The case for a healthy curriculum
For the longest time, physiotherapists were trained to be health professionals. They spent much of their time rote learning standardised methods of treatment and developing their handling skills so that they were equipped to supplement the workforce under the pretext that they were being prepared for clinical practice.
The advent of universities changed all of this, and students were no longer merely trained but were supposed to receive a broad education. Students became supernumerary to clinical staff, pedagogy began to inform teaching, practice became less about treatment and more about inquiry, research, and diagnosis.
The separation was underpinned by the belief that entry into professional practice should be only one possible outcome of university education, and that other routes (into research, teaching, management, for instance), ought to be provided for too.
Universities had to keep reminding their professional colleagues that “we don’t work for you”, and that their responsibility was, first and foremost, to the students not the profession. But physiotherapy, along with most of the other orthodox biomedical health professions, remained uneasy about this and keeps a close eye on the independence of university programs through audits and accreditation systems, making sure that the universities didn’t forget their responsibility to provide a well-trained workforce. It remains an uneasy tension.
If we think of training as dominating physiotherapy’s first education era, then, and university education as the second, it’s now possible to see the shoots of a new third movement occurring in healthcare education with the idea of the healthy curriculum.
The principle here is that health professionals traditionally learned to treat others while largely ignoring their own experiences. Even in universities, students mostly learn standardised approaches that change little depending on the people in the room, the location of the school, or shifting world affairs. The healthy curriculum changes all of that.
Rather than being centred on the ‘nameless other’ that the student may encounter in practice, the healthy curriculum focuses on the student’s own health and wellbeing. Learning is focused on ‘knowing thyself’: diagnosing one’s own abilities, aptitudes, experiences, and frailties; finding ways to gain greater insight, as well as methods of healing and repair, be it physical, psychic, cultural, spiritual, environmental, social, or otherwise.
The curriculum is designed to enhance the student’s understanding of health drawing on the most direct experiences available to them, and to use this to then expand their horizon to embrace the healing of others.
The healthy curriculum is a journey of exploration, so does not presume at the beginning that the student knows who they are or what they want to do with the skills they acquire. Some will want to become a physiotherapist, others architects or software engineers.
There are a number of drivers of the healthy curriculum, not all of them good. There is growing evidence, for instance, that students are disillusioned with university education. There is also an epidemic of poor mental health and a crisis of self-esteem amongst millennials. And we live in a time of profound connectivity and unprecedented loneliness. Universities, if they are to live up to their name, should respond to this and not presume that what worked for people in the 1980s will still work today.
‘Classical’ health professional training remains an attractive option for many, especially those looking for a degree of job security in countries where employment precarity has become the norm. But these programs may be found wanting as healthcare goes through its own post-professional moment in the coming years.
So now may be the perfect time for us to think about how health professional training can also be a healthy experience.