Physical Therapist Education Research Articles

A systematic review of assessments for procedural skills in physiotherapy education / Assessment von prozeduralen Fähigkeiten in der physiotherapeutischen Ausbildung: Ein systematischer Review

Abstract Introduction Learning of procedural skills is important in the education of physiotherapists. It is the aim of physiotherapy degree programmes that graduates are able to practice selected procedures safely and efficiently. Procedural competency is threatened by an increasing and diverse amount of procedures that are incorporated in university curricula. As a consequence, less time is available for the learning of each specific procedure. Incorrectly performed procedures in physiotherapy might be ineffective and may result in injuries to patients and physiotherapists. The aim of this review was to synthesise relevant literature systematically to appraise current knowledge relating to assessments for procedural skills in physiotherapy education. Method A systematic search strategy was developed to screen five relevant databases (CINAHL, Cochrane Central, SportDISCUS, ERIC and MEDLINE) for eligible studies. The included assessments were evaluated for evidence of their reliability and validity. Results The search of electronic databases identified 560 potential records. Seven studies were included into this systematic review. The studies reported eight assessments of procedural skills. Six of the assessments were designed for a specific procedure and two assessments were considered for the evaluation of more than one procedure. Evidence to support the measurement properties of the assessment was not available for all categories. Discussion It was not possible to recommend a single assessment of procedural skills in physiotherapy education following this systematic review. There is a need for further development of new assessments to allow valid and reliable assessments of the broad spectrum of physiotherapeutic practice

Physical therapist postprofessional education in the United States and Australia

Background: In line with policy recommendations from the World Confederation of Physical Therapy, Australia (AUS), and the United States (USA) actively promote postprofessional physical therapist education. Although postprofessional education pathways vary, the goal of educating specialists within the profession is shared.Objectives: In order to advance education, and ultimately the profession, it is necessary to understand what is offered for postprofessional programs. Therefore, this study aimed to investigate and compare physical therapist postprofessional education in two regions of the world.Methods: Data were collected from relevant professional organizations, electronic media, and academic programs. Descriptive statistics were generated to compare postprofessional programs in AUS and USA.Major Findings: Variation was demonstrated in postprofessional education between both countries. Notably, the number of programs was observed to be growing in the USA, but declining in AUS, where six programs closed during data collection. AUS offered 41 postprofessional programs, while the USA offered 242 residency, and 49 fellowship, programs. USA and AUS had the most programs in musculoskeletal/sports, 42.6% and 24.4%, respectively. Conversely, geriatrics comprised only 7.4% of USA residence programs and 0% of AUS clinical academic programs.Conclusion: This research compared postprofessional education in AUS and USA and demonstrated universal issues related to accessibility and programming. The declining number of programs in AUS is of great concern and warrants evaluation of postprofessional education globally. Educators need to ensure that postprofessional education is accessible, innovative, meets the population needs. This research demonstrates opportunities for international collaboration within the physical therapy profession to advance education and ultimately the profession.

National Study of Excellence and Innovation in Physical Therapist Education: Part 2-A Call to Reform.

This perspective shares recommendations that draw from (1) the National Study of Excellence and Innovation in Physical Therapist Education research findings and a conceptual model of excellence in physical therapist education, (2) the Carnegie Foundation's Preparation for the Professions Program (PPP), and (3) research in the learning sciences. The 30 recommendations are linked to the dimensions described in the conceptual model for excellence in physical therapist education: Culture of Excellence, Praxis of Learning, and Organizational Structures and Resources. This perspective proposes a transformative call for reform framed across 3 core categories: (1) creating a culture of excellence, leadership, and partnership, (2) advancing the learning sciences and understanding and enacting the social contract, and (3) implementing organizational imperatives. Similar to the Carnegie studies, this perspective identifies action items (9) that should be initiated immediately in a strategic and systematic way by the major organizational stakeholders in physical therapist education. These recommendations and action items provide a transformative agenda for physical therapist education, and thus the profession, in meeting the changing needs of society through higher levels of excellence.

National Study of Excellence and Innovation in Physical Therapist Education: Part 1-Design, Method, and Results.

