Once upon a time, physiotherapy students did most of their training at state-based colleges of health sciences like the Lincoln Institute of Health Sciences in Melbourne (which merged with La Trobe University in 1987) and Cumberland College of Health Sciences in Sydney (which became part of the University of Sydney in 1989).

Now students can study physiotherapy at 29 universities around Australia, in bachelor, master and most recently doctor of physiotherapy programs.

While the heart of these programs remains the same—teaching students the skills required to practise as a physiotherapist and enabling them to pass the competency requirements set out by the Australian Physiotherapy Council (APC) so they can register to practise—different universities take different approaches.

One thing is clear; the way students are taught is changing rapidly, shifting away from traditional lectures and tutorials to more independent modes of learning and problem-solving.

The COVID-19 pandemic lockdowns accelerated the process significantly.

‘COVID changed the way we approach curriculum.

‘It forced us to interrogate placement-based learning and to look for creative ways to ensure that our students get the experience and exposure they need.

Dr Julie Walters, current chair of CPDANZ and program director of UniSA's physiotherapy program, says the COVID pandemic changed the education landscape..

‘We are much more comfortable with simulation, for example, than we would have been historically,’ says Dr Julie Walters, program director at the University of South Australia and current chair of the Council of Physiotherapy Deans Australia and New Zealand.

Associate Professor Verity Pacey (left), associate dean of curriculum and learning (graduate health education) at Macquarie University, agrees.

‘There’s a lot more online learning and independence for students.

‘We still have face-to-face sessions, tutorials and workshops, but it’s a matter of curating the right information for students and assisting them to learn how to find the information they need.

‘It’s much less didactic,’ says Verity.

It’s not just the lectures that have changed—the challenges of AI force universities to be more creative with assessments to ensure that students really understand the concepts being taught.

Curtin University’s Dr Robyn Fary (left) says universities have moved away from traditional written assignments in order to assess both knowledge and understanding.

Professor Robyn Fary, from Curtin University, says AI has changed the way students are assessed.

‘When students do case-based assessments, they can’t just plug it into an AI service and say, “Write me an essay about this”,’ Robyn says.

Another factor is increased recognition of different learning styles and capabilities, leading to more individualised approaches for students—something that may be more achievable in smaller programs.

‘In the past we were dependent on students fitting into a system.

‘We taught one way and the students had to engage.

‘We’re moving towards more personalised education in the same way as we are moving towards personalised medicine,’ says Professor Louisa Remedios (right), who was part of the team that set up the University of Melbourne’s Doctor of Physiotherapy program and more recently is the head of discipline for the physiotherapy programs at Federation University.

Degree formats to suit every student

Regardless of whether a student completes an undergraduate or postgraduate physiotherapy program, they graduate as an entry-level physiotherapist.

For some students, the undergraduate pathway is the preferred option due to the high cost of fees, while for other students, postgraduate entry allows them to change their career focus.

It also gives students who may not have had the grades in high school an alternative pathway to entry.

Professor Louisa Remedios, from Federation University, says that the availability of different degrees meets the needs of potential students.

‘It meets market needs.

‘But it is confusing to patients and no doubt other professions,’ says Louisa.

In recent years, several Australian universities have started offering a doctor of physiotherapy.

Unlike a research doctorate, a doctor of physiotherapy program is an extended master’s, going for three years instead of the usual two.

In the USA, physiotherapy education has moved entirely to the doctor of physiotherapy program and since 2016 the degree has been a requirement of licensure to practise.

On the other hand, many countries, including the UK, only require physiotherapists to complete a three-year undergraduate degree and in some, like Canada, it is only offered as a postgraduate master’s degree.

But is there a benefit to doing the doctor of physiotherapy in Australia?

Graduates of these programs have to meet exactly the same clinical competencies (set by the APC) as graduates of bachelor and master’s programs in order to register as a physiotherapist.

APA Educators National Group chair Emily Riglar says from an employer's point of view, the type of degree doesn't matter.

‘An entry-level physio is an entry-level physio.

‘From an employer’s point of view, it probably doesn’t make a difference at all,’ says Emily Riglar (left), a physiotherapist and practice owner based in Melbourne and the current chair of the APA’s Educators national group.

