Entry-level Physical Therapist Research Articles

Clinical Reasoning: Survey of Teaching Methods, Integration, and Assessment in Entry-Level Physical Therapist Academic Education.

Although clinical reasoning abilities are important learning outcomes of physical therapist entry-level education, best practice standards have not been established to guide clinical reasoning curricular design and learning assessment. This research explored how clinical reasoning is currently defined, taught, and assessed in physical therapist entry-level education programs. A descriptive, cross-sectional survey was administered to physical therapist program representatives. An electronic 24-question survey was distributed to the directors of 207 programs accredited by the Commission on Accreditation in Physical Therapy Education. Descriptive statistical analysis and qualitative content analysis were performed. Post hoc demographic and wave analyses revealed no evidence of nonresponse bias. A response rate of 46.4% (n=96) was achieved. All respondents reported that their programs incorporated clinical reasoning into their curricula. Only 25% of respondents reported a common definition of clinical reasoning in their programs. Most respondents (90.6%) reported that clinical reasoning was explicit in their curricula, and 94.8% indicated that multiple methods of curricular integration were used. Instructor-designed materials were most commonly used to teach clinical reasoning (83.3%). Assessment of clinical reasoning included practical examinations (99%), clinical coursework (94.8%), written examinations (87.5%), and written assignments (83.3%). Curricular integration of clinical reasoning-related self-reflection skills was reported by 91%. A large number of incomplete surveys affected the response rate, and the program directors to whom the survey was sent may not have consulted the faculty members who were most knowledgeable about clinical reasoning in their curricula. The survey construction limited some responses and application of the results. Although clinical reasoning was explicitly integrated into program curricula, it was not consistently defined, taught, or assessed within or between the programs surveyed-resulting in significant variability in clinical reasoning education. These findings support the need for the development of best educational practices for clinical reasoning curricula and learning assessment.

Professionalism Unveiled in DPT Student Monologues

Purpose/Hypothesis: Doctor of Physical Therapy (DPT) students who reflect on personal beliefs and perform monologues in a capstone course were able to articulate strategies for advocacy and catalyzing change. Number of subjects: 40 DPT Students completed a questionnaire and participated in a focus group after performing monologue talks. Community members (n=20) in attendance at the monologue performances completed a questionnaire about lessons learned from the students. Materials and methods: This phenomenological study investigated DPT students (n=40) in a capstone course who performed Student TED (STED) talk monologues on the topic of becoming a new professional. Phenomenological methods were used to answer the following research questions: 1) How do experiences in life shape DPT student beliefs as an emerging entry-level physical therapist? 2) What do DPT students believe about their role as a new professional after performing a STED monologue talk? 3) What did the community learn about physical therapy after attending the STED monologue talks? Results: Students were shaped by personal experiences in their lives as they began transitioning identity into entrylevel physical therapists. Roles of an advocate were embraced. Students positively viewed their role in transforming society and catalyzing change through social responsibility. Community members gained a deeper understanding of what the physical therapy profession offers society. Conclusions: Beliefs of DPT students regarding the physical therapy profession were shaped by lived experiences as student transitioned to entry-level physical therapists. Students embraced advocacy as a professional duty. The community gained a deeper understanding of physical therapy. Clinical relevance: Unveiling professional identity requires reflection and an opportunity to embody professional roles beyond clinic walls. Opportunities to engage in public discourse should be encouraged in the curriculum.

Purposeful Error as a Diagnostic Tool to Assess Student Understanding and Determine Teaching Needs in the Neuromuscular Curriculum

Background and Purpose. Entry-level physical therapist (PT) students tend to make common errors when learning critical examination skills. Instructors often provide feedback on these errors during laboratory activities to enhance learning and knowledge of performance. Purposeful error by the instructor may also be used as a learning tool and as a tool for instructors to understand areas of difficulty for students. The purpose of this case report is to describe the development, implementation, and outcomes of a neurologic examination demonstration and discussion that included purposeful error to assess student weaknesses. Instructor reflections and student feedback following the session were then used to inform teaching priority areas. Case Description. Upon reflecting on performance during practical examinations, common mistakes were being made. To address these issues early in Neuromuscular 2 (NM2), the second course in a 3-part series, a plan was developed to simulate an examination. The instructors served as the patient/PT team and simulated an examination in which some items were performed correctly and others incorrectly. Students observed and identified correct/incorrect components. Areas of confusion were discussed as each error was identified. The simulation served several purposes: (1) to act as a diagnostic test to understand areas in which students were struggling, (2) to allow clarification of points of confusion, and (3) to allow instructor reflection on student weaknesses to guide teaching. Outcomes. This simulation lab has been conducted for 3 years. Each year, the instructor reflected on the examination demonstration lab and used these reflections to modify teaching of difficult concepts throughout the course. Students were pleased with the demonstration activity and felt that it was beneficial. Throughout the course, the instructor felt that student decision making improved at the midterm practical examination and scores on the final practical examination steadily increased. Discussion and Conclusion. This demonstration laboratory activity led to changes within the neuromuscular courses that were successful in improving student performance. Through a process of identifying the problem, conducting the exam as a diagnostic test, assessing immediate outcomes, altering teaching, and assessing student outcomes, the instructor was able to address the initial concern about student difficulty with some aspects of the neurologic examination. In the process, the instructor also developed as a teacher through reflection and application of change.

