 54. 1. 2. 3. 4. Nursing "in service" ed. activ i t y 55. 1. 2. 3. 5. Interprofessional ed. ac t i v i t y 56. 1. 2. 3. 6. "In service"short courses 57. 1. 2. 3. 7. Other (specify): 58. 1. 2. 3. 5. 112 3. How many non-credit professional or interprofessional short courses of one week or less have you attended in the past TWO years? Specify; 1. 0 59. 1. 2. 1 2. 3. 2 3. 4. 3 4. 5. 4 5. 6. 5 or more »• 4. Do you plan to attend any specific professional educational events in the next six months? Specify: 1. Yes 60. 1. 2. No 2. 3. Don't know 3, 5. Have you attended any non-professional adult education courses i n the last year? CI 1. Yes 61. 1. 2. No 2. 6. Of the non-professional adult education courses that you attended, How many were for credit? ^  62. How many were for non-credit? 63. 7. Have you purchased any books of value to your work i n the last year? How many? 1.0 64. 1. 2. 1 2. 3. 2 3. 4. 3 4. 5. 4 5. 6. 5 or more 6. 8. Have you borrowed, purchased or secured literature or other materials from your professional associations i n the last year? How often? 1.0 65. 1. 2. 1 2. 3. 2 3. 4. 3 4. 5. 4 5. 6. 5 or more 6. 6 . 29. W h a t o n e s o u r c e o f i n f o r m a t i o n o n r e c e n t d e v e l o p m e n t s i n p a t i e n t c a r e d o y o u m o s t f r e q u e n t l y c o n s u l t ? 1. A m e d i c a l l i b r a r y / p r o f e s s i o n a l l i b r a r y 6 6 . 1. 2. T h e p r o f e s s i o n a l a s s o c i a t i o n 2. 3. T h e S c h o o l o f R e h a b i l i t a t i o n M e d i c i n e 3. 4. R e f e r e n c e m a t e r i a l i n t h e d e p a r t m e n t 4. 5. O t h e r ( s p e c i f y ) : 5 . 30. H o w m a n y t i m e s i n t h e l a s t m o n t h h a v e y o u h a d a n o c c a s i o n t o r e f e r t o p r o f e s s i o n a l l i t e r a t u r e o r o t h e r m a t e r i a l s ? 1. 0 67. 1. 2. 1 2. 3. 2 3. 4. 3 4 -5. 4 5. 6. 5 6 -7. 6 7. 8. 7 8. 9. 8 o r m o r e 9. 3 1 . I n t h e l a s t s i x m o n t h s , h a v e y o u r e a d a t l e a s t o n e a r t i c l e i n t h e f o l l o w i n g p r o f e s s i o n a l j o u r n a l s ? Y e s N o 1. C a n a d i a n P h y s i o t h e r a p y J o u r n a l 68. 1. 2. A m e r i c a n P h y s i o t h e r a p y j o u r n a l 69. 1. 3. P h y s i o t h e r a p y 70. 1. 4. C a n a d i a n O c c u p a t i o n a l T h e r a p y J o u r n a l 71. 1. 5. A m e r i c a n O c c u p a t i o n a l T h e r a p y J o u r n a l 72. 1. 6. B r i t i s h J o u r n a l o f O c c u p a t i o n a l T h e r a p y 73. 1. 7. A m e d i c a l J o u r n a l 74. 1. 8. A n u r s i n g J o u r n a l 75. 1. 9. O t h e r s ( s p e c i f y ) : 76. 1. 1 2 . W h e n y o u r e q u i r e i n f o r m a t i o n a b o u t a p r o b l e m c o n c e r n i n g a p a t i e n t , w h o m d o y o u m o s t f r e q u e n t l y c o n s u l t ? 1. Y o u r s u p e r v i s o r 77. 1. 2. A t h e r a p i s t i n y o u r o w n i n s t i t u t i o n 2. 3. A t h e r a p i s t i n a n o t h e r i n s t i t u t i o n 3. 4. A P h y s i c i a n 4, 5. O t h e r ( s p e c i f y ) : 5 . 7 114 Dnta codes Cols. Response Respondent's Number. Card Number. 3. To which professional associations do you belong? 1. Canadian Physiotherapy Association 2. Canadian Association of Occupational Therapists 3. World Federation of Occupational Therapists 4. Chartered Society of Physiotherapy 5. Other (specify): Yes No 1,3. 4. 5. 6. 7. 8. Q . 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 4. Have you ever held office or served on any committees for your professional association? 1. Office 2. Committee 3. Both 4. Neither 10. 1. 2. 3. 4. 5. Have you held office or served on any committees for your professional association i n the last two years? 1. Office 2. Committee 3. Both 4. Neither 11. 1. 2. 3. 4. 6, How many meetings of your professional association have you attended during the last year? 1. 0 12. 1. 2. 1 2. 3. 2 3. 4. 3 4. 5. 4 5. 6. 5 6. 7. 6 7. 8. 7 8. 9. 8 or more 9. How many professional congresses/conventions have you attended in the last five years? 1. 0 13. 1. 2. 1 2. 3. 2 3. 4. 3 4. 5. 4 5. 6. 5 or more 6. 38. W h a t a r e y o u r c a r e e r g o a l s ? 115 1. S t a f f t h e r a p i s t 14. 1. 2. C l i n i c a l S u p e r v i s o r 2. 3. T e a c h i n g 3. 4. A d m i n i s t r a t i o n / s u p e r v i s i o n 4. 5. C o m m u n i t y w o r k 5. 6. C h a n g e t o a n o t h e r p r o f e s s i o n 6. 7. R e s e a r c h 7. 3. U n d e c i d e d 3. 