Perhaps more importantly, postgraduate degrees—both master’s and doctor of physiotherapy—have somewhat different requirements from undergraduate degrees for accreditation by the APC and the Tertiary Education Quality and Standards Agency, in recognition of the fact that postgraduate students have already completed an undergraduate degree.

‘They’ve come as an adult learner or a more mature learner.

‘They have learnt higher-level thinking skills and have higher-level research skills,’ says Robyn, a professor of physiotherapy at Curtin University, which replaced its master of physiotherapy program with the doctor of physiotherapy a few years ago (it also has an undergraduate physiotherapy degree).

One benefit of holding a doctor of physiotherapy qualification is that it’s easier to work in the USA.

Some doctor of physiotherapy programs, such as Macquarie University’s, make sure that students also meet the competency requirements for the USA and Canada, allowing them to market the program to international students from those countries.

The biggest disadvantage is the cost of doing a postgraduate physiotherapy degree, not only in the fees accrued as a student but in the pay they can expect to receive after graduating.

‘For the amount of time that these high-achieving people put into their education, they’re not recompensed in the same way as after other degrees of a similar length, such as a master of engineering or a medical degree.

‘You have to really want to do physiotherapy to do a postgraduate degree,’ says Robyn.
 

How have physiotherapy programs changed?

Compared to the programs of the 1970s and 1980s, physiotherapy education is now more evidence-based and patient-focused.

On the flip side, educators have a lot more to fit into the curriculum.

‘There’s a much stronger focus on building critical thinking and problem-solving capabilities,’ says Verity.

Physiotherapy education is very different now, says Associate Professor Verity Pacey, from Macquarie University.

It’s vastly different from the physiotherapy program that Verity completed in 1999.

Over the 10 years she has been teaching, the program has changed substantially, she says, from scheduling class time into blocks so that students can more easily work part-time to the content in the course.

These days, universities don’t just teach the basic, hands-on skills needed to practise physiotherapy.

They also teach students about the healthcare environment, ethics, legal issues, advocacy, interprofessional and multidisciplinary care, mental health—both their own and their patients’, trauma-informed care and emerging technologies such as AI and remote monitoring that can help them in their practice.

They prepare students to work in a multicultural environment, provide training on cultural responsibility and culturally safe practice for working with Aboriginal and Torres Strait Islander peoples and teach about gender, inclusion and diversity issues.

‘We’re always considering what’s new—what do we need to be teaching students about?

‘For example, women’s health has shifted to be more about gender health, encompassing male pelvic health problems and transgender people’s health as well,’ says Verity.

‘Digital competence absolutely has to be there, whether that’s AI or how to build a website or create an infographic.

‘We’re bringing more concepts about trauma-informed care into our curriculum, pushing harder on authentic assessments and staying up to date with the evidence.’

At Charles Darwin University, Professor Heather Malcolm (right) is setting up the curriculum for one of the newest physiotherapy programs in Australia—a four-year combined bachelor/master’s program.

Rather than focusing on each specialty separately—eg, musculoskeletal, cardiorespiratory or neurological—they are taking a more integrated approach, looking at physiotherapy sector by sector.

At Charles Darwin University in the Northern Territory, Professor Heather Malcolm is taking an integrated approach to the curriculum.

‘We are introducing our students to physiotherapy in the acute setting, in rehabilitation, in the community, across the life span, for special populations and in models of care such as the National Disability Insurance Scheme and then to advanced physiotherapy.

‘The first three units are case-based learning and students will have to investigate probably about a third of those case studies themselves.

‘Then the next unit, the first unit in fourth year, is using problem-based learning—we give them something and they have to go away and work on it for a few weeks.

‘They’ll have touchpoints but it’s really up to them.

‘We are looking for them to drive their own learning,’ Heather says.

Heather says this is especially important in the context of working with rural and remote communities because physiotherapists need to be able to think on their feet when they can’t consult with colleagues.

‘It’s a good approach for our students because a lot of practitioners might have to work on their own.

