Kruger, Gravett, Petersen Education as Change 2005 Learners’ perceptions of a community service programme within the therapeutic massage therapy qualification

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Kruger, Gravett, Petersen Education as Change 2005 Learners’ perceptions of a community service programme within the therapeutic massage therapy qualification
  Learners’ perceptions of a community service programme within the therapeutic massage therapy qualification Erika Kruger, Sarah Gravett, Nadine Petersen Published 2005 in Education as Change 9(1) p127-150 To cite this article: Kruger, E, Gravett, S & Petersen, N (2005) Learners’ perceptions of a community service programme within the therapeutic massage therapy qualification, Education as Change 9(1) 127-150  ABSTRACT Preparing learners for a health profession in a multicultural society and for a heavily burdened primary health care system requires more than merely transferring propositional knowledge and teaching techniques and procedures. Equally important in negotiating the unpredictable practical and ethical issues in the clinical encounter, is the health worker’s personal and professional effectiveness. In an effort to move beyond a vocationalist approach to training for a health service, the Massage Therapy Institute in Fish Hoek employs a model that combines practicum  and community service to guide future therapeutic massage therapists into the profession. The aim is to integrate theory and practice while simultaneously providing a service to the community. Furthermore it exposes learners to situations that resemble authentic clinical encounters in the health care context. This article focuses on a research project investigating learners’ and educators perceptions of this particular programme as a model that hones learners’ professional skills to encourage personal effectiveness in a multicultural society and that advances learner-therapists’ socialisation into their chosen profession. In order to contextualise the notion of combining practicum  and community service, we first explore the theory-practice relationship as well as the nature and role of professional skills to achieve fitness-for-purpose (competent to do the work) and fitness-for-practice (competent to perform social roles and functions associated with a health profession). We then investigate theory-practice integration by means of practicum  before looking at community service as both a civic duty and a learning experience. This serves as background to a discussion on the findings of the study and learners’ and educators’ perceptions of the programme’s success in transferring a number of professional skills namely interpersonal communication and establishing therapeutic relationships, dealing with patient’s world-views and values, negotiating cultural and religious issues and dealing with gender issues. Finally we indicate that honing these particular skills can assist with learners’ socialisation into the shared language, understandings, traditions, norms, values and philosophical underpinnings of a profession.  _____________________________________________________________________________________   ARTICLE FOR EDUCATION AS CHANGE , RAU ERIKA KRUGER 1  INTRODUCTION In this article we argue that preparing learners for a health profession and therapeutic massage therapy (TMT) in particular, requires both the transfer of propositional knowledge, techniques and procedures as well as professional skills that: 1) encourage personal effectiveness in a multicultural society and that 2) advance learner-therapists’ socialisation into their chosen profession. We further contend that the combining of practicum  and community service functions as a model that achieves the integration of theory and practice as it contextualises the profession and exposes learners to situations that resemble authentic clinical encounters in the South African primary health care context. As a result students are able to apply their theoretical knowledge and practical skills, hone their profession-specific skills and at the same time become assimilated into the profession. The South African primary health care system (PHCS) is currently facing challenges of unprecedented magnitude – Aids, tuberculosis, drug abuse and conditions related to high levels of poverty, crime and chronic stress. If TMT is to take its place as a relevant and appropriate health modality in this system, training of future therapists have to equip them to take up the responsibilities and challenges of primary health care (PHC) in a pluralistic society. We argue that merely focusing on propositional knowledge, techniques and procedures results in an attenuated vocational approach that does not take into account the unpredictable, indeterminate and uncertain situations that health professionals face in the South African PHCS. This article is by based on a study that was conducted among learners and educators at the Massage Therapy Institute (MTI) in Fish Hoek, Western Cape, during 2002/3, and which explored their perceptions of the combined practicum  and community service programme as a means of integrating theory and practice as well as honing generic and profession specific skills. We contextualise the study by briefly describing the recent professionalisation process of TMT before taking a closer look at 1) the theory-practice relationship in a profession; 2) the role and nature of professional skills and 3) the motivation for and merits of combining practicum  and community service to hone professional skills in preparation for a profession. After a discussion of the design of the inquiry, we examine the findings that relate to learners’ and educators’ perceptions of the MTI Community Service Programme’s capacity to foster professional skills such as effective interpersonal communication