9. O t h e r ( s p e c i f y ) : 9 * 39. W h a t a r e y o u r f u t u r e e m p l o y m e n t p l a n s ? I n t e n d t o : 1. W o r k i n d e f i n i t e l y 15. 1. 2. S t o p w o r k i n g p e r m a n e n t l y w h e n y o u m a r r y 2. 3. I n t e r r u p t w o r k f o r a p e r i o d o f t i m e f o r m a r r i a g e , 3. t r a v e l , e t c . 4. W o r k p a r t t i m e 4. 5. U n d e c i d e d 5. 6. O t h e r ( s p e c i f y ) : 6. i O . D o y o u h a v e a n y p l a n s i n t h e a r e a o f f o r m a l e d u c a t i o n ? P l a n t o s e e k : 1. S o m e c r e d i t s 16. 1. 2. D i p l o m a / c e r t i f i c a t e 2. 3. B a c c a l a u r e a t e d e g r e e 3. 4. M a s t e r s d e g r e e 4. 5. N o p l a n s 5. 6. O t h e r ( s p e c i f y ) : 6. ,1. A r e t h e p r o f e s s i o n a l c o n t i n u i n g e d u c a t i o n a l ( n o n - c r e d i t ) c o u r s e s c u r r e n t l y o f f e r e d i n B r i t i s h C o l u m b i a m e e t i n g y o u r n e e d s ? 1. Y e s 17. 1. 2. N o 2. 3. U n d e c i d e d / D o n o t k n o w 3. 2. W h a t k i n d s o f c o u r s e s / p r o g r a m s i f d e v e l o p e d w o u l d m e e t y o u r p r o f e s s i o n a l e d u c a t i o n a l n e e d s ? 1. E x t e n s i o n c o u r s e s - c r e d i t 2. E x t e n s i o n c o u r s e s - n o n c r e d i t 3. C o r r e s p o n d e n c e c o u r s e s - c r e d i t 4. C o r r e s p o n d e n c e c o u r s e s - n o n c r e d i t 5. O n e t o t h r e e d a y i n s t i t u t e s / w o r k s h o p s 6. I n d e p e n d e n t d i r e c t s t u d y - c r e d i t 7 . I n d e p e n d e n t d i r e c t s t u d y - n o n c r e d i t 8. F u l l t i m e p r o g r a m s - U n i v e r s i t y 9. F u l l t i m e p r o g r a m s - o t h e r e d u c a t i o n a l I n s t i t u t i o n s , e g . h o s p i t a l Y e s N o 18. 1. 2. 19. 1. 2. 20. 1. 2. 21. 1. 2. 22. 1. 2. 23. 1. 2. 24. 1. 2. 25. 1. 2. 26. 1. 2. 9 1 1 6 »3. I f n o n e o f t h e a b o v e m e e t y o u r n e e d s , w h a t w o u l d y o u s u g g e s t ? 4 4 . W h i c h o f t h e f o l l o w i n g , i f d e v e l o p e d w o u l d m e e t a n e d u c a t i o n a l n e e d f o r y o u ? Y e s N o 1 . P r o g r a m m e d l e a r n i n g m a t e r i a l s 2 7 . 1 . 2 . S l i d e f i l e 2 8 . 1 . 3 . V i d e o t a p e s 2 9 . 1 . 4 . C a s s e t t e s / t a p e s 3 0 . 1 . 5 . O t h e r ( s p e c i f y ) : 3 1 . 1 . 4 5 . W h a t a r e t h e b a r r i e r s t o y o u r p a r t i c i p a t i o n i n p r o f e s s i o n a l 2 . 3 . 4 . c o n t i n u i n g e d u c a t i o n a l p r o g r a m s ? 1 . L a c k o f f i n a n c i a l s u p p o r t L a c k o f s u i t a b l e o f f e r i n g s i n B . C . F a m i l y r e s p o n s i b i l i t i e s N e g a t i v e a t t i t u d e o f s u p e r i o r s / o r g a n i z a t i o n t o e d u c a t i o n a l a d v a n c e m e n t . D i s s a t i s f a c t i o n w i t h p r e v i o u s e d u c a t i o n a l e x p e r i e n c e s . L a c k o f e d u c a t i o n a l c o u n s e l l i n g N o i n t e r e s t a t t h e p r e s e n t t i m e M e e t i n g e d u c a t i o n a l p r e r e q u i s i t e s O t h e r ( s p e c i f y ) : 6 . 7 . 8 . 9 . Y e s N o 3 2 . 3 3 . 3 4 . 3 5 . 3 6 . 3 7 . 3 8 , 3 9 . 4 0 . 1 . 2 1 . 2 1 . 2 1 . 2 1 . 2 1 . 2 1 . 2 1 . 2 1 . 2 i 6 . I n w h i c h m o n t h s o f t h e y e a r w o u l d y o u p r e f e r e d u c a t i o n a l o f f e r i n g s t o b e h e l d ? 1 . J a n u a r y , F e b r u a r y , M a r c h 2 . A p r i l , M a y , J u n e 3 . J u l y , A u g u s t , S e p t e m b e r 4 . O c t o b e r , N o v e m b e r , D e c e m b e r 4 1 . 1 . 2 . 3 . 4 . 7 . W h a t a r e t h e m o s t s u i t a b l e d a y s o f t h e w e e k f o r c o u r s e s o r p r o g r a m s t o b e h e l d ? 1. M a k e s n o d i f f e r e n c e 2 . W e e k e n d s 3 . W e e k d a y s 4 2 . 1 . 2 . 3 . 10 What Is the most suitable time of the day for courses or programs to be held? RANK in order of preference. RANK 1. Mornings 9 am to 12 pm 1st 2. Afternoons 1 pm to 4 pm 3. Late afternoon 4:30 pm to 7 pm 2nd 4. Evenings 7 pm to 10 pm 3rd 4th COMMENTS: L E A R N I N G N E E D S 118 I N Y O U R P R E S E N T P O S I T I O N A S A T H E R A P I S T AND T A K I N G I N T O C O N S I D E R A T I O N Y O U R F U T U R E C A R E E R C O A L S , WHAT DO Y O U C O N S I D E R TO B E Y O U R L E A R N I N G N E E D S A T T H E P R E S E N T T I M E ? L i s t e d b e l o w a r e a n u m b e r o f t o p i c s r e l a t e d t o t h e k n o w l e d g e , s k i l l s a n d a t t i t u d e s i n y o u r f i e l d . W o u l d y o u r e a d t h e s e c a r e f u l l y a n d t h e n c h e c k t h e c o l u m n t h a t m o s t n e a r l y r e p r e s e n t s y o u r n e e d s f o r e a c h t o p i c . 