Reframing Physiotherapy Education: Joyful Complexity and Comfortable Uncertainty

This presentation, delivered at the Physiotherapy Conference 2024 under the theme Whakateere (to navigate or steer), explores the evolving landscape of physiotherapy education. Titled Reframing Physiotherapy Education: Joyful Complexity and Comfortable Uncertainty, the session challenges traditional linear models of learning and embraces the complexity and uncertainty inherent in both education and clinical practice. Drawing from philosophical insights (including Camus' Absurdity) and practical frameworks like mindlines, the Capability Approach, and examples from Delta and PACE, the presentation encourages educators and practitioners to create adaptive learning environments that foster critical thinking, agency, and resilience.

1. Reframing Physiotherapy Education: Joyful Complexity and Comfortable Uncertainty Physiotherapy Conference 2024 New Zealand Joost van Wijchen September 6 th 2024

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4. What to Expect ? Theme 1: Wondering Exploration and Curiosity: Embracing Uncertainty: Theme 2: Constructing Building Frameworks and Mindlines: Creating Learning Environments: Theme 3: Reflecting & Acting Critical Reflection and Practical Application: Iterative Process: 4

5. Wondering In a world filled with assumptions, w ondering begins with the act of questioning the familiar. Through curiosity and exploration, we suspend the need for certainty and embrace the strangeness of what we think we know . 5

6. BMJ. 2001 Oct 6; 323(7316): 799–803. ..to take appropriate and effective action to formulate and solve problems in both familiar and unfamiliar and changing settings. (Cairns 2000)

7. van Wijchen , 2013

8. “ If we are to do the best by our students , we have a responsibility to promote learning by all of them and not only those who can learn despite our teaching” ( Dall’Alba 2007) 10

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10. Wondering does not seek answers but opens space for deeper questions. The more we challenge what is familiar, the more we realize that certainty is fleeting. Each question leads us further into the unknown, inviting us to wonder again. 12

11. Wondering dilemmas: Do we seek certainty in education because it comforts us, or is the real value found in embracing the discomfort of complexity and ambiguity? Should education be framed as the delivery of knowledge, or as an exploration of the unknown, where all partners are co-creators of meaning? 13

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13. Theme 2: Constructing As we navigate uncertainty, we begin to build. But constructing is not about finding fixed answers; it’s about creating frameworks that guide us through complexity. These frameworks, like mindlines, are flexible and open to constant revision. 15

14. The capability of an individual is determined by their  freedom to choose  and their ability to convert  resources  into  functionings —the things they value being and doing. Capabilities reflect a person’s real opportunities to achieve the kind of life they have reason to value, going beyond material wealth to emphasise  agency ,  well-being , and  personal growth . Amartya   Sen Capability approach

15. The Capability Approach : Building Agency Focus on   agency : Freedom to choose and act . Convert resources into   capabilities  . Tailor education to enable personal and professional growth . 17

16. Van Wijchen & Alme, 2019

17. Comparative justice Equity : Ensure access to opportunities for all. Health as a right : How do we define health? WHO: Health as complete well-being. Huber: Health as adaptability and self-management. 19

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19. 21 Mindlines : Adaptive, evolving knowledge . Developed through practice  and  colleagues . Flexible frameworks that grow with experience .

20. Ostuzzi , F. (2017).  Open- ended design : explorative studies on how to intentionally support change by designing with imperfection . Ghent University . Faculty of Engineering and Architecture, Ghent, Belgium . http://hdl.handle.net/1854/LU-8539015

21. Theme 2: Constructing The act of constructing is never complete . Each framework we build is a temporary structure , evolving with our understanding . What we construct today will need to be reshaped tomorrow , as new insights and challenges emerge . 23

22. Constructing Dilemmas: When constructing learning environments, should we prioritize the fulfilment of desires (wants) or focus on meeting the essential needs for critical thinking and adaptability? Are we preparing .. to master fixed competencies, or are we helping them construct adaptive frameworks that allow them to engage with a world with unpredictabilities . 24

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24. Theme 3: Reflecting & Acting Reflection brings awareness to our actions, and through acting, we test the limits of our reflection. In this phase, we move from thought to practice, knowing that every action invites us to reflect again. 26

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28. Van Wijchen & Alme (2022) Sediments Socialisation through togetherness Freedom to choice Coping with uncertain ty Ability to adapt 30

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31. Theme 3: Reflecting & Acting Reflecting and acting is a cycle without end. Each action leads to new reflection , and each reflection prepares us for the next step . Our understanding grows not through final answers but through the continuous interaction between reflection and practice . 33

32. Reflecting & Acting Dilemmas: Is reflection a tool for confirming what we already know, or should it disrupt our thinking and open us to new uncertainties? In acting on reflection, should we aim to satisfy immediate demands, or take the longer, more complex path toward building foundational capabilities for the future? 34

