Professional Physical Therapist Education Research Articles

Effects of Meditation on Stress Levels of Physical Therapist Students

Background and Purpose. Due to the arduous nature of the professional (entrylevel) physical therapist (PT) education program, PT students often experience higher levels of stress than their age and gender-matched peers, which can negatively affect their academic performance and wellbeing. Therefore, finding methods to manage stress is important for students’ wellbeing and academic success. The purpose of this study was to investigate the effect of meditation on stress levels of students in a doctor of physical therapy program. Participants. Twenty-four PT students in their first and second year of an entry-level doctoral degree program participated in this study. Methods. This study examined the stress levels of 24 subjects via blood pressure, morning and evening salivary cortisol levels, and 3 different stress questionnaires (Perceived Stress Scale, General Anxiety Disorder 7, Stress Visual Analog Scale) using a quasi-experimental pretest-posttest design. The intervention was a twice-daily 20-minute beeja mantra-based meditation performed for 8 weeks. Results. All 24 students completed the study with average compliance of 91.6% ± 8.7% (mean ± SD) meditating at least once per day, and 77.3% ± 19.8% meditating twice per day. A paired t test was used to analyze the blood pressure readings, with systolic blood pressure decreasing by 2.9 ± 2.3 (standard error of the mean: SEM) mmHg (P = .022), and diastolic blood pressure decreasing by 4.6 ± 2.9 (SEM) mmHg (P = .005). Four subjects with prehypertensive systolic blood pressure readings prior to the meditation intervention moved into healthy normal range by the conclusion of the study. The Wilcoxon signed rank test was used to evaluate the questionnaires, which showed significantly decreased subjective stress levels (P < .05). No significant changes in mean morning (AM) or night (PM) salivary cortisol levels were found (P > .05). However, 9 of the 14 (64%) subjects who had at least 1 cortisol measurement outside of the normal range (established by ZRT Labs) at the start of the study had both AM and PM cortisol levels in the normal range following the intervention. Discussion and Conclusion. The results of this study show that an 8-week mantrabased meditation program significantly reduces blood pressure, significantly reduces perception of stress based on the subjective questionnaires, and that a 1-day AM/PM cortisol sample may not be sufficient to accurately analyze a subject's true daily cortisol level to show statistical change.

Using the PRECEDE-PROCEED Model and Service-Learning to Teach Health Promotion and Wellness: An Innovative Approach for Physical Therapist Professional Education

BACKGROUND AND PURPOSEPhysical therapists (PTs), along with other health care professionals, have been charged with the task of preventing chronic disease and premature morbidity, in addition to their traditional roles. The American Physical Therapy Association (APTA) recently adopted a bold new vision for the profession: Transforming society by optimizing movement to improve the human experience.1^1) The APTA Code of Ethics instructs PTs to reduce health disparities and health care inequities, improve access to health care services, and address the health, wellness, and preventive health care needs of people.2^2) The Commission on Accreditation in Physical Therapy Education (CAPTE) Evaluative Criteria CC-5.50 to 5.52 describe Practice Management Expectations which require professional physical therapy programs to include content related to prevention, health promotion, fitness, and wellness.3 These guiding documents clearly indicate that PTs have a role to play in prevention, and professional physical therapy programs have a responsibility to provide training in this area of practice. The profession's role in this arena was further reinforced with the recent APTA House of Delegates passing of 4 separate but related motions: RC 11-15, Health Priorities for Populations and Individuals; RC 12-15, The Role of the Physical Therapist in Diet and Nutrition; RC 13-15, The Association's Role in Advocacy for Prevention, Wellness, Fitness, Health Promotion, and Management of Disease and Disability; and RC 14-15, Physical Therapists' Role in Prevention, Wellness, Fitness, Health Promotion, and Management of Disease and Disability.4It has been stated that the use of planning models in public health may produce more effective interventions since it forces planners to address multiple areas of influence that impact health behavior change.5 The purpose of this paper is to describe the use of an established public health planning model to teach service-learning as part of the community health and wellness curricular content to entry-level Doctor of Physical Therapy (DPT) students.METHODS/MODEL DESCRIPTION AND EVALUATIONThe PRECEED-PROCEED ModelThe PRECEDE-PROCEED model is a tool for designing, implementing, and evaluating health behavior change programs. Whenever a problem affecting a target population is identified, health professionals can use this model to help guide the process of developing a solution. The cornerstone of the model is the premise that for a health promotion program to be successful, it must use a process that engages the active participation of the intended population.The PRECEDE-PROCEED model is divided into 2 components: PRECEDE (Phases 1-4) provides the formative process that leads to an intervention, and PROCEED (Phases 5-8) describes how to proceed with the intervention and evaluation (Figure l).6 The acronym PRECEDE (predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation) describes a detailed approach of problem diagnosis and project planning. The second part of the model continues with 4 additional phases as part of PROCEED (policy, regulatory, and organizational constructs in educational and en- vironmental development), which guide the implementation and evaluation of the program objectives and intervention that were designed in the PRECEDE phases.The PRECEDE-PROCEED model of health program planning and evaluation was developed by Lawrence Green and Marshall Kreuter in an effort to improve effectiveness of community health programs.'' One published study found that of 10 planning models studied, the PRECEDE-PROCEED model was considered to be the most useful for both research and practice.8 The model is utilized extensively among public health professionals. There have been over 960 published studies which apply various aspects of the model addressing an array of public health concerns.7 For example, it has been used in the implementation of church-based heart health promotion programs for older adults,9 as guidance for a faith-based healthy eating program,10 for development of a rheumatoid arthritis education program,11 and for establishment of an ergonomics training program to prevent work-related musculoskeletal disorders within supermarket cashiers. …

