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IntroductionPerkin (1996) argues that the twentiethcentury saw the establishment of the‘professional society’, in the developedworld at least. His argument that theconcept of occupations being professionspermeates many levels of society (Perkin,1989) is supported by the fact that manyin an increasing number of occupationssuch as accountancy and social workconsider themselves to be and are oftenwidely accepted by society as members of a profession (Johnson, 1972). Thispopularity suggests that professions areperceived by many to have positivecharacteristics to which it is desirable toaspire (Hoyle and John, 1995). However,despite the ongoing trend towardsprofessionalisation of occupations, thoseregarded as such are experiencingincreasing public disaffection andcriticism (Watts, 2000).

Higgs et al (1999, page 37) define aprofession as ‘a body whose membershipis accorded after a long effective training

under the control of experts in auniversity context, which guarantees thequality and effectiveness of members’work’. The essence of this definition is thequality of professional practice, which is alaudable aim. However, the definition alsocontains descriptive elements includingthe presence of a distinctive disciplin-ary knowledge base, unique skills andexpertise and exclusivity of membershipwhose need has justifiably been quest-ioned (Eraut, 1994). More importantly,this definition also lacks inclusion of the reason for the focus on quality ofmembers’ work: that of service to thepublic (Hargreaves and Goodson, 1996).

Historically, professionals were grantedprivileges including status, autonomy,power and exclusivity, on the under-standing that they did the best they couldfor the good of society (Johnson, 1972;Watson, 1992). For a long time socialstructures and governmental policiessupported this status quo (Perkin, 1989).However, in recent decades, both societaland associated bureaucratic changes haveled to scrutiny of professions. Perkin(1989) locates the start of this scrutiny inthe 1070s when widespread economicrecession and increased governmentalfocus on the application of free marketmechanisms to the public sector led tocriticism of the perceived power andprivileges of professions. The outcomes ofthis appraisal have not been favourable toprofessions, which have been deemed tohave been abusing their privileges andnot fulfilling their stated objective ofaltruistic service to society (Johnson,1972).

The primary responsibility of pro-fessionals is provision of an ethical andmoral service to their clients. However,directly related to this are the addit-ional responsibilities identified by Eraut

Current Issues ofAccountability inPhysiotherapy and HigherEducation Implications for physiotherapy educators

Summary Despite the ongoing trend towardsprofessionalisation of occupations, those already regarded as such have been experiencing widespread scrutiny andcriticism. The main area of concern relates to perceived lack of public accountability which, it is argued, has led to abuse of professional status, autonomy and power, to the detriment of society.

Professions in the public sector, including physiotherapyand higher education, have increasingly been required tofulfil often externally imposed accountability requirements.As members of both professions, physiotherapy educatorshave two sets of such requirements to meet. This situationcould make the expectations seem daunting and possiblyunachievable in light of educators’ high workloads. However,these demands, although challenging, are largelycomplementary and physiotherapy educators are in a positionto make a valuable contribution to the development of bothprofessions.

Key WordsProfessional accountability, physiotherapy, higher education,physiotherapy education.

by Jenny Morris

Morris, J (2002).‘Current issues ofaccountability inphysiotherapy andhigher education:Implications forphysiotherapyeducators’,Physiotherapy, 88, 6,354-363.

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Author and Addressfor Correspondence

Jenny Morris MSc BAGradDipPhys DipTPis a senior lecturer inphysiotherapy atColchester Institute,Sheepen Road,Colchester CO3 3LL.

This article wasreceived on April 20,2001, and acceptedon January 10, 2002.

(1994) to broader society, funding sources(largely the state in public sector pro-fessions), employers and the professionsthemselves. Criticisms of professions havelargely been around the issue that, over time, their members have fulfilledthe responsibility to themselves in anunacceptable way, with little regard forwhat should be their focus: all theexternal stakeholders, particularly theirclients (Perkin, 1989; Eraut, 1992, 1994;Friedson, 1994).

Thus, criticisms revolve essentiallyround the central issue of lack of publicaccountability and most of the changescurrently being demanded of professionsrelate to this (Eraut, 1994). Laffin (1998)states that professions do offer serviceslike medical care which have value tosociety and will continue to exist, but thattheir form and relationship with society ingeneral will be different in the future.This prediction is already being provedvalid in professions based within thepublic sector, including education andhealth where, for example, both the State and the public increasingly haveactive roles in decision-making (Laffin,1998).