33. Embracing Joyful Complexity & Comfortable Uncertainty Becoming is continuous : Every reflection and action adds a new layer of growth . Uncertainty as opportunity : Embrace uncertainty as part of the process to foster creativity and adaptability . Frameworks should be flexible : Construct educational environments that allow for growth , agency , and reflection . Foundational principles (sediments) : Socialization , freedom to choose , coping with uncertainty , and adaptability are the key elements that support growth . 35

34. Reaffirming the Role of Educators as Catalysts for Becoming Education , particularly in complex fields like physiotherapy , cannot be reduced to a transaction or a consumer service. It is a shared , iterative process where the educator’s role is to support and challenge students to engage with the complexities of an evolving world with joy , adaptability , and resilience . Learning, like  becoming , is continuous and dynamic , with each reflection and action building new layers of growth . 36

35. 37 Hope as action “Hope locates itself in the premises that we don’t know what will happen and that in the spaciousness of uncertainty is room to act. When you recognise uncertainty, you recognise that you may be able to influence the outcomes – you alone or you in concert with a few dozen or several million others.” Rebecca Solnit (2016)

36. Joost van Wijchen [email protected]

37. 39 References van Wijchen, J., & Nordheim Alme, M. (2022).  Becoming a Physio(therapist) .  In A. Le May & J. Gabbay (Eds.),  Knowledge Transformation in Health and Social Care  (pp. 139-157). Routledge .  https :// doi.org /10.4324/9781003158721-9 For discussions on  becoming  and identity in physiotherapy education. Dall’Alba , G. (Ed.). (2024).   Being and Becoming Through Higher Education . Springer Nature Singapore.  https://doi.org/10.1007/978-981-97-2062-0 For discussions on uncertainty and the  process of becoming  in education. Nicholls, D. A. (2023).   Physiotherapy Otherwise . Tuwhera Open Monographs.  https://ojs.aut.ac.nz/tuwhera-open-monographs/catalog/book/8 For discussions on alternative perspectives in  physiotherapy  and societal challenges. van Wijchen, J., Kerry, R., & Nordheim Alme, M. (2021).   QuaranTrain: An International Community of Practice for Learning . OpenPhysio Journal.  https :// doi.org /10.14426/art/1552 For an example of  sediments in action , highlighting community learning and adaptability. Edwards, I., Delany, C. M., Townsend, A. F., & Swisher, L. L. (2011).   New Perspectives on the Theory of Justice: Implications for Physical Therapy Ethics and Clinical Practice . Physical Therapy , 91(11), 1642–1652.  https://doi.org/10.2522/ptj.20100351 For discussions on  justice  in relation to ethics and clinical practice in physiotherapy. Fraser, S. W., & Greenhalgh , T. (2001).   Coping with Complexity: Educating for Capability . BMJ, 323(7316), 799-803.  https :// doi.org /10.1136/bmj.323.7316.799 For discussions on  complexity  and educating for  capability  in health professions. Robeyns , I. (2017).   Wellbeing, Freedom, and Social Justice: The Capability Approach Re-Examined . Open Book Publishers.  https://doi.org/10.11647/OBP.0130 For an in-depth re-examination of the  Capability Approach , including discussions on  wellbeing ,  freedom , and  social justice . Sen, A. (1999).   Development as Freedom . Oxford University Press. For the  Capability Approach  and the emphasis on agency and conversion of capabilities to resources. Gabbay , J., & Le May, A. (2011).   Practice-Based Evidence for Healthcare: Clinical Mindlines . Routledge . For the concept of  Mindlines  and knowledge in practice. Nicholls, D. (2017).   The End of Physiotherapy . Routledge . For discussions on  comparative justice  and the role of physiotherapy in societal challenges. World Health Organization (1948).   Preamble to the Constitution of the World Health Organization . For the  definition of health  as complete well-being. Huber, M., et al. (2011).   How Should We Define Health?   BMJ, 343 For the alternative  definition of health  as the ability to adapt and self-manage. Camus, A. (1942).   The Myth of Sisyphus . For the philosophical underpinning of  embracing absurdity  and seeing life as a continuous process of becoming. Belton , J., & van Wijchen, J. (2023).  Pain Education for Patients , Chapter 9 in H. van Griensven & J. Strong (Eds.),  Pain : Textbook for Health Professionals. Elsevier .  https :// www.elsevier.com / books / pain /van- griensven /978-0-323-87033-7 Focus on fostering   patient agency  and  self -management  through adaptive learning environments . van Lankveld, W., Maas, M., van Wijchen, J., Visser, V., & Staal, J. B. (2019).  Self-regulated learning in physical therapy education : A non- randomized experimental study comparing self-directed and instruction-based learning . BMC Medical Education , 19(1), 50.  https://doi.org/10.1186/s12909-019-1484-3 Emphasis on   self-directed learning  and the development of  student capabilities   through adaptable educational frameworks .