Development of Real World Learning Opportunities in Community Exercise Prescription for Health Professional Programmes - ‘Physio Hub’

doi:10.21203/rs.3.rs-47956/v1

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Development of Real World Learning Opportunities in Community Exercise Prescription for Health Professional Programmes - ‘Physio Hub’

https://doi.org/10.21203/rs.3.rs-47956/v1

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Background Given the challenge of chronic lifestyle diseases, the shift in healthcare focus to primary care and recognised importance of a preventive approach to health, including exercise prescription, the embedding of related learning in health professional programmes is critical.

Methods In response to these contemporary demands, a complex curriculum development project was undertaken at University College Dublin, employing a four dimensional curriculum framework for the development of health professional curricula that focused on (1) future orientation of healthcare practices (the why?), (2) defining capabilities of graduates (the what?), (3) teaching, learning and assessment (the how?) and (4) organisation/institution delivery (the where)? The process was informed by latest exercise, health promotion, educational and health policy literature, alongside engagement with multiple internal university and external community stakeholders.

Results Having sufficient clinical education opportunity for translating exercise theory into practice was identified as a key need (the Why?). Development of strategies for health promotion and design and delivery of evidence based exercise programmes with inter-professional and inter-sectoral network building were some of the graduate capabilities identified as being critically important. (the what?) The resultant UCD Physio Hub model of clinical education combines ‘on campus’ and ‘community outreach’ activity to facilitate inter-sectoral ‘real world’ experiential student learning in health promotion and exercise prescription for both healthy and clinical populations. Underpinned by social constructivist educational theory, students are encouraged to be creative and to collaborate in responding to identified health needs of specific community groups by designing and delivering community services. (the how?) In developing new student learning opportunities to enhance curriculum, a supportive organisational culture and context was critical with UCD having excellent exercise infrastructure and the Physio Hub project aligning with a community engagement ethos articulated in the university’s strategy. (the where?)

Conclusion This paper provides an overview of Physio Hub, its services, educational practices and translational research ethos, all of which are combined to deliver a rich exercise and health promotion learning experience. Although developed for physiotherapy in this instance, the curriculum process and resultant education model could be applied across medical and other health professional programmes and to facilitate interdisciplinary learning.

Educational Philosophy and Theory

Internal Medicine

Clinical Practice education

Curriculum development

Exercise prescription

Exercise is Medicine

Health Promotion

Healthcare Professional education

Ireland as elsewhere is facing unprecedented health system challenges with an aging population and a high prevalence of chronic, lifestyle diseases, demanding a shift in the focus of health care from an acute hospital service model, which treats disease, to a service which focuses on prevention and health promotion in community care settings. (Bacon and Newton, 2014 ; Hajat and Stein, 2018; Lupton and Easton, 2015;O Donoghue et al , 2014;Wang and Wang, 2016)

With an essential element of any effort to change a healthcare system being the education of future clinicians who will practice new approaches in new contexts (Allan et al, 2004) contemporary education needs to reflect the move away from the traditional focus on episodic care of individuals in hospitals to initiatives that foster learning in community health promotion and engagement (Dean 2009; Mc Mahon et al. 2014 ^a,bMc Mahon et al. 2016^a,b; WHO, 2013)

Physical activity promotion and exercise prescription are integral to this approach, highlighted by the Exercise is Medicine initiative (Pedersen & Saltin, 2015), with systematic embedding of exercise theory and practice in entry level health professional education programmes, including physiotherapy, critical. (Cardinal et al.2015; Dean, 2009; Gates et al. , 2017 & 2018 ;Stoutenberg et al., 2020)Clinical education traditionally provided in hospital settings, limits the opportunity for a preventive health approach and there are significant shortfalls in terms of opportunities for students to gain practical health promotion experience due to a lack of community health promotion and exercise programmes in the primary healthcare setting. (Mc Mahon et al 2014^a, 2016; Maharaj et al., 2018;O Donoghue et al. 2011 & 2012;) Diversification of clinical education to include community settings, schools, sports clubs health promotion units and tertiary centres ,allowing critical inter-sectoral, (Ndumbe-Eyoh & Moffatt, 2013) prevention and management of lifestyle related disease experience across diverse populations is warranted. (McMahon et al., 2016^b)