1. NOT I N T E R E S T E D 2. R E C E N T A D V A N C E S 3. G R E A T E R D E P T H I f t h e t o p i c i s n o t o f p a r t i c u l a r i n t e r e s t o r v a l u e t o y o u a t t h i s t i m e , c h e c k c o l u m n 1. I f y o u w o u l d l i k e a n o p p o r t u n i t y t o s t u d y t h e m o r e r e c e n t a d v a n c e s o n l y , c h e c k c o l u m n 2. I f y o u w o u l d l i k e t o s t u d y t h e t o p i c i n g r e a t e r d e p t h t h a n y o u p r e v i o u s l y l e a r n e d i t , i n c l u d i n g r e v i e w a n d r e c e n t a d v a n c e s i n t h e f i e l d , c h e c k c o l u m n 3. **-P L E A S E F E E L F R E E TO A D D F U R T H E R T O P I C S F O R W H I C H Y O U H A V E A L E A R N I N G N E E D C o l s . R e s p o n s e R e s p o n d e n t ' s N o . 4. B A S I C S C I E N C E S 1. F u n c t i o n a l A n a t o m y : i . M u s c u l o - s k e l e t a l S y s t e m a n d S u r f a c e A n a t o m y i i . R e s p i r a t o r y S y s t e m i i i . C a r d i o - v a s c u l a r S y s t e m i v . N e r v o u s S y s t e m 2. P h y s i o l o g y : i . M u s c u l o - s k e l e t a l S y s t e m a n d E x e r c i s e P h y s i o l o g y i i . R e s p i r a t o r y S y s t e m i i i . C a r d i o - v a s c u l a r S y s t e m i v . N e r v o u s S y s t e m 3. P a t h o l o g y : i . M u s c u l o - s k e l e t a l S y s t e m i i . R e s p i r a t o r y S y s t e m i i i . C a r d i o - v a s c u l a r S y s t e m i v . N e r v o u s S y s t e m 1. N . I . 2. R . A . 3. G . D . , 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. BASIC SCIENCES Continued: 1. N.I 2. R.A. 3. G.D. 1 1 9 Cols. Response 4. Psycho-pathology: 5. Psychology: 6. Growth and Development i . Physical i i . Psycho-social Physiological - psychology: Biomechanics / Kinesiology: Biochemistry: Histology: Radiology: Genetics: Epidemiology: 14. Drugs: Those acting on nervous, muscular and cardiovascular systems. 15. Laboratory procedures: Those associated with musculo-skeletal, respiratory, cardiovascular and nervous systems. 16. Other: (specify) 7. 8. 9. 10. 11. 12. 13. CLINICAL CONDITIONS: 1. N.I. Therapeutic Management: 1. Cardio-vascular conditions 2. Respiratory conditions 3. Psychiatric conditions 4. Infectious conditions 5. Musculo-skeletal conditions 6. Neurological conditions 7. Neurosurgical conditions 8. Traumatic conditions 9. Orthopaedic conditions 10. Sports Injuries 11. Obstetrics/gynecology 2. R.A. 3. G.D. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. Blank Blank Blank 120 CLINICAL CONDITIONS Continued: 12. Paediatrics 13. Geriatrics 14. Mental retardation 15. Deaf / Blind 16. Nutritional/metabolic/ endocrinal 17. Other (specify): PHYSICAL MEDICINE AND REHABILITATION: Assessment of the patient: Techniques of Management: 1. Physical/Functional Assessment 2. Perceptual Assessment 3. Psychological Assessment 4. Vocational Assessment 5. Electrodiagnosis 1. Therapeutic/remedial exercise s 2. Prosthetic Training 3. Perceptual Training 4. Modern Movement Education 5. Ice 6. Hydrotherapy 7. Electrotherapy 8. Homemaking 9. Functional Independence 10. Creative Activities 11. Recreational/social a c t i v i t i e s 12. Sheltered Workshops 1. N.I. 2. R.A. I 3. G.D. 1. N.I. 2. R.A. 3. G.D. Cols. Response 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. Blank Blank Blank 4 121 PHYSICAL «EDICINE AND REHABILITATION Continued: 1. N.I. 2. R.A. 3. G.D. 13. Transfers: Equipment and Methods 14. Splinting and Devices 15. Manipulation 16. Special Equipment used with or for remedial/ therapeutic exercises 17. Other (specify) ! i i J i i 1 i Cols. Response 71. 72. 73. 74. 75. 76 - 80 Blank Cols. Response Respondent's No. 1,3. Data Card No. 4. SOCIAL SCIENCES 1. 2. 3. N.I. R.A. G . D . 1. Anthropology: I 2. Sociology: ADMINISTRATION AND SUPERVISION 1. N.I. 2. R.A. 3. G.D. 1 » Administration & Supervision: 1. Office management & procedures 2. Economics of health care 3. Personnel managment & Supervision 4. Medical-Legal Problems 5. Program planning'and Evaluation 6. Learning and Instruction 7. Audio-visual aids, use and abuse 7. 8. 9. 10. 11. 12. 13. 