Third Annual Geneva R. Johnson Forum on Innovations in Physical Therapy Education: Formation of a Doctoring Professional: Are We Shying Away From Education that Really Matters in the Lives of Our Graduates?

Abstract

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 overarching themes of the discussions were centered on reaching the ultimate intentions for DPT education to graduate physical therapists prepared to lead, transform, and serve. CONCLUSION In a spirit of collaboration with our collective group of speakers, facilitators, and participants, the Forum coordinators encouraged all 2016 ELC participants to reflect and consider what each might do to illustrate passion, persistence, and perserverence within our own sphere of influence in this upcoming year. By doing so, we will, as Dr Stokes suggested, “walk with the dreamers,” and as Dr Johnson role modeled for so many years, “have the courage to act in a manner that indeed will advance physical therapist education.” Dr Johnson applauded the efforts and ideas of the 2016 Forum participants and challenged us to “make it happen” in some measurable way so we can share impacts of actions at 2017 ELC, where she plans to evaluate our progress! We thank everyone for their contribution to the success of the Third Annual GRJ Forum and look forward to 2017 Education Leadership Conference, where we will have opportunities to learn about actions inspired by this year's Forum discussion. An audio version of this year's GRJ Forum can be found on the ACAPT website (www.acapt.org.) ACKNOWLEDGEMENTS To the Board members of ACAPT and PTLI, for their collaborative efforts in supporting the Forum. To Beth Whitehead, PT, MBA, and the Whitehead Family Foundation, for their financial support to sponsor the Forum in Dr Geneva R. Johnson's name. To the table facilitators: Drs Denise Bender, Jacki Brechter, Nathan Brown, Catherine Certo, Amy Crocker, Mary Dockter, Mike Emery, Tony English, Sarah Gilliland, Jennifer Green-Wilson, Janet Gwyer, Laurie Hack, Karen Huhn, Chad Jackson, Merrill Landers, Sarah Luna, Terry Nordstrom, Mark Reinking, Anita Santasier, Mike Sheldon, Doreen Stiskal-Galisewski, and Susan Wainwright. Special thanks to Dr Mary Blackinton, ACAPT Program Planning Committee chair, for the support necessary to make the GRJ Forum a success, and to the ELC Program Planning Committee members for offering keynote conference and programming space within the Education Leadership Conference for this year's Forum.