As the number of physiotherapy programmes in Ireland has grown exponentially in the past decade, having sufficient and diverse clinical education capacity to provide experiential learning which reflects society’s evolving healthcare needs is essential and remains a constant challenge. This alongside reconsideration of traditional health professional clinical education models (Mc Laughlin et al., 2019) to reflect contemporary societal health needs, led to the development of a novel clinical education model at University College Dublin (UCD), the ‘Physio Hub’. This new model of clinical education facilitates inter-sectoral ‘real world’ student learning in community health, physical activity and exercise prescription for both healthy and diseased populations. As a complex curriculum project, it utilised Steketee et al’s (Steketee, 2013) ‘four dimensional framework for the development of health professional curricula’, as its scaffold. By applying the framework’s four dimensions, the aim of this paper is: to describe the ‘Physio Hub’ concept and development process, providing institutional context, underlying pedagogy, an overview of content and delivery mechanisms and preliminary data relating to its evaluation.

Setting: University College Dublin

University College Dublin (UCD) is one of Europe’s leading research-intensive universities and Ireland’s largest University with a longstanding reputation in providing healthcare professional (HCP) education, including Medicine, Nursing, Midwifery, Diagnostic Imaging , Clinical Psychology, Social Work, Clinical Nutrition and Physiotherapy. In addition, UCD is renowned for its sports and exercise facilities, attracting the country’s leading athletes through its sport scholarship and elite athlete training academy. The UCD School of Physiotherapy (established 1955) offers both BSc (4 year) and MSc (2 years for graduates) entry level Physiotherapy programmes alongside post graduate taught specialist and research programmes.

Curriculum Review and Enhancement Team

The ‘Physio’ Hub development team was comprised of university academic and clinical staff with education, clinical and research expertise in the following areas: physical activity and exercise prescription, public health, health promotion, health professional clinical education and curriculum design and development.

Stakeholder Involvement

In order to ensure broad representation, in terms of curriculum mapping to contemporary healthcare needs and defining graduate attributes for diversification of employment opportunity, a multi-stakeholder consultation process was instigated. This included drawing on the curriculum team’s existing collaborations and co-opting new stakeholders to include both internal and external stakeholders. The consultation process involved a series of dedicated group and one-to-one meetings, e-mail and phone communications with the wider stakeholder group over a six month period. Table 1 provides details of both the internal and external stakeholders , their areas of expertise and contributions to the ‘Physio Hub’ project.

Table 1. Stakeholders and Contributions to Curriculum Development Project

STAKEHOLDERS

Project Contributions

Internal Stakeholders (UCD)

Contributions

Physiotherapy academic staff

Curriculum design and delivery

Exercise curriculum research expertise

Clinical exercise research expertise

Clinical experience and expertise

Occupational health expertise

Health service management and service evaluation

Clinical data management

Guideline development for quality assurance

Governance committee representation

School of Public Health, Physiotherapy and Sports Science management team

Strategic Guidance

Budget management

Staff hiring and management

Quality assurance

Governance committee representation

Physiotherapy clinical education team

Mapping Physio Hub curriculum to clinical practice education standards required by UCD and accrediting bodies

Expertise in clinical practice education design and delivery

Clinical experience

Student supervision in practice education

Educational research expertise re preparing HCPs for primary and community practice

Governance committee representation

Sports and Leisure management team

UCD Sports centre staff management

Budgets

Reallocation of staff

Re-designating physical space at UCD sport

Health and Safety guidance

Physiotherapy students

Participants in Physio Hub curriculum design

Participants in clinical education research

Provide clinical education feedback

Sports Development

team

Experience in developing and marketing student sport & health initiatives

Sports administration

Development of client booking systems

Programme Marketing

Teaching and Learning unit

Action Based Learning Project expertise

Curriculum Design & Delivery Expertise

Human Resources

Devising contracts for new clinical practice education staff and exercise instructors

