Attitude of Physical Therapy Students Towards their Profession and Education in Punjab

Background:The quality of medical teaching can be refined based on the attitude of the students towards their clinical and teaching environment. The objective was to determine student attitudes towards their profession and education in Punjab.
Methodology:TThis cross-sectional survey was conducted from 20 th July to December 2021 after taking ethical approval. The data was collected through an online google document from physical therapy undergraduates and post graduates from different institutes of Punjab. The outcome was measured using “physical therapy student attitudes questionnaire (PSAQ)”.It had four sections, section A is about the knowledge of the profession, section B includes beliefs about future, section C is about patient exposure in clinical trainings and section D is about level of satisfaction from the learnings. The data was encoded and analyzed using SPPS V.23. The descriptive statistics and mean+ standard deviations were used to present the scores. The independent sample t-test was used to find the difference in mean scores of males and females with p value ≤ 0.05 taken as significant.
Results: Mean age of the participants was 46.24 ± 14.13 years. Female to male ratio was 2.73:1. Almost 38.4% patients had chronic cholecystitis, 35.2% had symptomatic gallstone disease, 24.8% had acute cholecystitis and 1.6% had gallbladder polyps. No major vascular or common bile duct injury were observed. 27.2% patients had per operative gallbladder perforation. Stone spillage occurred in 8.8% patients with retrieval in all of them. 75.2% patients were discharged on day 1. Per operatively, 98.4% patients were found to have cholelithiasis, 59.6% had adhesions, 9.6% had mucocele, 1.6% had empyema and 0.8% patients had collections.
Conclusion:The student attitude was quite satisfactory regarding their choice of physical therapy profession, good future, patient exposure and learning skills. There was no statistically significant difference based on the gender.
Keywords:Education, Patients, Physical therapy, Satisfaction, Training.

Physical therapy is a health care profession and a part of the health care in multi-disciplinary rehabilitation. It has an integral role in health care system for decades. ⁽¹⁾ This profession was started as a three years diploma in 1963. However, there was a demand for higher education and improved healthcare services. ⁽²⁾ To meet this need, universities started offering bachelor's degree programs in physical therapy (PT) in the late nineteenth century. ⁽³⁾ Good quality education is necessary and reflected in the quality of physical therapy services. To have a good physical therapy program, it is necessary to have diverse courses, qualified teaching staff, and well-organized clinical training. It is shown that almost 71% of undergraduate PT students feel that the difficulty level of course is greater than expected. The current educational system focuses on an important concept called student’s satisfaction. ⁽⁴⁾ As an academician, we can enhance students' understanding and learning by estimation of their satisfaction levels during their education and learning along with clinical trainings, tools for effective communication and proper time management. ⁽⁵⁾ This will enable us to modify the physical therapy program curriculum, clinical trainings and adopt new learning strategies in our institutions. ⁽⁶⁾ Interest in student satisfaction at undergraduate and graduate level is well- established within higher education in many countries but depends upon several factors. ⁽⁷⁾ The students’ attitude and knowledge about their profession, results in good reputation and a positive impact leading to social awareness and it is other way with decreased satisfaction. ⁽⁸⁾ In this era of emerging professions and advancement, physical therapy profession has gained importance. There is a need of educational foundations that enable students to build up their skills based knowledge and attitudes. ^{(9, 10)}
Not much studies done in Pakistan have addressed students’ attitudes in knowledge about the profession, beliefs about future, patient exposure in clinical trainings and level of satisfaction from the learnings. The objective was to estimate students’ attitudes towards their profession and education in Punjab and find any gender-based difference. This will help to implement new strategies for further improvement in the profession of physical therapy.

This cross-sectional survey was conducted from 20 th July, 2021 to 15 th December 2021 after taking ethical approval (Ref# IIRS/DPT/IERC-372). The data was collected online using Google document. We included physical therapy undergraduates and post graduates from different private institutes of Punjab including Agile Institute Rehabilitation sciences Bahawalpur, Bakhtawar Amin College of Rehabilitation Sciences, Multan, Imran Idrees Institute of Rehabilitation Sciences, Sialkot, Azra Naheed Medical College, Lahore and University Institute of Physical Therapy, Lahore. The calculated sample size was 255 by applying parameters, where, = 1.96 (Standard normal variants at 5% type I error (p<0.05), P= 0.79 (Expected proportion in population) and d= 0.05 (absolute error). (11) The online Google document was prepared based on the mentioned outcome tool with addition of basic details and informed consent, ensuring the privacy and confidentiality of the provided responses. The outcome tool was “physical therapy student attitudes questionnaire (PSAQ).”It had four sections including A, 6 Questions related to the knowledge about the profession, 5 Questions in B related to beliefs