Physiotherapy Education in Germany: Ready for Direct Access?

Objective: The aim of this study is to investigate whether the curricula for physiotherapy education in Germany conform to standards recommended in the World Confederation for Physical Therapy (WCPT) guideline for physical therapist professional entry-level education, published by the WCPT. This Guideline specifies education standards for physical therapists that are able to act as independent practitioners, without referral from another health care professional. Methods: To assess the German curricula of physical therapist education, a list of assessment dimensions was derived from the WCPT-Guideline by means of content analysis. The content validity of this list was estimated by nine experts using Lawshe's method. The German Training and Examination Regulations for Physiotherapists (PhysTh-AprV) and all available regional curricula were studied. All documents were evaluated by 2 independent coders who rated the conformity of the documents with the assessment dimensions. Results: Based on the Lawshe procedure, the whole test content validity index of the 61 out of 67 examined assessment dimensions was 0,84. Cohen's kappa coefficient for intercoder reliability was 0,71-0,97. The German curricula showed high correlation with the WCPT Guideline on many theoretical basic subjects. Fulfillment of some of the requirements showed heterogeneous results. Autonomous practitioners largely lacked special competencies. Conclusions: None of the German educational standards meets the expectations of the WCPT Guideline in terms of direct access. Considering the deficits of the German educational standards and the release date of some of them, a continuous development of the German education does not appear to be adequate. This issue needs to be addressed in the current debate on health policy.

Effects of early postoperative rehabilitation on infants with congenital cardiac disease

differences between cohorts were demonstrated in student self-assessment of Documentation performance at midterm (p= 0.011), and Financial Resources performance at the midterm and final rating periods (p= 0.022 and p= 0.012, respectively). For Clinical Instructor (CI) ratings, there was a statistically significantly difference between cohorts at the final rating for Financial Resources performance (p= 0.044), indicating a higher CI rating for those students that participated in the CRB instruction. Faculty survey results demonstrated that theCBRapproach benefitted student learning, was not difficult to integrate into existing courses, and enhanced faculty learning. However, faculty had concerns regarding their comfort level with the material and whether it was replacing more clinically oriented content. Conclusion(s):The outcomes generally support the effectiveness of the CBR approach for integrating insurance policy, regulations, and documentation in a professional level physical therapist education program. Students learned to use regulatory and insurance policy information when making clinical decisions and participating faculty did not feel unduly burdenedby the integration of the this content into established case studies. Although the results are encouraging, further research is recommended. Implications: The project presents one method to effectively integrate insurance, regulations, and documentation content into a professional level physical therapist education program. It is hoped that newgraduate physical therapistswill have improved understanding and application of contemporary regulatory and insurance policy to provide efficient and effective patient care.