Educating Physical Therapist Students in Tobacco Cessation Counseling: Feasibility and Preliminary Outcomes

Smoking is the leading preventable cause of chronic disease and premature morbidity. People with physical disabilities experience elevated smoking prevalence when compared with their non-disabled peers. The physical therapy profession is dedicated to meeting needs of people with physical disabilities, yet most physical therapists (PT) do not typically provide tobacco cessation interventions. Similar deficits exist among other health professions, creating a demand for improved services to address smoking-related health burdens. Within other health professions, insufficient tobacco cessation counseling (TCC) education has been linked to a lack of interventions and may account for similar deficits in physical therapy practice. Goals were to assess feasibility, implementation, and results of a tailored TCC educational program for entry-level physical therapist (PT) students. Two cohorts of entry-level physical therapist (PT) students (n = 12 and n = 17). Educational objectives were established based on prior review of the literature, a survey of national PT education programs, and clinical guidelines for TCC established by the United States Public Health Service (USPHS). Based on these objectives, the team designed a 3-hour workshop involving didactic content and problem-based skills practice. A pre- and post-test survey was used to measure 6 dimensions: knowledge, perceived barriers, perceived facilitators, self-efficacy, outcome expectations, and self-rated skill in TCC. Within each cohort, changes in score were compared using a paired t test. The ability to apply clinical guidelines for TCC was assessed using case scenarios and structured observation. These outcomes were selected based on the Theory of Reasoned Action, which states that future behavior is determined by intention to act. Intention to act is a product of knowledge, a positive balance between perceived barriers and facilitators, strong self-efficacy, favorable outcome expectations, and necessary skills. Student satisfaction with training was assessed through anonymous written feedback. Feasibility was based on cost analysis, including material resources, as well as faculty time and effort. Following participation, both cohorts improved in knowledge, perceived facilitators, outcome expectations, and self-rated skill. Cohort 2 also showed an increase in self-efficacy (P < .01). Structured observation revealed competencies in application of clinical guidelines for case-based scenarios. Mean student satisfaction ratings for the educational experience were 5/5, and cost-estimate for delivery of the 3-hour educational intervention was approximately $32 per student. This research study demonstrated feasibility and impact of an evidence-based curricular model designed to increase likelihood of TCC by future PTs by enhancing factors known to promote TCC behaviors. The program was well-received by students, and objectives were achieved through efficient use of faculty time and resources. Subsequent research should examine the effects of training on the provision of TCC within clinical settings, as well as the impact of TCC on smoking quit rates for patients who have received this intervention as a component of their physical therapy plan of care.

The Entry-Level Physical Therapist: A Case for COMFORT Communication Training

Entry-level physical therapists provide clinical care for patients with functional mobility limitations. Their care spans the continuum of settings, disease processes, and diagnoses. Although effective communication skills are required to conduct physical therapy work, there is limited instruction provided in physical therapy education and students receive little exposure to seriously or chronically ill patients. The goal of this study was to assess the effects of communication training for the entry-level physical therapist facing palliative and end-of-life communication with patients/families. A pre–post survey design and narrative writing were used to assess the effect of the COMFORT communication training curriculum provided to doctorally trained, graduating physical therapists. The study demonstrated decreased student apprehension about communicating with dying patients and their families, and a comparison of mean scores reflecting the students’ communication knowledge, confidence, and behaviors increased in a positive direction. As students became more willing to communicate, they were also more adept at integrating task and relational messages, as well as assimilating emotional support messages for patients and families. This study shows promise for the feasibility and utilization of the COMFORT curriculum for entry-level physical therapists. Further research should address the integration of COMFORT earlier into physical therapy education, as well as assess evidence of COMFORT communication skills in the clinical context.

Diagnostic and procedural imaging curricula in physical therapist professional degree programs.