The mean age of the participants was 22.5+6.5years. The current study comprised of more females as compared to males, participants belonging to middle class were 226 (88.62%). 71.36% of the participants were from 2 nd to 4 th professional year . (Table 1) The sum of all domains of PSAQ were calculated separately. The combined scoring showed no significant gender-based difference with P value >0.05. (Table *This scoring is sum of all boxes within male and females The response of the students showed that 120 (47.05%) agree that they were willing to be physical therapist in future and 140 (54.90%) had good theoretical background, others are presented.

Laparoscopic cholecystectomy is the treatment of choice and gold standard due to less pain, minimum surgical trauma, short postoperative hospital stay and early return to home. In our study, female to male ratio was 2.7:1 (73.2% vs 26.8%) which shows less female predominance as compared to another study conducted in Pakistan. 15 This may represent a changing trend of cholelithiasis, becoming more common in males in our region owing to dietary changes over recent times. However, the female predominance itself is consistent with international data. 16 Mean age in our study was 46 years which is consistent with regional and international studies. 15,16 In terms of presentation or indication for surgery, 38.4% patients had chronic cholecystitis, 35.2 % had symptomatic gallstone disease, 24.8% had acute cholecystitis and 1.6% had gallbladder polyps. This is consistent with the study done in Pakistan. 15 Mostly bleeding in laparoscopic cholecystectomy occurs from trocar site insertion, liver bed (especially in cases of acute cholecystitis and empyema gallbladder) and vascular injury (usually cystic duct or its branches or anomalous vessel). In rare cases, massive bleed can occur due to injury to abdominal aorta, vena cava, iliac vessels, hepatic artery or portal vein. 17 In our study, 72% patients had less than 50ml blood loss, 22% patients had 51 to 150 ml blood loss and 6% patients had more than 150ml blood loss. There was no major vascular injury in our study. 27.2% patients had per operative gallbladder perforation resulting in bile spillage. It is less as compared to an international study that reported gallbladder perforation in 36.1% patients. 18 It is variably common in 10 to 30% of laparoscopic cholecystectomies, but it is usually not associated with any dreadful outcome, surgical site infection or post-operative collection. 19 Suction irrigation of the contaminated area is sufficient to address it. Stone spillage occurred in 8.8% patients in our study. Spilled stones can be culprits for abdominal collection, abscess formation, pain ileus etc. To avoid these, stone retrieval was performed in all of such cases followed by lavage. Additionally, clips were applied from where the spillage started, to prevent further contamination and spillage. Acutely inflamed and over distended gall bladders were main factors for this intraoperative event. No common bile duct injury was noted. This is consistent with studies done in Karachi and Peshawar. 20,21 The incidence of common bile duct injury is strongly related to exposure of Calot’s triangle, experience, knowledge and proper training of a laparoscopic surgeon. It is one of the most dreadful complications while performing laparoscopic cholecystectomy. 15 High morbidity, mortality, and prolonged hospitalization is associated with common bile duct injury. 22 Accessory cystic duct was noted in two cases. This is a unique finding and requires active per operative vigilance to recognize it which otherwise will present as bile leakage and related complications. There are few cases of accessory cystic duct reported internationally. 23,24 75.2% patients were discharged on day 1 which is a routine worldwide in good laparoscopic centers. Patients requiring two or more days were mostly cases of acute cholecystitis, biliary pancreatitis or those who needed time for decision or second opinions with family and doctors regarding surgery in acute cholecystitis, empyema gallbladder etc.
Comorbidities included hypertension 19.2%, diabetes mellitus 12%, hepatitis C 3.6%, ischemic heart disease 2.4%, tuberculosis 1.2%, asthma/chronic obstructive lung disease 0.8% and hepatitis B 0.4%They were optimized with proper specialist consultations accordingly prior to surgery. This was a single-center study and retrospective in nature as all the data was collected from the past records that limits its quality. Multi-centered study with a larger sample size would have increased generalizability. Same surgeon performing all the operations adds to benefit on one side but also adds the bias to the study. It is pertinent to see the outcomes when another specialist performs the surgery with the same team. This study has provided evidence for improving surgical practices and demonstrated that proper training and experience decreases the risk of intraoperative complications and high end laparoscopic setup and vigilance improves the outcomes.

Laparoscopic cholecystectomy is a safe procedure in all types of gallstone disease presentations with a low complication rate.

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