Thrust Joint Manipulation Curricula in First-Professional Physical Therapy Education: 2012 Update

Descriptive online observational survey. To identify the extent of thrust joint manipulation (TJM) integration into first-professional physical therapy program curricula. The most recent survey of TJM curricula was published in 2004, with a wide variation in faculty responses noted. Since that time, faculty resources have been developed and TJM language in "A Normative Model of Physical Therapist Professional Education" from the American Physical Therapy Association has been updated, leaving the current status of TJM education in curricula unknown. Faculty from 205 accredited physical therapy programs were invited to participate in an anonymous 35-item electronic survey during the summer of 2012. Seventy-two percent of programs responded to the survey, with 99% of programs teaching TJM and 97% of faculty believing TJM to be an entry-level skill. Cervical spine TJM is still being taught at a lower rate than techniques for other body regions. Faculty deemed 91% and 77% of students, respectively, at or above entry-level competency for implementing TJM in their clinical practice upon graduation. Most respondents indicated that increased utilization of TJM during clinical affiliations (78%) and lab hours (78%) would be beneficial to the student's knowledge/application of TJM. The utilization of TJM and faculty perceptions in first-professional physical therapy programs in the United States have evolved over the past decade. With TJM content more fully integrated into educational curricula, programs can now look to refine teaching strategies that enhance learning outcomes.

Innovation in pediatric clinical education: application of the essential competencies.

At the Section on Pediatrics Education Summit in July 2012, consensus was achieved on 5 essential core competencies (ECCs) that represent a knowledge base essential to all graduates of professional physical therapist education programs. This article offers suggestions for how clinical instructors (CIs) might use the ECCs to identify student needs and guide student learning during a pediatric clinical education experience. Pediatric CIs potentially might choose to use the ECCs as a reference tool in clinical education to help (1) organize and develop general, clinic-specific clinical education objectives, (2) develop and plan individualized student learning experiences, (3) identify student needs, and (4) show progression of student learning from beginner to intermediate to entry level. The ECCs may offer CIs insights into the role of pediatric clinical education in professional physical therapist education.

A Case-Based Reasoning (CBR) Model for the Integration of Insurance Policy and Regulations in Professional Physical Therapist Education

Background and Purpose. The evolving health care environment brought about by health care reform and constantly changing insurance and regulatory requirements poses a great challenge for today's physical therapists (PTs). Because professional level PT students are expected to integrate these requirements into patient management, educational programs should explore ways to enhance student learning in these areas. The purpose of this manuscript was to describe a case-based reasoning (CBR) approach to integrating insurance, regulations, and documentation content into a professional level PT education program, assess the outcome on students’ clinical performance, and report faculty perceptions of the curricular changes. Method/Model Description and Evaluation. Faculty in a professional level PT education program developed a CBR instructional method to integrate insurance, regulatory, and documentation content throughout the curriculum. The goals for the curriculum change were to have thirdyear students begin their internships with the ability to analyze and apply appropriate insurance and regulatory policies to all patient cases, appreciate how policies affect patient management and access, and effectively document in the medical record. In addition to adding didactic material and interactive learning experiences, faculty modified existing cases used in clinical management courses. This modification resulted in students experiencing progressively more complex clinical cases layered with insurance and regulatory challenges. Outcomes. To determine the effectiveness of the CBR method, student performance was measured using 2 domains (financial management, documentation) of the Clinical Performance Instrument (CPI) during the student terminal clinical internship for 2 cohorts of students. The first cohort included all PT students for the 2 years prior to the implementation of CBR experiences, while the second cohort included 2 years of PT students who participated in CBR learning. Significant statistical differences between cohorts were demonstrated in student self-assessment of documentation performance at midterm (P = .011) and financial resources performance at the midterm and final rating periods (P = .022 and P = .012, respectively). For clinical instructor (CI) ratings, there was a statistically significantly difference between cohorts at the final rating for financial resources performance (P = .044), indicating a higher CI rating for those students that participated in the CBR instruction. Participating faculty survey results demonstrated that the CBR approach benefitted student learning, was not difficult to integrate into existing course learning experiences, and enhanced faculty learning. However, participating faculty had concerns regarding their own comfort level with the material and whether it was replacing more clinically oriented content. Discussion and Conclusion. The outcomes generally support the effectiveness of the CBR approach for integrating insurance policy, regulations, and documentation in a professional level PT education program. Students learn to use regulation and insurance policy information when making clinical decisions and participating faculty did not feel unduly burdened by the integration of this content into established case studies. Although the results are encouraging, further research is recommended.

