Magazine international assignment THIM 2022-2023

THIM

Physiotherapy students’ thoughts and opinions

Self management

Internationalisation

Life long learning

A cooperation between THIM University of Applied Sciences in Physiotherapy in the Netherlands and Switzerland.

In order to be able to provide tailor-made health care to people from all over the world, professionals should be able to identify with people from different ethnic, national, cultural, social and/or religious backgrounds in a foreign language. Awareness of their own cultural values and behavior is part of this as well. In this light, and to emphasize the international component of THIM University for physiotherapy, additional study assignments with an international focus have been added to the study program.

This magazine is an elaboration of the international assignment in the first academic year of THIM University. Within this task, first year physiotherapy students were teamed up with an international peer student to explore each other’s thoughts and opinions towards a hot topic in physiotherapy. Each student engaged through Zoom in a meeting with his/her (matched) international peer in which the interviews took place. There were three groups of students that attended:

•Fulltime students of THIM in Switzerland (THIM-CH)

•Dutch Fulltime Students of THIM in the Netherlands (THIM-NL)

•International students of THIM in the Netherlands (THIM-NL)

THIM lecturers and approximately 90 students have worked on this assignment in an active, committed and cooperative way. After a successful first edition of the international assignment and resulting magazine (2020-2021), the current magazine represents the results of the second edition of the international assignment (2021-2022). A great cooperation between Thim van der Laan BV in the Netherlands and Thim van der Laan AG in Switzerland which has resulted again in a beautiful product that is both professionally and socially an achievement.

We would like to thank all the students and teachers for their contribution and proudly present the international magazine 2022-2023.

2. Introduction

3. Contributors

4. Director of THIM

6. Topic Internationalisation

10. Topic E-health

13. Students THIM-CH

14: Topic Life long learning

17: International students THIM- NL

18: Topic Self Management

21: Dutch students THIM-NL

22: Topic Innovator

24: Topic Cultural Background

27: Exchange projects

Contributors

Melanie Agner

Laëtitia Blanchet

Elenia Coco

Andrea Conrad

Viktoria Dorfmann

Nico Dudler

Flavia Engel

Henrik Falk

Sarina Föllmi

Yannick Frehner

Andrina Fuchs

Marco Gander

Lea Gehrig

Janine Sabrina Geisser

Carl Geldmacher

Fabio Giudici

Noémie Gostanian

Melanie Sara Hählen

Timo Hartmann

Rafaela Heeb

Regina Helbling

Carla Hoffmann

Sanne Julie Hummel

Jana Hurschler

Laurin Imfeld

Anik Noe Kinzl

Rahel Koller

Malin König

Vanessa Lindner

Giuseppe Laganà

Mauro Mensing

Kieran Panachel

Tom Penkwitt

Isabelle Pleier

Melanie Schär

Elina Schiessler

Danaé Pascale Signer

Lukas Sommerauer

Jana Städler

Svenja Strub

Sarah Elena Strübin

Nicola Tescari

Simon Vallat

Till Weber

Hannah Zander

Sara Ali

Yous Awad

Nurettin Aydin

Jens Dingemanse

Bas van Gerwen

Mike Hansen

Luuk Hoogma

Tobias Jense

Franka Knoop

Joris Kroon

Onno Kui

Alexander Lens

Dylan van Maanen

Niels van Melzen

Wouter Nieuwenhuize

Joost-Jan Nitrauw

Tessa van Piggelen

Jacqueline Rijksen

Steven Ruijs

Thomas Sap

Lola Schipper

Anique Tavenier

Bjarne van de Velde

Danique Verburg

Martijn van Wely

Chiara Wolkorte

Danielle van Wolferen

Bram van der Worp

Duarte Wouters

Raoul Ypinga

Sem Zondag

Giulia Castelnuovo

Ephraim Duke

Joanna Erbslöh

Paul Gakopoulos

Katrine Hansen

Jean-Pierre Helmeyer

Luminita Madalina Ichim

Christabel Igwe-Oragbaksoi

Hana Jezberova

Ciara Kolhoff

Bailey Kuntz

Anna-Celina Marterer

Davina Nkasa

Eivind Øestvang

Juliette Pagni

Amir Razaz Razaghi

Nazman Rony

Sylwia Wnuk

Ayoob Vaghefi

Giulia Del Zotto

Thim van der Laan jr.

Founded in Holland in 1974 in Utrecht, THIM has also been active in Landquart, Switzerland for more than 30 years. I am pleased to have been able to lead THIM in Landquart for over ten years now whereas I guide THIM in Nieuwegein for about one year now. In total we educate about 1’000 students in the Netherlands, in Germany and in Switzerland. An international oriented staff of about 80 people with a wide variety of competences is the backbone of THIM.

At THIM University, we strongly believe in the benefits of international experience for both our students and our staff. We aim to give our students and staff as many opportunities as possible to develop international competences and skills, in order to optimize not only their international career opportunities as a physiotherapist, but also their personal growth. To this end, we organize an English-taught international Bachelor’s program in Physiotherapy, international minor programs and internship opportunities, and internationally orientated course components in both the Dutch- and Englishspoken curriculum. We participate in ENPHE, the European cooperation between educators in Physiotherapy and other national and international oriented organizations.

Personally, I strongly believe in the profession of physiotherapy in a modern setting with future-oriented ways of thinking. Accordingly, at THIM we try to incorporate the (physiotherapy) trends of the future, such as technology, interprofessionality and internationalisation, into the bachelor study program. For me, the international assignment in the first year of study is an excellent example of a successful international exchange. It is exemplary for the values of THIM and I am very happy that my students can get to know each other across borders and learn from each other as part of this exchange.

When I'm not fully dedicated to educating the future physiotherapists, one can surely find me on the football pitch of the rather alpine FC Davos of which I am currently the president. However, when I am working in the Netherlands, I like to spend my evening at our partner „De Loods“ at the Archimedesbaan. Even better then playing football or doing indoor training is hitting the ski slopes in my home town of Davos. For a nice sunny day on the slopes followed by après-ski, you can always contact me :-).

What aspects of internationalisation within your study do you think can contribute to you becoming a better physiotherapist?

Internationalisation

The recent emphasis on globalization in healthcare education includes the importance of internationalisation as an approach for providing students with international and intercultural competence. Despite the well-cited benefits and increased internationalisation opportunities within physiotherapy education, it seems that student participation in these experiences remains quite low.

THIM University also strongly believes in the benefits of international experience for students. The aim is to give students opportunities to develop international competences and skills, in order to optimize not only their international career opportunities as a physiotherapist, but also their personal growth.

By offering international/intercultural experiences either abroad or digitally at home, THIM hands students opportunities to gain invaluable knowledge, skills, and attitudes that are essential to not only be(come) a more complete professional, but also a more active member of the international society. In today’s and tomorrow’s pan-European society, looking across borders, and thus learning new viewpoints and different approaches, gaining understanding of different cultures and making new friends and connections, is invaluable for personal and professional growth. Student mobility will enable participants to become aware of their own international and intercultural competencies that are essential in their (future) professional field and will essentially make graduates more social, integrated, and employable within Europe.