Descriptive survey. To describe the status of diagnostic and procedural imaging curricula within United States physical therapist professional degree programs. As patient direct access to physical therapy services increases, the ability to refer patients directly for diagnostic imaging could promote more efficient delivery of care. Appropriate patient referral is contingent on physical therapists having the requisite knowledge base and skills. While evidence describing imaging competence of physical therapists with advanced training in military institutions exists, evidence is lacking for other physical therapists, including new graduates of physical therapist professional degree programs. Faculty members teaching imaging at 206 United States physical therapist professional degree programs recognized by the Commission on Accreditation in Physical Therapy Education were recruited via e-mail correspondence. An e-mail attachment included the survey on which faculty reported imaging curricula and faculty qualifications, attitudes, and experiences. Faculty from 155 (75.2%) programs responded to the survey, with imaging being included in the curriculum of 152 programs. Content was integrated by required standalone courses or clinical science track courses, and/or through elective courses. The average reported estimate of imaging contact hours was 24.4 hours (range, 2-75 hours). Emphasis was on the musculoskeletal system, including 76.3% of the required standalone course content. Student competence was assessed in 147 (96.7%) programs, primarily by written (66.7%) and practical (19.7%) examinations. Faculty rated student competence on a scale of 1 (not competent) to 5 (competent), with ratings ranging from a high of 4.0 (identifying normal anatomy on plain-film radiography) to a low of 1.9 (identifying common tissue pathological processes/injuries on ultrasound). While a majority of programs reported including imaging curricula, variability was noted in all curricular aspects. These results may serve as a benchmark for faculty to assess existing curricula, allow for further development of imaging curricula, and provide a benchmark for the profession regarding current level of training for recent graduates of entry-level physical therapist professional degree programs.

Tobacco cessation counseling training in US entry-level physical therapist education curricula: prevalence, content, and associated factors.

The US Public Health Service (USPHS) recommends tobacco cessation counseling (TCC) training for all health care professionals. Within physical therapist practice, smoking can have adverse effects on treatment outcomes in all body systems. In addition, people with physical disabilities have a higher smoking prevalence than the general population, creating a strong need for tobacco cessation among physical therapy clientele. Therefore, TCC training is an important component of entry-level physical therapist education. The aims of this study were: (1) to determine need for TCC training within entry-level physical therapist education and (2) to identify potential barriers to implementation of USPHS guidelines in the academic environment. A descriptive cross-sectional survey was conducted. Directors or academic coordinators of clinical education from entry-level physical therapist programs (N=204) were surveyed using an online instrument designed specifically for this study. Data regarding program and faculty characteristics, tobacco-related training content, and faculty opinions toward TCC in both physical therapist practice and education were analyzed descriptively. The response rate was 71%. A majority (60%) of programs indicated inclusion of tobacco-related training, most commonly 1 to 2 hours in duration, and of these programs, 40% trained students in the implementation of USPHS clinical guidelines for TCC. Data analyses were constrained by limited or missing data in some areas. A single faculty member completed the survey for each program. There is a need for TCC training in entry-level physical therapist education. Inclusion may be facilitated by addressing perceived barriers toward TCC as a component of physical therapist practice and promoting the relevance of TCC as it relates to intended outcomes of physical therapy interventions.

Preparing Students to Provide Services to Older Adults

Older adults currently represent at least 40% of the clinical caseload for physical therapists,1 and their health needs promise to increase substantially over the next 20 years. As early as the mid 1980s, physical therapy educators had recognized that geriatrics content in physical therapist education program curricula was both limited and fragmented.2 Curricular inadequacies and concerns about student interest in working with older adults were noted to have continued into the late 1990s,3 prompting a special issue of the Journal of Physical Therapy Education (JOPTE) in 2001 that highlighted curricular initiatives to better prepare physical therapist graduates to work with older adults. This struggle to ensure adequate preparation of physical therapy practitioners continues and is a reflection of the struggles across the broader health care community.In 2008, a landmark Institute of Medicine report, Retooling for an Aging America: Building the Health Care Workforce,4 warned of a looming crisis-the inadequate number and preparation across the spectrum of health care workers providing services for older adults. This report prompted immediate reaction by a range of health profession groups, including the Partnership for Health in Aging (PHA) and the American Physical Therapy Association (APTA) Section on Geriatrics (SOG) (now known as the Academy of Geriatric Physical Therapy). The PHA developed and disseminated the Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry-level Health Professional Degree5 in 2010. The SOG subsequently produced and made directly available to all SOG members and PT program directors the more professionspecific Essential Competencies in the Care of Older Adults at the Completion of the Entrylevel Physical Therapist Professional Program of Study6 in 2011 (see page 91 of this issue).While the specialty sections of APTA sometimes seem to operate in isolation from each other, the Section on Education and the Academy of Geriatric Physical Therapy have worked collabo rati vely on multiple occasions over the past 30 years, facilitating research, publications, joint conference presentations, and now this second special issue of JOPTE devoted to improving geriatrics education in our profession.Physical therapist management of older adults often requires complex decision making, as a host of internal and external factors must be taken into account. Age bias, fear of working with older patients, and difficulty recognizing and prioritizing multiple interacting factors all can impact the preparation of students for this major area of clinical practice. A primary goal of this special issue was to provide a forum for faculty to share educational strategies, approaches, and experiences that address these barriers. We hope you will agree that this goal has been achieved. This special issue begins with 2 Expert Perspective papers and continues with articles that provide examples of creative and effective educational strategies to enhance the real-life preparation of physical therapy practitioners to work with older adults.Guccione and associates open this issue by providing a demographic and sociopolitical backdrop, focusing on potential and impending changes in health care financing, utilization, and delivery of care to older adults. These authors examine the challenges and opportunities inherent in these changes and their likely impact on the physical therapy profession as it strives to meet societal needs related to our aging population. Next, Wong and colleagues describe efforts over several decades to improve the entry-level educational preparation of PT and PTA students to work with older adults, including the recent development of entry-level essential competencies. These authors believe that educator utilization of these competencies, and of their model that summarizes educational setting characteristics, practice expectations and curricular themes, are critical to the preparation of a physical therapy workforce that is well-qualified and inspired to work with older adults. …