122 A D M I N I S T R A T I O N AND S U P E R V I S I O N C o n t i n u e d : H e a l t h C a r e D e l i v e r y S y s t e m s : H u m a n R e l a t i o n s S k i l l s : 8 . R e s e a r c h D e s i g n 9 . C o m p u t e r s i n t h e H e a l t h S c i e n c e s 1 0 . S t a t i s t i c s i n t h e H e a l t h S c i e n c e s 1 . H e a l t h E d u c a t i o n -p r e v e n t i v e m e d i c i n e 2 . C o m m u n i t y H e a l t h a n d P u b l i c H e a l t h 3 . I n s t i t u t i o n a l C a r e 1 . I n t e r p e r s o n a l R e l a t i o n s h i p s : i . S t a f f i i . T h e r a p i s t - p a t i e n t i i i . I n t e r p r o f e s s i o n a l 2 . C o m m u n i c a t i o n , v e r b a l a n d n o n v e r b a l 3 . C o u n s e l l i n g a n d I n t e r v i e w i n g O t h e r ( s p e c i f y ) : 1 . N . I . 2 . R . A . 3 . G . D . i i j I C o l s . R e s p o n s e 1 4 . 1 5 . 1 6 . 1 7 . 1 8 . 1 9 . 2 0 . 2 1 . 2 2 . 2 3 . 2 4 . 2 5 . 2 6 . 2 7 . 2 8 . 2 9 . B l a n k B l a n k B l a n k B l a n k 123 resented below are a series of statements. There are no RIGHT or WRONG answers. Lease indicate how you personally feel about each statement at the present time. 3u can do this by c i r c l i n g the words that most closely represent your present opinion. *********************************************** Therapists have to spend too much time in keeping records and other c l e r i c a l tasks. Cols. Response 1. 2. 3. A. 5. 6. Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree 30. Therapists are educators and teachers at a l l levels of practice. 1. 2. 3. A. 5. 6. Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree 31. Therapists tend to treat a condition rather than the total patient. 1. 2. 3. A. 5. 6. Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree 32. Therapists should be less involved i n total health care. 1. 2. 3. A. 5. 6. Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree 33. Therapists feel that they are i n a dead end job with limited opportunity for professional advancement. 1. 2. 3. 4. 5. 6. Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree 3A. Therapists as health professionals are exceedingly r i g i d in their standards of practice. 1. 2. Strongly Moderately Agree Agree 3. A. Slightly Slightly Agree Disagree 5. Moderately Disagree 6. Strongly Disagree 35. 7 124 Therapists have a responsibility to t e l l the patient what therapeutic treatment i s being planned, the length of the treatment and whit can be expected as the end result. 1. 2. 3. 4. 5. 6. Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree 36. Therapists do not have a good concept of the interprofessional approach to health care. 1. 2. 3. 4. 5. 6. Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree 37. Therapists are allowed to use their own i n i t i a t i v e . 1. 2. 3. 4. 5. 6. Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree 38. Therapists should engage i n community a c t i v i t i e s in connection with their professional role. 1. 2. 3. 4. 5. 6. Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree 39. Therapists frequently waste time performing tasks that could be done adequately by well trained aides. 1. 2. 3. 4. 5. 6. Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree 40. Therapists must have a master's degree in their profession available to them. 1. 2. 3. 4. 5. 6. Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree 41. Therapists often put the patient secondary to their routines. 1. 2. 3. 4. 5. 6. Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree 42. 8 Therapists with continuing education could function as 'doctor's assistants" in Family Practice or Community Medicine. 1 . 2 . 3 . 4 . 5 . 6 . Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree Therapists today seem more concerned with wages and hours than with patient care. 1 . 2 . 3 . 4 . 5 . 6 . Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree The therapist's professional role i s understood by most doctors. 1 . 2 . 3 . 4 . 5 . 6 . Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree Therapists have a right to spend some of their on duty time reading, to keep abreast of advances i n their profession. 1 . 2 . 3 . 4 . 5 . 6 . Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree Therapists have a right to expect the nurses to make changes on the ward that would better suit the needs of the patient. 1 . 2 . 3 . 4 . 5 . 6 . Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree Therapists should have a regular evaluation of their work performance. 1 . 2 . 3 . 4 . 5 . 6 . Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree Therapists have a responsibility to question treatments ordered by doctors. 1 . 2 . 3 . 4 . 5 . 6 . Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree 9 T h e r a p i s t s s h o u l d b e g i v e n a j o b d e s c r i p t i o n f o r t h e e a c h p o s i t i o n t h e y f i l l . 126 !• 2. 3. 4. 5. 6. S t r o n g l y M o d e r a t e l y S l i g h t l y S l i g h t l y M o d e r a t e l y S t r o n g l y A g r e e A g r e e A g r e e D i s a g r e e D i s a g r e e D i s a g r e e 5 0 . T h e r a p i s t s r e c e i v e r e f e r r a l s f o r a l l p a t i e n t s w h o w o u l d b e n e f i t f r o m t h e r a p e u t i c t r e a t m e n t . 1 . 2 . 3 . 4 . 5 . 6 . S t r o n g l y M o d e r a t e l y S l i g h t l y S l i g h t l y M o d e r a t e l y S t r o n g l y A g r e e A g r e e A g r e e D i s a g r e e D i s a g r e e D i s a g r e e 5 1 . T h e r a p i s t s m u s t b e p r e p a r e d t o u p g r a d e t h e m s e l v e s a c a d e m i c a l l y . 1 . 2 . 3 . 4 . 5 . 6 . S t r o n g l y M o d e r a t e l y S l i g h t l y S l i g h t l y M o d e r a t e l y S t r o n g l y A g r e e A g r e e A g r e e D i s a g r e e D i s a g r e e D i s a g r e e 5 2 . T h e r a p i s t s w i t h e x p e r i e n c e s h o u l d h a v e t h e f r e e d o m t o c h o o s e t h e t h e r a p e u t i c t r e a t m e n t b e s t s u i t e d t o t h e p a t i e n t . 1 . 2 . 3 . 4 . 5 . 6 . S t r o n g l y M o d e r a t e l y S l i g h t l y S l i g h t l y M o d e r a t e l y S t r o n g l y A g r e e A g r e e - A g r e e D i s a g r e e D i s a g r e e D i s a g r e e 5 3 . T h e r a p i s t s e n t e r t h e p r o f e s s i o n s e e k i n g p e r s o n a l s a t i s f a c t i o n . 1 . 2 . 3 . 4 . 5 . 6 . S t r o n g l y M o d e r a t e l y S l i g h t l y S l i g h t l y M o d e r a t e l y S t r o n g l y A g r e e A g r e e A g r e e D i s a g r e e D i s a g r e e D i s a g r e e 5 4 . T h e r a p i s t s t o b e r e l i c e n s e d s h o u l d b e r e q u i r e d t o p a r t i c i p a t e i n c o n t i n u i n g e d u c a t i o n i n r e h a b i l i t a t i o n , 1 . 2 . 3 . 4 . 5 . 6 . S t r o n g l y M o d e r a t e l y S l i g h t l y S l i g h t l y M o d e r a t e l y S t r o n g l y A g r e e A g r e e A g r e e D i s a g r e e D i s a g r e e D i s a g r e e 5 5 . T h e r a p i s t ' s k n o w l e d g e a n d s k i l l s a r e e f f e c t i v e l y u s e d . 1 . 2 . 3 . 4 . 5 . 6 . S t r o n g l y M o d e r a t e l y S l i g h t l y S l i g h t l y M o d e r a t e l y S t r o n g l y A g r e e A g r e e A g r e e D i s a g r e e D i s a g r e e D i s a g r e e T h e r a p i s t s h a v e t h e t i m e t o a d e q u a t e l y a s s e s s a n d p l a n t r e a t m e n t s . e 1 ,1 2 ' 3 ' 4 - 5 . 6 . S t r o n g l y M o d e r a t e l y S l i g h t l y S l i g h t l y M o d e r a t e l y S t r o n g l y A g r e e A g r e e A g r e e D i s a g r e e D i s a g r e e D i s a g r e e 5 6 . 5 7 . 127 10 Therapists must develop a sensitivity to other professionals. 1. 2. 3. 4. 5. 6. Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree 58. Therapists i n planning treatment programs have a responsibility to consider the financial implications to the patient. 1. 2. 3. 4. 5. 6. Strongly Moderately Slightly Slightly Moderately Strongly Agree Agree Agree Disagree Disagree Disagree 59. INSTRUCTIONS Using a pencil, please complete a l l the questions by: 1. Circling the numbers to the l e f t of the answers. i.e. questions 2 and 5 etc. or 2. Placing a check mark in the appropriate column for each item. i.e. questions 21,22,31,42,44,45, etc. or 3 . F i l l i n g in the correct number (to a round figure) in the, appropriate blanks indicated by a red l i n e . i.e. questions 7,15,10,26, etc. If there i s a choice to be made select the one answer that i s appropriate the greater percentage of the time. If in doubt about your answer write in what you would lik e to say and I w i l l code i t appropriately. A l l questions may not seem to apply to you, however, I would like you to complete them as i f circumstances were such that they did. i.e. question 43 Please add any additional items or comments that may occur to you. Thank you APPENDIX B LETTERS OF TRANSMITTAL 129 T i l l : UNIVERSITY 01' BRITISH COLUMBIA 2075 