THIM strives to make internationalisation a fundamental part of the program for all of its students, be it through studying or courses abroad, short term blended mobility opportunities, or digital exchange from the home country.

Although the vision of THIM University is clearly described, THIM would like to know whether students support this vision on internationalisation. To answer this question, seven students of THIM-NL (from which three students were from an international class) and eight students from THIM-CH were interviewed by peers on this topic.

If you had the possibility to study abroad, would you take that opportunity? Why and why not?

Out of eight Swiss students, five students say that they would absolutely take this opportunity. On the other hand, one Swiss student who traveled the world before due to her job as a flight attendant, enjoys staying home now and would not consider this. Another Swiss student would consider studying abroad for a maximum duration of 2 weeks, and for another Swiss student it would depend on the timing and the country of destination. Out of four Swiss students that include preferable countries of destination, three students mention the Netherlands because there is a THIM school there, and the Netherlands being ‘well known for their high level of physiotherapy education’.

Out of four Dutch students, three would take that opportunity, of which one student indicates a maximal length of stay of 1 year. The fourth student states that it would depend on the country of destination. He would be very keen to go to America to ‘combine studying with exploring that big country’.

The three international students already grabbed the possibility to study abroad in the Netherlands. One Nigerian student explains: ‘because the educational system in the Netherlands and the level of physiotherapy is better than in Nigeria’. Although the other two students moved from their home country to the Netherlands too to study at THIM, they would also consider the possibility to study in another country than the Netherlands.

Even when keen on studying abroad for a while, they would also miss things;

- ‘I would miss my friends here, the Dutch food, my family and much more’

- ‘having grown up in the mountains, I don’t think I could be happy in a place without any significant mountains in the long run’

The most frequently cited argument for studying abroad is personal growth. Other arguments are to get to learn new people, improve social skills, improve English language skills, learn about different cultures, learn about different view points on physiotherapy and go on an adventure. To quote one student: ‘I think it is a really cool experience because when I hear other people who have been studying aboard I get a little jealous. I also think it is great for your personal growth, because there is no one to fall back on’.

How would internationalisation influence physiotherapy students, and how could this influence their job as a physiotherapist?

Students believe that there are a lot of positive influences of internationalisation. For example: ‘A semester abroad gives you the opportunity to improve your language skills, make new contacts and get to know other cultures. In addition, students learn to critically evaluate different opinions and therapeutic methods.

Internationalisation can open many doors, especially in terms of international cooperation between the top minds in their fields, but also in terms of personal and working relationships being formed

Internationalisation is therefore not only beneficial for the individual, but also for society as a whole; after all, everyone takes a part of what they have learned with them’. One student adds: ‘Although the anatomy remains the same, each country has its own methods and approaches’. This is supported by another student: ‘this can give a more eclectic approach to how physiotherapy can be done’.

One student puts things in perspective: ‘I like Switzerland, and I really like my family, but to study abroad is a good opportunity and if you have it I think you should take it’.

One student sees a role in internationalisation to help ‘standardize the practice of physiotherapy across the globe. This could make it easier to communicate with international colleagues and understand international research. It could also influence how we understand the patients culturally with regards to health, pain, and lifestyle’. Another student adds: ‘It could also create new opportunities career wise, for example teaching internationally, doing research internationally, working in different clinics across borders etc.’.

One Swiss student describes it as follows: ‘Internationalisation can open many doors, especially in terms of international cooperation between the top minds in their fields, but also in terms of personal and working relationships being formed. As for students specifically, I think it’s nice to be able to talk to people with the same aspirations and dreams as yourself and it helps to form a bigger picture about your field of study’. Students think that internationalisation during their study could make the physiotherapist more open, empathic, patient, and understandable towards patients from another culture. One student summarizes: ‘I do believe that moving to a different country, if only temporarily, provides you with a different perspective on life and your field of study. Having to overcome the challenges that inevitably come with such a relocation can help build character, increase confidence and leave you with a much more open mind for other people, cultures and systems’.

However, one student mentions that you don’t always need physical exchange to get a glimpse of physiotherapy across borders: ‘The whole process of exchanging ideas internationally is much easier and faster now due to innovations compared to ten years ago. We are able to talk to a lot of brilliant people without really leaving our country. So, you don’t necessarily need to leave your country physically to have an international experience’.

What do you expect from THIM regarding internationalisation of their students?

THIM students like the opportunity to get in contact with foreign (THIM)students. Most of them expect THIM to facilitate this contact and opportunities to study abroad for a while. To provide the best possible support and advice for students who are interested in a semester abroad: ‘The University should make the semester abroad attractive and convey to the students that this is an experience for life’.

Thereby, most students would like more projects such as this international assignment, or to do group projects together. To quote one student: ‘I expect them to give us the opportunity to link up internationally, because it is important to hear different international opinions and views’.

Most students indicate that they enjoyed the digital contact with a foreign student during this international assignment. However, they are also keen on visiting the THIM University in the ‘other’ country and meeting THIM students of that other country in person. Dutch students would also be keen on meeting Swiss students while skiing in Flumserberg in February 2023 and a Swiss student proposes THIM-CH and THIM-NL students could meet in Germany when THIM-CH students visit the dissection room in Heidelberg.

Two of the three students of the international class at THIM-NL add something important to the expectations of THIM regarding internationalisation of their students. They would expect THIM to stay updated with international guidelines.

What are the challenging parts of international study exchange compared to only being based in your country of origin?

Most students see the language barrier as the most challenging part. This is supported by an international student of THIMNL, who speaks from experience: ‘The language can be challenging, e.g., English is used in class. Language can also be an obstacle outside of school in daily life, such as talking to your landlord or looking for a hobby’.

Students also see a challenging part in missing family and friends and potentially get lonely: ‘your family and friends aren’t around to help and support you’. This is also supported by an international student:‘The challenging part of studying abroad is that you are far from home, and cannot see or hear your family in person, only through the phone’.

Several students add that a possible challenging part might be that you are out of your comfort zone: ‘being based in your country of origin of course provides many people, myself included, with a sense of comfort and security, as you already know how everything, from public transport to taxation, works’. However, ‘always staying in your comfort zone is counterproductive for personal growth’.

Being open-minded is one of the main key elements of internationalisation. How could you enhance it?

The students absolutely agree that open-mindedness is a key element in internationalisation. Students think that it can be enhanced by ‘approaching new ideas positively’, ‘inform yourself about other cultures’ and ‘expose yourself to different cultures’. One student adds: ‘sometimes you’ll be nervous for not knowing what’s coming, or you don’t know what you can expect. But most of the times afterwards you can say it was cool and you learned a lot from it’.

A good way to enjoy your international experience as a student and learn to get more open minded is summarized as: ‘try everything from the new country. Make new friends. Try to learn the language and maybe find a job so you can learn more about the country quicker. [….] Go out and have a drink on your own an try to make new friends. Find a job in a restaurant so you can make contact with people from the country and maybe learn their language and culture’.