The Carnegie Foundation for the Advancement of Teaching commissioned the Preparation for the Professions Program, a qualitative study of professional education in 5 professions: medicine, nursing, law, engineering, and clergy. These studies identified curricular structures, instructional practices, assessment approaches, and environmental characteristics that support the preparation of professionals and led to educational reforms. The physical therapy profession has not had any in-depth, national investigation of physical therapist education since the Catherine Worthingham studies conducted more than 50 years ago. This research was a Carnegie-type study, investigating elements of excellence and innovation in academic and clinical physical therapist education in the UnitedStates. Five physical therapist education researchers from across the United States used a qualitative multiple-case study design. Six academic and 5 clinical programs were selected for the study. The academic institutions and clinical agencies studied were diverse in size, institutional setting, geography, and role in residency education. Qualitative case studies were generated from review of artifacts, field observations, and interviews (individual and focus group), and they provided the data for the study. A conceptual framework grounded in 3 major dimensions was generated, with 8 supporting elements: (1) culture of excellence (shared beliefs and values, leadership and vision, drive for excellence, and partnerships), (2) praxis of learning (signature pedagogy, practice-based learning, creating adaptive learners, and professional formation), and (3) organizational structures and resources. Building on the work of the Carnegie Foundation's Preparation for the Professions Program, a conceptual model was developed, representing the dimensions and elements of excellence in physical therapist education that is centered on the foundational importance of a nexus of linked and highly valued aims of being learner centered and patient centered in all learning environments, both academic and clinical.

Advancing Pain Education in Canadian Physiotherapy Programmes: Results of a Consensus-Generating Workshop.

Purpose: This article reports on a national stakeholder workshop that focused on advancing pain education in physiotherapy programmes across Canada. Methods: Workshop participants included national leaders from the following stakeholder groups: people living with pain; physiotherapy students and recent graduates; pain educators; physiotherapy programme administrators; and representatives from the Canadian Alliance of Physiotherapy Regulators, Physiotherapy Education Accreditation Canada, Canadian Physiotherapy Association, and Physiotherapy Practice Profile project. During the workshop, barriers to, facilitators of, and strategies for advancing pain education were discussed, and a stakeholder-endorsed consensus statement was generated. The workshop was recorded, and data were thematically analyzed. Results: Participants identified important barriers and facilitators associated with the field of pain, standards and regulatory processes, physiotherapy programmes, and physiotherapy students and people living with pain. Strategies for advancing pain education included integrating pain competencies into standards and regulatory policy, encouraging the development of best teaching practices, partnering with people living with pain, building awareness, and setting goals and assessing clear outcomes. The consensus statement highlighted the central importance of pain education for physiotherapists and the need for a reference standard to guide its implementation in the Canadian context. Conclusion: This was the first initiative to specifically explore national stakeholders' perceptions of pain education. The workshop outcomes provide a strong mandate and direction for advancing pain education across Canadian physiotherapy programmes.

Patterns of Clinical Reasoning in Physical Therapist Students.

Clinical reasoning is a complex, nonlinear problem-solving process that is influenced by models of practice. The development of physical therapists' clinical reasoning abilities is a crucial yet underresearched aspect of entry-level (professional) physical therapist education. The purpose of this qualitative study was to examine the types of clinical reasoning strategies physical therapist students engage in during a patient encounter. A qualitative descriptive case study design involving within and across case analysis was used. Eight second-year, professional physical therapist students from 2different programs completed an evaluation and initial intervention for a standardized patient followed by a retrospective think-aloud interview to explicate their reasoning processes. Participants' clinical reasoning strategies were examined using a 2-stage qualitative method of thematic analysis. Participants demonstrated consistent signs of development of physical therapy-specific reasoning processes, yet varied in their approach to the case and use of reflection. Participants who gave greater attention to patient education and empowerment also demonstrated greater use of reflection-in-action during the patient encounter. One negative case illustrates the variability in the rate at which students may develop these abilities. Participants demonstrated development toward physical therapist--specific clinical reasoning, yet demonstrated qualitatively different approaches to the patient encounter. Multiple factors, including the use of reflection-in-action, may enable students to develop greater flexibility in their reasoning processes.

Counting the Dead: Who is Teaching Anatomy to Physical Therapy Students?

Background and Purpose. The purpose of this paper is to provide a summary of the history and current literature surrounding the use of unclaimed dead in anatomy education and to quantify the number, origin, and donation status of cadavers being used in teaching anatomy in physical therapist (PT) education programs. This data will support the need for anatomy educators in PT education programs to inform themselves and their students about willed body donation programs. Faculty should insist that every cadaver used in anatomy education in PT education programs has consented to be there. Participants. A list of accredited PT education programs was created (n = 217), and a survey was sent to each school for the anatomy educator to complete. Methods. An electronic survey was generated to collect number, sources, and origins of cadavers used in anatomy education in PT education programs. Descriptive statistics were used to report survey responses. Results. There were 99 responses (46% response rate), representing anatomy educators from 40 states. Anatomy educators reported during the past year they have taught PT anatomy alongside a total of 930 cadavers, and identified the sources of their cadavers: medical schools (52%); in house gift programs (24%); state anatomy boards (17%); private organizations (5%); a willed body program not attached to a medical school or in house (1%); and no source, as the program does not use cadavers (1%). Anatomy educators were asked if they knew the origin of the donors using the following definitions: (1) Registered donor: individual has consented to participate in anatomy education; (2) next of kin: family member has provided consent; (3) unclaimed dead: neither the individual nor a family member has provided consent. Discussion and Conclusions. Seventy-eight percent of anatomy educators reported knowing the origin of cadavers used to teach physical therapy anatomy, 10% reported not knowing, and 12% were uncertain. Anatomy educators reported that 72% (n = 670) of cadavers are registered donors, 3% (n = 30) are next of kin donations, and 0% (n = 0) are unclaimed dead. Anatomy educators were not able to categorize 25% (n = 230) of cadavers used during anatomy instruction in PT education programs. While the majority of PT education programs access cadavers via a medical school that has an anatomical gift program, some rely on state anatomy boards, private organizations, or on multiple sources. Most anatomy educators in PT education programs know the origin of the cadavers they use during instruction (78%), but some are uncertain. Anatomy educators report that their nonliving colleagues are mostly registered donors, and some are next of kin donations. No respondents report working with unclaimed dead. There is a difference of 230 cadavers (25%) who are not accounted for as registered, next of kin, or unclaimed. While these researchers recommend that direct consent be obtained from all of our nonliving colleagues, this could result in temporary donor shortages in anatomy laboratories. There is an immediate need for public education around the topic of whole body donation and increased involvement from anatomists in PT education programs in this process.