Data Protection

Guidance on development of secure clinical data storage mechanisms

Quality Office

Guidance on service quality indicators/ metrics

Legal Office

Legal Guidance

Health and Safety

Health and Safety Guidance

Insurance advice

External Stakeholders

Clinical Specialists

(Consultant Doctors, Physiotherapists, Clinical Nutritionists/Dietitians,Specialist Nurses)

Joint Clinical Governance for Physio Hub exercise programmes

Clinical Director/Exercise Leaders for exercise programmes

Clinical Expertise and guidance

Referral of Clients to Physio Hub

Community Sports Partnership

Sports Inclusion Disability Officer Guidance

Gym sector representatives

Consultation relating to exercise programmes’ content, marketing, pricing

Physio Hub Clients

Participants in Physio Hub on campus exercise programmes

Participants in Physio Hub outreach exercise programmes

Participants in clinical research

Provide satisfaction and quality assurance feedback

Curriculum Development Framework

As previously indicated, Steketee et al’s (Steketee, 2013) four dimensional framework for the development of health professional curricula was adopted to develop this new model of clinical education, the focus of which is to provide experiential learning in community health, physical activity and exercise prescription for healthcare professional students. This framework was selected as it recognises the dynamic, multi-dimensional and integrated nature of curriculum and the need to connect health directly to the larger political, social and economic issues, while at the same time, taking into account the multiple and often competing demands on educators and health systems (Steketee et al 2013). It is comprised of four key dimensions to frame curriculum development projects : (1) future orientation of healthcare practices; the why? (2) defining capabilities of graduates; the what?, (3) teaching, learning and assessment; the how? and (4) institutional delivery; the where? Figure 1 provides an illustration with framework dimension detail relevant to the current project.

Dimension 1. Future Orientation of Healthcare Practices: the why?

In the first dimension, the focus was on ‘the why’? Why is this novel model of clinical education needed? Whilst healthcare re professional curricula fittingly respond to the requirements of registration and accreditation bodies (Coru 2020;WCPT, 2011) it is imperative that they be responsive to service demands and shaped through work-based, inter-professional, inter-sectoral and public health foci (Steketee et al., 2013). As previously highlighted an aging population and the high prevalence of chronic, lifestyle diseases demands the shift in healthcare from secondary to community based care, with a greater emphasis on exercise prescription and health promotion (McMahon et al., 2016) Whilst exercise related learning occurs across a continuum of theory based (eg. Exercise physiology), practical and practice education modules, curriculum review identified that it was in the domains which focus more on translating exercise prescription into practice (clinical practice education) that gaps existed.(O Donoghue et al, 2011^a,b) This evidence base, in combination with a current shortage of practice education opportunities in community settings, the changing employment landscape for many HCPs and ongoing stakeholder feedback, were the key drivers for the ‘Physio Hub’ initiative. A mission statement was agreed that encapsulates why the ‘Physio Hub’ was established, what it stands for, what it considers to be its fundamental purpose and its overall ethos;

“To optimise the health of our students, staff and the wider community through the provision of evidence informed community health promotion and exercise services, led by health professionals and supported by health professional students. Underpinning this is a philosophy of integrating service provision with student education and research, consistent with best international practice”

Dimension 2. Defining graduate capabilities: the what?