Several students think that, to some degree, openmindedness is part of one’s personality, which might be hard to change. However, this is not impossible to change. According to one student, ‘you might get motivated to be more open-minded if you learn about the advantages of internationalisation, and what it can do for you, your practice and your career (and your patients)’. Another student adds: ‘maybe before you go to the country you are going to study, you can watch a few YouTube videos about the country and the city you will visit, so you know a bit more about it beforehand’.

Students not only think that being open minded stimulates internationalisation, but that internationalisation also stimulates being open minded. In addition one Swiss student believes that being open minded can be stimulated by ‘starting with internationalisation at the beginning of the study’.

The most important element that students name can however be summarized by the following: ‘Physiotherapists need to be extroverts, so try to become an extrovert and don´t be shy! Listen to other people, get social skills, just start conversation and be interested and curious’.

‘Physiotherapists need to be extroverts, so try to become an extrovert and don´t be shy! Listen to other people, get social skills, just start conversation and be interested and curious’.

How do you see the role of e-health in the future of physiotherapy?

E-Health

An important passage from the vision on future care (2022) issued by the Dutch government is: Appropriate care increasingly means hybrid care: a mix of digitally and physically offered care and health support, personalized and tailor-made where possible. Principles here are: self if possible, at home if possible and digitally if possible. In this, there is a lot of emphasis on self-management and e-health. Although physiotherapy is mostly regarded as a “hands-on” profession, physiotherapists began incorporating innovative technology in traditional in-person care delivery. This is known as e-health. E-Health is the use of information and communication technology (ICT) to support health and healthcare. Two major contributors to e-health are telemedicine and smartphone Apps. Telemedicine or telerehabilitation refers to the use of ICT to provide rehabilitation services to people remotely in their home or other environments. Such services include remote therapeutic interventions (such as training), remote diagnostic procedures, remote monitoring of progress, remote education and consultation and a means of networking for people with disabilities. The purpose of telemedicine is to increase accessibility and improve continuity of care in vulnerable, geographically remote populations with disabilities with the potential for saving time, costs and resources in health care.

Prior to the recent outbreak of COVID-19 telemedicine was acknowledged as an effective adjunct to traditional in-clinic methods. During the COVID-19 pandemic however telemedicine was used as a replacement of face-to-face physiotherapy, to allow patients to continue with a current therapy treatment plan, while adhering to shelter-inplace and social distancing orders. Will this also be a big element in the future of physiotherapy? Is it possible to replace a significant part of the physiotherapy meetings by telemedicine or by remote physiotherapy? And how will smartphone Apps (like Goniometer App or movement analysis Apps) will add to the physiotherapeutical process?

The Dutch professional competence profile for the physiotherapist (2021) states the following: The physiotherapist deploys healthcare technology, such as blended care and other e-health applications, when it suits the patient's care needs and living environment. Seven first year students of THIM-NL and six students of THIM-CH were interviewed by peers about their thoughts and opinions on the role of telerehabilitation in the future of physiotherapy.

Do you think it’s going to be easy for elderly people to adjust to the digitalization of physical therapy? If yes, why so? If not, why not?

Most students agree that this will be challenging for the elderly. A Dutch student states: ‘Most of the elderly are barely able to text, so this can provide a substantial challenge’. A Swiss student adds: ‘they really don’t know how to use a Handy or iPad’. However, most students think that although elderly people didn’t grew up using technology, this doesn’t mean they can’t learn: ‘They probably won’t learn fast but they can learn if they have people around them who can teach them how to use the technology’ There are more students that believe it is important for older patients to have people around them that can educate them in digitalization, such as relatives. Some students think the physiotherapist should play a role in this. One Swiss student believes this might be a good fit for physiotherapy interns, to help elderly patients with this digitalization.

They see several advantages. One student states that ‘it enables patients who are restricted in mobility for example, to gain access and can thus be a lower barrier for entry. It could also be useful for people who want more online assistance or guidance during exercise’. One student adds that digitalization of physiotherapy might enable patients with busy agendas to make the step towards care an appointment: ‘people have less and less time. Everyone has thousands of appointments these days, and when physiotherapy is added to the list, it becomes difficult. Not having to change location for an appointment, might increase willingness to go the physiotherapy appointment’. Another student adds: ‘everything is becoming more digital, so why not health too? Its importance will grow because people of the next generation doesn’t want to talk face to face anymore and is more comfortable with ecommunication. They are more into social media and communication with screen. You can have an appointment wherever you are and win time’

However, according to one Swiss student: ‘Ehealth may create a gap between generations and we need to make sure that no generation will be left out’

E-health may create a gap between generations and we need to make sure that no generation will be left out’

Would you prefer to work digitally (e-health) or rather face-to-face? And why?

In the end, students believe that the way in which elderly can improve their technological skills is dependent on their behavior towards innovation and technology: ‘there are elderly that are open minded towards the usage of new technology, but there are also the exact opposite’

Do you think the importance of e-health will grow in the future?

Students are unanimously in their answer: YES! They think the importance of e- health will definitely grow but that it won’t fully outgrow the need of face-to-face contact. They believe it would be something additional to use in combination with face-to-face sessions, instead of replacing it.

Almost all students agree that they would rather work face-to-face. Only one student said he/she would prefer to start digitally, for example in a screening and then switch to face-toface when this proves more effective. Although most other students acknowledge that a mix would be good, they prefer face-to-face contact with the patient: ‘you can see the patient, touch the patient, see their expressions, see the way they react to certain tests, do the necessary testing and that’s very important to a physical therapist’ Several students also believe that face-to-face results in a better understanding between the two;, ‘if you have a deeper connection this leads to a more effective treatment’. A student adds that communication is more difficult digitally: ‘when you are in a meeting you won`t say everything because you don`t know if it will be understood the way you meant it’

A Swiss student summarizes: ‘I think any profession with the domain of health should always include person to person contact. No technology can replace this. However, a balance between the two should be of importance’.

How can we assure that the patient is doing the exercises right, when working digitally?

Students believe that this would be hard if the physiotherapist only works digitally: ‘we would need to see the patient from all angles’. Thereby, ‘you cannot give tactile input or feedback, so your communication needs to really be on point’.

They acknowledge that good instructions would be key: ‘it is difficult for the physical therapist to assure that the patient is doing the exercises right at home because the physical therapist is not physically there, so it is of importance that the physical therapist makes sure the patient knows how to execute the exercise the right way before leaving the practice’.

However, several students add that the instruction should not only be limited to the praxis. They believe that with proper instruction videos, patients could get clear instructions, which they can repeat whenever they like. Some students also acknowledge the use of a mix between face-to-face and online physiotherapy (blended physiotherapy) where the physiotherapist can check whether the exercises are done correctly: ‘We can always set up a meeting, in which the patient comes in for a quick review. He will then perform the exercises, and we will control them.’

A Swiss students thinks that ‘there will be technology in the future, where we might be able to see the therapists or patient performing the exercises “in front” of us’. Another student adds that motivation also might play a major role in performing the exercise right, when working digitally:

Could online treatment ever become better then real life treatment in your opinion? Why so?