WKSHROOK (MACK -J^Q VANCOUVER. B.C.. CANADA V6T 1W5 FACULTY OF MEDICINE SCHOOL OF REHABILITATION MEDICINE June 21, 1972 INSTRUCTIONAL RESOURCES CENTRE Dear Since 1963 I have been an instructor at the School of Rehabili-tation Medicine at The University of B r i t i s h Columbia. I have j u s t completed the course requirements for a Master of Arts i n Education and am presently working on my thesis. In the study I am doing for this I am attempting to determine the learning needs of physical and occupational therapists i n B r i t i s h Columbia and to consider the implications of these for post graduate continuing education programmes. I have selected a random sample of therapists to interview and am writing to ask you i f you would pa r t i c i p a t e i n my study by completing every item on the enclosed questionnaire. I had hoped to v i s i t you i n person but time and distance have made this impractical. E x p l i c i t instructions appear with each section of the question-naire. Do not be concerned about the coding numbers on the right hand side, these are for my convenience only. The information that you give me w i l l be completely confidential. Your name w i l l not appear anywhere. Thank you very much for your assistance. I hope that you fi n d i t an inter e s t i n g experience. I know that i t i s going to provide me with a great deal of valuable data. I t would be much appreciated i f you could complete and return the questionnaire to me as soon as possible. An addressed envelope i s enclosed for your convenience. Your help i s c r u c i a l to the success of th i s study. Thank you for your co-operation. Yours very sincerely, LMcG:eg Louise McGregor. Iii U N I V E R S I T Y 01 ' BR IT ISH C O L U M B I A 2075 WESBROOk P L A C E VANCOUVER, B.C., CANADA V6T 1W5 FACULTY OF MEDICINE SCHOOL OF REHABILITATION MEDICINE INSTRUCTIONAL RESOURCES CENTRE 131 July 6, 1972 Dear About three weeks ago I wrote and asked i f you would be kind enough to take part i n the study which I am doing for my M.A. Thesis. The questionnaire that was enclosed with the l e t t e r does take about an hour of your time but i n order to make the study as representative as possible I am anxious to get responses from a l l areas i n B r i t i s h Columbia. I would greatly appreciate receiv-ing a reply from you as soon as possible. I r e a l i z e that this does take time but I would l i k e your p a r t i c i p a t i o n . Yours sincerely, Louise McGregor LM/pm APPENDIX C LEARNING NEEDS TABLE CI Basic Sciences C2 Cl i n i c a l Conditions C3 Rehabilitative Techniques C4 Administration and Supervision C5 Human Relations S k i l l s C6 Health Care Delivery Systems 132 LEARNING NEEDS Bivariate tables were produced from the completed check l i s t s of perceived learning needs for the 86 PTs and 25 OTs i n the study. A chi square test was computed for each of the items i n the s i x categories i n order to determine i f there were any s i g n i f i c a n t differences i n interests between PTs and OTs. Those on which there was a s i g n i f i c a n t difference at the .05 l e v e l or greater are indicated by an asterisk. 134 TABLE CJ-D i s t r i b u t i o n of Perceived Learn in.j Needs i n tUr l'...s:Lc Sciences Learning Need Musculo-skeletal Anatomy Respiratory Anatomy Cardio-Vascular Anatomy Neuroanatomy Musculo-skeletal Physiology Respiratory Physiology Cardio-vascular Physiology Neurophysiology Musculo-skeletal Pathology Respiratory Pathology Cardio-vascular Pathology Neuropathology Not Interested No. 7 Interested In Recent Advances No. % Interested i n Greater Depth No. % PT OT 29 33.7 6 24.0 21. 24.4 r, 24.0 36 41.9 13 52.0 TOTAL PT OT 35 3.1.5 41 47.7 15 60.0 _ "TI 24.3 25 29.1 6 24.0 49 44.2 20 23.2 4 16.0 TOTAL PT OT 56 50.5 40 46.5 14 56.0 ~3.l. 27.9 25 29.1 6 24.0 24 21.6 21 24.4 5 20.0 TOTAL PT OT 54 48.7 18 20.9 7 28.0 ~ 3 1 27.9 23 26.7 4 16.0 26 23.4 45 52.3 14 56.0 TOTAL PT OT 25 22.5 22 25.6 8 32.0 27 • 24.3 30 34.9 6 24.0 59 53.2 34 39.5 11 44.0 TOTAL PT OT 30 27.0 33 38.4 16 64.0 36 32.4 31 36.1 5 20.0 45 40.5 22 25.5 4 16.0 TOTAL PT OT 49 44.1 34 39.5 13 52.0.._ 36 32.4 28 32.6 7 28.0 26 23.5 24 27.9 5 20.0 TOTAL PT OT 47 42.3 19 22.il. 7 28.0 "35 31.5 28 32.6 5 20.0 29 26.1 39 45.3 13 52.0 TOTAL PT OT 26 23.4 27 31.4 9 36.0 _ 33 29.7 3.1. 36.1 5 20.0 52 46.9 28 32.5 11 44.0 TOTAL PT OT 36 32.4 35 40.7 14 56.0 36 32.4 33 38.4 7 28.0 39 35.2 18 20.9 4 16.0 TOTAL PT OT 49 44.1 36 41..') 