Both physiotherapy and higher educ-ation are currently being challenged torespond appropriately to importantcentral issues around professionalaccountability, including provision of an inclusive up-to-date evidence-basedservice by professionals from a wide rangeof backgrounds, and efficient use ofpublic funds (Watson, 1992; Laffin, 1998).This has important implications forphysiotherapy educators who have dualprofessional roles and responsibilities andresponding successfully to these two setsof accountability issues could potentiallyresult in them being subjected to separatecompounding professional expectations,with associated excessive work demands.Endeavouring to respond to suchdemands could result in ineffective andinefficient work which does little to fulfilthe expectations of either profession.

It will be argued, however, that thechallenges facing physiotherapy educat-ors around the current issues relating to professional accountability in bothphysiotherapy and higher education arelargely compatible and complementaryand, although not insubstantial, do notmake unjustifiable or excessive cumul-ative demands, allowing educators to

contribute positively and productively toprofessional and societal expectations.

Before discussing how they impact onphysiotherapy educators, the account-ability issues relevant to each professionwill be considered first.

PhysiotherapyThere is a perception within the healthprofessions that medicine is the majorculprit regarding unprofessional behav-iour, as in the cases of the Bristol infantcardiac surgery negligence and HaroldShipman’s murders, and that other healthprofessions have been unfairly criticisedby the public. However, there is no reasonto assume that only the medicalprofession is at fault and it is valid toargue that measures which improvepublic accountability across all healthprofessions should be welcomed because,provided they are appropriate, theiroverall effect should be maximisation ofthe service received by patients (Hunter,1998).

Physiotherapy demonstrates bothinternally structured and externallyimposed accountability measures.

Although positive on paper, the existinginternally constructed processes do havepotential or actual weaknesses, whichrecently imposed external measures aregoing some way to address.

From its beginnings in the 1880s(Barclay, 1994) the occupation ofphysiotherapy, like nursing, tookmedicine as its professional model(Ackroyd, 1998) and sought thepatronage of doctors (Jones, 1991a,b).

This association with medicine has hadboth positive and negative effects onphysiotherapy as a profession. In line withthe attributes demonstrated by medicine,one of the original professions, whicharose out of learning undertaken in medieval universities in Europe(Friedson, 1994), physiotherapy devel-oped a professional society as early as1894 and established standardised,supervised training and written codes ofpractice soon thereafter (Jones, 1991a).

On the basis of these actions, it has been argued that physiotherapy was establishing structures aimed atmaximising the quality of treatmentoffered to patients (Jones, 1991a).However, several authors have justifiablyargued that the existence of structureslike professional societies whose stated

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purpose is provision of optimal servicescan, in fact, lead to exclusivity and pro-fessional aggrandisement rather thanbeing used for the good of clients(Friedson, 1994).

The current issues around professionalaccountability in physiotherapy derivefrom both outside and within theprofession. In addition to those associatedwith professional behaviour and thequality of patient care and othersassociated with government-led changesin the structure of healthcare deliverythere are concerns regarding the exist-ence of a widely agreed ontological basisof physiotherapy (Higgs et al , 1999;Ohman et al, 1999). The latter issue mayappear to be self-indulgent, but it doeshave important implications for clinicalpractice too.

Responsibility for addressing theseissues lies with educators as well asclinicians. By virtue of their location inuniversity settings and their central role ofproviding undergraduate and post-graduate education, the former group hasa particular contribution to make.

Access to the ProfessionGovernment policy relating to workforceneeds in the National Health Service(DoH, 2000) has identified a need for themembership of health professions toreflect the demographics of the generalpopulation. Although the carefullyvalidated, standardised and monitoredform of physiotherapy education could besaid to help ensure high quality servicefor patients, access to programmes is verylimited and strongly based on academicperformance, even though the need forother abilities in physiotherapists hasbeen identified (Richardson, 1993, 1999;Higgs et al, 1999). This excludes manywho may possess these other attributes in addition to enough academic ability. In recent years, more mature and male physiotherapy students have beenrecruited, but still largely within theexisting framework of high academicperformance, which has been sustainedby very high demand for entry tophysiotherapy programmes. Of a totalannual intake in the United Kingdom ofapproximately 2,000 students, fewer thanaround 10% have non-standard academicor ethnic backgrounds and they are oftenadmitted to programmes specificallydesigned for them, ie part-time and with

specific funding arrangements (Mason etal, 2002).

