Physical Therapy Education Programs Research Articles

Systems Thinking and Systems-Based Practice Across the Health Professions: An Inquiry Into Definitions, Teaching Practices, and Assessment

ABSTRACTPhenomenon: Systems thinking is the cornerstone of systems-based practice (SBP) and a core competency in medicine and health sciences. Literature regarding how to teach or apply systems thinking in practice is limited. This study aimed to understand how educators in medicine, physical therapy, physician assistant, nursing, and speech-language pathology education programs teach and assess systems thinking and SBP. Approach: Twenty-six educators from seven different degree programs across the five professions were interviewed and program descriptions and relevant course syllabi were reviewed. Qualitative analysis was iterative and incorporated inductive and deductive methods as well as a constant comparison of units of data to identify patterns and themes. Findings: Six themes were identified: 1) participants described systems thinking as ranging across four major levels of healthcare (i.e., patient, care team, organization, and external environment); 2) participants associated systems thinking with a wide range of activities across the curriculum including quality improvement, Inter-professional education (IPE), error mitigation, and advocacy; 3) the need for healthcare professionals to understand systems thinking was primarily externally driven; 4) participants perceived that learning systems thinking occurred mainly informally and experientially rather than through formal didactic instruction; 5) participants characterized systems thinking content as interspersed across the curriculum and described a variety of strategies for teaching and assessing it; 6) participants indicated a structured framework and inter-professional approach may enhance teaching and assessment of systems thinking. Insights: Systems thinking means different things to different health professionals. Teaching and assessing systems thinking across the health professions will require further training and practice. Tools, techniques, taxonomies and expertise outside of healthcare may be used to enhance the teaching, assessment, and application of systems thinking and SBP to clinical practice; however, these would need to be adapted and refined for use in healthcare.

Linking the Essential Core Competencies to Pediatric Content in an Entry-Level Physical Therapy Education Curriculum: A Case Report

Background and Purpose. In 2012, the Section on Pediatrics (SoP) established five Essential Core Competencies in Entry-Level Pediatric Physical Therapy Education representing the expected pediatric knowledge base, skills, and abilities of all graduating physical therapist (PT) students. To facilitate the integration of the Core Competencies within curricula and to achieve intended academic objectives, educators need tools to connect or “link” specific didactic content to each of the five Core Competencies and their associated subcriteria. The purpose of the current case report was to introduce a novel systematic approach using linking rules to demonstrate comprehensive inclusion of Essential Core Competencies within professional (entry-level) PT education programs. Case Description. Course descriptions and objectives within the curriculum of an accredited entry-level physical therapy professional program were reviewed for pediatric content. Two investigators independently assigned pediatric curriculum content to the 5 Essential Core Competencies using 10 linking rules. A third investigator was used to establish a consensus during the linking process. Frequencies and percentages representing the inclusion of each of the competencies and their associated subcriteria were calculated. Percent agreement and Cohen's kappa (κ) between the two independent investigators were calculated to evaluate the interrater reliability of the linking process. Outcomes. One hundred sixty-five (17%) of the 976 course objectives within the entry-level physical therapy professional program contained pediatric content. All 5 of the Essential Core Competencies were represented at varying degrees: human development (17%), age-appropriate patient/client management (51%), family-centered care for all patient/client and family interactions (6%), health promotion and safety (12%), and legislation, policy, and systems (7%). The remaining objectives (7%) were considered either General Pediatric Content or Not Covered by the Core Competencies, or Not Definable. The linking process had substantial interrater reliability (κ = 0.76; standard error = 0.09; 95% confidence interval = 0.60–0.93) between the two independent investigators. Discussion and Conclusion. A systematic approach to linking pediatric curriculum content to the Essential Core Competencies was introduced and applied using an integrated professional (entry-level) physical therapy education program. Such reliable systematic processes support best educational practice by confirming that all relevant pediatric content is preserved throughout an integrated physical therapy curriculum and ensures that PT students are provided with the essential knowledge base, skills, and abilities needed to successfully work with children. Future research should apply the linking strategies to nonintegrated physical therapy curricula, programs in other geographic regions, and content outside of pediatrics.