‘General principles are what we’re trying to embed in our students, to inform their practice with an evidence base, lifelong learning and intuitive clinical decision-making,’ she says.

Work readiness and placements are two big issues that all universities are working through.

With around 70 per cent of students expected to work in private practice straight out of university and a high attrition rate in the early years, many educators are grappling with how best to prepare students for the workplace.

‘What we have seen over the history of physiotherapy is a gradual shift from new graduates first seeking employment in the public system and working in large teams with a clear hierarchy to them moving straight into small private businesses that don’t have the same infrastructure and bureaucracy there to support them.

‘Is it our job to close that gap? We certainly try to,’ says Julie.

Educator and researcher Vidya Lawton (left), a senior lecturer and the clinical education manager at Macquarie University, has just completed a PhD looking at the work readiness of graduating students.

She says there is a difference between meeting the competencies required for registration and being ‘work ready’.

Vidya Lawton, an educator and researcher at Macquarie University, says universities have the responsibility of producing 'work-ready' students.

‘As educators, we tend to focus a lot on profession-specific knowledge, skills and communication and less on the personal attributes required for work—resilience, self-care, being work-fit.

‘When we talk to graduates, that seems to be a big problem.

‘They feel the burden of taking on a case load,’ Vidya says.

Vidya notes that while universities have been given the responsibility of producing work-ready graduates, all stakeholders should be involved in determining what work readiness is.

‘If burnout and low resilience are some of the reasons why we’re losing parts of our profession very early, then all stakeholders including universities need to think about the development of these personal attributes.

‘We tend to assume that students will build those skills along the way—but we’ve got to give them the building blocks.’

As for placements, every physiotherapy program in Australia is looking at the best way to give students the broad range of experience they need, in the various settings where they may end up working after graduating—not just in hospitals and community services but within the private practice environment and in regional, rural and remote Australia.

The discussion includes the cost of placements to the university, the placement provider and the student as well as the availability of placements across the scope of physiotherapy.

‘It’s working in terms of our capacity to continue to graduate registration-ready physiotherapists—the quality of physiotherapy services in Australia has not diminished,’ says Julie, noting that in addition to cost, a big sticking point is finding ways for students to get private practice placement experience.

‘Private practices also need to be better supported to provide student placements.

‘Current legislation and health insurance rules preventing practices from charging patients for student-delivered sessions is a real problem in terms of placement capacity and work readiness.’

The role of the Australian Physiotherapy Council

The Australian Physiotherapy Council (the Council) is at the coalface of the evolution of physiotherapy education in Australia.

Reporting to Ahpra, it is responsible for the accreditation of entry-level physiotherapy programs nationwide, ensuring that they meet the standards required of the profession.

‘The accreditation process is very involved,’ says Dr Roma Forbes (right), a board director at the APC and the incoming national chair of the Accreditation Committee.

‘When a university decides to start a physiotherapy program, the accreditation process happens right from the first step, which is the university making a submission to the Council to advise their intentions.

‘Once a program is initially accredited, it will go through an update of this accreditation every two to seven years.’

While the accreditation process is complex, it is also collaborative.

Roma Forbes is the incoming chair of the Australian Physiotherapy Council's Accreditation Committee.

‘When people think of accreditation, they often think of auditing, but it’s much more of a partnership,’ says Roma.

‘We look at the overall outcomes that graduates come away with, not just what the program teaches.

‘So we’re interested in a whole range of perspectives, from academic staff, the university, employers, clinical educators, people in the community and of course the students themselves.’

The past decade has seen many changes to physiotherapy education, reflecting developments in the profession as well as contemporary shifts in higher education more broadly.

‘A key change across healthcare professional programs, including physiotherapy, is the growing involvement of the community, consumers, stakeholders and employers in what the curriculum looks like,’ says Roma.

‘Over a decade ago, we might have seen academic experts dominating curriculum design, whereas now, there’s much more collaboration on what the curriculum looks like.

‘From an accreditation perspective, there is an increasing expectation for programs to have this kind of external input into their curriculum.

‘Technological advancement is also having a big impact.