Mission of Physical Therapist Professional Education : Anticipated Activities for Ten Years Later

Mission of Physical Therapist Professional Education : Anticipated Activities for Ten Years Later

A Model for Designing a Geriatric Physical Therapy Course Grounded in Educational Principles and Active Learning Strategies

INTRODUCTIONThe goal of physical therapist education programs is to prepare practitioners to evaluate and treat movement dysfunction for individuals across the lifespan.1 The US Census Bureau projects that by 2050 the number of over age 65 in the United States is expected to reach 88.5 million-nearly double the 40.2 million over that age in 2010. 2 In 2008, the Institute of Medicine (IOM) of the National Academies published recommendations for preparing and growing the health care workforce in preparation for a graying America. This report emphasized the need to improve the geriatric-specific competence of health care workers, increase the number of geriatric specialists in all health professions, and develop new models for geriatric care delivery.3As the older segment of the population grows, so too does the proportion of older adults comprising the caseload of the typical physical therapist. The 2006 Practice Profile Survey from the American Physical Therapy Association tracked the mean percentage of patient care time spent with individuals by age group.4 persons (age 65 and over) comprised a majority of patient care time per week by practice setting, including: approximately 82% in skilled nursing facilities, 60% in home care, 54% in sub-acute rehabilitation hospitals, 52% in acute care hospitals, 31% in hospital-based outpatient clinics, and 27% in private practice. Specialized training is essential in both the academic and clinical environments to prepare physical therapist graduates to meet the needs of the older adult population across health care settings.John Rowe, chairman of the National Academy of Sciences Committee on the Future Healthcare Workforce for Older Americans, emphasized the need for all health care workers to demonstrate basic competence in geriatric care. This competence necessitates significant enhancements in educational curricula and training programs3(p xii) available to health care providers.3 A number of curriculum development models for physical therapist professional education have been described in the literature.59 These models discuss the development of curriculum on a larger program-level scale, considering factors that extend across academic courses of a given program. Shepard and Jensen discuss a general framework for stand-alone course design through their preactive teaching grid.7 The grid helps instructors to consider 10 different dimensions of instructional design, such as teaching methods, assessments, student preferences, and learning environment, in preparation for a course or single learning event. Models for content-specific course design in physical therapy, including geriatric physical therapy, are limited.10'13The purpose of this paper is to describe and evaluate a model for the design, development, and implementation of a dedicated course in a Doctor of Physical Therapy (DPT) program on the management of the aging adult. Educational theory that promotes student engagement, reflective practice, clinical decision making, and problem solving will be presented, followed by how these educational principles were incorporated into the course design. Grounded in educational principles, this model optimizes learning and preparedness for geriatric physical therapist clinical practice. The following describes the theoretical framework as the basis for this course design model, application of the design process to a course on the management of the older adult, and evaluation of the course outcomes to determine the efficacy of this model. We apply the model to a geriatrics course, but the model may be used to design or redesign courses related to a broad array of didactic content areas.Theoretical FrameworkCourse development is an iterative process requiring continuous assessment and alignment of objectives, instructional methods, and learner outcomes, incorporation of learner feedback, and integration of current evidence and trends in clinical practice (Figure 1). …

Professional Practice Opportunities: Preparing Students to Care for an Aging Population