A Practical Guide to Teaching Measures of Effect Size in Physical Therapist Education

(ProQuest: ... denotes formulae omitted.)BACKGROUND AND PURPOSEEvidence-based practice (EBP) is a key component of physical therapist (PT) education.1'2 The accreditation criteria developed by the Commission on Accreditation of Physical Therapist Education state that students should be able to critically evaluate sources of information, apply the knowledge appropriately, and integrate best-practice evidence in clinical decision-making.3 Interpreting the real world significance of research results requires specialized knowledge that may not be covered in graduate-level research methods and statistics courses.Research appraisal involves interpretation of statistical tests and the resulting P values associated with null hypothesis significance testing (NHST). However, the use of NHST is controversial, and its criticisms are well documented.4-10 Critiques of NHST include the arbitrary nature of alpha, the role it plays in publication bias, misinterpretation of P values, and the excessive influence of sample size.4,5'8-10 A common mistake is to equate statistical significance with clinical significance. Effect sizes offer an important way to move beyond the limitations of significance testing, because they offer estimates of the magnitude of treatment effects, betweengroup differences, and associations between variables.In 1999, the American Psychological Association (APA) convened a task force on statistical significance testing. The group concluded that the practice of significance testing should be deemphasized, and its recommendation to research authors was to include indices of effect size in research reports. The APA considers effect size reporting essential to good research.11 Currently, the editorial practices of top medical and rehabilitation medicine journals encourage the reporting of effect sizes. The Consolidated Standards of Reporting Trials (CONSORT) statement includes a recommendation to report effect sizes and 95% confidence intervals (CIs) for primary and secondary outcomes in randomized trials.12 Journals such as Physical Therapy and the Journal of Orthopaedic and Sports Physical Therapy require authors to follow CONSORT guidelines.The purpose of this paper is to provide a detailed review of commonly used effect size measures and to present opportunities for related learning activities. We discuss the uses, interpretations, applications, and strengths and limitations of each measure.POSITION AND RATIONNALEOur position is that a detailed, yet balanced presentation of effect size measures should be included in PT education to improve students' abilities to appraise the clinical and practical relevance of evidence. To critically appraise research, one must understand both the applications and limitations of effect size measures. When possible, we recommend comparing different effect sizes from the same data to demonstrate some of the nuances involved in choosing an effect size.Barriers to EBP in physical therapy include a lack of time, perceptions that findings are not generalizable or clinically relevant, and a lack of training in critical appraisal of research results.13-16 Knowledge transfer frameworks have received increased attention as formal processes that can mitigate these barriers and promote EBP in physical therapy.17,18 A thorough understanding of effect size measures may improve knowledge translation interventions. Effect size measures can be clinically relevant and they allow for comparison between studies and populations. The concepts may therefore help to bridge the gap between research findings and clinical decision-making.There are many journal articles and texts that review effect size. Most of them, however, focus on calculations and technicalities and do not provide practical suggestions for application of these concepts in research and teaching. This paper will focus instead on evaluation and interpretation of effect sizes as they apply to PT education, research, and practice. …

PEDIATRIC EDUCATION SPECIAL SERIES: Assessment of Teaching and Learning Activities in Pediatric Physical Therapy: Factors Influencing Knowledge Development and Confidence

