Can Proposals for Social Inclusion Promote Practices of Moral Exclusion? An Example of Moral Disagreement from the Physical Therapy Profession

Development of a Statement on Autonomous Practice

Introduction Culture has been defined as: “a tradition of knowledge and practice that is shared, albeit imperfectly, across the members of a society and across its generations” [Zou et al 2009]. It shapes people's experiences and their emotional reactions [Gard et al 2005], including their understandings of what it means to be healthy, the meanings of symptoms, attitudes towards disability and treatment, and coping strategies [Dean et al 2006; Gallaher et al 2001]. The study suggested here may offer new insights by exploring how culture shapes the experience of stroke care through the perceptions of Physical therapists working in the state of Qatar. Qatar is one of the wealthiest countries in the world. The culture reveals the modernising influences associated with oil exploration and technological advances whilst preserving collective traditions. The state provides extensive financial support for its own citizens including generous pensions and access to health care. However, in common with other Gulf st...

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

ABSTRACT.- physical therapy professionals are giving increased emphasis to including,ffimiky members and caregivers as partners in the patient education process, Physical therapy students and professionals can greatly benefit from being exposed to a family systems approach of patient education in both their academic and clinical education. A family systems approach to patient education is described as applied to various aspects of physical therapy practice. Physical therapy educators can play an important role in assisting students to appreciate the value of an expanded family approach to patient education. Suggestions for incorporating this approach in classroom and clinical education experiences are discussed. Physical therapy professionals have recognized the importance of patient education for many years. Clinicians working in pediatric, geriatric, or hospice practice are especially attuned to the value of family-centered patient care.1,2 Recently, there has been an increased emphasis across the profession of including family members and caregivers as partners in the patient educational process.3-9 Inclusion of family in patient-related education or instruction can enhance patient knowledge, decision making, progress, and safety.4 However, family dynamics such as family nonparticipation or ineffective participation can be problematic for practitioners in patient education endeavors.5 The focus of this article is to situate patient education within a larger social systems context so that patient education is extended to the family unit, a more inclusive and dynamic approach than the traditional medical model of including only the patient and professional health care provider. The family is broadly defined as the social group into which an individual is born or adopted (family of origin), or the social group created after leaving the family of origin (family of creation). Thus, family is not always composed exclusively of blood or marriage-related kin but rather should be thought of in very broad terms by health care providers. Because academic and clinical physical therapy educators have a powerful impact on how physical therapist students conceptualize patient education, this article will present patient education within an expanded family context. The frame of reference throughout the article is the physical therapy practitioner and how a family approach can inform and enhance patient education efforts. This frame of reference was chosen to match that typically utilized in classroom and clinical education settings. Additionally, some suggestions are included for physical therapy educators. DEFINING A FAMILY SYSTEM The definition of a family as a system is helpful in understanding the tasks and challenges individual family members face as they move through their individual and collective phases of the developmental process. As a system functioning within the larger social contexts of extended family, culture, and community, the family unit can be viewed as having characteristics and functions of a system. As a system, the family is a unified whole consisting of interrelated parts, functions according to a set of defined rules, processes information, and adapts to changing circumstances with the intent of preserving homeostasis, or balance, among its parts. The nuclear family of the past is no longer the typical family arrangement of today.10,11 Some patients live with their family of origin, some live with their family of creation, and others are living temporarily with family members due to disablement. Additionally, patients may be dealing with both of these families simultaneously; for example, a mother diagnosed with an orthopedic problem may have the responsibility of caring for young children as well as caregiving responsibilities for a disabled, frail parent or relative from the extended family system. FAMILY SYSTEM CHARACTERISTICS Just as an organization is composed of various parts and components striving to function as an integrated system to accomplish its mission, every family is composed of various members who attempt to function as a system with some level of integration. …