This trend may be a legacy ofdominance of the medical profession andthe way it is structured, but this does notmake this practice acceptable. If thosewho are accepted into physiotherapyeducation are not necessarily those whowould make the best therapists or bestserve patients, then the profession isfocusing more on itself than on itspurpose of service quality. Ongoingresponse by the profession to governmentinitiatives to widen access should helpimprove this situation, but the currentdemand for physiotherapy education byapplicants with very high academic gradesis not facilitating this process. Wideningaccess needs to be more seriously con-sidered and acted on than it has beenuntil now.

Scope of the Profession Helders et al (1999) identify a lack ofcoherence in the development of therange of activities which presently formphysiotherapy. They and other authors(Richardson, 1993; Grant, 1995; Ohmanet al, 1999) point out that the range ofactivities which forms physiotherapy hasgrown in an ad hoc and uncritical way, anargument supported by historical review(Barclay, 1994). List’s statement (1986)that, until recently, physiotherapy waslargely a ‘skilled craft’ provides supportfor these assertions.

The consequential perceived need ident-ified for development of a physiotherapyontology describing the nature and scopeof the profession is a current issue whichis also important with regard to pro-fessional accountability. Positively, thebasis for this need has been linked withthe need to maximise the quality ofservice provided to patients (Richardson,1993, 1999; Higgs et al, 1999). It would beencouraging if these concerns hadoriginated within the profession.However, this issue was raised at a verysimilar time to the largely externallyimposed requirements for evidence-basedpractice and related aspects of clinicalgovernance as part of accountability inhealthcare in this and other countries,suggesting that its identification wasreactive rather than proactive.

Ohman et al (1999) argue that the med-ical domination of physiotherapy may bean important reason for the delay

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in the development of a scientific andresearch supported base for physio-therapy, and Palastanga (1990) states that,until physiotherapists gained a reasonabledegree of professional autonomy, theywere not in a position to push foruniversity-based education and profess-ional research.

However, the proposal of a dependentlink between research and autonomycannot be justified, as other healthprofessions like nursing which can be argued to have less autonomy thanphysiotherapy have a long history ofresearch. Also, any dominance by themedical profession, with its strong focuson research, could have been used as apositive role model in physiotherapy.Physiotherapists appear to have largelybeen content to learn skills based on un-researched ‘expert’ opinion. It is, thus,highly relevant that the need for thedevelopment and establishment of anevidence-based physiotherapy ontologyhas been identified.

Ohman et al (1999) believe that thesituation has improved in recent times,with an ‘academisation’ of physiotherapypractice involving a shift from tacit andcraft knowledge to theoretical knowledge.However, Helders et al (1999) are not sooptimistic and posit convincingly that theoccupation has still not established asubstantial ‘physiotherapy theory’. Inreality, the profession is active in this area, but the value of some research hasbeen questioned and some authors have identified a theory-practice gap inphysiotherapy (Richardson, 1993). Thishas implications for the accountability of the profession with regard to howappropriate and up-to-date clinicalpractice may be.

Clinical PracticeIn addition to the demand for evidence-based practice, the need for undertakingcontinuing professional development andreflective practice by physiotherapists andother health workers identified in recentgovernment documentation has rein-forced the importance of public account-ability. These concepts are enshrined inthe objectives of the government-initiated proposals for the revision of the1960 Professions Supplementary toMedicine Act. The Act, whose purposewas to ensure provision of well quali-fied and disciplined allied health staff

(Barclay, 1994) was itself largely an instru-ment of accountability which focused oneducation of therapists, registration ofsuitably qualified local and overseastherapists, and investigation of therapistsreported for disciplinary issues relating tothe codes of practice written by therelevant professional bodies. However, theexistence of these structures should notroutinely be accepted as having beenadequate. The real extent of account-ability in some of these functions could be questioned.

The educational and registration roleshave been very successful and have beenretained by the Health ProfessionsCouncil which has replaced the Councilfor Professions Supplementary toMedicine from April 1, 2002. The avail-able disciplinary procedures may alsohave been adequate, but there were issuesof accountability regarding publicawareness of complaints rights andprocedures. Although CPSM disciplinarycommittees included representation fromother health professions, there was no lay representation. As in other profes-sions (Eraut, 1994), the allied healthprofessions, including physiotherapy, have probably thus also been guilty of protectionism in this regard.

