Widening Participation in P h ysi ot h e ra py Ed u ca t i on Part 3: Mature students in undergraduate education

Summary The third paper in this series addresses some of the potential concerns which surround widening participation in undergraduate physiotherapy education, with a particular focus upon the recruitment and retention of mature students within this discipline. It IS not the purpose of this paper to fragment the mature student issues under discussion and address them in isolation, but first to analyse each aspect under question - widening participation, mature students and physiotherapy undergraduate education - before attempting to integrate these into a more complex picture.

ldentifvina Mature Students T h e argument as to whether mature students are under-represented in higher education has not been resolved. In 1992, Allan commented that most institutions were continuing to increase the number of students over 21 years of age and that mature students were not now considered a minority group. The Department of Education, which stated that over 50% of the undergraduate population (including part-time students) were mature, also suppor ted this two years later. More recently however, the volume of mature students applying for higher education places has been decreasing. Warwick (1999) relayed concern from the U n ive rsi ties a n d C o 11 eges Ad ni i ss i o n s Service, the Commit tee of the Vice- chancel lors and Principals of t he Universities of the United Kingdom, and the Depar tment for Educat ion and Employment regarding the 18% drop in mature applicants in 1999. However, this concern conflicts with a more recent evaluation outlining that mature students are now considered ‘well represented’ in the mainstream of higher education (Hoy et al, 2000).

Much of the difficulty of determining under-representation of mature under- graduates is born of an inability to define ‘mature students’. I n English universities, ‘mature’ can characterise any age above

Key Words 285 LVidening partic-ipxtion, p h ysio t 11 e r-a p r ccluca t i( t i .

inclusion, mature stuclen ts, non-traditional elitran tc.

by Victoria Jmt. S p - k e s Carolyn Mason

19 or 26 years, (Bell rt al, 1986). In Scot- land and Wales, ‘mature’ is considered to be 23 years or above.

Mature students are less commonly full- time undergraduates (NCIHE, 1997). Many part-time and Open University s tudents a re included within h igher educat ion mature s tuden t numbers , which creates addi t ional complic- a t i o n s when de te 1-m i n i n g proportion a1 representat ion for mature s tudents u n d e r ta ki n g a t r ad i t i o n a 1 degree . The potentially inf ini te uppe r age limit encompassed within the term ‘maturity’ fu r the r compounds the difficulty in seeking proportional representation for ‘non-school-leaver’ students. With this in mind, and in an already ageing society, the population aged 19 years or above w i 1 1 in ass i v e l y exceed the populat ion of 18-year-olds. Hence the current ly accepted 50:50 ratio of mature to school- leaver students cannot be considered truly representative of the national age spread.

In an a t tempt to def ine under-rep- resentation in mature students, some studies have focused on previous educ- ational achievement as an indicator of a widening participation need at higher educat ion level (Tet t , 1999; NCIHE, 1997). Here, students who were previously poor performers at school (usually the socially deprived) are targeted as being those historically excluded from higher education, and non-traditional pathways towards a degree award are encouraged and developed. O the r indicators that signify under-representation can further co ni pou n d the pro bl e nis of identifying no n- par t i c i pa ti o n of ma tii re s tude n ts . These include disability, ethnicit): sex and sexual orientation. However most of these indicative characteristics a re already approached separately with regard to under-represeiitation.

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Nonetheless, complexities within mature students’ own individuality raise the question as to whether i t is ever possible to identify ‘mature students’. The example of mature students already in possession of an undergraduate degree may help to illustrate the route that widening participation initiatives are taking. In this case, students are con- sidered to have already coped with the traditional higher education system and therefore they become peripheral to the widening access and retention initiatives for mature students. Hence i t appears that widening participation for older people is less concerned with age per SP but is instead governed by an indicator representing a previous lack of exposure to educational opportunities.