Background and Purpose. Advances in our understanding of human genetics holds out the promise of significant diagnostic and therapeutic benefits in many fields of medicine, A number of basic questions and issues with respect to genetics and physical therapy practice and education need to he addressed. The purpose of this position paper is to highlight and explore some of those questions and issues, with the objective of advocating for increased education in relevant genetics-related topics and issues for both practicing physical therapists and students enrolled in physical therapist professional (entry-level) education programs. Position and Rationale. The position adopted in this paper is that increased education in relevant genetics-related topics and issues should be a priority for practicing physical therapists and students enrolled in physical therapist professional education programs. The rationale for this position is that in order to practice in the genomics era, health care clinicians should possess certain genetics-related competencies to more effectively manage and care for their patients. Some of the patient-related benefits that will result from an increased level of genetics education and awareness from within the physical therapy profession are the positive shaping of patients' attitudes towards genetic testing and counseling, the provision of accurate genetics information to patients, the generation of appropriate and timely referrals to genetics professionals, and effective advocacy on behalf of patients being discriminated against due to their genetic profiles. Recommendations. The implications of advances in genetics on physical therapist practice and education needs to be considered in a substantive manner. Academicians, clinicians, the American Physical Therapy Association (APTA), and the National Coalition for Health Professional Education in Genetics (NCHPEG) should initiate dialogue to decide on appropriate genetics competencies for the profession. Genetics education should be considered a priority in order for physical therapists to function as effective direct access practitioners and members of the health care team in the genomics era. Key Words: Human Genome Project, Genetics education and physical therapy, Genetics Core Competencies. INTRODUCTION Unprecedented growth in our understanding of human genetics and its role in disease, coupled with recent technological advances such as the advent of powerful gene sequencing and gene mapping techniques, are expected to yield significant diagnostic and therapeutic benefits in many fields of medicine.1-3 Because physical therapists are integral members of the health care team, physical therapist clinicians and educators alike need to consider the impact of genetics on contemporary clinical practice and education, both professional and beyond. In considering the implications of advances in human genetics on physical therapist practice and education, several basic questions need to be addressed. Should physical therapists in clinical practice concern themselves with a patient's genetic information? Are there minimum genetics competencies that clinicians should possess? Should physical therapists be educated in the ethical, legal, and social implications (ELSI) of genomics? In short, should issues relating to clinical genetics remain solely within the domain of the medical geneticist, genetic counselor, and nurse, or do they also need to be considered by physical therapists? The answers to these questions are important because they will ultimately determine the level of genetics education required by members of the physical therapy profession. Leaders in the genetics community have questioned whether primary care physicians are prepared for the incorporation of genetics into mainstream medicine,4 a question that could also be asked of physical therapists. The purpose of this position paper is to highlight and explore some of the questions and issues relating to genetics and physical therapy practice and education, with the objective of advocating for increased education in relevant genetics-related topics and issues for both practicing physical therapists and students enrolled in physical therapist professional education programs. …

Pagliarulo MA, ed. St Louis, MO 63146, Mosby, 2007, paperback, 387 pp, illus, ISBN: 0-323-03284-2, $44.95. The third edition of Introduction to Physical Therapy provides a comprehensive and current description of the profession and practice of physical therapy, as stated by the editor. The purpose and intended audience (physical therapist and physical therapist assistant students) remains consistent with the first 2 editions, published in 1996 and 2001. The book provides an overview of the current profession and practice of physical therapy in the United States. The book is organized in 2 parts: “Profession” and “Practice.” The 8 chapters in the first part define the profession of physical therapy. Chapter 1 provides a historic context for its evolution, beginning with the American Women's Physical Therapy Association in the early 1900s to the current American Physical Therapy Association (APTA) to APTA's Vision 2020 statement. Core professional documents are presented in chapter 2.Roles and characteristics of physical …