INTRODUCTIONFor nearly 100 years, physical therapist (PT) education programs have focused on preparing professionals for practice.1 The goal of these professional programs has been to provide high quality instructional activities that enable PT students to move from being unconsciously incompetent to becoming consciously competent professionals who are able to intentionally apply their knowledge and skills to effectively treat their patients.2-5 Bruno3 and Hunt and Furustig,4 in their confidence-based learning work, described this situation when they reported that learners who are highly confident, but possess low levels of knowledge, will often take actions that lead to negative outcomes. Alternatively, students who have high levels of knowledge, but lack confidence in their knowledge, may be reluctant to act in practice.3,4,6,7 Thus, the development of knowledge and knowledge confidence are essential aspects of competence, ones that PT students need to acquire as they prepare to enter the profession.Competence generally refers to the ability of someone to successfully complete a given task or demonstrate a specific skill.3,4,8,9 Recently, Rapport et al10 identified 5 essential core competencies around pediatrics that all PT students should attain in professional PT education. These competencies reflect a student's ability to successfully demonstrate knowledge, psychomotor skills, and other abilities such as self-confidence, interpersonal skills, clinical reasoning, and knowledge confidence, as related to human development, age-appropriate patient/client management, family-centered care for all patient/ client and family interactions, health promotion and safety, and understanding of legislation, policy, and systems. The focus of the current paper is on the teaching and learning activities that promote or inhibit the development of self-rated knowledge and knowledge confidence by PT students during a pediatric physical therapy course. Due to the limited amount of evidence that exists regarding the development of knowledge and knowledge confidence in pediatric PT education, the research questions for this study were: (1) Do the teaching and learning activities utilized in a pediatric physical therapy course result in an increase of students' self-rated knowledge and knowledge confidence regarding pediatric physical therapy? And, (2) which teaching and learning activities did students perceive as promoting or inhibiting the development of their self-rated knowledge and knowledge confidence in pediatric physical therapy content during this pediatric physical therapy course?Knowledge consists of the information, facts, and skills gained through education and experience.11 Knowledge confidence has been described and was operationally defined here as how certain someone is of their knowledge.12,13 Self-confidence has been defined as a general feeling of self-worth coupled with a belief in one's ability to handle certain situations or complete certain tasks, while a person's belief or confidence in being able to successfully execute a particular skill or behavior is known as self-efficacy.7,8,14-19 For example, to effectively assess a child's gait pattern, a therapist must understand concepts like step and stride length, initial contact, femoral anteversion, etc, then assess the child's range of motion and strength, interact effectively with the child and his/her family member(s), and confidently and accurately evaluate the presence or absence of critical events typical in gait. It is important to recognize that competence, confidence, and self-efficacy are closely related, but not synonymous.6 As noted above, students and practitioners with more confidence than knowledge may be dangerous in the clinic, while those with too little confidence in their knowledge and skills may not be willing to implement a given plan of care.3,4.6,7The development of competence in PT students occurs over time as a result of students who actively engage in their didactic education and clinical experiences. …

Student and Examiner Perceptions of an Innovative Model for Assessment of Neuromuscular Clinical Competence in a Professional Physical Therapist Education Program

Background and Purpose. Assessment of clinical skills is required in physical therapist (PT) education. It can be labor and cost intensive, and put significant demand on faculty time and resources. Currently there is no standard protocol for assessing clinical performance in the didactic portion of a physical therapy curriculum. The purposes of this study are to present an innovative model for assessment of the clinical competence of PT students managing patients with neurologic conditions that is time, labor, and cost effective, and to explore the perceptions of PT students and examiners relating to the innovative model. Participants. Seventy second-year PT students and 11 faculty/clinician examiners participated in this project. Methods/Model Description and Evaluation. A novel format for assessing clinical skills was developed and implemented over a 2-year period in a professional PT education program. Students acted as standardized patients and faculty/clinicians assessed 2 students performing the competency simultaneously. Perceptions of both PT students and examiners were explored using surveys. Data from the surveys were examined and presented. Total cost of the innovative model was calculated and compared to prior competency formats. Outcomes. Two cohorts of PT students and examiners completed the surveys. Student response rate ranged from 70% to 71%, and examiner response rate was 80%. Student responses were largely positive, particularly on questions relating to learning and stress reduction. Examiner responses were largely positive regarding the effectiveness of the innovative model. Significant cost and time reductions were achieved. The number of personnel hours was reduced to 36, representing a 50% reduction. Time was reduced by 50% and cost was reduced by 66%. Discussion and Conclusion. Students found the actor role beneficial to learning and to the development of empathy for future patients. Students being assessed found the experience less stressful, yet still felt that the competency effectively assessed their skills and clinical decision making. Examiners similarly found the innovative model of assessment of clinical skills effective. The reduction in time, cost, and labor demands could greatly benefit programs with large class sizes and small programs with fewer faculty. While satisfactory, this model warrants further development, and exploration of its validity for predicting success on clinical internships.