14 56.0 40 36.1 30 34.9 6 24.0 22 19.8 20 23.3 5 20.0 TOTAL PT OT 50 4IJ . 1 21 24.4 9 :u>.o 36 32.4 30 34.9 3 12.0 25 22.5 35 40.7 13 52.0 TOTAL 30 2 7.0 33 29.7 48 43.3 135 TABLE CI - (Continued) Interested Interested Not i n Recent i n Greater Learning Need Interested Advances Depth No. % No. % No. % Psycho-pathology* PT 48 55.8 24 27.9 14 16.3 OT 6 24.0 11 44.0 8 32.0 TOTAL 54 48.7 35 31.5 22 19.8 Psychology PT 35 40.7 30 34.9 21 24.4 OT 6 24.0 11 44.0 8 32.0 TOTAL 41 36.9 41 36.9 29 26.2 Physical Growth and PT 35 40.7 29 33.7 22 25.6 Development OT 6 24.0 13 52.0 6 24.0 TOTAL 41 36.9 42 37.8 28 25.2 Psycho-social Growth and PT 37 43.0 26 30.2 23 26.8 Development OT 4 16.0 12 48.0 9 36.0 TOTAL 41 36.9 38 34.2 32 28.8 Physiological Psychology PT 43 50.0 23 26.7 20 23.3 OT 7 28.0 9 36.0 9 36.0 TOTAL 50 45.1 32 28.8 29 26.1 Biomechanics Kinesiology* PT 24 27.9 30 34.9 32 37.2 OT 10 40.0 7 28.0 8 32.0 TOTAL 34 30.6 37 33.3 40 36.1 Biochemistry PT 64 74.4 12 14.0 10 11.6 OT 20 80.0 2 8.0 3 12.0 TOTAL 84 75.7 14 12.6 13 11.7 Histology PT 65 75.6 14 16.3 7 8.1 OT 19 76.0 4 16.0 2 8.0 TOTAL 84 75.7 18 16.2 9 8.1 Radiology PT 42 48.8 24 27.9 20 23.3 OT 15 60.0 6 24.0 4 16.0 TOTAL 57 51.4 30 27.0 24 21.6 Genetics PT 42 48.8 33 38.4 11 12.8 OT 11 44.0 11 44.0 3 12.0 TOTAL 53 47.8 44 39.6 14 12.6 Epidemiology PT 60 69.8 16 18.6 10 11.6 OT 19 76.0 4 16.0 2 8.0 TOTAL 79 71.2 20 18.0 12 10.8 Drugs: Those acting on PT . 8 9.3 45 52.3 33 38.4 nervous, muscular and OT 2 8.0 13 52.0 10 40.0 cardiovascular systems TOTAL 10 9.0 58 52.3 43 38.7 Laboratory Procedures PT 28 32.6 29 33.7 29 33.7 OT 11 44.0 9 36.0 5 20.0 TOTAL 39 35.2 38 i 34.2 34 30.6 * s i g n i f i c a n t at <.05 l e v e l . 136 TABLE C2 Di s t r i b u t i o n of Perceived Learning Needs for C l i n i c a l Conditions Interested Interested Not i n Recent i n Greater Learning Need Interested Advances Depth No. % No. % No. % Cardio-vascular PT 29 33.7 39 45.4 18 20.9 OT 13 52.0 6 24.0 6 24.0 TOTAL 42 37.8 45 40.5 24 21.6 Respiratory* PT 28 32.6 40 46.5 18 20.9 OT 15 60.0 8 32.0 2 8.0 TOTAL 43 38.7 48 43.3 20 18.0 Ps y c h i a t r i c * PT 50 58.1 28 32.6 8 9.3 OT 8 32.0 11 44.0 6 24.0 TOTAL 58 52.3 39 35.1 14 12.6 Infectious PT 54 62.8 20 23.3 12 13.9 OT 17 68.0 6 24.0 2 8.0 TOTAL 71 64.0 26 23.4 14 12.6 Musculo-skeletal PT 12 14.0 35 40.7 39 45.3 OT 7 28.0 7 28.0 11 44.0 TOTAL 19 17.1 42 37.8 50 45.1 Neurological PT 16 18.6 28 32.6 42 48.8 OT 4 16.0 6 24.0 15 60.0 TOTAL 20 18.0 34 30.6 57 51.4 Neurosurgical PT 21 24.4 29 33.7 36 41.9 OT 8 32.0 4 16.0 13 52.0 TOTAL 29 26.1 33 29.7 48 44.1 Traumatic PT 13 15.1 41 47.7 32 37.2 OT 8 32.0 7 28.0 10 40.0 TOTAL 21 18.9 48 43.3 42 37.8 Orthopaedic PT 12 14.0 38 44.2 36 41.8 OT 6 24.0 8 32.0 11 44.0 TOTAL 18 16.2 46 41.4 47 42.4 Sports I n j u r i e s * PT 21 24.4 33 38.4 32 37.2 OT 16 64.0 3 12.0 6 24.0 TOTAL 37 33.3 36 32.4 38 34.3 Obstetrics/Gynecology PT 52 60.5 26 30.2 8 9.3 OT 19 76.0 5 20.0 1 4.0 < TOTAL 71 64.0 31 27.9 9 8.1 137 Table C2 (Continued) Interested Interested Not i n Recent i n Greater Learning Need Interested Advances Depth No. % No. % No. % Paediatrics PT 39 45.4 25 29.1 22 25.5 OT 10 40.0 9 36.0 6 24.0 TOTAL 49 44.1 . 34 30.6 28 25.2 Geriatrics PT 42 48.8 34 39.5 10 11.6 OT 13 52.0 11 44.0 1 4.0 TOTAL 55 49.6 45 40.5 11 9.9 Mental Retardation PT 54 62.8 20 23.3 12 13.9 OT 12 48.0 11 44.0 2 8.0 TOTAL 66 59.5 31 27.9 14 12.6 Nutritional/Metabolic/ PT 54 62.8 23 26.7 9 10.5 Endocrinal OT 15 60.0 7 28.0 3 12.0 TOTAL 69 62.2 30 27.0 i 12 10.8 Deaf/Blind* PT 57 66.3 22 25.6 1 8.1 | OT 10 40.0 9 36.0 6 24.0 1 TOTAL 1 67 60.4 31 27.9 13 11.7 * Si g n i f i c a n t at <.05 l e v e l . 138 TABLE C3 Di s t r i b u t i o n of Perceived Learning Needs for Rehab i l i t a t i v e Techniques Interested Interested Not i n Recent i n Greater Learning Need Interested Advances Depth No. % No. % No. % Physical/Functional PT 11 12.8 41 47.7 34 39.5 Assessment OT 5 20.0 10 40.0 10 40.0 TOTAL 16 14.4 51 46.0 44 39.6 Perceptual Assessment PT 17 19.8 33 38.4 36 41.8 OT 2 8.0 6 24.0 17 68.0 TOTAL 19 17.1 39 35.1 53 47.8 Psychological Assessment PT 31 36.1 29 33.7 26 30.2 OT 5 20.0 10 40.0 10 40.0 TOTAL 36 32.4 39 35.1 36 32.4 Vocational Assessment* PT 36 41.9 34 39.5 16 18.6 OT 2 8.0 6 24.0 17 68.0 TOTAL 38 34.2 40 36.0 33 29.8 Electrodiagnosis PT 43 50.0 28 32.6 15 17.4 OT 16 64.0 8 32.0 1 4.0 TOTAL 59 53.2 36 32.4 16 14.4 Therapeutic Exercises* PT 13 15.1 42 48.8 31 36.1 OT 13 52.0 7 28.0 5 20.0 TOTAL 26 23.4 49 44.2 36 32.4 Prosthetics PT 35 40.7 29 33. 