and the ability to deal with a variety of worldviews, cultures, religions and genders. Finally we consider the programme’s role in assimilating learners into their chosen profession. PROFESSIONALISATION OF TMT MTI is a private higher education and training (HET) college that offers a two-year, 2 400-credit diploma in TMT that prepares students for a career in the newly regulated health profession. The passing of the second amendment of the Allied Health Professions Act No. 63 of 1982 on 12 February 2001 has propelled this manual therapy from the services sector into the country’s PHCS as a recognised health profession that   ARTICLE FOR EDUCATION AS CHANGE , RAU ERIKA KRUGER 2 is regulated by the Department of Health and the Allied Health Professions Council of South Africa (AHPCSA). TMT is defined as: (t)he manual application of mechanical, reflexive, connective tissue, fluid moving and percussive techniques to soft tissue to directly or indirectly influence normal or abnormal anatomical structure, physiological function, psychological state, emotional health and / or well-being for health maintenance, restoration, palliative care and / or condition management.  (Esterhuysen 2003:5) The new legislation regarding TMT in South Africa, has several implications for the profession: 1) it is a legal requirement for persons practising TMT to be registered with AHPCSA; 2) TMT has become part of the national health care system and 3) the profession is regulated and protected by the Scope of Practice of a TMT therapist. The emphasis in TMT has shifted from a leisure and recreation activity in the service industry to a clinical setting as part of the South African PHCS. This shift has brought with it an increase in expert power (higher level of theory, techniques, clinical governance, accountability and social validation) as well as a regulated responsibility towards the state and the public to provide a safe, ethical and effective service. The profession is also being challenged to provide a service relevant to the health and social needs of the wider South African population. Besides legal recognition, the notion of a health profession further implies 1) a specialist knowledge base and extensive training, 2) increased autonomy balanced by higher levels of accountability and responsibility and 3) a notion of service to the patient and the community (Eraut in Watts 2000:12, Fritz 2000:31-32).  At the same time as the assimilation of the therapy into the PHCS, TMT training has been incorporated into the transformed post-1994 HET landscape. Previously stand-alone massage training courses were not regulated and formed part of the informal adult education domain. Stand-alone training courses ranging in duration from two days to eighteen months were run by individuals and private training institutions respectively, and fell primarily in the ambit of ‘alternative therapies’ and the New Age worldview. A number of other therapies e.g. beauty/health and skin care therapy, physiotherapy and chiropractic have traditionally included massage as a module or subject in their curricula. We contend that for TMT to take its place as a relevant and appropriate health modality in the South African PHCS, training has to move away from a pure skills development or a vocational approach. Learners have to be equipped for a career in a newly established health profession that is finding its feet in a PHCS that is faced with enormous social and financial challenges. Preparing learners for a health profession at HET level requires a fresh and broader look at the knowledge, skills and attitudes considered important to include in the curriculum. This is in line with Teichler’s (1999:183) three educational tasks of higher education namely 1) the educational function  where learners immerse themselves in the disciplinary knowledge base; 2) the training function  “to foster knowledge and competencies … to prepare students for future professional practice …” and 3) the socialization function  “to shape values, attitudes, social behaviour and the communication skills relevant for action in socio-communicative contexts”. Alsop (2000:56) talks about fitness for purpose , that is, therapists who are capable employees  in the workplace (our emphasis) - people who are competent, safe and ethical health professionals. Therapists also need to be fit for practice , a term   ARTICLE FOR EDUCATION AS CHANGE , RAU ERIKA KRUGER 3 that describes the capacity of the individual to practice his or her profession within the “professional notions about scope and nature of practice which tend to change through time in an evolutionary or incremental way” (Alsop 2000:56). Learners thus require a model that will prepare them to do what they have been trained for but also to conduct themselves in accordance with the values and attitudes of a health profession. The MTI CSP seeks to both equip learners for the profession through the integration of theory and practice in practicum  and to introduce learners to real-life clinical situations through combining practicum  and community service. We argue that this model cements the professional knowledge-base while at the same time fostering deep learning through developing personal and professional skills and professionalism-as- service. By exposing learners to situations that resemble authentic clinical encounters, it encourages fitness-for-purpose and fitness-for-practice in a multicultural society and encourages their assimilation into the profession. Before discussing the specific findings of the MTI study, we explore this perspective under the following four headings: 1) the interrelationship of theory and practice, 2) the role professional skills can play in theory-practice integration, 3) the integration of theory and practice in practicum  and 4) community service as a civic duty and a learning tool.  