Most students don’t think so. They believe that emotions, thoughts and feelings of humans, can be best picked up through face-to-face contact. But, several students name a hybrid form a good opportunity for the future: ‘This means you have a mixture of online and personal treatments’. They state that some treatments can be done independently at home without supervision (after a good instruction). ‘For example stretching/ activation exercises’. But for other treatments this would be much harder. ‘Hands on treatments like massage can of course never be done through EHealth’. Another student adds: ‘We would always need some kind of human contact, because it’s always nicer to talk to a real person instead of a robot or someone behind a computer. It’s also hard to decide what’s wrong with a patient from a distance if you can’t physically do the testing. Online treatment could definitely be implemented in some kind of way but not in a way where it’s taking over the real life treatment’.

Several students also believe that a functional online treatment is heavily dependent on the type of patient;: ‘I can imagine that patients with a sports background have it easier to execute some exercises. I can hardly imagine this with elderly people, because they may need more (physical) support’.

Some students however don’t believe that e-health will continue to play an effective role in rehabilitation: ‘E-Health can be a good solution for example in times of COVID, but it will never be the same as face to face treatment’

‘If the patient isn’t motivated to improve whatever the patient is there for, then the patient wouldn’t pay as much attention to executing the exercise the right way and just do it because the physical therapist says he/she needs to do it. In this case the physical therapist could try to improve the patient’s motivation’.

First year full-time students of THIM CH

What is your vision on how to integrate ‘lifelong learning’ into daily practice?

In the late 1960s and early 1970s, it became apparent that undergraduate education (nowadays: bachelor’s degree) did not fully prepare an individual for working life or imply lifelong competence. As a result, a half-life concept to estimate the extent of becoming out of date with new technology and knowledge was proposed. A half-life of 5 years was applied to medicine and engineering, whilst 10–12 years was applied to psychologists. Mandatory continuing education was then first introduced in the USA for medical practitioners in 1971. It was another 10 years before it was introduced in physiotherapy in several countries.

Life long learning

Lifelong learning requires individuals to take personal responsibility for identifying their learning needs and evaluating if those needs have been met. This includes an awareness of learning needs and self-directed learning based on experience and perceived responsibility, and has been embraced internationally by numerous physiotherapy professional bodies. There has been much debate about whether lifelong learning in physiotherapy should be mandatory or voluntary. There are wide variations in lifelong learning across different countries, and most rely on professional self-regulation. It is often linked with statutory registration and therefore becomes an inherent requirement for health professionals to practice. Most lifelong learning systems are modeled on hourrelated input systems, where 1 hour equals one credit. Generally, accreditation cycles are of 3–5 years duration with a set number of credits required per year/ cycle (see Table 1). What do future physiotherapist think of the prospect of lifelong learning after they finish their bachelor’s degree? To answer this question, six first-year physiotherapy students of THIM-NL and eight of THIMCH were interviewed by peers about this.

How do you feel about mandatory lifelong learning in physiotherapy, is this a good or a bad thing?

Most students think that mandatory lifelong learning is a good thing. All six THIM-NL students and six out of eight THIM-CH students think lifelong learning should be mandatory. The other two Swiss students agree that lifelong learning is important, but they don’t ‘like the mandatory part’. They would rather choose for themselves. Some of the responses of the students can be found below:

- ‘It guarantees that all physiotherapists are up to date and can help their patients adequately’.

- ‘I don’t think that 4 years of physiotherapy study is sufficient to become a good physiotherapist. Further learning is needed, maybe not every year but at least every 2 or 3 years for one to be up to date with new information’.

-

‘It is a good thing, but I can understand that not everyone wants to learn new things every few months’

One student posted a follow up question to a Swiss student: Do you view the fact that Switzerland doesn't compel life-long learning for physiotherapist an advantage or disadvantage?

On which the Swiss student answered the following: ‘I think it has both its advantages and disadvantages. On the positive side, Swiss physiotherapists are not kept under financial pressure or suffer the fear of losing their jobs when not pursuing lifelong learning. On the negative side, it not being an official rule may disincentivize Swiss physiotherapists from pursuing lifelong learning which would overall be detrimental to the quality of their work with potential clients’

What kind of topics should be addressed in the courses physios follow to keep learning?

Students agree that anatomy shouldn’t be a topic: ‘stuff like anatomy is unnecessary, because in school you learn every bone and muscle and that does not really change over time’. Actually, most students think that technology in physiotherapy would be an important topic to address in follow-up courses: ‘every year technology becomes more important. For example with the new devices like the apple watch. I think we should include that in our therapy’.

Several students mention communication is such an important element of physiotherapy that it would be good to follow extra communication courses after attaining the bachelor degree: ‘communication is also important for me. So that we don’t lose the relationship when we are online with the patient. Because online with the new technology it’s like more distance with each other’

Several other possible topics that were mentioned by students were:

- ’current diseases, for example arthrosis’

- ‘alternative therapy methods’

- ‘lifestyle related topics’

- ‘the lates scientific topics’

How do you integrate lifelong learning in a busy life?

Students have different thoughts on how to integrate lifelong learning in a busy life. Some students mention social media as an effective way, because you can learn about updates in physiotherapy on your own preferred time: ‘Personally, I integrate lifelong learning by reading new facts and information on physiotherapy topics like fitness and nutrition on social media. You can integrate lifelong learning by daily tasks like swiping through Instagram or reading in a book while riding to work or school’. Another student adds: ‘Since everyone has a smartphone, he develops the habit, that he spends a lot of time on social media and other smartphone-based applications such as games and other. So, everyone needs to think about how they spend their time. And out of this point of view you will always find a bit of time, to integrate the lifelong learning in your daily life’. Other students mention a subscription on physiotherapy journals as an effective way of life long learning.

Several students think that physiotherapists should be encouraged by their employers for continuous learning: ‘They should make time and money available for this’. However, they acknowledge that it is also the therapist's responsibility to learn: ‘every therapist should develop a certain routine so that they don't forget to learn. This should be developed during studies and become a habit. If it is a habit, everyone will always learn something new’. One student believes that it is important in life long learning to pick your friends wisely: ‘friends who have the same profession, you can learn from them. For example, you have a friend who is a doctor, and works in a hospital. However, if you do not have such a friend group, you could also connect with people who you might be around a lot, for example, when you practice your sport or when you are in the gym’.

In addition to all the former, one student adds: ‘the most important part to life long learning is keeping it interesting and functional for yourself as a physiotherapist. Life long learning must not feel as a ‘must’, but as a fun and interesting experience. Physiotherapist in the Netherlands must have around 24 credits annual, so you better make it interesting and functional, so choose things that have something of value for your clients. If your work is something with elderly people, than you shouldn’t waste time with sport classes (to get the annual credits). So if you keep it fun for you, then you are probably motivated, and that’s a way you possibly can get more educated, there is always time in your agenda. It is just a problem of wanting to learn new things’

Do people with a lot of experience still need to keep up with long life learning?

Students agree that this is definitely the case: ‘because new techniques are always being researched in this field’. Another student adds: ‘You must keep learning, because you will otherwise fall back in knowledge and finally loose knowledge’. Also students acknowledge that technology is evolving rapidly and ‘although you have 30+ years of experience, maybe you are not upto-date enough with technology. That would be a big loss’.

