How to develop psychologically informed practitioners: An innovative curriculum for undergraduate physiotherapy students

Relevance: Mental ill health accounts for almost 20% of the burden of disease in theWorld Health Organisation European Region and mental health problems affect one in four people at some time in life. Additionally, there is a strong association between long-term physical illnesses and mental health problems. However, traditional physiotherapy practice has focussed on biomedical and biomechanical models of practice with inadequate attention to psychosocial factors. Therefore, in recent years there has been a call to action to increase the quantity and quality of undergraduate education in psychosocial principles. In particular, the need for physiotherapists to become psychologically informed practitioners has been highlighted, especially with the increases in self-referral to physiotherapy. Purpose: The aim of this piece of work was to develop an undergraduate curriculum thatwould develop students' skills in psychosocial assessment and intervention. Approach/evaluation: A 20 Scottish Credit and Qualifications Framework credit module was developed (10 European Credit Transfer and Accumulation System credits) in partnership academic staff from the Counselling Psychology Programme. The module comprised 200 notional learning hours, including 48 hours of tutorials supplemented by online interactive learning materials. The key aim of this 'Enhancing Physiotherapy Practice' module is the development of students' skills in the psychosocial assessment and management of patients, including addressing work-related issues. Teaching materials were developed using the UK's National Health Service Improving Access to Psychological Therapies (IAPT) training manual. The summative assessment of students' cognitive behavioural therapy (CBT) skills was based on the validated Cognitive Therapy Scale-Revised (CTS-R). Tutorials focussed on: active listening; providing empathic responses; the 5 Areas CBT Model; and low intensity CBT interventions, such as behavioural activation and graded exposure. Role plays were incorporated into most tutorial sessions. Outcomes: Following their participation in the module students reported, via an electronic questionnaire, the following: increased understanding of the importance of providing empathy and addressing patients' psychosocial concerns; improved active listening skills and ability to describe the 5 Areas CBT Model with patients; and improved confidence in discussing work-related issues with patients, relatives or carers. Unsurprisingly, students reported they would require checklists to guide their assessments to ensure that they addressed the essential areas. They also recognised that the skills developed in the module were essential to building good patient rapport and a positive therapeutic relationship. That said, when practising on clinical placement, students found difficulties in incorporating psychosocial principles into their treatment sessions. Additionally, concern was raised as to when to refer to more qualified psychological practitioners. Discussion and conclusions: The IAPT training manual, 5 Areas CBT Model and CTS-R proved to well-structured, non-threatening, and 'student-friendly' teaching and assessment resources. In the future greater guidance will be provided to students on practical ways in which they can incorporate psychosocial practices into their routine practice and referral pathways to clinical psychologists. Impact and implications: This innovative curriculum can be adapted by other physiotherapy programmes interested in developing students' skills in psychosocial assessment and intervention. The materials are also suitable for postgraduate students and qualified physiotherapists looking to undertake continuing professional development and become psychologically informed practitioners.