The Chartered Society of Physiotherapy(CSP) has also been actively involved indeveloping accountability-related practiceframeworks in response to external forces.This has included a recent review andrevision of the Standards of PhysiotherapyPractice which now reflect the currentscope and nature of practice. In similarvein, the CSP has been involved inreviewing and updating the Rules ofProfessional Conduct so that they reflectthe current changes in the context ofaccountable practice. The CSP has alsobeen directly involved in the writing of benchmarks for physiotherapy inassociation with the Quality AssuranceAgency and the NHS Executive.

All these developments are comm-endable and have the potential tomaximise the quality and nature of careoffered to patients, but unless they areupheld and seen to be upheld then theprofession would not be fulfilling societal,state and professional expectations.

Friedson (1994) states that the survivalof a profession relies heavily on cohesionamong members. He further argues thatprotecting a profession means protecting

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miscreant members and that this factimmediately violates desirable profes-sional attributes of primary concern forthe public. As mentioned in the previoussection, even if the means of investigatingreported unprofessional behaviour exist,unless they are made known to the publicas well as to members of professions, thenaccountability and the quality of service tothe public are threatened. In addition tothis issue, the structure of the Council forProfessions Supplementary to Medicinecontained an important weakness thatonly members of the professions madedisciplinary decisions about membersaccused of unprofessional conduct. Again,this demonstrated a lack of openness,which the new Health Professions Councilaims to reverse via inclusion of lay peopleon disciplinary committees.

A further expectation of physiother-apy which is centrally relevant to theaccountability of the profession in thearea of quality of service offered topatients is the way in which health servicesare delivered. Richardson argues (1993,1999) that in the past patients tended to receive largely unco-ordinated, often repetitive and or disjointed carefrom a variety of healthcare providersrepresenting a variety of professionaloccupations, because professionals had an internal uniprofessional rather than a co-ordinated seamless approach. Again, as a result of externally-imposedgovernment policy, health provision hasmoved towards a more desirable multi-disciplinary structure which requiresmembers of different health professionsto work together for the common good of patients (Richardson, 1999). Thisrestructuring, which is still not fullyestablished in all areas of clinical practice,should improve the care provided topatients and is thus another importantpart of improvement in professionalaccountability.

Although the demands of responding to restructuring of clinical services andcomplying with accountability measureshave put added pressure on therapists(Barnitt and Salmond, 2000), which makeundertaking all these activities prob-lematic, authors like Richardson (1993)correctly argue that the inclusion ofreflection in and on practice and relatedactivities of continuing professionaldevelopment is important both forindividual practice and the profession as a

whole. Physiotherapists need to be able tojustify the service they offer to patients ifthey are to maintain a role in patient care.This imperative is strengthened by thefact that physiotherapy is only one of anumber of professions, includingosteopathy and chiropractic, which usephysical approaches to manage patientproblems. The future of physiotherapyitself is thus closely linked with thepremise of best quality patient care.

Higher EducationThe positions of both Henkel (1998) andMorley (1999) that university teaching inthe United Kingdom has altered littleover the centuries and proved élitist,exclusive and resistant to change until the late twentieth century is stronglysupported by Martin (1999) who foundfrom surveys of lecturers that theirworking lives as recently as the 1960sinvolved few students, little teaching,minimal pressure to publish, high status,employment for life, no accountabilityand no external interference.

Possibly because the higher educationprofession had developed and advancedso little over time, the changes it hasexperienced in recent years have beensubstantial. University teachers are beingsubjected to the same per formancedemands as other professions, butbecause their practice has been out oftouch with social advance for so long, theeffects have been marked. In the past twodecades, higher education has undergonemassive externally imposed changes whichhave altered lecturers’ working livesdramatically (Martin, 1999) and alsoinfluenced the professional attributes ofuniversity teaching (Watts, 2000).

As with physiotherapy, increasedaccountability has been the main focus ofimposed changes. Unlike physiother-apy, university teaching had virtually no accountability structures in place,probably because it has never had anyprofessional structures like a memberorganisation (Henkel, 1998). This couldgo some way to explaining the scope andnature of accountability measures andstructural changes which are now centralfeatures within higher education.