INTRODUCTION Dr Geneva R. Johnson (Figure 1) continues to influence physical therapy education as an inspirational participant in the Third Annual Geneva R. Johnson Innovations in Physical Therapy Education Forum (GRJ Forum). Dr Johnson is recognized for her longstanding leadership and mentorship, having contributed to the advancement of physical therapy education, practice, and research for over 60 years. The GRJ Forum started in 2014 through the collaborative efforts of the Academic Council of Academic Physical Therapy (ACAPT) and the Physical Therapy Learning Institute (PTLI).3,12 Once again it was the keynote for the 2016 Education Leadership Conference (ELC) held in Phoenix, Arizona. As expected, the Forum continues to foster creative ideas for positive change to promote excellence in physical therapist education, a hallmark of Dr Johnson's legacy. As in previous years, the Forum set the stage for energy, enthusiasm, and excitement for conference participants as discussions evolved to explore new opportunities to promote excellence in education. The GRJ Forum design is like no other in our profession. Key to its success is provocative speakers who share personal perspectives, immediately followed by active engagement all participants. As Tschoepe shared in her recognition to Dr Johnson and the introduction of the Forum, many remember what has become known as “Dr Johnson's 3 Ps of strong leadership skills”: passion, persistence, and perseverance. Illustrations of these, as well as other essential personal leadership skills, were explored throughout the Forum by many speakers at ELC 2016.FigureGeneva R. Johnson, PT, DPT, PhD, FAPTA, is a national leader in physical therapy education through her search of excellence in patient care, clinical research, clinical specialization, administration, staff development, and postgraduate education. Her main contribution to the advancement of the profession certainly was “to expect physical therapists to be responsible for their actions, to care about themselves and each other, to value their contributions to patient care, and to create their own futures.”1 She envisioned limitless possibilities for the profession and shared that vision with others. Dr Johnson's leadership has been acknowledged over the years by the American Physical Therapy Association (APTA) Mary McMillan Lecture Award and Catherine Worthingham Fellow (1985), the APTA Lucy Blair Service Award (1988), the Army Physical Therapy Program Outstanding Alumni Award (1994,) and the APTA Pauline Cerasoli Education Award (2008). Most recently, her legacy was recognized by the American Council for Academic Physical Therapy (ACAPT), who established the Geneva R. Johnson Annual Forum on Innovation in Physical Therapy Education. 1. Johnson GR. Great Expectations: A Force in Growth and Change. Phys Ther. 1985;65:1690–1695. THE GRJ FORUM: ORGANIZATION AND STRUCTURE The GRJ Forum is designed to: Create a safe environment for key stakeholders in physical therapy education to discuss the infinite possibilities of the future, rather than solving problems of the past. Encourage vision, innovation, creativity, and provocative new ideas that can positively influence the future of physical therapy education. Challenge educators to proactively advance physical therapy education to prepare graduates to meet projected societal and professional needs rather than merely react to external pressures.3 The 2016 GRJ Forum featured Dr Emma Stokes, an international visionary leader and current World Confederation for Physical Therapy (WCPT) president, who energized the over-800 conference participants and set the stage for ongoing conversation and idea development throughout the conference. Her keynote was followed by 3 Ignite Talks from active leaders in physical therapy education in the United States - Dr Michael Majsak, Dr Bob Rowe, and Dr Chris Sebelski. Collectively, they shared individual perspectives of what each believed to be critical to foster graduate success in physical therapist practice that is entrepreneurial in spirit, illustrates personal ownership and accountability, and offers a unique value to the health care team to facilitate optimal, efficient, and effective individual-centered health promotion and management. Discussion by over 200 participants followed these speakers, and they more thoroughly explored the 13 themes presented, and discussed “how might we” or “wouldn't it be great if…” Participants had options to discuss 2 different themes, and table facilitators shared 3 possible highlights that might illustrate innovation and educational change to include education that really matters to better prepare physical therapist graduates for success in their future professional careers THIRD ANNUAL GRJ FORUM HIGHLIGHTS Keynote Address - Walk With the Dreamers Emma Stokes, PT, PhD, is deputy head of the Department of Physiotherapy and a fellow of Trinity College in Dublin, Ireland. She teaches in the university's entry to practice and PhD programs in Dublin and Singapore. Her research focuses on matters related to professional practice; particularly, leadership in the profession. She has received numerous awards and professional recognitions for her contributions to the physiotherapy profession and has been a board member of the World Confederation for Physical Therapy (WCPT) since 2007. She was elected as the president of WCPT in 2015. Dr Stokes opened her inspirational keynote with a quote from John F. Kennedy: “Let us think of education as the means of developing our greatest abilities, because in each one of us there is a private hope and dream, which if fulfilled can be translated into benefit for everyone.” Stokes brought us on a journey, as an outside international colleague looking in, that examined whether the introduction of the DPT fulfilled its desired intentions; whether, in its current design, it meets the needs and ambitions of the profession, and whether it facilitates leadership skills needed for our graduates to be able to respond to, shape, and serve the future health needs of society. Stokes challenged all participants to reconsider curricular priorities and improve balance in our DPT education programs. Stokes reminded us of the original intentions of the move to the DPT as part of Vision 2020. Rothstein11 stated that the move to postbaccalaureate education was “based on a moral authority derived from educational need and the expectation that a profession serves society before itself,” and the “need to prepare physical therapists to exemplify the highest standards of health care, use evidence, skillfully apply techniques, be thoughtful and effective…within the confines of a healthcare system that can promise nothing but chaos for the foreseeable future.” Her review of the stated aims and key expected outcomes of Vision 2020 led her assessment to confirm that not all of the anticipated outcomes have been realized. For example, she noted the matter of reimbursement, fully implemented and available direct access, and the balance of clinical content with leadership and advocacy within DPT curriculum are not yet fully appreciated. While there is a move in countries such as Pakistan, Iran, and Taiwan to move to entrylevel DPT, as well as discourse in Canada and Australia9 suggesting such a need, the global physical therapy community has not followed suit and the baccalaureate degree remains the most common entry-level qualification. Moreover, the country with unquestionably the largest scope of practice in physical therapy—the United Kingdom—achieves this with an entry-level education requirement of a bachelor's degree. She stated unequivocally