Physiotherapy: An academic and vocational degree Marks ( the differences between a liberal and a vocational education. Historically, liberal knowledge was critically considered ‘ornamental’ and for intellectual enhancement. It is characterised by the development of questioning, democratic, non-ideological citizens. Conversely, vocational education has its historical roots in training the masses for employment. It is a technical ideology whereby pupils are exposed to practice via apprenticeship, and skills are learnt which enable participants to perform within industry. Physiotherapy undergraduate education therefore has divided priorities.

To study for a degree in physiotherapy is to achieve the goal of an academic qualification and chartered physio- therapist status, which provides a licence to practise as a physiotherapist. I t is wholly a vocational degree and ultimately employment is the intended outcome. Chartered physiotherapists are highly qualified autonomous practitioners. They are independent clinicians who make educated clinical judgements. Their qualification is transferable internation- ally, and within the UK from the National Health Service to the independent sector of healthcare. Where a degree in phys- iotherapy is positioned within Marks’ (1999) diverging ideals for pursuing higher education is difficult to determine, as qualified professionals are expected to maintain competence in clinical skills while contributing to the expanding body

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of knowledge underlying the profession. The many different stakeholders

involved in the implementation of a degree programme compound much of the complexity of physiotherapy educ- ation. Although the degree is university based, funding is quite separate from traditional higher education courses, in that NHS regional consortia are the channels through which the government distributes funds. Students receive a means-tested grant, and the government pays course fees. Physiotherapy is there- fore a programme which is exposed to all of the quality assurance mechanisms imposed upon higher education ins- titutions, yet is also indirectly managed by the government at NHS level. In addition to this, the Chartered Society of Physio- therapy validates each degree course in order to grant chartered status.

It is therefore apparent that under- graduate physiotherapy education has many governing bodies and is influenced not only by the present higher education climate, but also by the political under- currents affecting the NHS. Used as a political tool, both education and health have been sectors subject to continuous restructuring, and physiotherapy under- graduate education being at the centre of both arenas has experienced the aftershock of many political objectives. Despite this, physiotherapy is an except- ionally well-subscribed degree course, wi t h a p p r o x i in ate 1 y t we n t y a p p 1 i can t s for every university place. The current governmental push towards increasing the numbers of allied health professionals by 6,500 by the year 2004 has preceded competition for funding by universities for further physiotherapy degree places (NHSE, 2000). Physiotherapy is a luc- rative discipline for any university, especially as it is certain that no places will be superfluous.

It has been established that physio- therapy is vastly over-subscribed as a degree course, and universities can therefore command the highest A-level grades when offering a place on a physiotherapy programme. The question must be posed - is there any need to widen participation?

Harvey and Newman (1993) examined equal opportunities in physiotherapy undergraduate education and noted that the profession was still dominated by white middle-class women. Before

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1991 physiotherapy studies were award- ed graduate diploma status from independent hospital-based schools. Little was known about their recruitment policies, and marketing strategies if any were similarly non-standardised. It was not of major concern that there were many un de r-r e p re se n te d groups , in c 1 udi n g mature students, men, ethnic minorities and those with disabilities - and little was done to redress the balance. From the information that has become available since physiotherapy education achieved university status, the integration of these groups has been slow. The Chartered Society of Physiotherapy (CSP, 1995, 1996, 1997, 1998, 1999) collated equal opportunity statistics from all physio- therapy undergraduate programmes and it was found quite surprisingly that in the case of mature students (over-21-year- olds) some universities had recently reduced their intake. Included in these was a western university, which had seen a decline from 52% of mature students in 1996 to 10% in 1999. A midlands university followed a similar route, with the most recent three years seeing a mature student intake of below 10%. Conversely, another midlands university demonstrated a consistently high intake of mature students over the most recent five years to a maximum of 55%.

Colchester Institute (a course specif- ically designed for physiotherapy support workers) is the only institution to have achieved 100% intake of mature students. The ‘old’ universities recruited fewer mature students for physiotherapy undergraduate education than the ‘new’ universities, which is in accord with the national distribution outlined in the Dearing Report (NCIHE, 1997). At a national level, the total percentage of mature student intake in physiotherapy reduced from 37% in 1996 to 30% in 1999, even though the total intake of students had increased by 346 places over five years.