THEORY AND PRACTICE – TWO SIDES OF THE SAME COIN  According to Usher, Bryant and Johnston (1997:122), it has traditionally been the development of a body of theoretical knowledge “which has marked out a practice as a ‘profession’”. The theory part of the theory-practice relationship in professional education is made up of disciplinary knowledge and research processes. Disciplinary knowledge “constitute(s) a knowledge base or foundation that supports the superstructure of practice … because of its universality, security and reliability” (Usher et al  1997:68 - 69). It tells us how the world is  while practice refers to the way members of a group act in the world . Although disciplinary knowledge “are distinguishable in terms of their theoretical and practical orientation” (Usher et al  1997:69), rather than being opposites, theory and practice are different aspects of the same process (Bawden 1991:12, Rolfe 1996:24). This process is circular in nature, it moves between the abstract and the concrete, the mental and the manual, reflection and doing. Bawden (1991:12) describes it as a “flux between sensory experiences of the world and their mental abstractions - between experiencing and making meaning of these experiences, between sensing and making sense!” The link between theory and practice is the professional - the person who, by having attained a level of disciplinary knowledge, identifies the problem to be solved and takes appropriate action to solve it. Professionals’ actions are informed by the theories they have constructed within the paradigms to which they are committed. Carr (1995 in Fakier 2001:135) considers practice a process of being ”initiated into knowledge, understandings and beliefs bequeathed by that tradition through which the practice has been conveyed to us in its present shape.” As such a practice is not just doing something or applying a skill to   ARTICLE FOR EDUCATION AS CHANGE , RAU ERIKA KRUGER 4 identify a problem nor finding a solution and applying the solution. It involves more than a techno-rational input-output process transforming raw material into a product by means of human action. It is a complex action that takes place within the boundaries set by the group. Noughts-and-crosses is not a practice - it is not sufficiently complex (Mulhall & Swift 1992:82-3). In the same way, the act of massaging a body is not a practice but TMT as a health profession is a practice. Participation in a practice implies acceptance of authority of the standards and paradigms operative in that practice at that time. A practice should however, not be confused with an institution. According to MacIntyre (in Mulhall & Swift 1992:82-3 ) chess, physics and medicine are practices but chess clubs, laboratories and hospitals are institutions. Practices are sustained and protected by institutions (McTaggart 1991: 52) but it is the professional’s actions in the world that constitutes a practice not the legal bodies regulating it, or the professional associations supporting it or the training institutions teaching it. In summary then, practice refers to a community that organises and monitors its members’ actions in the light of a particular way of looking at the world. For the sake of efficacy, they set up systems and structures to coordinate the governing processes (regulatory bodies) and to socialise new members (training institutions). Neither of these two types of institutions, however entrenched, constitutes a practice. They reflect the current manifestation of cooperative activity and theorising of the group. Changes to these theories can thus not occur without affecting the practice and vice versa. There is a dialectical relationship between knowledge and action, theory and practice.  A professional’s training most often starts off with an introduction to theory - propositional knowledge and foundational skills gained from lectures, textbooks, journals, the electronic media etc. We argue that merely concentrating on what  students know and their foundational and practical skills (e.g. massage techniques, draping and bolstering methods and assisting patients on an off the plinth) leads to an attenuated approach to training and in the long run and does not equip learners to cope with real world problems (Luckett 2001:56). However well techniques and procedures are executed, it does not prepare a therapist to deal with the rich and complicated situations arising in real world situations. In the case of TMT in particular, since the therapy does not make use of any other instruments besides the therapist’s body and mind, his emotional maturity and personal development are decisive factors in achieving success. Kennedy (1999:35) and Usher et al  (1997:128) explain, in relation to teaching, and we argue it is equally true of TMT, that the practitioner’s knowledge is also particularistic, dynamic, context dependent and developed from personal experience and is as such private and often attained in an inherently idiosyncratic manner. It is after all a characteristic of the complementary health approach that the therapeutic relationship is seen as particular to two individuals, the health professional and the patient who come together, each with their own strengths and weaknesses, to work towards healing. The therapist’s expertise is in service of a particular patient rather than a disease or condition. According to Usher et al  (1997:128) the “possession of practical wisdom or knowledge … is knowing how to act appropriately in relations to the circumstances of a particular situation or context”. We argue that being able to explain the world does not automatically lead to being able to act in the world. It is not enough to acquire only theoretical knowledge about a particular discipline.
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