Cost Analysis of a Student-Run, Free Physical Therapy Clinic

Introduction. Within many physical therapy education programs, service learning is essential to student development and often complements the institutional priorities of serving the community. Service learning experiences vary from local, institution-hosted clinics to international experiences. Although the benefits of service learning to the students and community have been widely reported, it is also important to appreciate the cost to implement and support a service learning clinic within an academic department. The purpose of this study was to determine the cost of running a student-run free physical therapy clinic for estimated labor costs calculated as wage opportunity cost, quantify equipment and infrastructure cost per patient, estimate facility cost, and derive an estimated cost of care delivery per patient. Methods. This retrospective study reviewed patient charts and clinic data from a student-run free clinic between January 2013 and December 2014. Both total outgoing cost and potential total cost were determined for this study. The total outgoing cost was determined by calculating equipment cost and cost of liability insurance. The potential total cost was determined by calculating volunteer hours, facility cost, and outgoing clinic costs. Results. In the 2-year study period, the clinic incurred a potential total cost of $68,405.40. However, the total outgoing cost of the clinic was $1,993.23 for 253 patient visits, which gives the clinic an average cost per visit of $7.64. Discussion/Conclusion. This study demonstrates the feasibility of a student-run, free physical therapy clinic through monetized gain for the community while enhancing students' skills. Furthermore, this study demonstrates a method to capture quantifiable monetary cost and benefit to program stakeholders and the community.

Defining Underrepresented Minorities and Promoting Holistic Review Admission Strategies in Physical Therapist Education

Background and Purpose. Given the changing demographics of the United States, it is important for Doctor of Physical Therapy (DPT) education programs to address how best to recruit and retain students who will be able to provide culturally competent and sensitive care. Compared with the general population, the racial and ethnic diversity of professional membership in the American Physical Therapy Association and applications to and acceptance in professional physical therapist education programs has remained relatively static and does not mirror the diversity of the population at large. Position and Rationale. To best determine effective recruitment and retention strategies to address this shortfall in PT education, it is necessary to have (1) a unifying definition of underrepresented minorities (URMs) in physical therapy education and (2) an understanding of what is currently being done to promote a diverse student body. The American Council of Academic Physical Therapy empaneled its Diversity Task Force in January 2013 to address these two issues. This position paper reports on the efforts of the Diversity Task Force in developing a working definition of URMs in physical therapy education that reaches beyond traditional racial and ethnic descriptors, along with supporting information from a survey of entry-level DPT program directors on barriers to increasing diversity within the professional PT student population and strategies currently in place to overcome them. Discussion and Conclusion. Based on a uniform definition of URMs and the current status of recruitment/retention policies and practices designed to foster a diverse student population, we conclude that ongoing work is needed to increase diversity within DPT education and that utilization of a holistic application review process for admissions is one method to increase diversity.

Application of Digital Human Models to Physiotherapy Training

The importance of physiotherapy is becoming more significant with the increasing number of countries with aging populations. Thus, the education of physiotherapists is a crucial concern in many countries. Information and communications technologies, such as motion capture systems, have been introduced to sophisticate the training methods used in physiotherapy. However, the methods employed in most training schools for physiotherapists and occupational therapists remain dependent on more conventional materials. These materials include conventional textbooks with samples of traditional gait motion photographs and video archives of patients' walking motion. Actual on-site clinical training is also utilized in current physiotherapy education programs. The present paper addresses an application of a previously developed digital human model called the kinematic digital human (KDH) to physiotherapy education with a focus on improving students' understanding of the gait motion of disabled patients. KDH models for use in physiotherapy were constructed based on Rancho Los Amigos National Rehabilitation Center (RLANRC) terminology, which is considered the preferred standard among clinicians. The developed KDH models were employed to allow the three-dimensional visualization of the gait motion of a hemiplegic patient.

Experiential learning in physical therapy education

Background and purposeExperiential learning can provide students in entry-level physical therapy (PT) education programs the opportunity to practice skills and techniques, learned in the classroom, in a real-world setting. Experiential learning is currently being utilized in all entry-level PT programs in the form of professional practice experiences but may be integrated throughout the curriculum to enhance student engagement and knowledge application and retention. The purpose of this paper is to express the need for increased integration of experiential learning into entry-level PT education curricula.Position and rationaleExperiential learning can effectively replace a portion of in-class laboratory time in entry-level PT education programs. Several methods of experiential learning exist, including simulation, integrated clinical experiences, service learning, community patient resource groups, and professional practice opportunities. Students benefit from the ability to practice hands-on skills in a safe, nonjudgmental environment. Students can still experience consequences of poor decisions but can have multiple opportunities to master the skill without the fear of negative outcomes. Incorporation of high-risk age ranges and diagnoses can be achieved through simulation.Discussion and conclusionExperiential learning can be integrated into any PT curriculum if faculties are committed and flexible. Experiential learning may be particularly useful in specialty practice areas where there are fewer opportunities for students to practice skills. The practice of reflection upon experiences that is commonly performed in conjunction with experiential learning will help prepare students for the type of reflective practice that is essential to transition from novice to expert practitioners.