Hand Therapy Content for Entry-Level Physical Therapist Education: A Consensus-Based Study

Background and Purpose. Hand therapy is an area of physical therapist (PT) specialty practice, and its scope has been well-defined by its parent organization, the Hand Therapy Certification Commission (HTCC). It can be difficult for PT educators to determine the depth and breadth of a specialty area to include in an entry-level program. Educators must balance the volume of content required for entry-level practice with time constraints, while also providing introductory coverage of specialty practice areas. The purpose of this study was to establish guidelines for hand therapy content in entry-level PT education using a consensusbased approach. Methods. Three questionnaires were developed by the researchers to identify hand therapy content that should be included in entry-level PT education. The initial questionnaire (89 forced-choice and 4 open-ended items) sought to identify content that should or should not be included as well as the level of teaching and learning that should be achieved. Subsequent questionnaires were developed based on responses from the previous round and included new items as well as items requiring consensus. Percentages of responses were used to determine consensus, and topics that did not reach consensus were carried forward to subsequent rounds. Results. Thirty individuals completed 3 questionnaires over a 5-month period, for a 100% response rate. Participants agreed on 64 content items for inclusion in the cognitive domain and 52 items in the psychomotor domain. Consensus on the level of teaching and learning for these items was also achieved. Conclusion. Results provide PT educators with guidance on determining the breadth and depth of hand therapy content for entry-level PT education.

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?

INTRODUCTIONDr 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.THE GRJ FORUM: ORGANIZATION AND STRUCTUREThe 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.3The 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 careersTHIRD ANNUAL GRJ FORUM HIGHLIGHTSKeynote Address - Walk With the DreamersEmma 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. …

PEDIATRIC EDUCATION SPECIAL SERIES: A Collaborative Model of Integrated Clinical Education in Physical Therapist Education: Application to the Pediatric Essential Core Competency of Family-Centered Care

Background and Purpose. Physical therapist (PT) clinical education models in the pediatric setting need to be evaluated. An early, collaborative, integrated clinical education (ICE) model was examined in the pediatric setting to determine the extent to which key characteristics (KCs) and entrustable professional activities (EPAs) of the pediatric essential core competency (ECC) of “family-centered care for all patient/client and family interactions” are reflected in student self-evaluation and guided reflection responses. Method/Model Description and Evaluation. Students’ self-evaluation and guided reflection responses were analyzed using retrospective document analysis. Qualitative coding procedures were used to assess documents for a priori codes including the pediatric ECC of “family-centered care for all patient/client and family interactions.” Outcomes. In both student self-evaluation and student guided reflection responses, analysis consistently revealed student discussion of all KCs and most EPAs; the guided reflection responses demonstrated all KCs and nearly all EPAs. Overall, students’ assignments revealed a clear emphasis on the KCs of “positivity,” “sensitive,” and “collaborative.” The assignments revealed an emphasis on the KC of “responsive,” and the EPAs “factors of the family system that influence the child” and “collaborate with families.” Discussion and Conclusion. The pediatric ECC of “family-centered care for all patient/client and family interactions” most likely emerged through this early collaborative ICE model due to the model's conceptual framework as well as students having concrete experience in the pediatric setting.

Academic and Clinical Dissonance in Physical Therapist Education: How Do Students Cope?

INTRODUCTIONA primary goal of physical education is to graduate practitioners who will advance practice and the profession.1,2 Educational programs strive to provide students with cutting-edge information and to instill ideal attitudes, values, beliefs, and skills for providing high-quality care.3 However, students are taught is the right way in their didactic preparation may not be they encounter in clinical settings.4,5 For example, students may rarely see their clinical instructors search for and apply evidence or thoroughly document patient care. Conversely, students may wonder why a progressive intervention approach learned from a clinical instructor is not being taught in the classroom. In both of these situations, students are left to struggle with making sense of why they are taught one thing in school and something else in the clinic.4,5 The messages that students receive from this implicit or hidden curriculum in clinical education are particularly important because physical students spend a large amount of time exposed to the professional practice culture.6,7 If students experience different types of knowledge, values, and behaviors in clinical versus academic settings, then conflicting messages about it really means to be a good physical therapist can result in cognitive dissonance or feelings of discomfort from holding conflicting beliefs.5,8How students cope with and process dissonance can have important effects on educational activities.8 A greater understanding of how physical students experience and cope with cognitive dissonance caused by competing curricular factors has the potential to provide the basis for targeted educational approaches, enhanced learning environments, reduced student emotional stress and, in some cases, improved health care. The purpose of this research study was to explore how physical students experience and cope with dissonance in academic versus clinical settings.REVIEW OF LITERATURESeminal work on cognitive dissonance was published by psychologist Leon Festinger9 in the 1950s. His theory proposed that when a person experiences ideas or beliefs that are not psychologically consistent with one another, then he or she will try to reduce the inconsistency to maintain a state of consonance.10,11 Festinger10 explained dissonance in terms of a person's expectations. Throughout a person's life, he or she accumulates information and has expectations about what things go together and things do not.10(p94) When such an expectation is not met, dissonance results.10 This dissonance causes psychological discomfort, motivating the person to reduce the dissonance.12 The motivation to resolve dissonance impels a person to reassess beliefs and change opinions or behaviors.10,11In a qualitative study of medical students, Thompson et al8 indicated that the processing and reduction of dissonance occur in 2 forms: reconciliation and preservation. Reconciliation involved students altering their own internal ideals to align with external ideals. In preservation, students discounted or diminished external ideals so that they could maintain their internal ideals. In most cases, dissonance was found to be coupled with negative emotions; that is, students were uncomfortable when experiencing the inner conflict and tension of dissonance.8A common form of cognitive dissonance experienced by health care students and new graduates is the dissonance between they have learned in their educational programs and they have experienced in clinical practice.12-14 This dissonance leads students to question to believe: the academic ideal or the clinical reality.12 In a longitudinal study of newly qualified nurses, Maben et al13 found that professional and organizational constraints in the workplace were serious threats to the implementation and sustainability of nursing ideals and values in practice. Professional constraints included covert rules and a lack of positive attitudes and role models; organizational constraints included time pressures, staff shortages, and poor skill mix, resulting in intensification of nursing work, and role constraints. …