Not all students agree however that life long learning is just as important for the older more experienced physiotherapist as for the younger, more inexperienced one.

One student states the following: ‘I think with a certain amount of work experience you have enough knowledge’. Another student disagrees: ‘there are no upper limits to knowledge. Even hearing different aspects of something you already know could help to do something different or think different about it’. One student adds: ‘the older we get, the more our interests change. This can be an opportunity to learn new methods on new topics’.

One student sums it up as: ‘I believe that you should be able to acknowledge that you will never stop learning, and that you are never perfect’.

What will happen if you do not participate in lifelong learning?

Students agree that this wouldn’t bring them as a physiotherapist further. They think that this would be negative for the treatment of the patient, for the motivation of the physiotherapist, and the future of physiotherapy.

- ‘We would miss out on opportunities to help the patients with their well-being and diseases’.

- ‘Your clients will go to another physiotherapist because the other physio knows new and better techniques’.

- ‘For me personally, I would get bored if I never learn something new’.

One student summarizes nicely: 'You will stay on the start-line, just after you ended your physiotherapy study, and you will not be able to develop yourself. It may also cause, that you get bored in your profession. So, if that happens, you automatically loose the motivation to carry out your profession’.

'I believe that you should be able to acknowledge that you will never stop learning, and that you are never perfect’.

First year, international students of THIM-NL

Self Management

Shared decision making and self-management: How

An important passage from the vision on future care (2022) issued by the Dutch government is: Appropriate care increasingly means hybrid care: a mix of digitally and physically offered care and health support, personalized and tailor-made where possible. Principles here are: self if possible, at home if possible, and digitally if possible. In short, there is a lot of emphasis on self-management and e-health.

The need for self-management or self-management support in various conditions is growing and becoming increasingly important. Beneficial effects of self-management include: gaining greater autonomy, self-confidence, better quality of life, and more optimal participation. Self-management means that patients can choose the extent to which they want to take control of their lives and co-direct how available care is used. Self-management support is the systematic delivery of education and supportive interventions to patients (and possibly their family and social network) so that patients can cope with the consequences of their illness (on physical, mental and social aspects). In doing so, patients develop skills and confidence to maintain health-promoting behavior for the rest of their life.

Physiotherapists’ actions to stimulate proper self-management are designed as much as possible through shared decision-making. Today, shared decision-making (SDM) is, largely, espoused as the preferred model for making decisions in everyday health care. It is a process whereby professionals and patients share knowledge, values and preferences for different options towards treating complaints and diseases. This decision-making process is greatly relevant if one is to achieve informed consent and patient centered care. SDM typically involves the provision of evidence-based information about options, outcomes and uncertainties. This helps patients to consider their options and improves patients’ biomedical and psychosocial health outcomes. It may too increase their knowledge, trust and ownership of their health.

Some healthcare professionals express doubts, saying that patients don’t want to be involved in decisions or don’t want to have so much influence on their own health. Patients might lack the cognitive capacity or ability, might make ‘bad’ decisions. These health care professionals question the ability of patients to take control over their own actions to ‘get better’. THIM is curious what future therapists think on this matter. How should SDM be handled and self-management effectively stimulated? To answer this question, seven first-year physiotherapy students of THIM-NL and five of THIM-CH were interviewed by peers on this topic.

much influence can you give a patient?

Do you think self-management is important in physiotherapy?

Not surprisingly, all the students perceive selfmanagement as important in physiotherapy. To quote one student: ‘if patients do not have self-management competencies, there is no way they are going forward or improve themselves’.

Students acknowledge that to stimulate selfmanagement, it is important that the physiotherapist has good communication and coaching skills. One student mentions: ‘most clients don't like to be told what to do and think you are talking down to them. By communicating well, we could make it appear that it is their idea. Then they might be more likely to do it’. Another student adds: ‘by narrowing down options and highlighting the option I as a physiotherapist would prefer, I could let them think that they choose by themselves but secretly we choose for them’.

However, although students think self-management is really important, they believe that it is also fundamental that patients can always seek for help of a professional: ‘as a patient, you don’t need to do everything alone’.

How can shared-decision making (SDM) help patients with their therapy?

Students think that SDM might help motivate patients for the therapy: ‘because nowadays patients receive more active therapy and have to do more exercises at home, it is important that the patient agrees with these exercises’.

One student adds that SDM stimulates a sense of responsibility in the patient, about how his/her own therapy can help decrease their complaints. This is backed by some other students, who state that it is important that patients sense a feeling of control over the situation and over their functional improvements. ‘With shared-decisions we can give patients the feeling to be a part of it and be also involved in the process and not obligate them to - do this and that because we know it better than you’.

Although students think SDM is important, some highlight that the physiotherapist is the one who knows best how to help patients and reach their goals: ‘the physiotherapist is better educated for the job than the patient. She/he has the knowledge and must always have control of the therapy’.

Another student concludes: ‘as a therapist you know all the theory and have the experience to help the patient. However, a patient knows his/ her body better than anyone else. So together you make the best decisions’.

Do you think all patients are capable of shared decision making?

Most students agree that not all patients are capable of SDM. Children are often mentioned as a group that is not suitable for SDM. Also, elderly people, and/or patients with an intellectual disability are likely not a good fit for this approach. To quote two students:

- ‘as an adult (18 years and older), you are better in evaluating yourself than children and retirees’.

- ‘some people are mentally unable to find a reasonable or appropriate decision in their situation. Or shortly, certain people are not as smart as other people and are not capable to do this’.

Another student adds: ‘a lot of people can’t separate between what is healthy and what isn’t healthy for them. They don’t want exercises, but a more passive treatment’.

On the contrary, two students believe that everyone is capable of SDM. Some people just find it easier when other people tell them what to do : ‘these patients want you to solve the problem for them and they don’t want anything to do with it’.

One student adds: ‘the therapist just has to install a feeling of confidence allowing the patient to feel free to say everything’. Students however do not name patient education as a means to increase knowledge in their patients. This would be a valid way to increase the patient’s capability to SDM.

Where do you see problems in SDM and selfmanagement?

Several students foresee problems with an increasing SDM and self-management in the physiotherapeutical practice. They fear that it might be difficult to stimulate patient to do their homework exercises where ‘self-management also includes doing things at home without the physiotherapist being there to constantly motivate’. Sometimes patients favor a more passive approach over an active one, as acknowledged by the students:

- ‘some patients might lack a bit of self-discipline’

- ‘some people want you as a physiotherapist to solve their problems’.

- ‘some people are just lazy and not motivated, then it can be very difficult’.

Most students are aware however that good communication is an important element to convince these patients. Education is however barely named. Thereby, according to some students, it might be extra challenging to convince patients when they are ‘stubborn’ or ‘think they have found the solution on Google’.

Another problem that students foresee is that some patients are less capable in SDM and self-management. One student states: ‘some patients select exercises that can be cool for themselves to do but aren’t really effective to solve the problem they came for’. He/she adds: ‘Physiotherapists must retain control of the therapy and have the “last word” if something isn’t effective or doesn’t make sense’.