The reasons for historically favouring school-leaver students can only be speculated. Perhaps it was deemed that younger students would have more scope for employment within the NHS, which at the time capped an upper age limit to entry at 30 years old, in line with that of medicine and dentistry (Bell et al, 1986). Possibly other historical practices can be identified as influential. For instance.

physiotherapy was previously considered a less autonomous profession, under- graduate course delivery was considerably dogmatic and students were expected to conform to a ‘professional mould’. It was perhaps a less daunting task to form school-leavers into this mould than it would have been to direct mature students. Although either scenario could be responsible for embedded historical practices, physiotherapy must now be seen to progress within the context of higher education. Currently there is a move away from an autocratic approach to higher education and students are encouraged to illuminate seminars with life experiences, valued opinion and social awareness. It can be argued, therefore, that mature students have a wealth of experiential learning, social acumen and informed judgement to contribute to physiotherapy undergrad- uate education and instead of being the marginalised minority, should become a proportionally represented population within the profession.

Degree Performance Many published studies have identified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

the performance of mature students at degree level, and most have presented the positive outcome of mature students in higher education. Chiswick (1991) gathered perception-based data derived from course tutors, concerning mature students’ performance in higher educ- ation, in comparison to standard entry students. She found that the positive attributes of mature students listed by the tutors included increased confidence, refined people-skills, richer life exper- ience and a higher level of motivation. Sutherland (1999), following an invest- igation into mature students studying for a postgraduate certificate in education, found that they were more adept at using a deep approach to learning. Sutherland also commented that motivation was a crucial factor in educational success and that mature students were largely perceived as a very highly motivated group. Gibbs (1991) similarly reported that mature students approached learning more effectively than their school-leaver counterparts in that they were able to grasp complex learning approaches more readily, though institutions perversely put them under perpetual pressure to adapt to the traditional educational framework.

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’Mature students are discussed as if they have “remedial“ needs in a way that standard entrants have not. Courses in study skills, for example, are often regarded as necessary to bring mature students up to the level of standard entry students. These courses can be very good in making mature students efficient in surface approaches to learning, providing the technical skills necessary to survive and succeed on traditionally structured and assessed courses’ (Gibbs, 1991, page 20).

A surface approach to learning (rote learning) has been linked with the traditional A-level entry into higher education. Bell et al (1986) illustrate this by referring to a study undertaken by Walker in 1975 which investigated mature student performance at Warwick Uni- versity, and this study firmly demonstrated that those students who entered university by non-traditional routes performed better than standard A-level entrants. It must be mentioned, however, that since this study both non-traditional modes of entry and A-level qualifications have undergone extensive redevelopment. Nonetheless Bell et al (1986), through reviewing many studies, suggest that mature undergraduates’ superior performance is not universal. Instead, they consider the level of achievement of mature students in science-based subjects to be secondary to that of school-leavers, and conversely, mature students tend to excel within ar t and social science courses.

However, to generalise the mature student population in order to determine performance indicators is believed to be addressing only par t of the picture. Hartley et al (1998) found that in general the performance of mature students at Keele University was consistent with what Bell had outlined, but make an additional pertinent suggestion. They advise that mature students should be investigated as individuals as opposed to being analysed collectively within a category. They point o u t that there a re major inherent differences between mature student experiences. For example the experience of a 35-year-old mature student who lives at home and has dependant children differs from that of a 21-year-old student living in halls of residence who is more readily integrated into the younger undergraduate community. ‘ Mature

students’ are not all the same. The micro-level perspective of invest-

igating mature students was also recommended by the Further Education Funding Council (1997). In accordance with what Bell et a1 (1986) outlined from higher education retention figures, it also found that mature students in further education have a slightly increased likelihood to drop out of their prog- ramme of study. The reasons given for this largely blamed time pressures, domestic circumstances and additional external demands placed upon mature students. The Council proposed that additional support should be offered to mature students within each institution -- a strategy that had been found to increase retention rates by 7% for this subject group. Additional support was defined as:

‘An activity which provides direct support for learning to individual students which is over and above that normally provided in a standard learning programme which leads to the primary goal of learning‘ (FEFC, 1997, page 12).