‘Digital learning tools have come a long way and although prior to the COVID pandemic we may not have considered online learning, it’s now allowing programs to diversify how students engage with content, especially in terms of more flexible approaches to learning.

‘Another key development has been the growing focus on cultural competence and safety in physiotherapy curriculum, along with a shift towards interprofessional education.

‘This recognises not only the need to better serve diverse populations as clinicians, but also the fact that as health professionals, we have a leadership role in this space.

‘Physiotherapists need to work closely with other professionals so that they’re not only experts in their field, but also effective team players who can understand the broader context of healthcare.’

Placements are one area where more may need to be done.

‘Clinical placements are a fundamental part of physiotherapy education,’ says Roma.

‘High-quality clinical placements with the capacity to support our growing number of students is something our profession needs to prioritise at every level.

‘We’re likely to continue to see a shift in where students are hosted.

‘The move away from a traditional reliance on the public sector, particularly large tertiary hospitals, and towards more participation from the private sector is a positive one because placement providers play an essential role in shaping our workforce.

‘Research has found that resource constraints are one of the biggest tangible barriers to hosting students, particularly space and time constraints.

‘The Council encourages innovation in clinical placements and flexibility is key.

‘We know from many placement providers that there are strategies that help, such as part-time placements, students completing relevant, high-quality projects or providers hosting students at different sites.

‘We are even seeing physiotherapists and their students go into new, emerging areas of clinical practice. It’s an exciting time.’

>> Click here for more information about the Council’s work in accreditation and physiotherapy education.

Guy Zito: Diploma of Physiotherapy, 1972

When Dr Guy Zito MACP completed his three-year diploma course at the Melbourne School of Physiotherapy in the early 1970s, physiotherapists were still very much under the control of the medical profession.

Guy Zito completed his initial physiotherapy training in the 1970s.

At that time, it was unethical for physiotherapists to treat patients without a referral from a doctor.

The referral would commonly be in the form of a non-specific diagnosis (eg, low back pain) and would contain instructions on the sort of treatment that could be administered, such as short-wave diathermy and extension exercises.

Guy says that the diploma, awarded under the auspices of the Masseurs Registration Board of Victoria, provided an ‘adequate knowledge base for the time’.

Physiotherapists were educated in anatomy, physiology and pathology as well as core competencies in neurology, cardiorespiratory and orthopaedics.

Much of the orthopaedic training centred on working with peripheral joints and muscles, reflecting a significant proportion of the patient load then.

Students also spent a lot of time learning about massage and electrotherapy.

‘With regards to spinal manual therapy, we were discouraged from doing anything like that,’ Guy says.

‘We were given quite a good education for those days— commensurate with our responsibilities.

‘What we were taught then was good but the rationale and the evidence behind it were often lacking.

‘We were taught things that had been passed down over the decades—things that seemed to work—but there was no evidence for them,’ he says.

While the diploma course covered various practical skills that Guy could use in the workforce, he developed a particular affinity for orthopaedics during his studies.

The ability to prescribe exercises to patients, coupled with the fact that doctors were not particularly involved in this aspect of medical care, meant Guy could treat his patients with little to no interference.

‘On the whole, doctors left it up to the physiotherapists to decide on the exercise side of things,’ he adds.

During his university breaks, Guy worked as a tram conductor in Melbourne, earning more per week than he would go on to earn in his early career as a physiotherapist.

After graduation, Guy was earning $55 a week as a physiotherapist, whereas a tram conductor was paid $60 a week including shift allowances.

In the 52 years that followed, Guy worked in both clinical practice and education.

He opened his own private practice, Carlton Physiotherapy Centre, in 1976 and studied a Graduate Diploma in Advanced Manipulative Therapy under the tutelage of Geoffrey Maitland in Adelaide.

When he returned to Melbourne in 1981, he was approached by Pat Cosh, then Head of School of Physiotherapy at the Lincoln Institute, to coordinate and lecture in the fledgling manipulative therapy course, which he did for many years.

Guy also completed a Doctor of Clinical Physiotherapy degree at the University of Melbourne, along with other postgraduate research and coursework qualifications.

He holds an honorary appointment within the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne as a senior fellow.