HIV-Related Content in Physical Therapist Education Programs: A Curricular Needs Assessment

INTRODUCTIONOver the past 30 years, the development of antiretroviral therapy has drastically extended the life-span of people living with HIV (PLH). Because of this increased longevity, HIV is becoming a chronic disease; with proper treatment, PLH can have a life expectancy similar to that of their counterparts who are HIV negative.1 Therefore, the management of HIV has shifted to addressing the chronic systemic effects of the disease, such as musculoskeletal, neurological, and chronic pain issues. Mitigation of these effects requires a multidisciplinary approach to management of HIV-related impairments/, with an increasing role for physical therapists in the continuum of care for PLH.In an effort to enhance the use of physical therapy as part of the medical management of HIV, a 3-phase initiative was developed to analyze the current role of physical therapy in the HIV health care spectrum. Phase 1 assessed patterns of referral for physical therapist services made by physicians specializing in HIV management in Atlanta, Georgia, a city with a high prevalence of PLH. The results revealed that although most providers did refer their patients for physical therapist services, 30% of providers did not do so; the most commonly cited reasons were a lack of patient insurance, a denial of service by the clinics to which the patients were referred, and patient financial burdens.2 Phase 2 evaluated the knowledge and beliefs about HIV of 129 physical therapists practicing in the metropolitan Atlanta area. The results revealed that although most (65.1%) of the physical therapists surveyed reported their basic knowledge about HIV as advanced or competent, less than one-third of the respondents could correctly identify all methods of HIV transmission. Only half reported that learning best practices for treatments of HIV-related impairments was included in their physical therapist education.3On the basis of these results, this study (phase 3) was created to determine any potential gaps in HIV coverage in accredited physical therapist education programs throughout the United States. The aims of this study were to answer 3 questions: What percentage of physical therapist education programs cover HIV in their curricula? In what contexts is HIV covered (eg, pathophysiology, common physical therapy-treatable impairments, and interventions) in the programs surveyed? What needed teaching materials related to the inclusion of HIV are identified by surveyed faculty?REVIEW OF LITERATUREHuman immunodeficiency virus is a retrovirus that targets CD4+ T cells, reducing the human body's innate ability to fight off infections. The virus is spread through 4 specific bodily fluids (blood, semen, vaginal fluids, and breast milk). Seroconversion from HIV to AIDS occurs when the CD4+ cell count drops below 200/mm3, rendering a person more prone to opportunistic infections, such as tuberculosis, pneumonia, and lymphomas.4,5 In 2010, the Centers for Disease Control and Prevention estimated that in the United States alone, there were approximately 1.2 million PLH, and approximately 50,000 people continue to become infected with HIV each year.6,7 Because of the development of antiretroviral therapy for diminishing the immunosuppressive effects of HIV, the healthadjusted life expectancy-that is, the average number of years an individual is expected to live, with consideration of any disease or injury-has been extended for PLH.4,8-10A deterioration in physical function secondary to musculoskeletal, neurological, and cardiopulmonary impairments can be a consequence of chronic infection and systemic effects of antiretroviral therapy in PLH, leading to a significant decline in quality of life.11-13 These impairments fall within the scope of physical therapist practice. Musculoskeletal impairments secondary to deficits in bone remodeling and bone metabolism include myalgia, arthralgia, low back pain, osteoporosis, bone infection, and an increased risk for fractures. …

Research productivity of doctor of physical therapy faculty promoted in the southeastern United States