Dimension 2 was concerned with identifying learning outcomes, expressed in relation to standards and sets of attributes, knowledge, skills and capabilities as well as dispositions. Health professional practice is multidimensional, contextually specific and relationally complex, and this must be reflected in the capabilities of graduates (Steketee et al., 2013). Although UCD’s HCP programmes have clearly articulated graduate capabilities mapping to international professional standards, the need to reflect the changing healthcare landscape demanded that the curriculum review team identify additional capabilities specific to community care and exercise prescription. More generic graduate attributes of autonomy, leadership and advocacy coupled with those more specific to community health promotion and exercise prescription were identified as important by way of the stakeholder consultation process, professional and accrediting body position statements and competency documentation. (American College of Sports Medicine;Dean et al, 2014; Health Services Executive, 2016; O Donoghue and Cusack, 2011;Stoutenberg et al., 2017;WCPT, 2011^a,b) Capabilities included development of strategies for exercise promotion and building inter-professional and inter-sectoral networks among exercise and health care professionals, which are often more challenging to address at traditional clinical education sites.

Key learning outcomes articulated for students include achievement of competence in: assessment of physical activity (PA) levels, pre exercise screening and risk stratification, exercise programme design, delivery of safe and evidence informed exercise programmes, creation of exercise and health promotion resources for clients, interaction with clients (individual and group) which reflects behaviour change theory, measurement of outcome, client advocacy, leadership, interdisciplinary and inter-sectoral communication skills and administrative aspects of integrating physical activity in health systems.

Dimension 3. Teaching Learning and Assessment: the how?

Teaching, learning and assessment, core to higher education, make up the ‘the how’? and are the focal point of dimension 3. The identified limitations of learning about exercise in the classroom context, recognised importance of contextual learning(Lave et al, 1991)and the need to provide a more focused opportunity to facilitate theory-practice transfer(Hajian, 2019) were central in informing this dimension.

The ‘Physio Hub’ is located within UCD Sport (university sports complex) where it acts as a community health hub with a focus on exercise prescription for healthy sedentary and clinical populations and sports injury prevention both on campus and via outreach activity with community and health service partners (Figure 2). Initially it built upon a small number of existing physiotherapy led community exercise programmes based at UCD Sport but a further client base has been achieved by embarking on projects to increase inter-professional and inter-sectoral working, that serve both the university and wider community. Physio Hub services see health promotion and exercise prescription being realised for healthy and clinical populations across the lifespan, making student experiential learning in these areas a reality for our students (listed and described in Table 3). A university appointed physiotherapy clinical educator supervises students with the emphasis on facilitating self -directed learning (average of 1:5 as tutor: student ratio), using a a mix of direct, indirect and remote supervision, encouraging students to become confident in their practice, while assured that advice and mentorship is always available.

The underlying pedagogy is one of social constructivism (Mascolo MF, 2005) with a focus on advancing psychomotor, clinical reasoning and metacognitive skills. Students at the ‘Physio Hub’ are encouraged to lead, collaborate and negotiate with one another, their clinical educator, service-users and community partners, to be creative and to co-construct knowledge in order to develop, market, deliver and formally evaluate research- informed exercise and community health initiatives. This learning is facilitated by embedding an action based learning project within their educational experience to address real world health challenges.(Cunningham et al.,2017) Projects have included delivery of health promotion and exercise initiatives on campus that target the general population and community outreach activities that assist students’ inter-sectoral learning in community organisations including disability organisations, schools, sports cubs and local authority fitness facilities. Table 3 provides more details. Students are encouraged to leverage technology in preparation for the rapidly changing and networked world of work (e.g. fitness apps, wearable sensor technology, social media). (Weller, 2019) Consistent with its translational research ethos , the ‘Physio Hub’ acts as a ‘living laboratory‘ to support exercise related research, facilitating BSc, MSc and PhD level research projects with students assisting in data collection, data entry and analysis. In addition to standard assessment of student performance over the course of the clinical education block (4 to 6 weeks), novel assessment strategies have been developed and embedded to drive learning that achieves the more context- specific learning outcomes. These include design and delivery of; exercise programmes, online resources, brief interventions, public health talks and presentations to multi-sectoral audiences re proposed new exercise services and their evaluation. Impact on student learning is captured by way of assessment rubrics which incorporate both generic and more specific exercise and health promotion learning outcomes in combination with student reflective learning portfolios and formal placement feedback surveys.