Background and Purpose. In the United States, a large proportion of older adults will require services to address their health care needs. Physical therapy students’ early exposure to working with this population is important; however, the current clinical climate and full curricula can make these experiences challenging to arrange. In an attempt to address this challenge, we have developed a novel clinical education offering, the professional practice opportunity (PPO). The intent of PPOs is for students to gain exposure, insight, and experience in order to develop a set of common practice skills necessary to work with older adults. The purpose of the paper is to present a method/model describing our professional physical therapist education program’s use of PPOs to supplement integrated clinical education. Method/Model Description and Evaluation. Needs assessment of the curriculum and relevant program stakeholders was performed. The PPOs were implemented in integrated clinical education courses that complemented direct patient care experiences. The students submitted a reflective portfolio at the end of the semester. Students accounted for time spent, linked project activities to curricular threads, and discussed application to future practice. Outcomes. PPOs for 1 academic year included 58 students, 2,320 hours of PPO time, and 40 mentors; 52 PPOs specifically addressed needs of older adult clients. The most frequently performed activities were interactive clinical observations, education, and research. Feedback from reflective portfolios and course evaluations demonstrated a positive impact on students’ attitudes, value, and enthusiasm for these professional activities. Mentor feedback was extremely positive and is most likely attributed to the fact that PPOs were stakeholder-centered and matched for student interest and skills. Discussion and Conclusion. Though patient exposure is paramount in early clinical courses, other objectives include professional socialization and developing the skills to work with individuals of all ages—which can be achieved through exposure to a variety of patients and practice settings. PPOs were a useful tool to meet these goals, in addition to supporting other program stakeholder interests.

Clinical Reasoning in First- and Third-Year Physical Therapist Students

Background and Purpose.The development of clinical reasoning skills is a crucial component of professional physical therapist education. Prior research has described reasoning patterns in novice and expert practitioners, yet little is known about how professional physical therapist (PT) students dev

SECTIONS Model: Strategizing Technology-Based Instruction in Physical Therapist Education

Background and Purpose. The purpose of this educational case report is to present an innovative application of Bates and Poole’s SECTIONS model9 to promote the use of web-based videos in a professional physical therapist education curriculum. Case Description. This case report provides a description of the SECTIONS model and its application to the educational endeavor using iTunes U©, in addition to outcomes and recommendations for further areas of study. Outcomes. Hybrid learning was effective and produced the following outcomes for the Department of Physical Therapy and Rehabilitation Science (PTRS) at the University of Maryland School of Medicine: (1) reduced face-to-face class time by 10%-15%, (2) enabled faculty with heavy teaching responsibilities to perform scholarship and service activities, (3) allowed lab time to be used for clinical integration, (4) increased learner responsibility for their own education, and (5) enhanced relationships between core and associated faculty by allowing clinicians access to current information through PTRS’ online resources. Discussion and Conclusion. The SECTIONS model provided a stellar framework with which to plan, implement, and analyze the use of clinical-skill videos posted to iTunes U©. There was very little expenditure risk and much reward gained with implementing this instructional technology.

Outcome Measures for Individuals With Stroke: Process and Recommendations From the American Physical Therapy Association Neurology Section Task Force

The use of standardized outcome measures (OMs) can support clinicians' development of appropriate care plans, guide educators in curricular decisions, and enhance the methodological quality and generalizability of clinical trials. The purposes of this case report are: (1) to describe a framework and process for assessing psychometrics and clinical utility of OMs used poststroke; (2) to describe a consensus process used to develop recommendations for stroke-related OMs in clinical practice, research, and professional (entry-level) physical therapist education; (3) to present examples demonstrating how the recommendations have been utilized to date; and (4) to make suggestions for future efforts. A task force of 7 physical therapists with diverse clinical and research expertise in stroke rehabilitation used a 3-stage, modified Delphi consensus process to develop recommendations on OM use. An evidence-based systematic review template and a 4-point rating scheme were used to make recommendations on OM use by care setting and patient acuity, for research, and for inclusion in professional education. An initial list of 77 OMs was developed based on input from numerous professional sources. Screening measures and duplicate measures were eliminated. Fifty-six OMs received full review. Measures spanned the constructs of body structure/function (21), activity (28), and participation (14). Fourteen measures received a rating of "highly recommend." Use of highly recommended OMs may provide a common set of tools enabling comparisons across patients, interventions, settings, and studies. The use of a clearly defined, comprehensive assessment template may facilitate the pooling of data on OMs and contribute to best practice guidelines. Educational recommendations may inform curricular decisions.