7 22 25.6 OT 11 44.0 6 24.0 8 32.0 TOTAL 46 41.5 35 31.5 30 27.0 Electrotherapy* PT 36 41.9 42 48.8 8 9.3 OT 20 80.0 4 16.0 1 4.0 TOTAL 56 • 50.5 46 41.4 9 8.1 Homemaking* PT 53 61.6 27 31.4 6 7.0 OT 2 8.0 16 64.0 7 28.0 TOTAL 55 49.6 43 38.7 13 11.7 Functional Independence* PT 26 30.2 38 44.2 22 25.6 OT 2 8.0 12 48.0 11 44.0 TOTAL 28 25.2 50 45.1 33 29.7 Creative A c t i v i t i e s * PT 52 60.5 26 30.2 8 9.3 OT 4 16.0 13 52.0 8 32.0 TOTAL 56 50.5 39 35.1 16 14.4 139 Table C3 (Continued) Interested Interested Not i n Recent i n Greater Learning Need Interested Advances Depth No. % No. % No. % Recreational/Social A c t i v i t i e s * PT OT 47 6 54.7 24.0 26 9 30.2 36.0 13 10 15.1 40.0 TOTAL 53 47.8 35 31.5 23 20.7 Sheltered Workshops* PT OT 45 2 52.3 8.0 31 11 36.1 44.0 10 12 11.6 48.0 TOTAL 47 42.3 42 37.8 22 19.8 Transfers Equipment and Methods PT OT 19 6 22.9 24.0 45 12 52.3 48.0 22 7 25.6 28.0 TOTAL 25 22.5 57 51.4 29 26.1 Sp l i n t i n g and Devices PT OT 19 5 22.1 20.0 45 9 52.3 36.0 22 11 25.6 44.0 TOTAL 24 21.6 55 48.7 33 29.7 Manipulation* PT OT 21 16 24.4 64.0 18 6 20.9 24.0 47 3 54.6 12.0 TOTAL 37 33.3 24 21.6 50 45.1 Special Equipment used with or for Remedial Exercises PT OT 24 10 27.9 40.0 43 9 50.0 36.0 19 6 22.1 24.0 TOTAL 34 30.6 52 46.9 25 22.5 Ice* PT OT 22 20 25.6 80.0 45 4 52.3 16.0 19 1 22.1 4.0 TOTAL 42 37.8 49 44.2 20 18.0 Hydrotherapy* PT OT 35 18 40.7 72.0 39 4 45.4 16.0 12 3 13.9 12.0 TOTAL 53 47.8 43 38.7 15 13.5 * Si g n i f i c a n t at <.05 l e v e l . 140 TABLE C4 Di s t r i b u t i o n of Perceived Learning Need for Administration and Supervision Int erested Interested Not i n Recent i n Greate r Learning Need Int ereste d Advances Depth No. % No. % No. % Office Management and PT 53 61. 6 14 16. 3 19 22. 1 Procedures OT 14 56. 0 8 32. 0 3 12. 0 TOTAL 67 60. 4 22 19. 8 22 19. 8 Economics of Health Care PT 47 54. 7 26 30. 2 13 15. 1 OT 15 60. 0 8 32. 0 2 8. 0 TOTAL 62 55. 9 34 30. 6 15 13. 5 Personnel Management and PT 50 58. 1 13 15. 1 23 26. 7 Supervision OT 9 36. 0 7 28. 0 9 36. 0 TOTAL 59 53. 2 20 18. 0 32 28. 8 Medical-Legal Problems PT 37 43. 0 30 34. 9 19 22. 1 OT 9 36. 0 7 28. 0 9 36. 0 TOTAL 46 41. 4 37 33. 3 28 25. 2 Program Planning and PT 37 43 0 17 19. 8 32 37. 2 Evaluation OT 7 28 0 9 36. 0 9 36. 0 TOTAL 44 39 6 26 23. 4 41 37. 0 Learning and Instruction PT 39 45 4 20 23. 3 27 31 4 OT 7 28 0 9 36. 0 9 36. 0 TOTAL 46 41 5 29 26. 1 36 32. 4 Audio Visual Aids PT 39 45 4 28 32 6 19 22 1 OT 7 28 .0 8 32. 0 10 40 0 TOTAL 46 41 .5 36 32. 4 29 26 1 Research Design PT 51 59 .3 19 22 16 18 .6 OT 14 56 .0 7 28 0 4 16 0 TOTAL 65 58 .6 26 23 .4 20 18 .0 Computer i n the Health PT 55 64 .0 15 17 4 16 18 .6 Sciences OT 16 64 .0 4 16 .0 5 20 .0 TOTAL 71 64 .0 19 17 .1 21 18 .9 S t a t i s t i c s i n the Health PT 52 60 .5 20 23 .3 14 16 .3 Sciences OT 15 60 .0 5 20 .0 5 ' 20 .0 TOTAL 67 60 .4 25 ,22 .5 19 17 .1 141 TABLE C5 Distribution of Perceived Learning Need for Human Relations S k i l l s Int erested Intereste d Not in Recent in Greater Learning Need Interested Advances Depth No. % No. % No. % Staff Relationships PT 34 39 .5 29 33. 7 23 26. 7 OT 4 16 .0 11 44. 0 10 40. 0 TOTAL 38 34 .2 40 36. 0 33 29. 8 Therapist-patient PT 25 29 .1 40 46. 5 21 24. 4 Relationships* OT 3 12 .0 10 40. 0 12 48. 0 TOTAL 28 25 .2 50 45. 1 33 29. 7 Interprofessional PT 25 29 .1 39 45. 4 22 25. 6 Relationships* OT 5 20 .0 7 28. 0 13 52. 0 TOTAL 30 27 .0 46 41. 4 35 31. 5 Communication: Verbal and PT 29 33 .7 29 33. 7 28 32. 6 Non-verbal OT 3 12 .0 8 32. 0 14 56. 0 TOTAL 32 28 .8 37 33. 3 42 37. 8 Counselling and PT 38 44 .2 23 26. 7 25 29. 1 Interviewing* OT 3 12 .0 9 36. 0 13 52. 0 TOTAL 41 36 .9 32 28. 8 38 34. 2 * Significant at <.05 level. 142 TABLE C6 Di s t r i b u t i o n of Perceived Learning Needs for Health Care Delivery Systems Interested Interested Not i n Recent i n Greater Learning Need Interested Advances Depth No. % No. % No. % Health Education and PT 25 29.1 37 43.0 24 27.9 Preventive Medicine OT 7 28.0 12 48.0 6 24.0 TOTAL 32 28.8 49 44.2 30 27.0 Community Health and PT 37 43.0 33 38.4 16 18.6 Public Health OT 6 24.0 12 48.0 7 28.0 TOTAL 43 38.7 45 40.5 23 20.7 I n s t i t u t i o n a l Care PT 42 48.8 32 37.2 12 14.0 OT 11 44.0 11 44.0 3 12.0 TOTAL 53 47.8 43 38.7 15 13.5 

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