Utilizing the "Plan, Do, Study, Act" Framework to Explore the Process of Curricular Assessment and Redesign in a Physical Therapy Education Program in Suriname.

To describe how a multinational team worked together to transition a physical therapy (PT) educational program in Paramaribo, Suriname, from a Bachelor level to a Master of Science in Physical Therapy (MSPT) level. The team was made up of PT faculty from Anton De Kom Universiteit van Suriname (AdeKUS), the Flemish Interuniversity Council University Development Cooperation (VLIR-UOS) leadership, and Health Volunteers Overseas volunteers. In this case study, the process for curricular assessment, redesign, and upgrade is described retrospectively using a Plan, Do, Study, Act (PDSA) framework. PT educational programs in developing countries are eager for upgrade to meet international expectations and to better meet community health-care needs. An ongoing process which included baseline assessment of all aspects of the existing bachelor's program in PT, development of a plan for a MSPT, implementation of the master's program, and evaluation following implementation is described. Curricular assessment and upgrade in resource-limited countries requires the implementation of process-oriented methods. The PDSA process is a useful tool to explore curricular development. The international collaboration described in this paper provides an example of the diligence, consistency, and dedication required to see a project through and achieve success while providing adequate support to the host site. This project might provide valuable insights for those involved in curricular redesign in similar settings.

Demographic Characteristics of Applicants to, and Students of, Ontario Physiotherapy Education Programs, 2004-2014: Trends in Gender, Geographical Location, Aboriginal Identity, and Immigrant Status.

Purpose: The authors analyzed the demographics of potential future physiotherapists to determine whether they were representative of the Canadian population. The specific objectives were to examine selected demographic variables from all applicants to and students in Ontario English-language Master of Physical Therapy programmes in admission cycles 2004-2014, inclusive, and to analyze the results as compared with Canadian population data. Method: Anonymized applicant records (n=14,135) were obtained for admission cycles 2004-2014, inclusive. Variables examined for applicants and students included their gender, geographical location from Canadian and international regions, Aboriginal identity, and immigrant status. A descriptive analysis of counts and proportions was conducted for all variables. Results: The majority of applicants were women (70%), from southern Ontario (73%), and Canadian born (82%). Aboriginal and rural applicants made up small proportions of the applicant pool (1% and 12%, respectively). The number of applicants from British Columbia was proportionally high relative to those from other Canadian provinces. Conclusion: Although Ontario's physiotherapy education programmes remain female dominated, the demographics of applicants and students are otherwise mostly representative of the diverse Canadian population, although very low in the number of Aboriginal peoples. Further research is needed to understand the diversity and composition of the Canadian physiotherapy workforce.

The Spectrum of Student Enrollment-Related Outcomesin Physiotherapy Education Programs in Westafrica

Background: This cross-sectional study investigated student enrollment-related outcomes from physiotherapy education programs in West Africa.Methods: The Head of Department of all physiotherapy education programs in Nigeria and Ghana universities (N=14) completed a questionnaire that sought information on admission capacity/goal, student enrollment, baccalaureate (BPT/BS) and postgraduate (MS, Ph.D.) degrees conferred and the student-core faculty ratio (SFR).Results: In Nigeria, 4,748 BPT, 325 MS and 50 Ph.D. degrees in physiotherapy were conferred over a 50 year period; 2,038 BPT, 160 MS, and 42 Ph.D. students are currently enrolled. In Ghana, over a 14 year period, 277 BS degrees were conferred and 162 students are currently enrolled. The mean SFR for the undergraduate program in Nigeria and Ghana was 17.6 and 13.5, respectively. In Nigeria, 83.3% of the physiotherapy programs are located in Federal owned university; while in Ghana 100% of the programs are in State-owned university (χ² = 8.556; p =.014). Admission goal and university ownership are significantly (p<.05) influenced by the number of students annually admitted, students enrolled and SFR.Conclusion: The number of physiotherapists currently produced by universities in West Africa is inadequate to meet the regional physiotherapist needs.