One student does not see any negative points in shared decision making. In his/her opinion it only brings advantages: ‘of course, the patients can get lazy or busy, but then it is up to you as a physiotherapist to make an exact and motivating plan for them’.

One student sees it a bit differently: ‘The biggest problem I see within SDM and self-management is that the therapist learns for the job and knows what is good for you. It is nice to see that patients think about their body and learn what is good for them. But they are insufficiently equipped for making possible life changing decisions. If they can make a decision on their own, they can also do the work as a therapist. A therapist can also not make a house if you get me. Maybe I’m hard on this, but I pay a lot of money to go to school to be a therapist and it is strange that someone that is not a therapist can say if something is right or not’

What is your personal opinion on hybrid care?

Although most first year physiotherapy students would rather see their future patients face-to-face, they see hybrid care as here to stay. The benefits of faceto-face therapy are quoted as:

- ‘you can better see mimic and gestures of patients’

- ‘the patient can feel safer when a physiotherapist is physically there’

- ‘therapist and patient have a closer contact’

- ‘errors can be corrected right away’

- ‘it might be challenging for older people to cope with modern technology’

- ‘it is more effective’

The last argument is eye-catching, since several scientific articles appeared recently which concluded hybrid care being just as effective, in several patient groups, as non-hybrid care.

Unfortunately, students did not connect hybrid care with self-management. It would’ve been interesting to learn what students think about possibilities for hybrid care to support self-management.

First year, full-time Dutch students of THIM-NL

In the recent adjustment of the Dutch professional competence profile for the physiotherapist (2021), a more important role was set aside for the physical therapist as an innovator. The following part (in italics) was taken from this profile:

It is the physical therapist's responsibility to apply and implement relevant innovations in his action. The physical therapist uses care technology, such as blended care and other ehealth applications when this fits in with the patient's request for help and the patient’s environment. This can happen in addition to treatment, but also as a (partial) substitution of physiotherapeutic treatment with the aim of making the care better and/or more effective. The physical therapist therefore should have an open and critical attitude towards innovations.

The Dutch professional competence profile for the physiotherapist (2021) states the following: The physiotherapist deploys healthcare technology, such as blended care and other e-health applications, when it suits the patient's care needs and living environment.

THIM University is curious about its students’ perceptions on how important they think this innovator role is in their future as a physiotherapist, what they think counts as an innovation, and how they would apply this role of innovator within their future praxis. To answer these questions, 9 THIMNL students and 6 THIM-CH students were interviewed by peers on this topic.

What is meant by ‘innovation’ in physiotherapy?

Most students answer this question in the following manner: ‘Innovation in physiotherapy are new methods, new technologies, new systems, and new products for healthcare’. One student adds: ‘innovation for me means we strive for the highest standard’.

Students reckon that innovating the field of physiotherapy is very important: ‘I think that it’s good to have innovations in physiotherapy. For example, online coaching for the patients. That can be a huge thing because it can save people time and money’.

What kind of innovations would you like to see in the future?

One student mentions the use of artificial intelligence in physiotherapy would be interesting. But also virtual reality and blended physiotherapy, both already used in physiotherapy, would be good according to this student: ‘I also like the idea of the hybrid system which gives the opportunity to partially do treatment from home. It’s for sure more relevant to meet in person but some small treatments or minor adjustments could be doable from home’ Another student adds: ’online treatment and tele-health are becoming more popular in other areas. Hopefully this also becomes a trend in physio as well. Although there needs to be more advancements in e-health to fully allow the physio to do everything they need to be able to do online. Apps will also hopefully play a role in the future, where you can upload exercises and patient videos. There will also hopefully be more technical devices that can be used, but cost will be an issue, as new technology is rarely cheap’.

How do you see the role of innovator (as described in the Dutch professional competence profile) within your future physiotherapy profession?

One Swiss student has an idea for a new innovation: ‘A nice idea would be to introduce robots that can give massages or be able to keep medical records with as much detail as possible’.

Most students however find it challenging to come up with innovations they like to see in the future: ‘I don’t know what technologies I want to see in the future, but I want to see more innovations that already exist to be used by everyone’. Another student adds: ‘and the introduction/usage of these innovations should be subsidized by the government’.

What are the advantages and possible disadvantages of new inventions, in particular regarding the more and more complex devices seen today?

Several advantages are mentioned by students:

- Saves time for the physiotherapist

- Easier and more data collection (for example with wearable devices such as AppleWatch)

- More accessible (distance physiotherapy)

- More fun and/or interesting (gamification)

- Accurate

- Stimulates home exercises (with an app) While on the disadvantages’ side:

- More expensive

- Complicated

- More time to learn about these new inventions

- Less personal contact and human interaction

One student shares a fear regarding future innovations: ‘in the future there could be machines or other technologies that would be better than a Physiotherapist and therefore our future jobs can be at risk’.

Why is it important to continuously strive for innovation in the field of physiotherapy?

Students see a responsibility towards the patient and their own profession: ‘you owe the patient, to help him as best as you can. This means that you should always know the best and newest ways to take care of the patient in the best possible way’. Another student adds: ‘it is important to continue innovating the field of physical therapy because we want to develop our health care to more successful therapy for the patient. When we keep learning, we will find more answers and solutions for problems and difficult questions’.

Do you think that the schools in general have to teach differently due the innovation in the job of physiotherapy?

Students agree that the school is responsible for creating an open attitude towards innovations by teaching about them: ‘we should be getting more lessons about innovations, because it’s our future and it’s in the competence profile’. Another student agrees and adds: ‘So that students will be ready when it comes to working later when they’re done with school’. Some students mention that they haven’t seen much lessons on innovating physiotherapy yet in the first semester. One student mentions: ‘It is important to know things like anatomy and physiology but as you get further in your study, we need to start learning about these innovations to stay up to date to give the best care we can to future patient’. Another student adds: ‘I think that schools don’t change their things that they teach every year. I don’t know how often that changes, but let’s say that every year they change the stuff they teach. They have to do that because otherwise they teach you stuff that isn’t relevant anymore’.

How can a physical therapist personally contribute to the advancement of his/her field?

The students reckon that it is most important that you are open to change: ‘Basically, be curious and be open to try new things. Especially try to grow as a person and never think that you know everything. There is always a new and better way, but if you always stick to the things that you already know, the field will not advance itself’. Other students add that staying active towards attaining more knowledge, also after you finished school, would be a suitable contribution. For example: ‘follow various courses’, ‘read research papers and talk to colleagues’, and ‘attend conferences and seminars’. But the most important personal contribution to the advancement of the field can be summarized by one student: ‘questioning status quo on a daily basis’.

How does the cultural background of the physiotherapist influence therapeutic interventions chosen?

Cultural Background

Working and studying in another country within the European Union (EU) is encouraged which has contributed to an increased migration significantly in recent years. The EU has set up the Erasmus program to encourage student exchanges with foreign countries. THIM has also recently received accreditation for student exchange with other countries through this Erasmus program. This means that it is possible for THIM students to study abroad for some time.