that the current DPT education was shying away from what is critically needed to develop the next generation of leaders to be equipped to advocate and lead the transformative change articulated in the ambitious plan of the American Physical Therapy Association (APTA) and to respond to the health challenges facing our communities, now and in the future. What does the next generation of DPT leaders need to lead the transformation required? Leadership development cannot be a “footnote” in our core values and in our curricula. Drawing on a conversation with Orla Tinsley, a young woman living with cystic fibrosis (CF) and a passionate advocate for people with CF, she recounted Orla's message to participants: “Sometimes in science it can be hard to reach for the marvelous. We are taught that science is a place of precision and parameters when really these are the elements we need to step into the space of the marvelous. Once we know the rules, we must not be afraid to push forward and learn how to bend and even break them in ways that can be calculated and revelatory.” Stokes asked us to reflect and be sure we have a place for both the marvelous and the matter of fact in our DPT curricula. In other words, have we enough space within a curriculum to teach the next generation of leaders the skills and knowledge they need for successful advocacy and leadership? Her view at current continues to be a resounding “no.” Stokes shared that transformative leadership requires new rules, new ways of acting, and new perspectives. It requires that we consider design not only function; story not only argument; symphony not only focus; empathy not only logic; play not only seriousness; and meaning not only accumulation.10 It will require physical therapists who understand themselves, others, and organizational dynamics, and who have the skills, capacity, and willingness to lead.4 Are we shying away? Stokes maintained the answer is yes, we are shying away from providing leadership and advocacy skills in our entry-level education. She cited the Commission on Accreditation in Physical Therapy Education's standards for professional entrylevel education, and noted that unfortunately, leadership is cited only 4 times, and on 3 occasions, it related to the faculty. If this is the behavior we want from graduates, then where is the emphasis on leadership and advocacy in these standards? She encouraged us to consider how might we create a greater urgency of the importance of curricular balance at the accreditation, program, and faculty intention levels. Stokes continued by considering the Delors et al5 report for UNESCO on education—“Learning, the treasure within”—and contends that in our entry-level programs, we teach “learning to know, and learning to do” well. However, she is not convinced that we place sufficient time and emphasis on “learning to live together and learning to be,” key aspects of personal leadership development. At the WCPT Futures Forum, Sefan Jutterdal,8 president of the Swedish Physiotherapy Association, called upon the global physiotherapy community to be more like Pippi Longstocking - responsible, courageous, and imaginative. Stokes asked participants to identify and ensure we build into curricula the responsibility to be courageous and transformative. She closed her keynote with some difficult yet insightful questions for the group: Do we reward behaviors we want? If we want the next generation to be leaders, to be advocates, to be transformative, do we reward these behaviors in the same way that we reward clinical skill performance? Do we clearly define and measure our leadership and advocacy deliverables? Do the organizations that evaluate how well we, as academic programs, achieve our educational outcomes, evaluate, and reward inclusion of leadership and advocacy learning experiences? In closing, she wished the group, “for today, for tomorrow, for the rest of the time that we teach and learn and research and educate the next generation of leaders, to ‘walk on air, against your better judgment.’7 Only in this way is it possible to teach what really matters to our future graduates!” IGNITE TALKS The IGNITE speakers had 5 minutes to share their personal perspectives to the Forum question or to offer a response to the key points of Dr Stokes’ keynote address. Each was encouraged to challenge the status quo, share new ideas and approaches, or raise emotional levels of conference participants in a manner to foster evaluation and action of new practices in physical therapy education. First Ignite Talk - Curious: What Does It Take to Believe and Act? Dr Chris Sebelski, PT, DPT, PhD, OCS, associate professor at Saint Louis University, director of the SLU-SSM Physical Therapy Orthopedic Residency Program, and a fellow of the Education Leadership Institute (ELI), offered her IGNITE TALK from a faculty and residency director perspective. She asked, why are physical therapists perceived to be better advocates for their patients than for themselves and the profession? Also, why are physical therapists comfortable with being quietly competent when the profession is in need of a unifying vision and an identifiable, marketable skill that secures a position as a provider and expert of the movement system and movement dysfunction? To answer these questions, she examined self-efficacy and actions of physical therapists in today's practice environments. Sebelski referenced Bandura,1 who describes self-efficacy as the personal judgment or conviction that one can successfully execute the behavior(s) required or execute a desired course of action to produce certain outcomes. In her recent research, over 600 therapists responded to a request to complete a standardized tool on leader self-efficacy. Through a series of questions, an aggregate score was used to determine an overall rating of perceived self-efficacy in leadership. Physical therapists in her study reported moderate to strong beliefs that they have the skills and behaviors to lead. Although the therapists in the study had moderate to strong self-efficacy leader beliefs, those therapists over 40 years of age had greater beliefs that they knew how to coach and how to inspire others, behaviors recognized by several authors to be critical in personal leadership development. These findings lead her and others to explore explicit directions to encourage attainment of positional leadership by those in our profession. Therapists need to develop skills to coach and inspire not only their patients but each other. Seasoned therapists need to live the performance accomplishments of a leader, thus giving the more novice physical therapists role models, examples, and vicarious opportunities necessary to further develop personal leadership skills early in their professional careers. Younger therapists need to be more consistently exposed to a lens where leadership skills beyond the individual patient interaction is explicitly discussed and expected. Leadership training should be intentionally addressed within curricula at entry-level, residency, and fellowship programs. She encouraged harnessing these beliefs of leader self-efficacy into the attainment of explicit leadership skills and the commitment to act in a manner that will advance our profession. Sebelski ended her IGNITE within the spirt of appreciative inquiry: “What would happen if since we strongly believe that we can lead that we actually feel empowered to act and lead?” Second Ignite Talk - Do Great Students Make Great Physical Therapists? Dr Bob Rowe is the executive director of Brooks Institute of Higher Learning (Brooks IHL) within the Brooks Health System, located in