Table 2. Overview Physio Hub Exercise and Health Promotion Service Provision

Services/ Programmes	Target Groups	Overview
Get in Gear/Active Campus Europe^Ö	Sedentary University Students	Health screening and exercise programme x 12 weeks aligned with academic terms
UCD Better Bones^Ö	Age 55+ with bone health issues/osteoporosis	Group Exercise and interdisciplinary education programme x 12 weeks on campus
UCD Better Hearts^Ö	Clients with cardiac health issues	Group Exercise and education programme x 12 weeks on campus
Injury Prevention Sports Teams^Ö	UCD/local club Gaelic Athletic Association football/hurling, UCD Soccer, Rugby	Injury Prevention Programme over season at UCD/other local clubs
Crumlin Olympic Challenge	Children with intellectual Disability, their teachers & parents	6 weeks- health promotion talks & exercise classes both in community and at UCD sport
UCD-Simmons College Boston, USA Traveller Healthy Living Project	Traveller Community Pavee Point Traveller Representative Organisation	International Service Learning Health Promotion project
Enable Ireland-UCD Kids’ Camp	Children with Physical Disability	Physiotherapy supported kids’ multisport camps on campus
Parkinson’s ‘On the Move’	Individuals with Parkinsons’ Disease	12 week exercise programme (Spin/Circuit/Tai Chi) with related research on campus

UCD-DLR Rathdown Leisure services ‘Move don’t Sit’ (MedaliST)	Older adults (> 65) with multiple morbidities in area of social disadvantage	12 week exercise & public lecture series at community gym

Healthy Eating Active Living Community Health Project	Primary School Children	Fitness testing, PA programme & health promotion talks at primary school (6 weeks)
UCD Festivals	UCD and Local Community	Fitness testing & PA promotion at hub health & wellbeing festival zone

WCPT Active Ageing	Older Population	Exercise Class & Public Lecture on campus

Darndale Active Girls Project	Teenage girls in area of social disadvantage	Social entrepreneurship PA promotion project
UCD Workplace Health	Office workers on Campus	Development of Guidelines for Workers

ÖLongstanding programmes running several years providing consistent client base

Note: List not exhaustive; each practice education block has an embedded active learning project and some initiatives are threaded through all practice education blocks, with modifications as required

Dimension 4. Supporting Institutional Delivery - the where?

In developing new student learning opportunities to enhance curriculum , the organisational culture and context is crucial to the process. The Physio Hub project aligned well with the university strategy, providing an experiential learning environment to strengthen scholarship in disciplines, facilitate translation of theory to practice, build engagement locally and nationally, service student health well -being and sport and with demonstrated ability to attract international students via unique service learning opportunities. (Cunningham et al., 2017) UCD has a programmatic approach to curriculum design and enhancement with emphasis on learning outcomes and graduate attributes and with health professional programme curricula needing to map to professional accrediting and state registration bodies. (CORU, 2020;WCPT, 2011)The top class exercise facilities at UCD, coupled with a history of positive working relationships and resource sharing between the physiotherapy academic, sport and leisure service units and clinical networks, was a key enabler with this ecosystem acting as a springboard for the new initiative. This project copper fastened shared goals and built the case for the redeployment of space to the Hub, leveraging of the existing client booking system, reception services and also linking into additional channels for promotion and ‘branding’ of the Hub activities. Governance, management and budgetary structures to enable the team’s vision were realised via consultation with representatives from UCD quality, legal, data protection, health and safety and existing clinical partners (Table 1). This resulted in the formation of a governance committee comprised of representatives from the UCD academic physiotherapy unit and UCD Sports Centre with a joint clinical governance arrangement between UCD and its clinical partners.

Preliminary Evaluation

Although the focus of this paper is on the process of curriculum development for UCD Physio Hub , some preliminary outcome evaluation has been conducted from both the institution and student perspectives. Formal evaluation of student data (student surveys and focus groups) is underway and therefore only preliminary indications are provided here.