Camelot Revisited: Legacy of the Physical Therapy Education Program at Case Western Reserve University

…I am deeply touched by the expressions of support by former students, co-workers, and colleagues that must have been submitted to convince the selection committee to pick me for this ultimate award. …I hope that I will in some small measure prove equal to the task before me. First, I want to remind you of a few historical events. The American Physical Therapy Association (APTA) was founded in 1921. Mary McMillan died in 1959. The first physical therapy education program designed to provide the initial professional preparation at the graduate level was established at Western Reserve University (later named Case Western Reserve University [CWRU]) in Cleveland, Ohio, 30 years ago. The first student was enrolled in 1960 and graduated in 1962; the last class graduated in 1971.…

The Work of Accreditation On-site Evaluators<subtitle>Enhancing the Development of a Profession</subtitle>

The purpose of this study was to explore the work of on-site evaluators in the physical therapy accreditation process. Specifically, this research investigated how the accreditation on-site visit may serve as a method for defining the dominant values of a developing profession. A set of criteria selected from the literature describing the process of professionalization served as an operational model of professional values for the study. The model served as the framework for analysis and categorization of the professional values that evaluators emphasized during the on-site visits. The qualitative data collection methods of interview, nonparticipant observation, and document analysis were used in constructing case studies of five physical therapy education program accreditation visits. Results of this research indicated that on-site evaluators represent an elite community within the field and share similar values about the profession. These shared values about the professionalization of physical therapy formed the basis for evaluators' interpretation of accreditation standards. Evaluators' emphasis on the professional values that focus on defining and validating the body of knowledge in physical therapy and faculty endorsement of the norms of the academic work place have implications for the continued professionalization of physical therapy.

Expert opinion regarding the preparation of entry-level physiotherapists for primary healthcare practice, examined using Biggs 3P’s model of teaching learning

Introduction: The scope of contemporary physiotherapy practice is a critical factor in determining the appropriate educational preparation for physiotherapists now and into the future. The world-wide shift from secondary to primary healthcare has, and is, continuing to result in new and different ways of working. It is crucial that curricular changes reflect these developments. In this study a qualitative approach using Biggs 3P’s – Pressage, Process and Product model to discuss curriculum design. Objective: The aim of the study was to explore the perspectives of both national and international physiotherapy educators/practitioners in primary healthcare, on the key elements required in physiotherapy education programmes to prepare future primary healthcare practitioners. Methods: Snowball sampling was used to identify experts in education and/or primary healthcare practice. Semi-structured interviews were conducted using an interview guide based on the Biggs 3P’s model. Participants: Twelve participants were recruited from Ireland (n = 2), the UK (n = 4), Canada (n = 3), New Zealand (n = 2) and Australia (n = 1) using snowball sampling. Results: Interviews were analysed using thematic analysis. Themes identified included; understanding the philosophy of physiotherapy practice, cultural competence, inter-disciplinary team working and communication skills. Contextual factors and teaching and learning strategies were discussed. Conclusions: There is an urgent need for physiotherapy education programmes to adopt the concept of primary healthcare as the basis for the physiotherapy curriculum and illuminate key components for consideration.

CONTENTS AND FEATURES OF “SYLLABI” FOR UNDER GRADUATE PHYSIOTHERAPY EDUCATION IN NORTHERN INDIA: A CROSS SECTIONAL STUDY

Introduction: The syllabus is a description and plan for a course and, if well written, may be a tool that improves student learning, facilitates faculty teaching, improves communications between faculty members about their courses, and assists with monitoring program quality. The level of education for physical therapists should reflect the current and future needs of professional practice and society and changes in physical therapy roles and function as well as changes in the legislation that regulates physical therapy practice. Therefore, through our study, we would assess the existing contents and features of syllabi of various universities conducting Under-graduate Physical Therapy education program in Northern India and throw a light whether they are diverse or in consonance to each other. Aim and Objective: To study the contents and features of various syllabi for Under-graduate Physiotherapy education conducted by various Universities and Institutes of Northern India with special focus on Orthopaedics and relevant subjects. Materials and Methods: There are 24 universities conducting Undergraduate Physiotherapy program in Northern India, 20 universities were found suitable out of which data of 19 universities could be collected. The data was collected by personal visit, from official website of universities, via e-mail and by other sources. The data collected includes course scheme – syllabus, transcript, subject credits and examination scheme Results: The results of this study show that features of syllabi in these universities differ on the basis of total number of academic hours, subject allocation in various years, number of theory and practical hours allotted, percentage weight age of hours, maximum marks, and percentage weight age of marks of each subject. Conclusion: This study concludes that syllabus of the Bachelors of Physiotherapy program in Northern India is variable. The variability is not seen in the program structure rather in: Total number of subjects, Curriculum hours allotted to each subject, Subject allocation in various years, Examination system – annual or semester system, Maximum marks allotted to a subject in the university examination scheme, Total academic hours in a year, Hours allotted for clinical training.

Modifiable variables in physical therapy education programs associated with first-time and three-year National Physical Therapy Examination pass rates in the United States.