ABSTRACTBackground: Little information exists on the research productivity of successfully promoted tenure-track Doctor of Physical Therapy (DPT) faculty.Objective: To determine the research productivity that typically results in successful promotion.Design: We collected publicly available curriculum vitae (CVs) from faculty currently in accredited DPT programs and who had been successfully promoted from an institution in the southeastern USA from 2000 through 2016.Total publication count, journal impact factor, funding, citations, and other metrics were analysed from 45 subjects of 22 of the 64 CAPTE-accredited DPT programs in the southeast.Results: None of the studied metrics were normally distributed with time to promotion as determined by a Shapiro-Wilk test. These faculty exhibited a median publication count of 4, range 0 to 43; median of average citation count of 12.4, range 0 to 87.25; median of average journal impact factor of 2.866, range 0 to 6.280; median external funding received of $9910, range $0.00 to $19 543 198; and median author h-index of 3, range 0 to 17. The median number of years before promotion was 6, ranging from 3 to 13 years. Linear regression analysis indicates a poor fit with no significant correlation between years before promotion and any of the studied metrics. No correlation between journal impact factor and number of citations was observed (m = −0.22, p = 0.728, R2 = 0.0003). Prior to promotion 31% (14 of 45) did not receive external funding and 24% (11 of 45) had a 0 h-index. The Carnegie Classification of the institution did not significantly correlate with research productivity metrics in this dataset (p = 0.213).Conclusion: While faculty unsuccessful in promotion were not identifiable using this method, this research can be used by faculty and committees to evaluate research productivity against regional data and promote competitive standards with peer institutions.Abbreviations: CAPTE: Commission on Accreditation in Physical Therapist Education; DPT: Doctor of Physical Therapy

Physical Therapist Studentsʼ Conceptualizations of Clinical Practice

Introduction. Patient-centered collaborative reasoning is a hallmark of expert practice in physical therapy that is not consistently demonstrated in the work of novices. Current theories suggest that professional competence extends beyond skills and knowledge to also include an individual's conceptions of the role and identity of the professional, though few studies have addressed physical therapist (PT) student professional development from this perspective. The purpose of this study was to examine the ways PT students conceptualize the practice of physical therapy. Subjects. Eight entry-level PT students from 2 programs participated in this study. Methods. Semistructured interviews and a modified Q-sort were used to examine the students' perspectives on physical therapy practice. Qualitative analyses focused on the students' conceptualizations of the purpose of the physical therapy patient encounter, the level of participation expected of the patient, and the type of knowledge valued in the interaction. The students' perspectives were then analyzed for their relationship to the students' clinical decision making processes during a standardized patient encounter. Results. The students exhibited a broad range of perspectives on physical therapy practice, ranging from a PT-centered mechanistic view to a patient-centered holistic view. Students who held more mechanical views of practice indicated that the patient's expectations for therapy were not highly important in their work, while those who held patient-centered views highly valued the patient's interests and expectations. Conclusion. Students should be engaged in learning opportunities during entrylevel PT education that support development of patient-centered perspectives, as well as the skills and knowledge necessary for such practice.

PEDIATRIC EDUCATION SPECIAL SERIES SOLO-Framed Flipped Learning Environment: “Speaking the Language of Todayʼs Learner”

Background/Purpose. Based upon the evidence documented in educational research literature and the needs of today's technologically engaged students, learning environments have transitioned from being teacher-focused to student-focused. With this movement toward a studentfocused learning environment, various teaching strategies (eg, webinars, videos, cases, mind mapping, and concept mapping) have been introduced into the classroom. Recently, the notion of creating a “flipped classroom” has emerged in the literature. Flipped classrooms use videobased recording technology to capture faculty lectures, which are then posted online for student access. In the flipped classroom model, the placement of lectures online is only 1 part of the learning environment. To develop students as active critical thinkers, the learning environment includes in and out-of-class experiences to engage students and maximize active learning opportunities. The purposes of this method/model presentation paper are twofold. First, this study seeks to describe how the flipped classroom can move beyond online lectures to an environment that engages physical therapy students in deeper learning of pediatric content and principles. Using the Structure of Observed Learning Outcomes (SOLO) model of learning as a framework, flipped learning environments can be designed to transition students to learning experiences of increasing cognitive complexity. The scaffolding approach identified in the SOLO taxonomy provides pediatric faculty a framework for designing learning activities that can aid in moving students along the 5 stages of understanding identified by SOLO (prestructural, unistructural, multistructural, relational, and extended abstract) while exploring pediatric content. Second, the authors will share quantitative and qualitative data of a small sample of physical therapist (PT) students and their perceptions regarding the impact of this SOLO-framed flipped classroom environment within a pediatric physical therapy course. Outcomes. Students consistently perceived that the SOLO-framed flipped learning environment increased their ability to prioritize pediatric course material, enabled a deeper understanding of the material, aided in preparation for written exams and lab practical exams, fostered their oral communications skills, helped integrate concepts associated with pediatric conditions and interventions, and promoted retention of course topics. Finally, in enhancing the application of learning, students reported increased self-confidence when working with the pediatric population, and that the flipped learning environment fostered their ability to work in a team. Discussion/Conclusion. In general, the data supports that a SOLO-rich flipped learning environment engages PT students in questioning and guides them to a deeper awareness and insight specific to the pediatric course content. Thus, this is a teaching and learning strategy that could be employed by faculty, not only within pediatric courses, but also across the PT education curriculum.