On the Summit

I have been a physical therapist long enough to remember a 1994 article in the Wall Street Journal that had a huge impact on our profession. The article, titled Health: One Bum Knee Meets Five Physical Therapists, highlighted the variability in physical therapist practice that one patient experienced for a seemingly simple diagnosis.1 Since that time, our profession has made great strides in establishing best practice guidelines for the services we provide, while still enabling every clinician to approach each patient in a personalized manner. Yet, in the world of education, we continue to live with a significant level of variability in how we teach our students. We ask our clinical instructors to teach students who come from a variety of academic programs that have a variety of curricular structures. These students come in with varying levels of preparation and varying expectations for performance. Our peer professions, patients, and employers struggle with this level of variability as well. However, as Jette et al state in the first article in this issue, while the evidence on best practices in physical therapist clinical education is not always strong, as professionals we have to make decisions based on best available evidence. It is time for us to take that step as educators.I am excited to present you with this special issue of the Journal of Physical Therapy Education focused on clinical education as a key step in this process. As a former director of clinical education, I am well aware of our profession's efforts over many years to improve clinical education, often through standardization of processes and cooperation across programs. Our profession has had a number of successes in this process: the development of the Clinical Performance Instrument, the credentialing of clinical instructors, formation of many active regional consortia, to name just a few. However, any of us involved in clinical education are aware of many of the challenges that we face.As our profession has grown and developed, the climate surrounding physical therapist education has changed as well. Health care reform, changes in Medicare payment structures, population demographics, and the increased emphasis on chronic disease management have all influenced our current system of clinical education. The changing landscape of health care and its influence on education was part of the reason for the formation of the American Council of Academic Physical Therapy (ACAPT), which has provided physical therapist academic programs with a structure to facilitate decision making on issues related to physical therapist education. These past successes and current challenges in clinical education, combined with the efforts of ACAPT, that created the motivation to orchestrate a change in clinical education. At the 2012 APTA Combined Sections Meeting in Chicago, the construct of a process for developing a for physical therapist clinical education began. From this first meeting, it was recognized that a shared vision is one that recognizes and strengthens partnerships across the entire spectrum of physical therapist education, from entry-level through postprofessional, clinical through academic.As a current member of the ACAPT Board of Directors, I serve as co-chair on the steering committee that is guiding this process. This steering committee is comprised of 10 members representing the Education Section, the Clinical Education Special Interest Group (CESIG) of the Education Section, ACAPT, the Federation of State Boards of Physical Therapy (FSBPT), and APTA, and includes members who are directors of clinical education, academic program administrators, and clinical faculty. Together, we have collaborated on a process that leads us to a Clinical Education Summit in October 2014 where we anticipate reaching agreement on best practices for clinical education in entry-level physical therapist education with specific recommendations to ACAPT for implementation. …