Jacksonville, Florida. Currently, he serves as a director on the APTA Board of Directors, and is the immediate past president of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Bob shared his IGNITE from a clinical practice and residency perspective. He pointed to a lack of passion demonstrated by the majority of physical therapists in today's practice environments, as evidenced by the intent “to do nothing beyond the minimum requirements of employment and licensure,” a challenge in our profession. He encouraged the academic community to develop admission criteria that consider passion and to design intentional efforts to develop passion in thoughtful learning experiences within DPT professional entry and postprofessional residency education. Rowe challenged participants to consider the types of students accepted into DPT education programs. He confirmed that we recruit academically superior students who graduate and pass the national licensure exam. Yet, only 30% of physical therapist licensees in the United States are APTA members and only 10% of these members contribute to the APTA Political Action Committee (PAC). Rowe posed 4 reflective questions: How many physical therapists show up to their employment site at the designated time and then leave at the designated end of the day? How much time do physical therapists spend in daily reflection on their patient's needs and progress or their own professional development? How many physical therapists are committed to being actual lifelong learners versus merely meeting the minimum state requirements for continuing education for licensure? How many physical therapists have ever attended a legislative advocacy hearing, or visited their state legislator or member of Congress to advocate for the profession? Rowe acknowledged that physical therapists often provide skilled services, yet questioned why they are not committed to their profession to the extent that we need them to be and wondered what is missing. Rowe compared his observations of medical students and physical therapist students and shared that medical students’ “passion quotient” does not change significantly during 4 years of medical school. Instead, it is within postprofessional residency training that medical residents become new human beings socialized with passion, an appreciation of their profession, and their role within it, with a particular emphasis on the subculture for their specialty area of practice. Rowe's recommendation to improve passion is requiring mandatory postprofessional residency program immediately after entry-level graduation. He shared his belief that residency training is the most appropriate tool to instill and nurture passion, a recognized critical leadership behavior. He was passionate in his IGNITE to share that it is only through intentional processes that we will be able to successfully instill passion that will lead to transformation of the professional, profession, association, and society. Third Ignite Talk - Walking Towards Our Vision: Are We Over Involved and Under Committed? Dr Michael Majsak, PT, EdD, associate professor and department chair at New York Medical College, recognized for his efforts to establish a DPT/MPH dual degree and for his leadership in integrating IPE curriculum across multiple graduate health professions, offered his IGNITE from an ACAPT representative academic administrator's perspective. He focused his talk on the concept of “education that matters,” a key component of this year's Forum question. Dr Majsak acknowledged that his perspectives are shared by numerous program administrators and confirmed that although we are developing excellent clinical skills in our graduates, we may not be developing reflective practitioners who are prepared to lead, represent our profession to others, and practice effectively in a constantly changing health care system. He encouraged all educators not to “shy away” from these latter essential graduate learning outcomes, but instead reevaluate how we may be over committed in teaching a wide breadth of clinical sciences and under committed to issues of professionalism, leadership, and public health necessary to attain APTA's Vision for the profession, “transforming society by optimizing movement to improve the human experience.” Dr Majsak drew a distinction between being involved versus being committed by sharing the whimsical metaphor that a hen is only involved, but a pig is fully committed in contributing to a breakfast plate of ham and eggs. Similar to the pig, Dr Majsak suggested that being committed means sometimes sacrificing things we intrinsically personally value to achieve higher priority goals, such as visions for future DPT professionals, the profession of physical therapy, and ultimately, the health of society. He challenged all stakeholders involved in physical therapist education to design not only transmissive or transactional learning experiences within DPT programs, but rather transformative learning experiences that result in structural and cultural shifts in how students think, feel, and act as a doctoring professional. Majsak went on to challenge educators to ensure that DPT students have sufficient time and experiences for self-reflection and self-directed learning, interprofessional education, and opportunities in service-based learning to appreciate and value issues in public health policy and management, as well as the social determinants of health that ultimately influence the future success of DPT graduates and our profession. CAFE STYLE DISCUSSIONS Small group café style discussions allowed all participants of the GRJ Forum to have their voices heard in reaction to the keynote address and IGNITE Talks. The discussions were facilitated using an appreciative inquiry approach to inspire purposeful changes based on the best of what currently is and with the potential of generating positive unforeseen outcomes. The focus was not on what was wrong or needed to be fixed but on what worked well. To create positive visioning, participants were encouraged to share success stories related to the discussed topic and to finish sentences such as “How might we…” and “Wouldn't it be great if we could…” Each participant had the opportunity to discuss 2 of 13 topics. The tangible outcomes of the discussions were innovative directions for physical therapy educators to explore. The 13 topics and highlights from the discussions are presented in Table 1. The themes of the discussions were on the intentions for DPT education to graduate physical therapists prepared to lead, and In a of with our group of speakers, and the Forum encouraged all 2016 ELC participants to reflect and consider what each might do to illustrate passion, persistence, and within our own of influence in this we as Dr Stokes with the and as Dr Johnson role for many years, the to act in a manner that will advance physical therapist Dr Johnson the efforts and ideas of the 2016 Forum participants and challenged us to it in some way we can share of actions at where she to evaluate our We for their contribution to the success of the Third Annual GRJ Forum and forward to Education Leadership where we will have opportunities to learn about actions by this year's Forum of this year's GRJ Forum can be on the ACAPT To the Board members of ACAPT and for their collaborative efforts in the To PT, and the for their to the Forum in Dr Geneva R. Johnson's To the table Catherine Mary and to Dr Mary ACAPT Program Committee for the necessary to the GRJ Forum a and to the ELC Program Committee members for keynote conference and space within the Education Leadership Conference for this year's

