Knowledge Transfer

When the participants were asked about knowledge transfer back to India they struggled with the question; it appeared not to be something that they had really considered before and the returnees did not appear to perceive that they were contributing to transferring knowledge. Throughout the various interviews there was evidence that individuals had implemented learning gained from their overseas experiences into their current working practice. For some this was just about their own personal, professional clinical practice within their working context and within the system constraints. However, it often extended to sharing their knowledge and perspectives with other colleagues, thereby providing opportunities for others to take the learning on board and to change their practice.

"So, yeah that has happened and they are interested in knowing what new things or different things that I have learnt from there and come back,

yeah."

Minda (overseas returnee)

"Yeah. I can say that 30% of our change in the Indian practice is basically because of the international students those who are trying abroad, come

back they give their view and thereby there are changes."

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The educationalists reported that they had implemented ways of thinking and ways of working and ideas that they had acquired whilst they travelled overseas. They identified that this sharing of practice had impacted upon other colleagues involved in education delivery who, in turn, changed their educational approach to comply.

" So there when we kind of complete the circle with my input and their input, I feel that we structure our teaching methodology better than other

colleges."

Ashna (overseas returnee, educator)

They considered that these changes then influenced the educational development of the students, their expectations and the way they were equipped to function as newly qualified physiotherapy professionals. However, as has been identified, if the students then go out into 'parochial' work environments, they often become frustrated with the employed clinical context not matching their training.

FG1 (just arrived in the UK) talked about changing practice across the profession and the health sector, but felt the challenge would be too much for individual returnees. The aspiration to improve practice in India seemed to be an important element for those who were more recently qualified and there was a clear sense that to effect this level of change, return was required. Also for this group there was minimal emphasis on sharing practice, possibly because there was a perception from many of the participants that those who returned to India did not share their expertise; they identified that this could be due to the competitive nature of Indian culture as, returnees needed to capitalise upon their investment and did not wish to share their knowledge with competitors. The interviews with those who had returned, identified that they felt they needed

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more experience prior to setting up the continuing professional development courses that they perceived were a key route to sharing their knowledge.

It was identified that the overseas diasporas network was keen to share its knowledge either through lectures for academic staff or students when they returned to India on family visits, or through setting up online journals or discussion forums. Most participants considered that to influence effectively the profession and practice in India the physiotherapist should return. A need that was identified during some of the interviews was the establishment of a support network for those who had returned. The challenges of return for clinicians focused upon the ability to apply and utilise the international physiotherapy knowledge and ways of working but also to support the dissemination and sharing of practice.

King (2000) described different types of return, retirement, failure, conservatism and innovation. 'Return of failure' was where migrants had failed to adapt to their host country and this was identified as a concern; whilst UK visa changes had perhaps 'forced' an earlier return than some participants had planned, there was no sense that they had failed. 'Return of conservatism' was planned for, once goals had been met, often related to remittances and savings, they did not aim to change the social context they left. 'Return of innovation' was where migrants remain overseas for longer than planned, and return with ideas, values and ambitions. They considered themselves innovators and carriers of change. The participants interviewed in this study fell between King's conservatism and innovation categories; they aspired to innovation but felt constrained by the social context. The increasing return of physicians to India arguably falls in the innovation category and it is postulated that these entrepreneurs could help to change the character of medical practice in India and create a better

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environment for nurses and other health professionals when they return (Haour- Knipe and Davies 2008).

The narrative captured within the journey category illustrates the complexity of the context from which the Indian physiotherapist originates, the significance of social, cultural, political and economic influences on the decision to travel overseas and also their influence upon the decision and ability to return. The challenges that the Indian physiotherapy profession faces, as it strives to establish its position in the Indian healthcare infrastructure, has clearly impacted upon individual physiotherapists as they have worked to develop their skills, thinking and role in order to deliver more effective physiotherapy practice. The importance of personal professional development, the desire to engage with different experiences, skills and knowledge and a global perspective on physiotherapy practice, all underpin the Indian physiotherapist's journey. Embedded within the desire to travel overseas and fuelling the journey was the ultimate aspiration to achieve a better life. The elements that underpin this ambition were identified by the participants and are discussed in the next chapter, 'Wanting a Better Life'.

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