Academics have largely resisted thesechanges and regarded them negatively(Ramsden, 1998; Martin, 1999). Prof-essional resistance to change is notunusual, but may be stronger in

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occupations like university teaching whichhas had a long history of autonomy.Martin’s research (1999) into lecturers’reactions to recent developments hasshown that, although there are academicswho have found the outcomes of changepositive, they are a minority.

Accountability issues in higher educ-ation have centred three main areas:access to higher education, researchpurposes and use and teaching quality.

Access to Higher Education One of the arguments made againstprofessions in the 1970s, against abackground of general recession (Perkin,1989), was that they were power ful,privileged and unproductive. Theproductivity issue in higher education inrelation to student numbers and workloadis supported by the lecturers’ responses toquestions asked about the nature ofuniversity life in the research reported byMartin (1999) and the feelings andopinions they expressed when askedabout how their working lives hadchanged. The increase in numbers ofuniversity students and all the associateddemands show that higher education fellshort in terms of accountability to societyby being exclusive and élitist. Thesubstantial increase in student numbers in recent years suggests that there was a large demand in society to whichuniversities were unwilling to responduntil their source of funds, the gov-ernment, stepped in and imposedchanges in access and course provision(Martin, 1999).

Although university student numbers in the United Kingdom have beenincreasing over a number of years theDearing Report (NCIHE, 1997) explicitlyidentified a need to widen access not onlyin general, but especially to people fromethnic minorities and those with non-standard academic backgrounds. Theidentification of these groups so recentlyagain suggests that higher education wasstill tending to be exclusive in relation tostudent admissions.

Research Focus As part of the autonomy enjoyed byacademics, they were granted funding forresearch without having to do much inthe way of accounting for spending orundertaking research for specific endusers (Henkel, 1998). Part of the reforms

introduced in the 1980s was theintroduction of the Research AssessmentExercise. The aim of the RAE is to directscarce research funds to those most ableto use them maximally (Henkel, 1998).The essence of the process is thus one ofevaluation. This is a positive move withregard to public accountability. However,this is not as open as it could be as it usesa system of peer review (Henkel, 1998)and the reality that funding tends to gomainly to institutions with establishedhigh ratings may represent a biased focuson quantity rather than quality.

Teaching Quality and Learning SupportAccountability issues are even moreextensive in the teaching aspect oflecturers’ professional lives. Ramsden(1998) highlights the fact that, unlikedisciplinary knowledge and researchskills, university lecturers have not beenrequired by their employers to demon-strate knowledge and skills with regard toteaching or education-related support forstudents, even though it is a core activityin higher education. Watts (2000) agreesand argues correctly that, unlike thesituation in other professions, academicsneed both educational and subject-specific expertise to be professionals. Thepoor outcomes resulting from thisomission are associated with a range ofissues including poor quality assess-ment processes, absent or insufficientidentification of learning aims andobjectives, failure to encourage activestudent learning and inappropriatemethods of delivery (Ramsden, 1998).

Watts (2000) appropriately concludesthat university education has beenrequired to move from a parochial self-centred concept of service to a client-centred one. The government hasintroduced two main structures aimed at monitoring and improving the quality of teaching and the student learn-ing experience in general. The QualityAssurance Agency was established despiteopposition from universities (Henkel,1998) and is responsible for assessing the quality of education provided byuniversities. The subject review activity ofthe Quality Assurance Agency is a positiveforce in terms of accountability to severalstakeholders, not just students, includingparents, employers and funding bodiesand, thus, the state. However, the struct-ure does have similar weaknesses to the

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Research Assessment Exercise in that it isa system of peer assessment without inputfrom other interested parties.

The lack of emphasis on attainment oftraining in the education of students hasbeen addressed by the formation of theInstitute of Learning and Teaching as suggested in the Dearing Report(NCIHE, 1997) which both proposed theestablishment of the Institute of Learn-ing and Teaching and argued for arequirement that lecturers shouldbecome members via demonstration ofexcellence in teaching. In response to these initiatives, universities havedeveloped teacher training courses forlecturers, if they were not alreadyavailable. However, many require onlynewly or recently appointed staff to attendthem, thus bypassing the large majority oflecturers. This trend is an accountabilityissue, but it has been addressed to someextent by the Institute of Learning andTeaching as it does offer membership toexperienced lecturers who can produceevidence that they are effective teachers.Again, however, this process involves asystem consisting largely of peer review.