Clinician's Commentary

Background and Purpose. Health care professionals (HCPs) in the United States are beginning to realize that they work in a multicultural, multiethnic, and culturally diverse society. Prior research has shown that limited or lack of cultural adaptability and cultural competence by HCPs is potentially dangerous to patient care and treatment outcomes. Prior to studying the cultural adaptability of physical therapist (PT) students, the reliability of using cross-cultural instruments needs to be established. The purpose of this study was to establish the reliability of using the Cross Cultural Adaptability Inventory (CCAI) with PT students. Subjects. The sample consisted of 288 entry-level master's degree PT students. Methods. The CCAI, a 50-item instrument that measures the construct of cultural adaptability on 4 dimensions (emotional resilience, flexibility/openness, perceptual acuity, and personal autonomy) was administered during the fall academic semester. Results. Data were analyzed and the reliability was estimated using the Cronbach alpha coefficient of internal consistency. The total score had an estimated reliability of .90. Discussion and Conclusion. The data supported the hypothesis that the CCAI is a reliable instrument for use with PT students. Further research could explore the cross-cultural adaptability levels of faculty, students, and clinical practitioners.

Letter to the Editor-in-Chief of JOSPT as follows: "Manual Therapy: More Than Elaborate Swordplay" with Authors' Response "Comparing Dry Needling to Corticosteroid Injection for Greater Trochanteric Pain Syndrome" with Authors' Response J Orthop Sports Phys Ther 2017;47(8):580-585. doi:10.2519/jospt.2017.0204.

Purpose: To determine perspectives towards opioid use, knowledge on managing an opioid overdose, and awareness towards individuals who use opioids of Indiana physical therapy (PT) professionals. Methods: An online questionnaire was disseminated to PT professionals in Indiana from various practice settings. This questionnaire included two standardized measures, the Opioid Overdose Knowledge Scale (OOKS) and the Opioid Overdose Attitude Scale (OOAS). An additional 12 questions regarding the role of PT and other groups in the opioid crisis as well as opioid education were included. These questions were developed by discussion between investigators as well as feedback from another rehabilitation professional. Descriptive statistics were primarily used to analyze the data. Further investigation via non-parametric tests, including Mann-Whitney U and Kruskal-Wallis tests, were performed to analyze the impact of demographic variables on OOKS and OOAS scores. Results: Of 1840 surveys disseminated, the questionnaire was initiated by 67 PT professionals, while 58 participants completed it. The OOKS score was 30.24 mean (5.67 standard deviation) and the OOAS score was 90.36 (9.36). 93.1% of respondents reported wanting to help in an overdose situation, but 94.8% of respondents also reported needing more training. Only 48.3% of participants received education on the opioid crisis within the last 3 years that significantly impacted their clinical practice. Those who had opioid education in the last 3 years had higher OOKS scores (p = .003) and OOAS scores (p = .002) compared to those who did not receive opioid education. American Physical Therapy Association members had statistically significant higher OOAS scores (p = .005) but not OOKS scores (p = .322). Conclusion: A sample of PT professionals in Indiana surveyed in this study lack knowledge and awareness on opioid use, specifically managing an overdose. While most want to help, further education or training is needed for them to confidently manage these situations.

Cecilia Graham, in the 2015 Cerasoli lecture, shared her passion for a new curricular model, the concept-based curriculum. Big ideas are the focus of this type of curriculum development and the instructional goal is to develop a deep understanding of these ideas in the learner by exploring linkages between the concepts and active learning.1 A big idea is certainly embodied in the vision statement for the physical therapy profession: “Transforming society by optimizing movement to improve the human experience.”2 This vision statement has been rapidly integrated into the organizational life of the American Physical Therapy Association (APTA). For example, APTA's Board of Directors has set its 3 major goals of transforming society, the profession, and the association. Many of the components are building plans and developing activities in a similar fashion. In addition to the vision statement, 8 guiding principles have been adopted to demonstrate how the profession will appear when this vision is enacted. One of those principles is “identity”: The physical therapy profession will define and promote the movement system as the foundation for optimizing movement to improve the health of society. Recognition and validation of the movement system is essential to understand the structure, function, and potential of the human body. The physical therapist will be responsible for evaluating and managing an individual's movement system across the lifespan to promote optimal development; diagnose impairments, activity limitations, and participation restrictions; and provide interventions targeted at preventing or ameliorating activity limitations and participation restrictions. The movement system is the core of physical therapist practice, education, and research.2 This principle has generated a great deal of conversation. For example, the APTA Board has adopted this definition of the movement system: “The human movement system comprises the anatomic structures and physiologic functions that interact to move the body or its component parts.”3 At the same time, the Board adopted the following statement on the specific role of the physical therapist relative to the human movement system.3 PHYSICAL THERAPIST PRACTICE AND THE MOVEMENT SYSTEM Human movement is a complex behavior within a specific context. Physical therapists provide a unique perspective on purposeful, precise, and efficient movement across the lifespan based upon the synthesis of their distinctive knowledge of the movement system and expertise in mobility and locomotion. Physical therapists examine and evaluate the movement system (including diagnosis and prognosis) to provide a customized and integrated plan of care to achieve the individual's goal-directed outcomes. Physical therapists maximize an individual's ability to engage with and respond to their environment using movement-related interventions to optimize functional capacity and performance. Read that again. We have defined a new system of the human body and stated that physical therapists bring a unique perspective to evaluation of this system and to movement-related interventions. Nordstrom used this concept to develop an Ignite Talk at the 2014 Geneva R. Johnson Innovations in Physical Therapy Education Forum. He postulated that this topic could become the universal accepted framework for physical therapist education curriculum.4 Graham also speaks to this, saying: We envision movement system experts who are leaders, innovators, collaborators, and entrepreneurs who can synthesize rapidly changing information, integrate advances in technology into practice, and have the flexibility to thrive in an evolving health care environment.5 This is indeed a big idea, one that can serve as the focus of our curricula, our research, and our practice. Do you understand the implications of defining a new body system on all that we do? How will you change what you teach, how you teach it, or how you organize your teaching? Are you prepared for this big idea?