How this would impact upon academic staff time and resources would need to be re-evaluated if participation of mature students is to be increased - institutions may need to secure funding in order to develop this strategy to best effect.

A Homogeneous Group? The studies illustrated in the previous section confirm that there are many investigations into the performance of mature students from a meso- and macro- level. However, it has also been shown that there is a lack of research into mature initial entrants into higher education, particularly from an individual perspective or at a micro-level (Hoy et al, 2000). Motivating factors behind mature students’ return to education have been offered as a means of scrutinising a micro- perspective component for this type of participant. Walters (2000) presents a model, ‘The Three Rs’, to identify the reasons behind mature students’ late entry into higher education. This model proposes that the latter is triggered by any of the following:

Redundancy - proactive and reactive responses to life events initiating change.

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Recognition - there is an awareness of

Regeneration -mature students are

a need to develop.

driven by a wish to change their life, which is coupled by a strong sense of identity and self-worth.

Walters (2000) also suggests that future research should now focus on mature students’ experiences as an alternative to monitoring performance levels of mature students as a group. Tett (1999) similarly believes that the process of adults returning to education is an interplay of cultural, social and educational forces, and outlines how their position can shift as they progress within higher education. In her example of working-class adults in higher education, Tett (1999, page 113) found that the subjects initially consid- ered themselves divorced from the other ‘wee swots’ within a higher education institute. Over a period of time, however, their outlook changed and the mature students became more confident about what they were able to offer to their particular degree programme - namely life experience. Higher education inst- itutes would do well to foster this attitude towards mature students. Marks (1999, page 165) elaborates on this point when he suggests that ‘perhaps we should be less concerned with trying to make the mature students more like traditionals than with encouraging the traditionals to be more like the mature students’.

The difficulties in categorising mature students as a group when comparing them to traditional entry students is explored by Wilson (1997) who looked at the social construction of marginality within mature students a t a Scottish university. It was found that mature student characteristics varied greatly; most divergences arising from the nature of their domestic circumstance, motivation and reasons for entry into higher education. Wilson also found that there were conflicts between age and empowerment with respect to the mature students’ relationships with both course lecturers and fellow students. The outcome of the study suggested that maturity can cause marginality; younger mature students considered themselves to be very different from older mature students and more akin to school-leaver undergraduates, whereas older mature students felt marginalised from the

school-leavers and in turn deemed them immature.

The diverging mature student stand- point at a Scottish University was a double-sided issue (Wilson, 1997). On one hand, having a more adult relat- ionship with their course lecturers and having family support during their studies enhanced their experience, but on the other, negative experiences occurred out of pressures arising from commuting, financial difficulties and family resp- onsibilities. Conflicting perceptions between some mature students consid- ering themselves to have special needs, and those who did not, exacerbated this divide. Wilson referred to the wealth of qualitative data obtained from this study, and suggested that mature students should not be considered a homogeneous group.

I t is apparent, therefore, that the diversity that has been uncovered within the ‘mature student’ classification must be acknowledged, and generalisations associated with mature students could potentially lead to misrepresentation of their individual experience.

Mature Students in Physiotherapy There has been very little research ...... , .......................................................................................

into mature student performance in physiotherapy undergraduate education. However, Green and Waterfield (1997) collated all the available nation-wide data of previous academic performance within this group, and compared this to their performance at undergraduate level. They found that A-level entrants gained slightly fewer first-class or upper second class honours degrees than Access or Btec non-traditional entry students. Their study did not investigate the relationship between previous academic performance and clinical effectiveness, but they recommended that such a study should be undertaken. The outcome of their study suggested that ‘ the broader approaches of alternative study such as Btec might prepare students better for physiotherapy than study for three A- levels’ (Green and Waterfield, 1997, page 478).

The authors similarly question the current recruitment practice in physio- therapy of perpetually demanding higher grades at A-level, pointing out that this is a means of reducing numbers to a more manageable level as opposed to recruiting

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students who may make excellent phys- iotherapists. From a performance per- spective, they also found that previous educational experience, for example a first degree, was more beneficial than maturity alone.