In 1999 Guy became a Titled APA Sports and Exercise Physiotherapist and a Titled APA Musculoskeletal Physiotherapist.

He has also been involved in mentoring and examining physiotherapists undertaking the specialisation examinations through the Australian College of Physiotherapists.

In 2015 he was awarded the Australian Physiotherapy Association (Victoria) Achievement Award for his contribution to the advancement of the physiotherapy profession.

Reflecting on his early education, Guy says he still employs techniques he was taught in the 1970s but notes that there have been significant changes in physiotherapy education and clinical practice since that time.

Guy says, ‘Physiotherapists attained first contact practitioner status in the late 70s and the profession continued to grow.

‘That has meant that the teaching had to change completely.

‘Education of graduates moved into the university system and an evidence-based practice philosophy and a biopsychosocial model approach to patient management were adopted.

‘Bringing these into physiotherapy education and clinical practice has been fantastic.

‘I celebrated 50 years as a physio two years ago and it is this best practice approach that keeps me going because I treat the person with the problem.

‘I don’t treat the problem.’
 

Rachel Penninsi: Bachelor of Physiotherapy, 2013

After completing her Bachelor of Physiotherapy at James Cook University in Townsville, Queensland, Rachel Pennisi felt ready to become the rural practitioner she had always hoped to be.

Rachel Pennisi graduated with a Bachelor of Physiotherapy in 2013.

With a mission to facilitate more rural and regional placements, James Cook University has its students undertake six placements of five weeks each during their four-year degree, offering the real-life experience of working in small towns.

The university’s mission was one of the reasons Rachel chose it for her tertiary education.

As an undergraduate, Rachel was part of a relatively small cohort of 60–70 students, which she says enabled better access to educators as well as facilitating deeper peer-to-peer networking.

While the curriculum was heavily physiotherapy-focused, students were also offered subjects in tropical, rural and remote, and Aboriginal and Torres Strait Islander health.

This solidified Rachel’s desire to pursue a career in rural health.

After graduating in 2013, she went on to complete a Graduate Diploma of Rural Generalist Practice in 2021.

For her graduate placement, Rachel moved to Gayndah, two hours west of Bundaberg, and often travelled to outreach centres in rural towns such as Childers, Gin Gin and Monto, driving vast distances.

She also attended the tertiary hospital in Bundaberg, the main referral hospital in the region, on a monthly basis for upskilling and networking.

‘How James Cook University does it is two and a half years of pure theory, with a few little dabbles of prac along the way, before we undertake a block of clinical experience,’ Rachel says.

‘I think that was very helpful— to do the theory first and then the hands-on stuff later.

‘Having already done a majority of the theoretical work allowed for a deeper understanding on placement.’

Rachel says there was a lot of learning in the four years of her degree, including two semesters on anatomy, which was essential to master.

Anatomy and physiology formed the building blocks to help students understand assessment and treatment of a wide range of conditions.

‘Obviously, if you don’t know anatomy, you are probably lacking further down the line.

‘Whether that was something that could have been done over a longer period of time, I don’t know.

‘I feel it was very rushed and if you don’t have that grounding then it’s really hard to build other concepts on top of it,’ she reflects.

After graduating, Rachel started at Townsville University Hospital, doing on-call work, treating patients in the intensive care unit and working in rehabilitation.

In 2019 she moved back to her home town of Ingham, 1.5 hours north of Townsville, where she works at Ingham Hospital.

Currently on maternity leave, Rachel plans to return on a part-time basis to her role as senior physiotherapist, which includes mentoring new graduate physiotherapists.

She has noticed some changes in the knowledge and skills of this generation compared to her cohort of 11 years ago, most notably in their adoption of technology such as telehealth.

‘Being able to deliver physio without touching has been a huge change,’ Rachel says.

‘When I first started my degree, I wouldn’t have thought you could even complete a rehab program over a computer screen.

‘COVID-19 certainly pushed telehealth along.

‘When you consider paediatrics, for example, it’s enormously beneficial for a child to be able to access therapy in their own home rather than going into a sterile clinic.

‘And I think the ability to find information has certainly changed since I was at uni.’