Exploring DPT Studentsʼ Perceptions of Team Function in a Collaborative Integrated Clinical Education Experience

Introduction. Integrated clinical education (ICE), defined as clinical learning experiences embedded within the didactic portion of a DPT curriculum, is an integral component of an overall clinical education curriculum. The collaborative supervisory model has been applied to ICE experiences in DPT curricula. Two physical therapist (PT) education programs developed similar ICE experiences incorporating the collaborative model as a component of their clinical education curricula. Benefits for student learning have been described in the literature for both of these models—in isolation, but not combined. The purpose of this study was to determine factors that students felt contributed to successful team function in a collaborative ICE experience. Review of Literature. ICE can provide opportunities for students to develop knowledge, skill, and professional behaviors in preparation for full-time and final clinical experiences. There is a great deal of literature that supports the collaborative model of clinical education to facilitate teamwork and collaboration, deeper level of critical thinking and problem solving, and enhanced clinical competence. Despite the benefits of including ICE in a DPT curriculum, as well as the benefits of the collaborative model of clinical education, the physical therapy literature does not describe factors leading to successful team function when these 2 models of CE are combined. Methods and Subjects. Subjects were 51 PT student teams (3 to 4 people each) from Duke University (2 cohorts) and the University of Colorado (1 cohort) who participated in a collaborative ICE experience. Following their first 2 weeks of ICE, student teams were instructed to create a mind map that depicted how their team functioned together in the clinic. Teams utilized an online mapping tool, “Coggle It,” to complete the mapping. The research team employed incident coding processes established in the literature to code the primary concepts of the team mind maps. Chi Square analysis was used to determine numeric differences across all codes among the 3 student team cohorts. Results. Twenty-four distinct codes were assigned to the primary concepts. Chi Square analysis revealed no significant differences between the 3 cohorts (P > .01) across all codes. More than 50% of teams indicated that “group dynamics” and “team communication” were vital to the effective functioning of their team in the clinic. More than 25% of the teams included “individual student qualities,” “the learning environment,” “practicing skills,” “the instructor's teaching strategies,” “adult learner characteristics,” and the “clinical instructor” of key importance. From the data, 4 themes emerged as being important for effective collaborative learning in an ICE: The Team, the Clinical Environment, the Individual Student, and the Clinical Instructor. Discussion and Conclusion. The 4 themes identified in this study contribute to the literature surrounding student learning in clinical education, specifically a collaborative ICE experience. This study suggests that these characteristics are important for positive experiences and should be factors that are considered by both academic programs and clinical instructors when designing, implementing, and teaching in a collaborative ICE experience.

The Design and Evaluation of Worked Examples in Neurological Physical Therapy Education

Background and Purpose. Learning and practising clinical reasoning related to patient cases is a standard part of physical therapist (PT) education. Research in the area of example-based learning provides evidence and structure for the development of learning modules related to patient cases. The purpose of this project was to develop and evaluate 2 e-learning modules that explicitly incorporated principles of example-based learning (worked example, observational learning, and analogical reasoning). Method/Model Description and Evaluation. Two computer-based worked examples specific to neurological physical therapy were developed using e-learning software. The modules were based on individual patient cases and focused on standing balance assessment and gait assessment and treatment. The standing balance module was a fully worked example, taking the student through all the solution steps of how to assess a patient's standing balance. By contrast, the gait module was a partially worked example where students contributed information throughout the module to help to solve the problem. Students completed the modules in a neurological physical therapy course as preparatory (standing balance) and consolidation (gait) activities. They completed an evaluation on Google Forms that addressed perceived learning outcomes as well as logistical issues (ie, how long to complete, what device). Outcomes. Completion times for the modules ranged from 15 to 90 minutes, with an average completion time of 36 minutes. Students generally perceived the modules to be helpful to their learning as well as fun. Students who attempted to complete the module on a smart phone had technological problems completing the module. Discussion and Conclusion. The modules adhered to the principles of worked examples and embedded observational learning and analogical reasoning. They provide useful and versatile learning options for novice students. Future evaluation of learning outcomes is planned. With minor modifications that provide opportunities for the learner to complete some of the solution steps, the modules can be used with more senior students or as continuing education.