Lately, I've been thinking a lot about professionalism in physical therapy, more precisely, about professionalism in physical therapy education. So, too, have many others, judging from the numerous presentations and conversations about this topic at the 2004 Combined Sections Meeting of the American Physical Therapy Association (APTA) this past February. Driven by APTA's Vision 2020 statement and the vision of a doctoring profession, the recently developed and adopted document, Professionalism in Physical Therapy: Core Values,1,2 provides a valuable blueprint for physical therapy educators as they consider how to promote student learning and development as future health care professionals who will embrace and enact these core values in their everyday practice. The result of an APTA sponsored consensus conference, the document identifies and defines seven core values that are essential to professionalism in physical therapy: accountability, altruism, compassion and caring, excellence, integrity, professional duty, and social responsibility.1 As I read through the definitions and indicators put forth in this document, I couldn't help but think that teaching and learning about these values and dimensions of professionalism is not so much about what is being taught and learned as it is about how we are teaching, and, perhaps most importantly, who we are as teachers in relation to our students. Furthermore, I believe these values urge us to attend to and critically examine how we teach and who we are as faculty both individually and collectively in physical therapy education. Professing and owning these values is obviously not the stuff of rote memorization and recitation of some oath or pledge—it is living them; it is about “ways of being” with our students as they make the journey toward professionalism. Sam Feitelberg, in his recent Pauline Cerasoli address to physical therapy educators, “The Influence of Leaders,”3 echoed my thoughts, and I hope those of many others, on this matter: We should never forget that a student is a learner and should be respected…and is not a lower form of person on the road to becoming a professional. If we go forward to adopt a pledge or oath, then we have committed ourselves to behaving in a way that will bring meaning and life to the words as students recite them. Many authors have written about the importance of who we are in relation to our students (ie, our relational stance or ways of being with students in educational endeavors) and the influence of such presence on learning.4-10 This presence can have both positive and negative influences on learning. Social constructivist theories of learning remind us that teaching and learning are extraordinarily relational, contextual, and reciprocal endeavors. As such, they also remind us that learning does not just occur in one's head but through active and authentic engagement with academic content through and with other individuals. Thus, our presence as faculty (both academic and clinical) is critical. Students, educational researchers, and educational philosophers have all helped us to identify and understand characteristics, attributes, and behaviors that contribute to positive presence and that enable and enhance learning. In one recent study of physical therapist students and their approaches to learning, Sellheim9 reported positive presence factors as faculty enthusiasm, respectful and positive attitudes toward students, and accessibility. Alternatively, negative presence factors were reported as intimidation, egotistical attitudes, and mistrust. Other influential authors have urged teachers to explore and develop positive presence as a means for facilitating learning through “thoughtful teaching,”6 “mindful practice,”11,12 and, last but not least, “pedagogical sensitivity and tact.”7 The latter of these concepts, described in van Manen's7 treatise on the moral dimensions of teaching, The Tact of Teaching: The Meaning of Pedagogical Thoughtfulness, should be required reading for physical therapy educators, in my opinion. Max van Manen's reflections on our ways of being teachers and our relationship with learners can inform and potentially transform our philosophy and practice as educators. In fact, he suggests that if we cultivate tact in our teaching, then the hope of many teachers that we will “…not leave the student untouched in his or her fundamental being” is more likely to be realized.7(p187) Such an aim seems to be of crucial importance as we ponder teaching and learning about professionalism in physical therapy. It should be obvious that our presence (as individual and collective faculty) and student learning can be shaped by a variety of external and internal factors. Among these factors are the physical environment, the sociocultural climate of the educational program and university, student beliefs and perceptions about teaching and learning, and curricular design and content. I believe that the latter of these factors takes precedence when traditional views of teaching and learning, in which knowledge and course content is viewed as a thing to be delivered and transmitted to the student, reign supreme. In such conceptions, course content and knowledge is something the faculty member has (in addition to status and power) and that the student does not have, at least at the outset of a course or a curriculum. An unfortunate corollary to this view, in addition to creating haves and have-nots, can be faculty wedded to their content areas within a curriculum versus attentive to (1) the broader aims of a curriculum and (2) the people and professionals we are seeking to develop and transform through the professional educational experience. In physical therapy education, I suggest that one sign of this myopia can be our all-too-often content-driven and over-laden curricula; related symptoms can be divisiveness among and self-orientation of faculty and overburdened, frustrated, and tired students. The study by Sellheim9 found that when students feel overwhelmed by content overload and strapped for time to accomplish required tasks in physical therapist curricula, they revert to “surface” approaches to learning in spite of their desire to attain “deep” learning and understanding of the material and experiences that constitute their professional education. It is difficult for me to discern how an “education-as-commodity,” “student-as-consumer,” and “delivery-of-goods” approach to teaching and learning will help us transform our students (and ourselves, for that matter) into individuals who embody the values described in the Professionalism document. On the other hand, I find it tremendously exciting and challenging to think deliberately, critically, and, I hope, creatively, about how physical therapy educators and our students can become better models of professionalism and good stewards of the profession. Returning to my original assertion that teaching and learning about professionalism is more about how we engage with our learners and who we are in that relationship rather than about what we teach (or delivering content), I'll conclude this reflection with a quotation from a recent book titled Credo, by William Sloan Coffin.13 Although this excerpt has to do with social justice and equality/inequality, I believe it is pertinent to some of the ruminations I have put to the page here: When we are intent on being, rather than on having, we are happier. And when we are intent on being, we don't take away from other people's being— in fact, we enhance it. But when we are intent on having, we create have-nots….13(p51) In the pages of this volume you will find many articles articulating what I believe are creative and thoughtful ways of addressing some of the issues raised in this editorial, and introducing ways of facilitating learning and growth regarding the core values that have been identified as the essence of professionalism in physical therapy. You will also find a new feature—some educational software reviews that replace book reviews in this particular issue. As always, the editorial board and I welcome your comments and suggestions in response to the content of the Journal of Physical Therapy Education. Elizabeth Mostrom PT, PhD Editor