Whether through international work or within the multicultural societies where many clinicians live and work, physiotherapists are exposed to cultures that differ from their own. While we like to think our therapeutic concepts are universal, each culture has a different understanding of the body, health, illness, and healing. Cultural competence, the ability to work in cross-cultural situations, has been acknowledged as a core skill for physiotherapists and other health professionals. As a culturally competent physiotherapist you recognize, respect and respond to individual needs, and adapt your practice accordingly. Understanding and reflecting on your own culture including the underpinning values and beliefs that contribute to it, is the starting point for the process of acquiring cultural competence.

Differences in cultural background can also exist in cultures that are perceived to be very similar, for example Switzerland and the Netherlands. In general Dutch people tend to experience Swiss people as very friendly and polite, but more reserved and introverted. The Swiss may experience the Dutch as open and easy-going, yet also as very direct and sometimes thoughtless. Also, where the physiotherapist in the Netherlands is seen more as a coach who guides people, in Switzerland he is seen more as a practitioner who treats people. There are differences between the health organization of both these countries too. For example, in the Netherlands, in contrary to Switzerland, there is direct access to physiotherapy. Direct access physiotherapy has been defined to the situation in which physiotherapy services are available directly to patients and they can refer themselves to a physiotherapist without having to see a physician first. In Switzerland there needs to be a referral from the physician to see the physiotherapist.

Mostly, people are not consciously aware how their own cultural background influences their perceptions and actions. However, the awareness of one's own cultural values and beliefs is important to understand the vision of another. This is referred to as cultural sensitivity. Cultural sensitivity is the ability to perceive cultural differences through an open attitude, behavior, and communication. It is important that caregivers are aware of, and take into account the cultural aspects of the patient on the one hand, and on the other hand are aware of their own thoughts and feelings, experiences, and cultural background that may influence the patient.

THIM University is curious about its students’ cultural sensitivity. Therefore seven first year students of THIM-NL and five of THIM-CH were interviewed by peers on this topic.

What kind of barriers could there be due to culture differences?

The main barrier mentioned by students was communication. ‘People might speak different languages’. But also other forms of communication were named, such as non-verbal communication: ‘for example in Bulgaria nodding the head means no, and shaking the head means yes. Quite the opposite of how we would perceive that. That can create a lot of confusion’. Other students think that the approach to communication can differ between countries. Some are more preserved or introvert, while some are more direct: ‘We Dutch are direct and straightforward, which is not always easy for other cultures’.

Another barrier often named by students is religion: ‘for example, in physiotherapy there can be a difficulty if a male physiotherapist treats a woman with a religion in which it is unusual to remove the cloths in front of another man than her husband, or get touched by him’. The physiotherapist needs to be very sensitive to the feelings of a patient. He or she might feel uncomfortable, but might also be less direct in saying so. ‘We as physiotherapist need to be sensitive for, and capable of, adapting to our patients and their thoughts or believes and we need to adjust everything that we do to that’. This is, according to a student, not only bound however to religion: ‘for example if you treat a woman than you might act differently than you would if you treat a male patient’.

Touching one another is, according to the students, not only based on religion but also on culture itself: ‘in Swiss we are very formal, we won’t touch someone. First we have to ask if they’re okay with it. Here, the Swiss people want to know what will happen next, so we don’t touch them directly’.

Thereby, also certain therapy methods would be more or less accepted by different cultures: ‘for example, countries in Africa might prefer the old traditional method by healing people with rituals because that’s their inherited culture, where they probably never learned a western treatment’. These therapy methods probably won’t be very popular with the health insurance companies in the Netherlands or Switzerland.

What is important in the treatment of a person from another culture?

Most students agree, this is respect: ‘respect towards every client, independent of religion, gender or culture’. One student adds: ‘with respecting the other, you will gain mutual respect’. Also, ‘being open to other cultures and accepting them’ is often mentioned by students.

Communication is key here according to the students: ‘by communicating you will know your patient values, which will make her/him feel more comfortable’. One student adds: ‘it is very important that the client knows what he or she can expect’. ‘Shared decision making’ is mentioned as an important element to do so.

According to the students it is important that the patient feels comfortable: ‘he should understand you and agree with what you’re doing all the time’. In that ‘listening well to the patient’ and ‘being sensible and empathic’ plays an important role in making them feel comfortable. This increases ‘trust in the physiotherapist’. Considering all the above, according to a students: ‘people underestimate how difficult it is to be a good physio’.

One student adds that ‘it can be a great learning experience to work with people from other cultures and you might learn things that you can apply in your own treatment’. Therefore, acquiring intercultural skills during education is of great added value.

Some students however keep it simple:

- ‘Well I guess, what is most important, is getting the problem solved. So as long as you do that, the approach is always right.’

- ‘It is important to do the treatment on the right part of the body. If you have a treatment on the shoulder, make sure you only do the shoulder’.

Have you thought of studying abroad? Why/ why not?

At THIM-NL there is an international class with students who moved to the Netherlands to study here. Amongst the students that were interviewed, two are from this international class. One of these students says: ‘it is not easy to leave your home but it can be a very good chance to take, and I am really glad that I did it’. Another student mentioned: ‘I wanted to move to another country since I was 10 years old, but I promised my parents I would always be back for Christmas’.

Most Dutch students have an interest in studying abroad for a while. To quote one student: ‘yes, I would love the idea of studying abroad and learn about different cultures and countries. I lived in the Netherlands for like 21 years and it’s boring always being in the same country. But on the other side I am also scared to go because I’m afraid that I won’t make friends and fit in. And I really like our culture and our food. I don’t like the food in other countries except the Italian cuisine. But I’m also afraid that, when you get your diploma abroad in another country, the diploma is not certified in your hometown. And of course I would miss my family and friends’.

Students appreciate the opportunity to get to know different cultures: ‘through the experience of living with people from a different culture, you can be learn to be more open to ‘other’ ideas’. However, not all students would want to go far. One Dutch student thought about studying abroad: ‘but when I say abroad, I mean Belgium due to the fact that then there would be no language barrier’.

From the five Swiss students interviewed on this topic, only two would consider this. Although they think this would be an asset to their personal and physiotherapeutical development, they would miss out too much at home or ‘would be a bit anxious’. Or, to quote another Swiss student: ‘Swiss are really shy to live on their own in another country and they feel very uncomfortable trying to learn other languages and other type of culture. However, studying abroad can also give them a fresh perspective of the other side of the world and it forces them out of their comfort zone to learn the different types of cultures’.

How do you get information about the culture of your patient?

Students acknowledge that the best way to get information about the culture of the patient is to ask them. However, the physiotherapist needs to be sensitive to whether this is acceptable for the patient: ‘it should not be like an uncomfortable questioning’ Another student adds: ‘you shouldn’t ask everything, you still need to respect the privacy from the client. You need to check if the patient is comfortable with answering the questions. If not, you’d rather stop, and you’ll see how it goes’. This supported by a third student: ‘it is important to ask your patients respectfully about their beliefs and try to avoid stereotyping based on religious or cultural background’.