Student Learning

To date, 125 BSc and MSc (graduate entry) physiotherapy students have completed blocks (4 to 6 weeks each) of professionally accredited practice education at the Physio Hub. Student feedback has been utilised on an ongoing basis to inform enhancement of the learning experience. Levels of student engagement are excellent as evidenced by students rising to the challenge of addressing real world issues and excelling in delivering projects with tangible outputs. Despite some initial hesitancy among students regarding Physio Hub, accustomed to the more traditional clinical education experience in the early project phase, feedback on the learning experience is overwhelmingly positive and Physio Hub has become a highly regarded and sought after practice education option.

Clinical educators report student achievement of both the previously articulated and additional unplanned learning outcomes, including enhanced skills in exercise prescription, communication, project work, time management, advocacy, team work, exercise programme administration and written resource generation.

Institutional Benefits

From an institutional standpoint, the Physio Hub has had many benefits supporting UCD’s stated goal of maximising relevance and impact on society, while at the same time augmenting the student learning experience and researcher engagement. Physio Hub has added significantly to practice education capacity, a major challenge for higher education institutions. It has enabled UCD Physiotherapy students to contribute both to the University community and broader society aligning with service learning models.(Jacoby, 1996) Strategic partnerships with public and non-governmental agencies, education, community and professional organisations have been established consistent with both a public engagement and community outreach ethos. Physio Hub initiatives map well to the ‘Healthy UCD’ staff and student well-being initiative and were integral to UCD achieving ‘Exercise is Medicine’ campus accreditation in 2020.

Formal Recognition of the Physio Hub as an Education Initiative has been achieved as follows:

International ‘Exercise is Medicine’ Campus Accreditation Silver Award (Exercise is Medicine, 2020)
European Network of Academic Sports Services Award (2018) (Students helping Students category) for Active Campus Europe Project
UCD Competitive Teaching and Learning Award -‘Outstanding Contribution to Student Learning’ (2018)
UCD Sustaining Partnerships Realising Change Award (2017) - Crumlin Olympic Challenge Project
Dun Laoghaire Rathdown (DLR) County Council Move Don’t Sit (MEDALIST) programme funding to support a partnership (UCD staff and students & DLR) approach to exercise programme development and delivery for older adults in an area of social disadvantage

This paper describes the concept and development process for UCD Physio Hub, a unique clinical education model which provides focused real world learning in community health promotion and exercise prescription, mapping to society’s broader health priorities of chronic disease prevention and management. Emphasis on supporting and empowering individuals to live well in their own communities through encouraging individuals to engage in preventive health behaviours, including exercise, is consistent with the shift in healthcare focus to primary care. This new translational research and learning environment creates rich student learning opportunities and acts as research infrastructure to support a parallel clinical exercise research programme at the university. Additionally, the Physio Hub represents a solution for higher education institutes (HEIs), who are often challenged by the finite clinical education capacity of health systems, over which they have limited control and where providing the ideal range of clinical experiential learning opportunities is difficult.

The need to report the curriculum development process (Haji et al., 2013) has been addressed, using Steketees’ four dimensional curriculum framework to provide the institutional context, underlying pedagogy and an overview of content and delivery mechanisms. This enabled a shared vision of what it is that the Physio Hub set out to achieve and demanded consideration of bigger picture issues, overcoming a tendency to regard curriculum review in terms of content and delivery methods only.(Haji et al., 2013) Models based on the Physio hub could be implemented across a range of health professional programmes and to facilitate interdisciplinary learning in preventive health approaches. The feasibility of the sports facility-based Physio Hub as a model of community health promotion has been demonstrated with the university thus having acted as a think-tank developing and testing a new model which may prove worthy of adoption in healthcare systems.