Quality in Physical Therapist Clinical Education: A Systematic Review

Many factors affect student learning throughout the clinical education (CE) component of professional (entry-level) physical therapist education curricula. Physical therapist education programs (PTEPs) manage CE, yet the material and human resources required to provide CE are generally overseen by community-based physical therapist practices. The purposes of this systematic review were: (1) to examine how the construct of quality is defined in CE literature and (2) to determine the methodological rigor of the available evidence on quality in physical therapist CE. This study was a systematic review of English-language journals using the American Physical Therapy Association's Open Door Portal to Evidence-Based Practice as the computer search engine. The search was categorized using terms for physical therapy and quality and for CE pedagogy and models or roles. Summary findings were characterized by 5 primary themes and 14 subthemes using a qualitative-directed content analysis. Fifty-four articles were included in the study. The primary quality themes were: CE framework, CE sites, structure of CE, assessment in CE, and CE faculty. The methodological rigor of the studies was critically appraised using a binary system based on the McMaster appraisal tools. Scores ranged from 3 to 14. Publication bias and outcome reporting bias may be inherent limitations to the results. The review found inconclusive evidence about what constitutes quality or best practice for physical therapist CE. Five key constructs of CE were identified that, when aggregated, could construe quality.

Educational Perspectives and Teaching Styles of Faculty Who Lead International Service-Learning Experiences

Background and Purpose. Many professional physical therapist (PT) education programs are adding international service-learning (ISL) opportunities to their curricula as a way to address the increasingly global nature of the profession. There is a paucity of physical therapy literature addressing ISL, with a particular deficiency related to ISL faculty. The purpose of this study was to describe faculty demographics, teaching styles, and educational perspectives, and to compare faculty who provided ISL experiences for physical therapist students with those that did not.Subjects. The subjects included 205 faculty of physical therapist education programs; 23% led ISL.Methods. Subjects were recruited through 2 professional listservs and data were gathered via a commercial web-based service. Faculty with and without ISL experience were compared on demographic variables, teaching style, and educational perspective. Measurement tools included standard demographic inquiries, the Grasha and Riechmann-Hruska Teaching Style Survey, and a researcher-developed educational perspective questionnaire. Logistic regression was used to explore characteristics predictive of participation in ISL.Results. Subjects' most common teaching style was Personal Model/Formal Authority/Delegator and a Professional focus was the most commonly identified educational perspective. Familiarity with key ISL education authors was limited. There was no relationship between ISL involvement and teaching style, but a relationship was identified between ISL involvement and the Critical perspective. The factors in this study were not predictive of ISL participation.Discussion and Conclusion. In general, faculty ISL experience did not differ from their colleagues without experience. However, study findings can inform, and provide rationale and support for existing and future ISL programs. This study also provides a context for encouraging the discussion and exploration of faculty teaching styles and educational perspectives.Key Words: Physical therapy faculty, International service-learning, Teaching style.BACKGROUND AND PURPOSEInternational service-learning (ISL) is popular throughout higher education, and many professional physical therapist (PT) education programs are adding ISL opportunities to their curricula.1 Development of these ISL experiences aligns with student interest as well as the increasingly global nature of our profession.2 Globalization is influencing health care, and physical therapists are likely to encounter marked diversity in any setting in which they practice. Indeed, the 21st century has seen the profession of physical therapy taking a more global stance and positioning itself for enhanced international awareness and collaboration.3 Therefore, providing opportunities for physical therapist students to experience diversity and increase their cultural competence is critical. One way to address these issues in academic programs is to provide ISL opportunities, which may help to develop skills and attributes that enhance students' preparation for practice in this culturally diverse and global health arena.Before exploring ISL further, differentiating it from service learning (SL) is appropriate. Seifer4 defined SL as structured learning experiences that combine community service, explicit learning objectives, preparation, and reflection. (p274) Service-learning conducted in international settings is referred to as ISL; ISL conceptually and pedagogically grew out of SL. There is a sizeable and growing body of SL literature; in contrast, there is a remarkably limited body of ISL literature. This study was conceptualized in the context of SL and ISL literature.Many prominent educational theorists and researchers have explored important pedagogical issues associated with SL at the college level. Issues that have been explored include authenticity,47 higher-order thinking,811 theoretical support,6'8 reflection,1214 key features of campus-community partnerships,1422 and student outcomes such as general impact,4·1728 citizenship and service levels,29'30 and application of course content. …

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.