In a more recent study, Woodbryne and Yung (1998) investigated the mature student experience of physiotherapy undergraduate education in Southern Ireland. The majority of the mature students were found to be motivated to study by the prospect of future employment. The authors propose that the reduced number of mature students in physiotherapy undergraduate educ- ation is caused by the nature of the course itself.

Woodbryne and Yung (1998) expand by stating that the physiotherapy degree needed to continue as full-time study, and that in doing so, it did not lend itself to mature student undergraduates, particularly those with additional do- mestic responsibilities such as a spouse or children. However, contradictory to this assumption their study showed that the full timetable was not the barrier to socialising with university peers for mature students that it was for traditional entry undergraduates. Instead, family commitments were considered more of a restriction than the workload.

Perhaps this signifies that priorities for mature students are to gain educational and ultimately professional success, and that the heavy workload of physiotherapy education is an expected and achievable means to an end. Their study did re- cognise that mature students showed higher levels of motivation and were more confident within the clinical environment. As with Green and Waterfield’s (1997) study, this signifies a need to investigate mature student physiotherapists’ per- formance within the clinical setting.

The changing nature of healthcare and the attributes of mature students seem to marry well within physiotherapy educ- ation. For instance, i t has already been shown that mature students excel in social science subjects - the holistic nature of physiotherapy incorporates, often inherently, many social aspects of care. To quote the Government (NHSE, 2000, page 13): ‘The allied health professions are uniquely well placed to work across the boundaries of health and social care’, and it can be proposed that mature

students will readily accept this challenge. Similarly, the changing nature of

physiotherapy undergraduate education has been offered as a reason to recruit more mature students. Hunt et a1 (1998) discussed how recent university level study in physiotherapy has created the need to develop intellectual maturity - for undergraduates to develop thinking, communication and problem-solving skills. These are attributes most closely associated with the deep approach to learning which has been shown to be readily adopted by mature students (Sutherland, 1999). The primary sug- gestion arising as a result of this paper is for widening access for mature and non- traditional entry students in order to foster a lifelong learning philosophy. The authors also believe that workplace challenges and professional development will similarly be enhanced by the skill of self-directed independent learning.

Widening Access and Retention Incentives It has already been established that there is most certainly a need to widen access for mature students in physiotherapy. Not only are they nationally under- represented when compared to other degree courses -- approximately a 20% shortfall (NCIHE, 1997), but they are currently largely undervalued. Their performance has at worst equalled that of traditional entrants, and their motivation and perseverence has been shown to exceed that of traditional undergraduates. They bring with them life experience which can help shape both their learning style and their ability to communicate with people, a resource most valuable when treating patients and working as part of a healthcare team.

The National Health Service Executive gave an example of good practice for widening access for occupational therapy, within an individual health authority:

’Their ability t o use the Training Support Programme t o sponsor support workers who wish t o train as occupational therapists is an ideal way of attracting mature entrants who are able t o bring invaluable life experience t o the service’ (NHSE, 2000, page 21).

Physiotherapy is now developing strat- egies to address the issue of access for mature students. In a workshop run by

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the Chartered Society of Physiotherapy (CSP, 2000), widening participation for mature students was discussed. The degree programme at the Colchester Institute was offei-ed as an example of good practice for recruitment of this population. The course at Colchester spans four years and is run for 44 weeks per year for two days pel- week. Students applying are encouraged to study on access cvurses as opposed to gaining A- levels, as the former are considered to place a stronger emphasis and value up011 life experience. The students are a l l mature physiotherapy assistants who are able to approach the theoretical aspects of their studies with relevant experience.

At the workshop, some of the perceived issues of the programme were raised on behalf of the students. These included delegated inappropriate work as a qual- ified member of staff, time management problems and insecurities regarding academic ability. However, the benefits have far outweighed these problems, and a second similar degree programme is currently being developed in the north of England.