Lack of awareness and knowledge of the occupational therapy (OT) and physical therapy (PT) professions has been cited as a barrier to consideration of these professions as career options. This study examined the types of exposure to, knowledge of, and career interest in OT and PT of students from underrepresented minority (URM) and non-Hispanic White and Asian American (NHW-AA) populations. A questionnaire was administered to a convenience sample of 150 high school and undergraduate college students. Demographic data and student responses to questions regarding exposure to, knowledge of, and career interest in OT and PT were collected. Descriptive statistics and chi-square tests of association were computed, and qualitative data were analyzed for themes. The study findings revealed limited exposure to and knowledge of the OT profession among URM and NHW-AA students. Even though participants from both groups showed better knowledge about PT, they reported limited to no interest in the professions as careers. Further research is needed to examine contextual factors that may influence student perceptions of the OT and PT professions, including how clinical encounters can best be leveraged to improve public knowledge and consideration of these professions as careers for high school and undergraduate college students.

Background and Purpose. As doctors of physical therapy achieve increased autonomy and take greater leadership in the provision of health care, a correspondingly higher level of professionalism will be expected. APTA's 2006 Education Strategic Plan, Goal 7, states, Identify and use strategies to effect behavioral change in physical therapists and student physical therapists to: ... Integrate professionalism core values into physical therapy practice. The purpose of this article is to describe how recognized behavioral theory supports The Facilitation Process described by May et al as an effective approach to the development of professionalism in both the academic and practice settings. Case Description. This article presents a case study demonstrating the development of professional behavior in Jordan, a physical therapist student, as she progressed through her academic and clinical education. Using a conceptual model that shows the relationship between Prochaska and DiClemente's11 Transtheoretical Model of Change, Bandura's12 Social Cognitive Theory, and The Facilitation Process, Jordan's case is analyzed to demonstrate how the application of the conceptual model and adult learning theory contributed to her developing professionalism. The role of academic faculty is contrasted with the role of clinical supervisors in promoting professional behavior. Outcomes. The Facilitation Process provides guidance in organizing activities and interactions that are generally present in the academic or practice setting and enhances their effectiveness in promoting behavioral change without adding responsibilities to the academic advisor or clinical supervisor. Discussion. The conceptual model presented in this article demonstrates that the elements of The Facilitation Process are consistent with 2 accepted theories of behavioral change. The case analysis demonstrates how adult learning theory can enhance the effectiveness of The Facilitation Process in effecting behavior change in adult learners. Key Words: Generic Abilities, Core Values, Professional behavior, Professionalism, Behavioral change theory. INTRODUCTION In addition to a core of cognitive knowledge and psychomotor skills, success in any profession, discipline or organization requires a repertoire of behaviors.1 In part, the 2006-2020 APTA Education Strategic Plan,2 Goal 7, states, Identify and use strategies to effect behavioral change in physical therapists and student physical therapists to: ... Integrate professionalism core values into physical therapy practice. Therefore, the question is not whether professional behavior is important, but rather how to facilitate the development of the values and abilities that demonstrate professionalism. The purpose of this article is to describe how recognized behavioral theory supports 1 model, The Facilitation Process, as an effective approach to the development of professionalism in the clinical and academic setting.3 The Facilitation Process begins with a student's initial acceptance into a professional education program and extends through staff development in the practice setting. The process is consistent with accepted theories of behavioral change and adult learning theory. This article examines how recognized theory in the areas of behavioral change and adult learning supports The Facilitation Process and demonstrates how the process is applied to an authentic case of a student developing professional behaviors. The Facilitation Process can be used to aid in the development of the 10 physical therapy-specific generic abilities4 identified by the faculty of the physical therapist education program at University of Wisconsin at Madison in 1991 or the Core Values5 identified by APTA in 2002 (Figure 1). It also supports development of any set of professional behaviors identified by a given profession, discipline, or organization. The Facilitation Process does not add responsibilities to academic faculty or clinical managers. …