Geriatric Screening as an Educational Tool: A Case Report

BACKGROUND AND PURPOSEThe aging population is growing in the United States. Currently, 1 in 8 Americans is over the age of 65,1 with a projected increase to 1 in 5 by 2030.2 In response to the increasing aging population in the United States, the American Geriatrics Society3 and the American Physical Therapy Association (APTA) Section on Geriatrics4 (now known as the Academy of Geriatric Physical Therapy) released essential competencies for practitioners working with older adults. The American Geriatrics Society established general competencies designed to be used by practitioners in a variety of health care disciplines that work with older adults.3 The APTA Academy of Geriatric Physical Therapy's Essential Competencies in the Care of Older Adults at the Completion of the EntryLevel Physical Therapist Professional Program of Study4 (see page 91 of this issue) serves as a guide for accredited physical therapy education programs in teaching students how to provide care for older adults. The establishment of the essential competencies4 provides a framework for physical therapist education programs to ensure that their students meet competencies upon entry into the profession. Currently, the literature lacks evidence of innovative methods that graduate physical therapist education programs are using to meet these essential competencies.4Didactic and laboratory classroom experiences are essential initial components for teaching physical therapist students to work with an aging population. With a classroom foundation, clinical experiences allow students to hone skill sets with a variety of patient populations, including older adults. Experiential learning provides a bridge between the classroom and the clinic and serves the important purpose of reinforcing classroom learning5 and increasing cultural competence.6 Experiential learning, when conducted in communities and settings that are underserved, aligns with the Commission on Accreditation in Physical Therapy Education (CAPTE) criteria and the APTA core values related to social responsibility and advocacy7,8 and provides the opportunity to develop social responsibility.9 Using experiential learning as an adjunct to classroom education about the older adult population could be an important component in developing the essential competencies4 for working with older adults. This case report is a description of an experiential learning activ- ity for first-year physical therapist students to supplement didactic coursework that could be easily replicated by other physical therapist education programs.The Widener University Institute for Physical Therapy Education (IPTE) has older adult content embedded throughout the 3-year didactic curriculum in various courses that emphasize musculoskeletal, neuromuscular, integumentary, and cardiovascular systems in various practice settings, including acute care, outpatient, and skilled nursing facilities, covering such topics as therapeutic exercise intervention for the older adult, motor control and motor learning, health literacy, multisystem aging, and in-depth selected topics in aging.10 The courses with geriatric content focus on a number of different essential competencies for the older adult. In the first-year physical therapist education, students take a 2-credit Lifespan Adulthood course. This course focuses on the broader psychosocial, motor, and cognitive aspects of aging, as well as broader subjects such as ageism and successful aging, and serves as an introduction to topics that will be explored in greater depth in other coursework. The course also places an emphasis on health screening for older adults. Students are taught that early detection of physical performance deficits, depression and cognitive changes, and appropriate intervention by the health care team can help to interrupt loss of physical function that older adults can experience.11,12 Students learn to advocate for appropriate levels of physical activity to promote the health and wellness of older adults. …

Integrated Clinical Experiences in a Campus Onsite Clinic: A Self-Contained Model of Physical Therapy Clinical Education

Purpose: This paper describes a self-contained model of integrated clinical experiences (ICEs) that take place during the academic portion of an entry-level physical therapist education program in a campus onsite clinic. Description of Model: Students participate in ICEs for three consecutive semesters. Students provide pro bono physical therapy services to individuals with impairments, functional limitations, or changes in physical function resulting from a variety of health conditions. In addition, students participate in an exercise/wellness program for individuals who wish to improve or maintain their current levels of fitness. The first ICE consists of second-year students observing/assisting third-year students in the onsite clinic with basic patient care skills and participation in an exercise/wellness program. Students in the second and third ICEs provide ongoing one-on-one skilled therapy for individuals with neurological or musculoskeletal diagnoses. Results: Feedback obtained from onsite clinical instructors, core academic faculty, students, and patients receiving care in the onsite clinic through group debriefings, questionnaires, and interviews is used to assess students’ readiness for full-time internships and effectiveness of the ICEs. The feedback reveals that the ICEs are meeting their intended goals. Category ratings in the “red flag” areas of the Clinical Performance Instrument (CPI) are consistently above expected levels for students completing their first full-time clinical internship. In addition, patients receiving care in the onsite clinic report a high level of satisfaction with the care provided. Conclusion/Possible Recommendations: This model provides students with an opportunity to gain clinical confidence in a realistic setting while reinforcing concepts presented in academic coursework. Providing ICEs on campus decreases reliance on clinical facilities and allows for academic program oversight of the quality of the learning experiences and early identification of students who have deficits in clinical skills and/or academic knowledge. The learning experiences provided in the onsite clinic give students a transitional experience that helps them benefit more fully from full-time internships. A potential challenge to this model is finding the space and financial resources needed to make it viable.