Purpose:This study aimed to examine the modifiable programmatic characteristics reflected in the Commission on Accreditation in Physical Therapy Education (CAPTE) Annual Accreditation Report for all accredited programs that reported pass rates on the National Physical Therapist Examination, and to build a predictive model for first-time and three-year ultimate pass rates.Methods:This observational study analyzed programmatic information from the 185 CAPTE-accredited physical therapy programs in the United States and Puerto Rico out of a total of 193 programs that provided the first-time and three-year ultimate pass rates in 2011. Fourteen predictive variables representing student selection and composition, clinical education length and design, and general program length and design were analyzed against first-time pass rates and ultimate pass rates on the NPTE. Univariate and multivariate multinomial regression analysis for first-time pass rates and logistic regression analysis for three-year ultimate pass rates were performed.Results:The variables associated with the first-time pass rate in the multivariate analysis were the mean undergraduate grade point average (GPA) and the average age of the cohort. Multivariate analysis showed that mean undergraduate GPA was associated with the three-year ultimate pass rate.Conclusions:Mean undergraduate GPA was found to be the only modifiable predictor for both first-time and three-year pass rates among CAPTE-accredited physical therapy programs.

Physical Education, Exercise, Fitness and Sports: Early PM&R Leaders Build a Strong Foundation

Physical Education, Exercise, Fitness and Sports: Early PM&R Leaders Build a Strong Foundation

Academic integrity practices by faculty in physical therapy education programs

Academic integrity practices by faculty in physical therapy education programs

Comprehensive examinations in physical therapy education programs

Comprehensive examinations in physical therapy education programs

BMI, pain and function in patients with knee osteoarthritis

Purpose: To evaluate the relationship between BMI and pain and function in patients with knee osteoarthritis (KOA) undergoing multiprofessional clinical treatment. Methods: Thirty-eight patients (four men and 34 women) aged 47-83 years old (mean 63.2 years) in usual treatment for knee OA for more than three months, i.e. oral diacerhein and analgesics (according to pain), orthotics (when indicated) were selected for a two-days two months apart multiprofessional (medical, nutritional, psychological, physical and occupational therapy, physical educator and social workers) educational program on Ostearthritis. X-rays were performed to classify the OA degree (Kelgreen & Lawrence – K&L). All patients were evaluated at baseline (one month prior to first class) and at 6 months (3 months after the second class) with height, weight (BMI estimation), and asked to complete WOMAC, Lequesne, and visual analogue pain scale questionnaires. Results: Eight patients had grade I (K&L), eleven, grade II, thirteen, grade III and six, grade IV. The results regarding change in VAS, WOMAC-pain, WOMAC and Lequesne did not correlate to the initial degree of osteoarthritis. There was no significant BMI variation in this study (average -0.2, SD= 0.22, range -4.9, 2.7). The higher the initial BMI, the lower the improvement in pain (Spearman test, p = 0.03). Pain did not improve significantly (p = 0.2). Function improved (p <0.001) in inverse ratio to the initial BMI. However, the group that decreased BMI tended to improve pain and function and the group that increased BMI tended to improve pain and function (Kruskal-Wallis test, not significant). Conclusions: BMI determines how patients will improve pain and function.

The Preprofessional Degree: Is It a Predictor of Success in Physical Therapy Education Programs?

Background and Purpose.Admitting physical therapist (PT) students to professional programs based on predictors of future academic, clinical, and licensure examination performance has been the subject of a number of studies. The best known predictor of student performance is the admission grade point

Physical therapy education in Saudi Arabia.

[Purpose] To review the physical therapy educational program model, professional curriculum, and gender representation at major universities, as well as the quality and scope of physical therapy practice in Saudi Arabia. [Methods] Information regarding course curriculum, gender representation, and the quality and scope of physical therapy practice was collected from six universities in Saudi Arabia, the Saudi Physical Therapy Association, and the Saudi Health Commission. [Results] The first bachelor’s degree course of physical therapy was started in Saudi Arabia more than 30 years ago. In the last 10 years, the number of universities offering a bachelor’s degree in physical therapy has risen from 6 to 16, of which 14 are governmental and two are private. The 5- to 6 year bachelor’s degree program in physiotherapy includes an internship and preparatory prerequisite courses. Postgraduate study in physical therapy was introduced in 2000. Most universities offer segregated physical therapy courses for male and female students. [Conclusion] The enrollment of students in physical therapy programs in Saudi Arabia is gradually increasing. There are many opportunities to extend the scope of practice and contribute to the health needs of the Arab population and international communities.