Overall, although they have not gener-ally been welcomed or seen as necessaryby many academics, the changes andprocedures which have been imposed onhigher education, if not perfect, havemade accountability processes moreapparent and public. For example,Quality Assurance Agency subject reviewscores are published on the Internet andrecent increases in the number of matureand other non-standard entrants will alsohave had an impact on society. Watts(2000) agrees that all these monitoringand review processes have changed thenature of professional autonomy inuniversities. However, she arguesencouragingly that these changes mayhave led to increasing professionalisation,rather than the deprofessionalisationclaimed by others (Hargreaves andGoodson, 1996). Based on the pastinadequacies of university teaching inrelation to the public, such changes asthere have been were necessary and,overall, they are a positive force regardingthe professionalism of university lecturers.

ImplicationsPhysiotherapy educators have an imp-ortant role to play in responding app-ropriately to both sets of profession-

specific accountability issues discussedabove. Higgs et al (1999) recognise thatuniversity educators who teach on voc-ational programmes have to serve twomasters; physiotherapy educators have to reconcile the demands of both theuniversity and the profession for whichthey educate students. From a positiveperspective, with regard to the currentaccountability issues, physiotherapyeducators, by virtue of having a foot inboth professional camps, are in a strongposition to make a valuable contributionto addressing these issues.

By being located in higher education,opportunities exist for physiotherapywhich did not when training took placeoutside universities. This argument wasstrongly made by Palastanga (1990) whostated that an important advantage tophysiotherapy of the move into highereducation would be that the universitycontext would encourage students’education to be broader and deeper thanit had been before and enable them todeal positively with the changing demandsof professional practice.

However, the fact of being responsibleto two masters and being physicallydistant from and usually no longeractively involved in clinical practice hasbeen identified by some as problematic.Cavanaugh (1993) states that there iswidespread criticism of the fitness forpractice of graduates from vocationaleducation settings resulting largely fromthe academic culture focusing more onresearch than academic scholarship,because the type of research encouragedtends to create a theory-practice gap andnon-integrated curricula are taught bysubject specialists who lack a broader view. These dangers to do exist, but canbe avoided if physiotherapy educators are aware of them and actively retainconstructive links with clinicians.

If the accountability issues in physio-therapy and higher education arecompared, they are surprisingly similarand, taken from either professionalperspective, they are mostly mutuallymanageable, a very useful factor from aphysiotherapy educator’s point of view.

Widening AccessThe requirements of the Department ofHealth (2000) and the Dearing Report(NCIHE, 1997) with regard to wideningaccess are very similar. Both identify a

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need to broaden access to include non-standard entrants. This means that, in onepolicy move of making entry require-ments more realistic and consciouslyencouraging applications from non-standard entrants, physiotherapy educ-ation providers can meet the demands ofboth professions. As described earlier,some progress has been made in wideningaccess to physiotherapy by including morenon-standard entrants, but there is stillsome way to go.

Research and Knowledge DevelopmentAs Palastanga (1990) states, one of themajor advantages gained by physiotherapyfrom the move into universities was thatbeing located within higher educationwould facilitate work on the developmentof a research base for the profession.

In terms of accountability within highereducation, the emphasis of universityresearch is on it having both high qualityand a purpose (Henkel, 1998). Thisrequirement is comfortably fulfilled inphysiotherapy education departments ifthe disadvantages of a theory-practice gapare recognised and research is designedand undertaken with the ongoing devel-opment of clinical practice as a focus, anaim central to the research needs ofphysiotherapy.

Richardson (1993) correctly arguesthat, unlike in the past, research shouldbe driven by practice, rather than byacademic interest, thereby helping tonarrow the theory-practice gap. Greateruse of collaborative research involvingdirect interaction between clinicians andeducators will make it more likely thatresearch will be clinically relevant andalso, via increased ownership, lead toincreased use of the results in informingpractice. In addition, Higgs and Titchen(1998) also argue correctly that researchshould be broad in its thinking and use avariety of methodologies.

Although clinicians have an importantrole to play in developing a specificknowledge base and undertaking soundresearch to maximise the quality ofclinical practice, academics have certainadvantages including the nature of thework they undertake as educators andworking in an institutional context whichencourages research (Helders et al, 1999;Rothstein and Scalzitti, 1999).