A Clinical Service Learning Program Promotes Mastery of Essential Competencies in Geriatric Physical Therapy

BACKGROUND AND PURPOSEIn 2010 there were 40 million older adults, defined as those 65 years of age and older, in United States. This number is predicted to more than double by year 2030.1,2 By 2050, individuals 65 years of age and older will make up approximately 20% of US population.2,3Older adults are a heterogeneous group ranging from those who are frail elders to elite athletes. Brummel-Smith4 defined optimal aging as the capacity to function across many domains-physical, functional, cognitive, emotional, social, and spiritual-to one's satisfaction and in spite of one's medical conditions. A large majority of older adults fail to live into this ideal. The slippery slope of aging described by Schwartz5(P3) depicts a general decline in physiological and functional ability that has been observed with increasing age. Approximately 80% of older adults report living with at least 1 chronic medical condition and 50% have 2 or more.6 Obesity, arthritis, diabetes, osteoporosis, hypertension, heart disease, stroke, depression, injuries related to falls, and hearing and vision impairments often co-occur with typical multisystem changes associated with aging.7'9 Age-related decline in physical performance in conjunction with additional pathologic conditions often results in loss of functional ability. Approximately 36% of older adults report a disability of some kind, with 23% reporting limitations in walking and 8% reporting some dependence in self-care.10Physical therapists must be able to identify variable needs of older adults and provide care that is commensurate with those needs in order to promote optimal aging and quality of life. Physical therapist education programs must prepare future PTs to address health promotion, safety, mobility, and physical performance issues of older adults. Students need to recognize normal changes that occur with aging, understand common pathologies associated with older adults, and then discern among effects of new pathology, normal effects of aging, or a combination of two in order to direct care appropriately. They must be able to engage in interprofessional collaboration and caregiver training in order to provide competent care to older adults across health care continuum and in community.The American Physical Therapy Association Section on Geriatrics (now known as Academy of Geriatric Physical Therapy) developed Essential Competencies in Care of Older Adults at Completion of Entry-level Physical Therapist Professional Program of Study (see page 91 of this issue)11 to identify skills necessary to provide competent care to this older adult population. The essential competencies11 are organized into following 6 domains: Health Promotion and Safety, Evaluation and Assessment, Care Planning and Coordination Across Care Spectrum, Interdisciplinary and Team Care, Caregiver Support, and Healthcare Systems and Benefits. Within each of these 6 domains,11 cognitive, psychomotor, and affective skills essential to providing physical therapy care to older adults are identified. A variety of pedagogical approaches may help to ensure that academic programs in physical therapy foster student development of these skills in order to serve aging population.Service learning and other experiential learning opportunities may help enhance academic coursework that prepares students to fulfill essential competencies.11 Service learning combines community service with academic coursework for purposes of satisfying explicit academic objectives.12,13 Experiential learning can also be accomplished through student participation in provision of volunteer services, which are often provided free of charge.14'16 In both cases, students have opportunity to apply classroom knowledge to real-world scenarios and develop cognitive, psychomotor, and affective skills relevant to physical therapist practice, including practice with older adults. …

Building the Physical Therapy Workforce for an Aging America

BACKGROUND AND PURPOSEA landmark Institute of Medicine (IOM) Report in 2008, Retooling for an Aging America: Building the Healthcare Workforce,1 provided a discouraging assessment of the readiness of the health care workforce to meet the needs of the rapidly growing older adult population and stressed the critical need to enhance educational preparation in geriatrics. The IOM report examined workforce data and educational preparation across the spectrum of health disciplines, concluding that (1) the health care workforce in general is inadequately prepared to deliver effective and efficient health care services to older adults, and (2) the numbers of health care practitioners choosing to specialize in geriatrics is critically insufficient to meet the needs of the population.This is not the first call for greater emphasis on geriatrics in health professional education. This need was widely discussed in the late 1970s and early 1980s.2,3 The IOM's 1978 report 'Aging and Medical Education4 focused on the changing demographics and the need to better prepare clinicians for these changes. The implementation of geriatric education centers (GECs)5 by the US Public Health service in 1983 was spurred by the recognition of this growing and unmet need for better preparation of health care practitioners in geriatrics.In 1990, the APTA's Department of Accreditation, recognizing the critical need for enhanced geriatric content, received an Administration on Aging grant to support a project aimed at enhancing the aging-related content and learning experiences in physical therapist (PT) and physical therapist assistant (PTA) education programs. A survey was conducted, resource manual produced, and a cadre of physical therapy professionals with advanced knowledge in geriatrics were trained as onsite reviewers for the accreditation of PT and PTA academic programs.Despite the effort of many over the years, the gap between the need for and the existence of a well-prepared workforce remains large. A crisis is now upon us. Older adults are currently the predominant group using the health care system. Older adults access the health care system at 3 times the rate of other age groups, have longer hospital stays, have more office visits, and spend more money on health care than other age groups.6 Given our population demographics, this growth will continue for at least the next several decades. A workforce well prepared to deliver quality health services in a resource-efficient and clinically effective manner is essential to meet the health care needs of the population. Quality health care for older adults will not be achieved through the services of specialists alone. All health professionals must have a solid preparation in the management of older adults, and students seeking entry to health professions programs should recognize that the majority of them will regularly work with older adults.The patient demographics within physical therapy mirror other health professions. In the 2011 Analysis of Practice for the Physical Therapy Profession: Entry-Level Physical Therapists7 commissioned by the Federation of State Boards of Physical Therapy, a large and representative sample of PTs reported the percentage of their typical caseload by age bracket (18 or younger, 19-65, 66 or older). The summary data indicated that, on average, 47% of patients managed by PTs are 66 years of age or older. This compares to 37% of patients between 19-65 and 13% of patients 18 years or younger. The parallel document for the PTA, the Analysis of Practice for the Physical Therapy Profession: Entry-Level Physical Therapist Assistants,8 reports that, on average, 63.6% of the patients treated by PTAs are 66 years of age or older, 28.8% are between the ages of 19-65, and 5.5% are 18 years of age or younger. Thus, the older adult constitutes an even higher percentage of the PTAs caseload.Bardach and Rowles9 reported on the contemporary status of geriatric education across 7 health care disciplines, including physical therapy. …