Also, students mention the internet as a way to get information of the background of the patient. To quote one student: ‘I would use google because I use google for everything, because you can find everything. ”I love google”. I would compare different websites and take the information’.

Exchange projects

THIM facilitates exchange programs to offer students and staff the opportunity to broaden their horizons, discover new cultures, and improve their language and communication skills. We see these exchange programs as an enrichment of the educational program and as a way to promote international cooperation. Moreover, an exchange program can be an unforgettable experience for students and can contribute to their personal development and growth.

In the reports below, exchanges are described that THIM facilitated in the past year.

Students exchange THIM-NL and THIM-CH

In year three THIM organizes an international minor week in which students of THIM-CH can study in The Netherlands for a week and students of THIM-NL can study in Switzerland for a week. This study year 9 students of THIM-NL and 6 students of THIM-CH participated in this exchange.

THIM-NL students in Switzerland

Highlights were the lessons at THIM-CH, the sceneries from our rental house, cheese fondue, and visit to an ice hockey match of HC Davos.

THIM-CH students in the Netherlands

Highlights were Virtual reality at THIM, ‘The Rum-Club in Utrecht’, the nightlife at Utrecht and baking poffertjes (small pancakes).

On 25 and 26 January 2023 Dr. Ron Clijsen and Dr. Erich Hohenauer of THIM-CH gave a workshop on scientific data collection, interpretation of these data and the use of these within the physiotherapy practice at THIM-NL. In this workshop students measured, among others, blood flow of the m. vastus medialis after massage gun application and vertical jump performance after partial body cryotherapy. After the morning session where data were collected, students presented their measurements in the afternoon session. An interesting workshop in which students learned to collect data using high end technology and a beautiful expression of the international connection between the two schools.

Dr. Ron Clijsen

As part of increasing internationalisation within THIM University of Applied Sciences in Physiotherapy, director Thim van der Laan and internationalisation coordinator Kevin Engelman visited one of the new cooperation partners, Father Muller Medical College (FMMC) in Mangalore (India). The FMMC is a medical college where students are educated to become doctors, nurses, physiotherapists or speech therapists, among others. However, it is not only an educational institute, but also a hospital. In this hospital they offer a wide range of specialities, such as oncology, cardiology, pulmonary, musculoskeletal, neurological and pediatrics. One of the strengths of this institute is that they combine education with working on real-life patients in the physiotherapy and rehabilitation department of the hospital. This report describes the experiences of this visit to FMMC and India, from Kevin Engelman’s point of view.

After a stopover at Mumbai, we arrived at Mangalore airport. A driver from the FMMC then guided us through the honking, busy traffic of Mangalore, overtaking pedestrians, scooters, rickshaws and cars and avoiding oncoming traffic and randomly crossing people and street dogs. Impossible overtaking manoeuvres seem possible here and our taxi seems to narrow more than once like The Night Bus in Harry Potter, allowing us to slip through. India's traffic was our first culture shock.

After a ceremonial warm welcome at FMMC we were shown around the hospital and campus. In the hospital, as in the rest of India, the difference between rich and poor was evident. Rich patients get a private room equipped with air conditioning in a separate wing of the hospital. due to the mix of doctors, nurses, physiotherapists and students, there is a lot of staff present per patient. As a result, patient care looks very personal and tailored. Nevertheless, with an outside temperature of between 30 and 40 degrees Celsius, high humidity, smog and only few air-conditioned rooms, spending several days in a hospital bed here must be not very pleasant.

The campus has loads of medical faculties, hospital buildings, student residential complexes (where 90% of the students stay during their studies), a church, mortuary, library, simulation centre, sports centre and an impressive conference hall, which can hold more than 1,500 people and would be the envy of many theaters in the Netherlands. Curious glances from patients, staff, students and visitors towards us gave the impression that not much Westerners come here. We concluded that FMMC offers their students a very good mix between education and patient care and that we can safely send THIM students here for a short internship (minimum 2 weeks).

On the way back home we had a very impressive city tour in Mumbai. This city with officially around 22 million inhabitants, but unofficially more than 30 million according to our guide, is a city with a great contrast between rich and poor. 45% of the people live in wretched conditions in the slums, working 12 hours a day seven days a week, for example, recycling plastic waste with little prospect of a future. But on the outskirts of these slums stands a 27storey private house owned by India's richest man and his family, built for a sloppy €2 billion. This is absolutely incompatible for us.

In the end, what stayed with me from our visit to India? The traffic, the crowds, the many strong smells and the smog that lies as a grey translucent blanket over the city of Mumbai and to a lesser extent Mangalore. But above all, the character of the people: friendly, humble, obliging, hospitable and incredibly intrigued by us tall Westerners. Interested in an internship at FMMC? Contact kevin@thim.nl

In February 2023, teacher Ingrid Veenendaal (THIM-NL) participated in an exchange project to DEUSTO University in San Sebastian (Spain) funded from an Erasmus+ grant. This is a grant that enables a short learning path for a teacher in an international setting. Two students from THIM-NL are also currently studying for six months at DEUSTO University with an Erasmus+ grant. This report describes her experience.

Deusto University in San Sebastian offers physiotherapy, sports science, pedagogy, economy, business and social courses and has a very good reputation throughout the country. A university for which people are willing to travel. In a beautiful new building of only two years old, students take their classes. The university is very innovative and international. An eye-catching characteristic of Deusto University is their mobility module in the second semester of the third year, where all courses are offered in English. This encourages international exchange which is an important goal of Deusto. Students are stimulated to go on international exchanges to gain a broader perspective on the profession. At the time of my visit, there were 120 students from abroad studying at Deusto. A great partner for international exchange of THIM students and teachers.

In addition, San Sebastian is a beautiful city that has much to offer in terms of cuisine, sport and culture. I went out for a nice dinner with our two THIM students studying there for six months and they were very happy with their choice. All in all, an incredibly fun experience, but above all a fantastic opportunity for THIM students to further develop themselves not only in the profession, but also on a personal level in a beautiful city.

Report on 5 months exchange of THIM-students in San Sebastian from Dutch students Olga and Sanne

Hola chicos y chicas,

Sanne and Olga here from Spain with a brief update on our study currently at Deusto University in San Sebastian. We are now already in the sixth week of classes here and tomorrow we have our first physio exam in our course

Physiotherapy and Ultrasound in the Critically Ill Patient. The exam will be in the form of an escape room. The build-up of the program here is quite differently from that in the Netherlands, with students here having already chosen more of their specialization direction. This means there are topics they know more about, like ICU, but also topics we know more about, like sports physiotherapy. In addition, they work much more with Ultrasound here than in the Netherlands. All in all, we learn a lot about the physiotherapeutical approach here in Spain and how it differs from the Netherlands. Very interesting!

In addition, the experience of living in another country is very educational and cool. You get to know a culture very quickly. The nice but also the difficult thing about living in San Sebastian is that they speak two languages here: Spanish and Basque. Many people don't speak English. This sometimes makes communication difficult, but it also makes us learn Spanish words and sentences faster.

The weather here is already super nice. We have already had days where it was almost 30 degrees. Great for learning (chilling) on the beach. All in all, a super cool experience! Adios.