These epistemological, ontological andpractice-related research needs challenge

physiotherapy educators, particularlythose who qualified from diploma courseswhich did not include research and, until the move into higher education, did not progress beyond diploma level.However, time has shown that most havebeen able to meet the challenge by comp-leting higher degrees and by teaching on successful undergraduate and post-graduate physiotherapy programmes.

Teaching Quality/Graduate QualityThe requirements for provision of highquality teaching and student learningsupport in higher education and theexpectations which current clinicalpractice has of physiotherapy graduatesare complementary. However, thesedemands pose large challenges forphysiotherapy educators, as those whograduate as physiotherapists need notonly to have had high quality learningexperiences, but also have been socialisedinto the profession (Higgs et al, 1999).Achieving the latter requirement is noteasy for educators based in highereducation outside clinical settings.However, the fact that the vast majority ofphysiotherapy educators are physio-therapists with experience of workingclinically makes this task easier.

Richardson (1993, 1999) and Hunt et al(1998) highlight the need for physio-therapy educators to prepare graduatesadequately as autonomous independentlythinking problem-solvers with generic aswell as discipline-specific skills who canmanage the ever-changing demands ofclinical practice. Hunt et al (1998) alsoidentify the added need to enablegraduates to undertake continuing pro-fessional development and be lifelonglearners.

In order to achieve all these graduaterequirements, Hunt et al (1998) correctlyargue that the physiotherapy curriculumneeds to be integrated, to reflect thereality of the workplace in terms ofcontent and design and to be taught inways which foster high quality studentlearning. In the past, physiotherapycurricula would not have achieved theseaims. However, programmes do nowcontain many of the required designelements.

With regard to teaching quality asrequired by the Dearing Report (NCIHE,1997), most new physiotherapy educatorsattend relevant teacher education

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programmes validated by the Institute ofLearning and Teaching and experiencededucators, many of whom already haveteaching qualifications, have applied for,are in the process of applying for, or areconsidering applying for membership ofthe Institute of Learning and Teaching.

The need identified by Higgs et al(1999) for educators to socialise stud-ents into the profession before theygraduate, while at the same time teachingstudents the skills needed for them towork in multi-disciplinary contexts, is also important.

Although often not working clinically,physiotherapy educators in the UnitedKingdom who are themselves physio-therapists continue to be members of theprofessional body and subject to the samestandards of professional and ethicalconduct as those members in clinicalpractice. This has advantages as itidentifies parameters of behaviour andalso facilitates the socialisation of studentsinto the profession.

In addition, Rothstein and Scalzitti(1999) emphasise the importance ofphysiotherapy educators who no longerwork in clinical practice remaining up to date with both the literature anddevelopments in practice. This is animportant issue, particularly when mostphysiotherapy educators are in full-timeuniversity employment and those who alsocontinue to work clinically have limitedtime available to do so. The implicationsof this pattern of employment have beenrecognised and those who educatestudents on their clinical placements areclinicians. However, educators still need

to remain up to date with practicedevelopments and research findings.

These expectations are demanding butvalid, and their attainment shouldfacilitate provision of high qualitygraduates, while also supporting currentexpectations of higher education.

ConclusionAlthough numerous issues associated withaccountability have been discussed, theyall appropriately centre on maximisingthe quality of service to clients and society.

What society wants, as has been clearlyshown in regard to physiotherapy andhigher education, is that professionsprovide a needed service, but that this must be offered in an open andaccountable way which is positivelyresponsive to internal and external dev-elopments. Such a structure embodies thecharacteristics identified as displaying‘democratic professionalism’ (Whitty,1998).

In addition to showing that phys-iotherapy educators have a central role inboth professions in addressing theseissues, it has also been argued that theyare largely complementary and thateducators can use one set of requirementsto solve the other and vice versa.

Addressing the accountability issues inphysiotherapy and higher education ischallenging for physiotherapy educators,but responding to the expectations of twoprofessions does not mean a doubledworkload and their compatibility enableseducators to make a substantial positivecontribution to fulfilling the account-ability requirements.

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363Scholarly paper

Key Messages

� Bothphysiotherapy andhigher educationneed to beprofessionallyaccountable.

� This hasimplications forphysiotherapyeducators whobelong to bothprofessions.

� Accountabilityrequirements are largelycomplementary and not cumulativein their timedemands.

� Although both sets ofrequirements arechallenging,physiotherapyeducators are in a strong position to meet themsuccessfully andcontribute to bothprofessions.

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