Encouraging students to gain relevant inter sectoral experience was integral to the Physio Hub project, given that most of the social determinants of health lie outside the sphere of the health sector and collaboration with governmental and non-governmental sectors is important to improve health equity. (Ndumbe and Moffatt, 2013) Positive relationship building both internally and with external community partners was imperative in the establishment of new initiatives and our experience supports the recommendation of establishing fewer but more significant and sustainable inter sectoral partnerships which balance student and service user needs. (O Connor et al.,2019) The service learning practices at Physio Hub map well to the well recognised PARE (Preparation , Action, Reflection , Evaluation) model of service learning (University of Maryland, 2015) which represents a useful scaffold for development of further community exercise and health promotion opportunities. Learnings from the curriculum development process include the importance of having high level institutional support and leveraging the broader, education, research and governance expertise in addition to the more obvious health discipline input (Table 2)

Although student‐led, community‐based clinical education placements appear to impact positively on the well‐being of community service users and feedback from clients has been overwhelmingly positive, more formal inclusion of patient representative groups in the curriculum development process could have taken place, consistent with patient as partner engagement approaches.(Karazivan et al., 2015;Regan and Nunn, 2016) Challenges encountered in this project related to developing robust clinical governance structures in a non- healthcare setting , acquiring adequate resourcing of clinical educator staff from the HEI budget, managing student expectations regarding a non traditional clinical education model and resourcing the significant administrative workload associated with developing and delivery of health services. Although this paper’s purpose was not to evaluate the student experience, this is obviously a key outcome of any curriculum development process and based on initial data analysis, preliminary insights reveal a positive impact on student learning. From an educator perspective, a greater level of autonomous practice has been observed with students operating as ‘portfolio’ workers, gaining valuable experience to enhance their entrepreneurial skills and career options for the current employment landscape characterised by its flexibility in working hours, freelancing, freedom in the choice of work and independent contracts.(Alanezi and Alanzi, 2020) Such capabilities are required of future healthcare professionals to pre-empt and be responsive to society’s healthcare needs and for enhancing career opportunities as independent contractors and advanced practitioners. (Fennelly et al, 2020) Further systematic evaluation of data relating to student experience and impact on learning is already underway to ensure these critical perspectives are robustly evaluated without bias.

Findings from the Physio Hub project reported here should inform the efforts of others who wish to develop equivalent initiatives at their HEI, with the evaluative act about generating reliable, valid and useful information for curriculum developers seeking to adapt programmes in the light of evolving contexts. (Eva et al, 2010)

This paper describes a successful theoretical framework- based curriculum development process for embedding real world exercise and health promotion experiential learning opportunities in health professional programmes with tangible benefits at both student and higher education institutional levels. Findings from this process have important implications for health professional programme providers given the current emphasis on the need for preventive health approaches, including exercise, to be systematically incorporated in health professional education programmes with opportunity for students to translate theory into practice.

Ethics

Nil specific required by University for this curriculum development process

Competing Interests: None

Authors Contributions:

Caitriona Cunningham, Study Concept, Data Collection,analysis and Interpretation, Lead Author on paper, approval final paper (Founder and Director Physio Hub

Catherine Blake Study Concept, Data Collection, analysis and Interpretation, Paper writing, review and approval

Grainne O Donoghue Study Concept, Data Collection, analysis and Interpretation, Paper review and approval

Ciaran Purcell Data Collection analysis and Interpretation, Paper review and approval

Ulrik Mc Carthy Persson Data Collection, analysis and Interpretation, Paper writing, review and approval

Karen Cradock Data Collection, analysis and Interpretation, Paper review and approval

Sinead Mc Mahon Study Concept, Data Collection analysis and Interpretation, Paper writing, review and approval (Cofounder Physio Hub)

Consent

Consent has been obtained from all authors

Funding

Nil to declare

Data

We the authors agree to comply with journal’s copyright and data availability guidance

Acknowledgements:

University College Dublin Sports Centre Staff; Clinicians across University Hospital Network; Community Partners

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Development of Real World Learning Opportunities in Community Exercise Prescription for Health Professional Programmes - ‘Physio Hub’

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