Although degree-level study is therefore being adjusted in some institutions to suit mature students: until recently little had been developed to bridge the gap between further and higher education for physiothci-apy undergraduates. Currently however the Colchester Institute has taken its project onc stcp further by developing a foundation programme specifically for entry to physiothcrapy under gr ad ua te e du c a ti on ( Col c h e s t e r Institute, 2000). This is in response to its opinion that standard entry requirements do not currently conform to policy in the Dearing Report (NCIHE, 199’7). In addition, they point out that as A-level requirements are being elevated con- tinuously, alternative routes are not universally accepted as adequate prep- aration for undergraduate physiotherapy study. The course is due to be piloted soon, and the evaluation will be eagerly awaited.

It has been shown that mature students are potentially more effective learners than their school-leaver peers, and it has been suggested that more mature undergraduates should be admitted to the profession. However; another important issue for mature students is the financial implications associated with higher

education study. Thc paradox of funding for this group within physiotherapy education should also bc discusscd. The Higher Education Funding Council is currently distributing funds in a bid to widen participation, and higher education mature undergraduates (in addition to students with disabilities) are presently having their first-year fees paid for by the Government (Warwick, 1999).

However, funding for physiotherapy degrees is more complex. Students already have course rees paid, and are in receipt of a means tested grant , but addilional iriceritives could be eiiiployed to render the physiotherapy degree programme rriore ‘mature student compatible’. Uden (1996) for example believes that the Government should fund childcare and the 16-hour rule (for withdrawal of unemployment benefits) should be abolished. He implores the Government to recognise mature stud- ents’ participation in higher education as a step towards attaining employment, not as a means to avoid it.

Ward (1999) considers the financial burden of higher education for mature students and the marketing strategies to widen participation as hypocrisy - the Government striving to encourage adult learners to participate on one hand, yet taking away the means to participate with the other. Perhaps the funding of vocational courses is no surprise in light of the Government’s drive to educate for employment. Nonetheless, it does place mature students in physiotherapy at a distinct advantage. Although physio- therapy undergraduates are in thc fortunate financial position of receiving Government funding, this in itself is a paradox -- the tradition of a minority of mature student places prevails in spite of the financial assistance available, which itself could be used to encourage recruitment of more mature graduates.

So Tar as initiatives towards mature student recruitment go, physiotherapy still falls far s h o r t of recommended strategies of good practice. Some of these have in c 1 u d e tl spec i Ti c marketing strategies, student support initiatives and staff development programmes (Bennett, 1991). Further recommendations take the form of flexible timetables, welcoming approaches targeted at mature students, accommodation p r ovi si o n for fam i 1 i e s , nurse r y an d c h i 1 d c are opportunities , I

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financial help and mature social and mentoring support systems (Uden, 1996; Ward, 1999; Wilson, 1997). Although Woodbryne and Yung (1998) believed that physiotherapy undergraduate education does not lend itself to flexible or part-time learning, the Colchester Institute’s example has proved this to be a misled assumption. However, in order for mature students to be fully integrated into the undergraduate physiotherapy curriculum, universities nationwide must reverse their approach to accepting mature students and instead begin valuing their contribution to a cohort (MacArthur, 1991).

comed within physiotherapy under- graduate education still remains un- disclosed. There are many attributes which mature students can offer both a physiotherapy programme and ultimately the profession, and it therefore seems unfortunate that widening participation initiatives are not being adequately employed within physiotherapy. However, it must be noted that mature students will not be targeted by admissions programmes, nor accepted for their differences within degree programmes, unless they are considered worthy of such efforts.

Summary - Barriers There are many improvements to be made to both att i tude and course provision when considering widening participation for mature students in undergraduate physiotherapy education. These need to be considered from both a national level via the CSP, and at regional NHS confederation and institutional level.

Tett (1999) summarises institutional factors that militate against success for non-traditional undergraduate students. These include:

H Admissions procedures favouring traditionally qualified young students.

Inflexibility of course delivery which places adults with domestic responsibilities at a disadvantage.

H Financial services for students which discriminate against mature learners.