Utilization of an Integrated Clinical Experience in a Physical Therapist Education Program

Background and Purpose. Integrating skills learned in the classroom into the clinical setting can be challenging. An integrated clinical experience (ICE) is an active-learning method allowing early interactions between physical therapist students and patients/clients. The purpose of this paper is to describe an ICE model that includes peer mentoring, service learning, and pro bono components. Method/Model Description and Evaluation. The ICE consists of 3 courses offered in successive semesters. Peer mentoring occurs during the first and third semesters. All sessions are supervised by faculty. Students work 1-on-1 with patients/clients who commit to participating throughout the entire semester. An examination and individualized plan of care is completed for each patient/client. Students are challenged to provide interventions that are practical and meaningful for patients/clients with different levels of functional ability. Physical therapist students, with faculty guidance, explore patient/client problems, co-morbidities, and intervention strategies leading to future interventions and treatment goals through a debriefing meeting at the end of each session. At the end of each course, a group debriefing is completed to assess the method of teaching. Outcomes. Topics assessed in the group debriefing include: (1) ICE strengths and challenges, (2) individual task strengths and challenges, (3) suggested course/curriculum changes, (4) benefits and challenges working with wellness and previous patients/clients, and (5) guided reflection of what was learned during the pro bono experience. Discussion and Conclusion. The ICE advances entry-level physical therapist student clinical exposure, provides students the opportunity to advocate for health and wellness in a pro bono service-learning setting, and promotes 1-on-1 patient/client care, which will increase the physical therapist student’s ability to modify plans of care. This method model describes a developed and implemented ICE for an entry-level physical therapist education curriculum. Based upon the student and faculty experiences implementing and assessing the ICE model within Clarke University’s physical therapist education program, the authors encourage similar education programs to consider developing an integrated clinical experience within their curricula as a means to provide early exposure to advocacy for patients/clients in a planned experience. This allows for early practice, development, and assessment of affective, psychomotor, and cognitive skills in a supervised setting to prepare for external clinical education experiences and future clinical practice.

Preparing physical therapy students for the role of clinical educator: A case study report

The purpose of this case report was to describe an innovative model for transforming physical therapist students into clinical instructors with the use of a pro bono clinic. This model may assist other academic programs in creating effective approaches to transition entry-level students into future quality clinical instructors. Third year physical therapist students served as clinical instructors for second year students. Peer and self assessments were collected to assess intended objectives. Second year students were made more aware of the role of the clinical instructor and were able to evaluate the effectiveness of clinical teaching and third year students appreciated the impact of clinical teaching and increased their desire to become clinical instructors in the future. Student self and peer assessments reveal that this experiential model is an effective way of transitioning entry-level physical therapist students into the role of clinical instructor.

Students' description of factors contributing to a meaningful clinical experience in entry-level physical therapist professional education

The objective of this study was to identify student, clinical instructor (CI), and environmental characteristics and behaviors that make for positive clinical experiences as perceived by physical therapy students. Nine third-year physical therapist students from entry-level physial therapist education programs around the United States participated in this study. In this phenomenologic study, participants were interviewed using open-ended questions designed to facilitate rich description. Interviews were recorded, transcribed, validated, and analyzed. Themes were identified through collaborative analysis using constant comparative coding. Students described student, CI, and environmental factors and behaviors that contribute to a quality clinical experience, including: the students' demonstration of initiative to prepare for the clinical experience and preparation after clinic hours; the importance of the CI's insight, allowing CIs to ascertain how much guidance to give in order to foster independence in the student; and the clinical environment's ability to welcome a student and provide the student with novel learning experiences. The student descriptions, including positive and negative examples shared by the interviewees, demonstrate essential characteristics that contribute to a positive clinical experience. Many of the factors identified by students can be influenced by student and CI training and preparation prior to the clinical experience.

