Urban ideals and rural realities: Physiotherapists navigating paradox in overlapping roles
Bibliographic record
Abstract
OBJECTIVES: Rural practitioners who develop a sense of belonging in their community tend to stay; however, belonging means neighbours become patients and non-clinical encounters with patients become unavoidable. Rural clinical experiences expose students to overlapping personal and professional relationships, but students cannot be duly prepared to navigate them because ethical practice standards primarily reflect urban, and not rural, contexts. To inform such educational activities, this study examines rural physiotherapists' strategies for navigating overlapping relationships. METHODS: Constructivist grounded theory guided iterative recruitment of 22 physiotherapists (PTs) living and practising in rural, northern or remote (RNR) communities in British Columbia, Canada, and analysis of their experiences navigating overlapping relationships. RESULTS: PTs routinely navigate overlapping relationships while mindful of practice standards, neighbourly and community expectations, personal well-being and patient welfare. While off-duty, they balance opposing expectations and manage various responsibilities to achieve contradictory goals such as being a professional who protects patient confidentiality while being an active and cordial community member. While on-duty, they face ethical dilemmas where deciding not to treat acquaintances potentially denies access to care but allows for clearer personal-professional boundaries and deciding to treat contravenes (urban) practice standards but could allow for customised patient care based on knowledge gained through both clinical and social interactions. CONCLUSION: Overlapping relationships are a rural norm. Urban ethical practice standards imposed on rural contexts put RNR practitioners in a paradoxical situation where clinical and social interactions must be but cannot be partitioned. Examining the identified strategies through the lens of paradox theory shows sophisticated cognitive framing of the conflicting and interrelated aims inherent to living and practising in RNR communities. Consequently, introducing a paradox mindset in educational activities could be explored as a way to prepare students for the ethically complex overlapping relationships that they will need to navigate during RNR clinical experiences.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".