Staff lack of understanding of mature student circumstances.

Assessment procedures which reflect A-level assessment.

Apart from the advantage of financial support, the above barriers have been shown to exist within the provision of undergraduate physiotherapy at a national level.

How mature students could be wel-

Conclusion It is hoped that as the third paper in this . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

series, this article has addressed some of the barriers to widening participation for mature students in physiotherapy undergraduate education, while s i ni u 1 tan e o u s 1 y expo sing the many attributes that mature students have to offer this discipline. Presently, some widening participation initiatives are being employed within higher education, and these are being adapted for the physiotherapy degree course. However, progress is slow and with the extreme popularity of the physiotherapy degree, there is little incentive for either individual institutions or the CSP to wholly address proportional repres- entation shortfalls.

In summary, Ward states that the only way forward for truly widening part- icipation is to branch away from trad- ition and rhetoric and that ‘in order to move beyond a tokenistic approach to these issues, higher education institutes will need to develop much greater institutional flexibility and innovative curricular approaches’ (Ward, 1999, page 197) . Physiotherapy undergraduate education should take this statement into account and begin by developing a more proactive and less elitist approach to mature students both applying for, and currently undertaking the physiotherapy degree.

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References Allan, C (1992). ‘Widening participation in higher education: A PCFC perspective’, Journal of Access Studies, Spring, 33-41.

Bell, J, Hamilton, S and Roderick, G (1986). Mature Students Entry to Higher Education: A guide to students and advisers, Longman, Essex.

Bennett, S (1991). ‘Marketing higher education to mature students’ in: Locke, M (ed) op cif, pages 8-10.

Chartered Society of Physiotherapy (1995). Analysis of 1995 Student Intake by Sex, Age (over 21) and Ethnic Origin, unpublished, CSP, London.

Chartered Society of Physiotherapy (1996). Analysis of 1996 Student Intake by Sex, Age (over 21) and Ethnic Origzn, unpublished, CSP, London.

Chartered Society of Physiotherapy (1997). Statistics for 1997 Intake ofPhysiotherapy Students -Full time 3 / 4 year courses, unpublished, CSP, London.

Chartered Society of Physiotherapy ( 1998). Equal Opportunities Statistics Report - 1998 Intake, unpublished, CSP, London.

Chartered Society of Physiotherapy (1999). Equal Opportunities Statistics Report - 1999 Intake, unpublished, CSP, London.

Chartered Society of Physiotherapy (2000). Access to Physiotherafl Education Workshop, Jub 17 (summary) unpublished, CSP, London.

Chiswick, L (1991). ‘Access students in higher education’ in Locke, M (ed) op cit.

Colchester Institute (2000). Oiling the Gate Project, Section 4: Tasks and Outcomes, unpublished document, Department of Physiotherapy, Colchester Institute.

Department of Education (1994). ‘Mature students in higher education: Great Britain 1982-1992’, Government Statistical Service Bulletin, September 16, London.

Further Education Funding Council (1997). Widening Participation in Further Education: Statistical evidence, FEFC Publishing, Coven try.

Gibbs, G (1991). ‘Improving student learning’ in: Locke, M (ed) op cit.

Green, A and Waterfield, J (1997). ‘Admission and progression trends in physiotherapy undergraduate education’, Physiotherapy, 83, 9, 472-479.

Hartley, J, Trueman, M and Lapping, C (1998). ‘The performance of mature and younger students at Keele University: An analysis of archival data’, Journal of Access Studies, 12,

Harvey, T and Newman, G (1993). ‘Equal opportunities and entry to physiotherapy education’, Physiotherapy, 79, 6, 406-407.

98-112.

Hoy, J, Kumrai, R and Webb, S (2000). ‘Practitioner research with a difference: Widening participation projects’ in: Jackson, A and Jones, D (eds) Researching ‘Inclusion’: Papers from the 30th annual conferencr of the Standing Conference on University Teaching and Research in the Education of Adults, July 3-5, 2000, Continuing Education Press, Nottingham, pages 153-159.