Rachel says another significant shift she has noticed in early career physiotherapists is the advent of student- led learning culture.

She says a deeper understanding of learning styles has filtered through the curriculum, creating a safe space for students to engage in learning in a way that suits them.

Recognition of mental health and its impact on students has also become more of a focus than when Rachel was an undergraduate.

‘That might just be the physiotherapy profession and the universities having a better understanding of mental health—that sometimes you have a good day and sometimes it’s a bad day.

‘I don’t know if it’s even got to do with the actual curriculum of teaching physio.

‘We may have simply reached a point where it’s accepted that students are individuals,’ Rachel says.

Sangram Chauhan: Doctor of Physiotherapy, 2023

Sangram Chauhan APAM was in the second year of a Bachelor of Science degree at the University of Melbourne when he began delving into anatomy and human physiology.

Sangram Chauhan is a recent graduate of a Doctor of Physiotherapy program.

Noting his enthusiasm for the subjects, Sangram’s friends suggested he consider studying physiotherapy—and Sangram hasn’t looked back.

As a 17-year-old VCE student, Sangram wasn’t sure what career he eventually wanted to pursue (‘You’re really just focused on surviving Year 12’) so he began looking for a generalised degree at a university that could offer flexible options.

Having investigated La Trobe and Monash Universities, Sangram sought the advice of his sister, who had been a student at the University of Melbourne.

‘Melbourne University worked out the best because my sister had been there and she’d given quite golden reviews of it so I thought I’d have a go at the Melbourne program,’ Sangram says.

‘I started a Bachelor of Science, majoring in anatomy and human physiology, and it worked out that Melbourne Uni had a nice Doctor of Physiotherapy program.

‘It’s an extended master’s but it does sound nice—Doctor of Physiotherapy—as your title.’

Sangram started at the University of Melbourne in 2017.

Like many of his peers, he was passionate about playing sport (‘It’s cricket and footy for me’) and had been on the receiving end of physiotherapy care for his sporting injuries.

Having a solid understanding of anatomy and human physiology allowed Sangram to combine his intellectual and sporting passions.

‘Physiotherapy fitted nicely with some of the subjects I was studying, the more scientific ones like anatomy and physiology.

‘A strong foundation in those things helps you to move into physiotherapy.

‘It was a career that brought all that together and something I thought I would really enjoy,’ Sangram says.

Having made the switch to the three-year Doctor of Physiotherapy course and planning a gap year to travel, Sangram found himself grounded by the COVID-19 pandemic, his travel plans dashed.

He took up casual work at a supermarket, which he says helped to keep him occupied during the lockdowns and travel restrictions in Melbourne at that time.

His coursework continued online until he was back at university three to four days a week, offering him the flexibility to work casual jobs while living at home.

Sangram went on to graduate in 2023 and especially enjoyed learning about musculoskeletal physiotherapy, sports physiotherapy and the importance of manual therapy.

He also relished his placements, of which there were eight in total, each lasting from three to five weeks.

Seven of the placements were in either hospital or community settings and one was in a private practice, where Sangram had firmly set his sights post-graduation.

He now works at Premium Physiotherapy in Macleod, in Melbourne’s north-east, as a new graduate physiotherapist.

Reflecting on his education, Sangram says the curriculum was packed and was a lot to take in over a short duration.

While he felt well prepared by the instructional aspects of the degree, Sangram believes he would have benefited from more preparation and instruction about working in private practice rather than in public and community health settings.

‘I think it was hard to do in the time we were studying.

‘One of the difficult aspects of studying physio is that there’s a lot you need to learn in a short period.

‘We spent a lot of time in front of computers—you know, seven- or eight-hour days, lots of Zoom meetings—and that was more the contextual stuff,’ Sangram says.

‘University gives you a baseline understanding of what you need to know but, as many other students say, it’s when you’re actually working that you learn the most,’ Sangram says.

‘I would have liked to have seen more private practice-oriented subjects.

‘I don’t know if it’s the same at other universities but definitely Melbourne Uni is very geared towards working in the hospital setting.

‘With private practice, though, you get microdoses of it and then you go into it and have to sink or swim.’