A Model for Designing a Geriatric Physical Therapy Course Grounded in Educational Principles and Active Learning Strategies

Abstract

INTRODUCTIONThe goal of physical therapist education programs is to prepare practitioners to evaluate and treat movement dysfunction for individuals across the lifespan.1 The US Census Bureau projects that by 2050 the number of over age 65 in the United States is expected to reach 88.5 million-nearly double the 40.2 million over that age in 2010. 2 In 2008, the Institute of Medicine (IOM) of the National Academies published recommendations for preparing and growing the health care workforce in preparation for a graying America. This report emphasized the need to improve the geriatric-specific competence of health care workers, increase the number of geriatric specialists in all health professions, and develop new models for geriatric care delivery.3As the older segment of the population grows, so too does the proportion of older adults comprising the caseload of the typical physical therapist. The 2006 Practice Profile Survey from the American Physical Therapy Association tracked the mean percentage of patient care time spent with individuals by age group.4 persons (age 65 and over) comprised a majority of patient care time per week by practice setting, including: approximately 82% in skilled nursing facilities, 60% in home care, 54% in sub-acute rehabilitation hospitals, 52% in acute care hospitals, 31% in hospital-based outpatient clinics, and 27% in private practice. Specialized training is essential in both the academic and clinical environments to prepare physical therapist graduates to meet the needs of the older adult population across health care settings.John Rowe, chairman of the National Academy of Sciences Committee on the Future Healthcare Workforce for Older Americans, emphasized the need for all health care workers to demonstrate basic competence in geriatric care. This competence necessitates significant enhancements in educational curricula and training programs3(p xii) available to health care providers.3 A number of curriculum development models for physical therapist professional education have been described in the literature.59 These models discuss the development of curriculum on a larger program-level scale, considering factors that extend across academic courses of a given program. Shepard and Jensen discuss a general framework for stand-alone course design through their preactive teaching grid.7 The grid helps instructors to consider 10 different dimensions of instructional design, such as teaching methods, assessments, student preferences, and learning environment, in preparation for a course or single learning event. Models for content-specific course design in physical therapy, including geriatric physical therapy, are limited.10'13The purpose of this paper is to describe and evaluate a model for the design, development, and implementation of a dedicated course in a Doctor of Physical Therapy (DPT) program on the management of the aging adult. Educational theory that promotes student engagement, reflective practice, clinical decision making, and problem solving will be presented, followed by how these educational principles were incorporated into the course design. Grounded in educational principles, this model optimizes learning and preparedness for geriatric physical therapist clinical practice. The following describes the theoretical framework as the basis for this course design model, application of the design process to a course on the management of the older adult, and evaluation of the course outcomes to determine the efficacy of this model. We apply the model to a geriatrics course, but the model may be used to design or redesign courses related to a broad array of didactic content areas.Theoretical FrameworkCourse development is an iterative process requiring continuous assessment and alignment of objectives, instructional methods, and learner outcomes, incorporation of learner feedback, and integration of current evidence and trends in clinical practice (Figure 1). …