Hunt, A, Higgs, J, Adamson, B and Harris, L (1998). ‘University education and the physiotherapy professional’, Physiotherapy, 84, 6,264273.

Locke, M (ed) (1991). Mature Students: Exploring good practice in higher education, Polytechnic of East London, Centre for Institutional Studies, Commentary Series.

MacArthur, I(l991). ‘Student services’ in: Locke, M (ed) op cit, pages 11-13.

Marks, A (1999). ‘Really useful knowledge: The new vocationalism in higher education and its consequences for mature students’, British Journal ofEdducationa1 Studies, 47, 2,

National Committee of Inquiry into Higher Education (1997). Higher Education in the Learning Society (The Dean’ng w o r t ) , HMSO.

National Health Service Executive (2000). Meeting the Challenge: A strategy for the allied heaZth professions, NHSE, Bristol.

Sutherland, P (1999). ‘A study of the learning of mature adult students on a professional course’, Journal of Further and Higher Education,

Tett, L (1999). ‘Widening provision in higher education: Some non-traditional participants’experiences’, Research Papery in Education, 14, 1, 107-119.

Uden, R T (1996). ‘Widening participation: Routes to a learning society’ (edited version of his keynote address to the 1996 NAICE Annual Study Conference, University of Warwick), Adults Learning, May, 224227.

Walters, M (2000).‘The mature students’ three Rs’, British Journal of Guidance and Counselling; 28, 2, 267-278.

Ward, K (1999). ‘From marginality to expansion: An overview of recent trends and developments in widening participation in England and Scotland’, Journal of Access and Credit Studies, Summer, 192-203.

Warwick, D (1999). ‘Widening participation in higher education: From Clitism to inclusion’ at: ht tp: / /m~w. universitiesuk. ac. uk/Services/ show. asp?p=l &sp=22

Wilson, F (1997). ‘The construction of paradox? One case of mature students in higher education’, Higher Education Quarterly, 51, 4, 347-366.

Woodbryne, E and Yung, P (1998). ‘Mature students in full-time professional education’, Irish Journal ofEducation, 29, 42-51.

157-169.

23, 3, 381-389.

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Conclusion to the Widening Participation Series The concept of widening participation in higher education in general has dramatically increased over the last few years, enthused by the bounty of funding provided by the Higher Education Funding Council for England. For physiotherapy however the greatest motivation to improve access has been derived from the moral requirement to achieve diversity in the workforce and the threat of targets imposed by governmental policy and law. Until now physiotherapy has been entrenched in its white middle-class culture and its own physiotherapy stereo types have emerged which have allowed preferences and patterns to be developed in the access and retention of both ethnic minority and mature students which have proved very difficult to eradicate. These patterns have been manifested in actions by staff, which could be perceived as discriminatory, and by minority students through pragmatic choice. The consequence is that the physiotherapy workforce today is not

representative of the diverse nation from which it was spawned, or of the patients that it treats.

Those involved in physiotherapy educ- ation need to respond to the challenges of widening participation. The lack of published material on physiotherapy educational issues suggests that more physiotherapy lecturers have an interest in clinical matters rather than educational ones. To this end the danger is that assumptions will be made and policies will be developed which are a t risk of deepening inequalities in access and retention of physiotherapy underg- raduates rather than improving them. Unless educators are encouraged to engage proactively in educational research, and begin to analyse their practices in a reflexive manner, physio- therapy education will remain an intro- verted and insular discipline which has failed to embrace the socio-political challenges faced by providers of health care in the twenty-first century.

Key Messages

H The physiotherapy workforce remains entrenched in its ‘white middle-class female’ culture.

H Physiotherapy has a moral and legal requirement to achieve diversity within the workforce.

H Widening participation is a strategy offered by the Government to address inequality in further and higher education.

H Physiotherapy education needs to respond to the challenges of widening participation and be aware of the risk of deepening inequalities rather than improving them.

H Providers of physiotherapy education must proactively engage in research which embraces the socio-political challenges of the 21st century.

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Physiotherapy May 2002/vol HH/no 5