Clinical Instructors' Perspectives

This study explored clinical instructors' perspectives regarding specific aspects of pediatric content that should be included in the curricula of entry-level physical therapist education programs. This mixed methods sequential explanatory study was conducted using 2 groups of participants. The survey-only group consisted of 278 participants who anonymously completed a Web-based survey. The mixed-data group consisted of 9 purposively selected participants who completed the Web-based survey and participated in a one-on-one qualitative interview that explored their survey responses. Participants provided recommendations pertaining to the depth and breadth of pediatric content in entry-level curricula. A diagram was created to depict the participants' perspectives on how pediatric content in the entry-level curricula should be structured. Clinical instructors offer valuable insights that can be used to guide entry-level curricular content in pediatrics. The results of this study may assist physical therapist faculty in preparing students for entry-level practice in pediatrics.

Measures of Evidence in Evidence-Based Practice

Measures of Evidence in Evidence-Based Practice

Physical Therapy Clinical Educatorsʼ Perspectives on Students Achieving Entry-Level Clinical Performance

Background and Purpose. The move to a doctorate in physical therapy education has led to changes in the expectations for entry-level student performance. Members of the Iowa Clinical Education Consortium were interested in how clinical educators in their region would respond to this change in expectations. The purpose of this study was to explore the range of opinions among clinical educators regarding the educational implications of an enhanced definition of entry-level physical therapist performance. Participants. Thirty-four clinicians from the Midwest were invited to participate in regional focus groups. Methods. Each focus group was asked the same 3 questions considering a proposed entry-level definition: what ideal clinical education would look like; what obstacles would need to be overcome; and what support would be needed to achieve ideal clinical education based on the definition. Results. A multi-step process of thematic analysis was used to determine the core themes identified by the participants. These themes related to various academic and administrative issues that need to be addressed to implement the proposed definition in the clinical setting. These issues were diverse in nature and varied across and within practice settings. Discussion and Conclusion. This research contributes to the literature by identifying key concepts and concerns of clinical instructors in relation to implementation of the proposed definition of entry-level performance. This research provides a foundation for further exploration of this issue in terms of clinical educators' expectations of what would be necessary to implement the new definition and the potential impact on their current practices. Key Words: Clinical education, Entry-level education, Qualitative research. BACKGROUND AND PURPOSE Entry-level education in physical therapy has changed markedly in the past 20 years, not only in numbers of education programs and degrees awarded, but in curricular content. Eighty- six percent of the accredited physical therapy programs awarded a doctorate level degree in 2007, as compared to only 9.4% in 2000, and zero in 1987.1 Clinical education, or learning in the context of patient care, has always been a significant component in all physical therapist professional education programs, and now accounts for an average of 31.3% of the time spent in a physical therapist programs professional curriculum. The average total length of full-time clinical education has increased from 29.2 weeks in 2001 to 33.6 weeks in 2007. However, there is wide variation in total length of clinical education between programs, with a range of 20 to 55 weeks.1 As the clinical education portion of the curriculum has expanded, more has been asked of the facilities providing clinical education and their clinical instructors (CIs). Coupled with the increased length of clinical education experiences is the expectation that graduates will enter the profession with a higher level of competency, requiring less guidance or supervision when addressing patient problems, and demonstrating competent time-management skills.2'3 For physical therapist education programs to be accredited by the Commission on Accreditation of Physical Therapist Education (CAPTE), they must meet stringent evaluative criteria. The criteria state that schools must document that their clinical education experiences encompass: (a) management of patients/clients representative of those commonly seen in practice across the lifespan and the continuum of care, (b) practice in settings representative of those in which physical therapy is commonly practiced, (c) interaction with physical therapist role models whose practice is consistent with the program's philosophy of practice, (d) opportunities for involvement in interdisciplinary care; and (e) other experiences that lead to the achievement of expected student outcomes.4 The first goal of the Education Strategic Plan from the American Physical Therapy Association (APTA) emphasizes the importance that the profession has placed on quality clinical education. …

Exploring the cultural adaptability of doctoral entry-level physical therapist students during clinical education experiences.

Doctor of Physical Therapy Student Department of Health Care Sciences George Washington University Washington, DC