Establishing and Upgrading Physical Therapist Education in Developing Countries: Four Case Examples of Service by Japan and United States Physical Therapist Programs to Nigeria, Suriname, Mongolia, and Jordan

Background and Purpose. Physical therapist (PT) professional (entry-level) education programs are non-existent in most developing countries. The PT professional education programs that do exist in some developing countries may need to upgrade and strengthen their existing curricula. Many of these programs are in significant need of additional PT faculty and advanced education for their existing PT faculty. Efforts to create or enhance PT education programs in developing countries are frequently limited by inadequate human and material resources. Method/Model Description and Evaluation. This paper describes and discusses 4 models of collaboration and international partnerships in which educators and PT education programs in developed countries with more human and material resources partner with universities in developing countries to help establish or enhance PT education programs. Experiences of PT education programs in the US working with programs in Nigeria, Suriname, and Jordan, and a program in Japan working with a program in Mongolia, are presented. Outcomes. The models of collaboration between service and host countries resulted in provision of online education to practicing physical therapists, consultation on curriculum, short-term teaching/consulting for existing and developing programs, and PhD education of foreign PTs with the intention that they return to their country of origin as faculty members in PT programs. Discussion and Conclusion. These case examples of international collaboration serve as models for other PT programs and educators to form similar international partnerships and to develop new models. Key Words: International, Education, Physical therapy. BACKGROUND AND PURPOSE Developing countries carry over 55% of the global burden of disease, but have less than 15% of global health care work force.1 In contrast, many developed countries carry a lower global burden of disease, but have a relatively higher ratio of the global health care work force. For instance, the United States with 10% of the global burden of disease has 25% of the global health care work force; whereas Africa, which carries 25% the global burden of disease, has less than 4% of the global health care work force.24 The shortage of health care work force in developing countries is exacerbated by migration of health care professionals from resourcepoor to resource-rich countries. This concept of migration is known as brain drain.2,510 Often, health care professionals in developing countries immigrate either for pecuniary reasons, a poor practice environment and infrastructure, or political instability.7,1113 To address this disparity and perennial health care work force shortage, efforts by the World Health Organization (WHO) and governments in developed and developing countries primarily focus on training, retention, and recruitment of health care professionals in medicine, nursing, pharmacy, dentistry, imaging, and medical laboratory sciences.14,15 For instance, education and training specific to medical and nursing health care professionals in sub-Sahara African countries have received a tremendous boost in funding, human and material resources, and partnerships with many US academic institutions.1618 These initiatives, driven by HIV/ AIDS funding, have been funded by the US government through the Medical Education Partnership Initiative (MEPI)19,20 and the Nursing Education Partnership Initiative (NEPI)21,22 programs of the National Institutes of Health (NIH) and the US President's Emergency Plan for AIDS Relief.19,20 Specifically, successful upgrading of nursing education programs through NEPI have been reported for Botswana, Lesotho, Kenya, Malawi, Zambia, Brazil, India, Thailand, and the Philippines.22 The Consortium of Universities for Global Health,23 comprised of over 50 academic institutions in the United States and Canada, and funded by the Bill and Melinda Gates Foundation and the Rockefeller Foundation, currently partner with developing countries and their institutions. …

A History of Physical Therapist Education Around the World

INTRODUCTION The roots of the physical therapist education reach back through the ages. The development of physical therapy as an autonomous profession based on current scientific knowledge was in large part due to Per Henrik Ling of Sweden. In 1813, he founded the Royal Central Institute of Gymnastics (RCIG) in Stockholm for the training of gymnastic instructors. With the founding of RCIG, Ling provided a professional identity for the physical therapist. Thereafter, physical therapist education evolved in different ways around the world. In the United Kingdom, it was through the Society of Trained Masseuses. In Norway and Finland, it was influenced by the work of Ling, with an emphasis on massage training. In the United States, it was as a result of the polio epidemics and the need to treat those wounded during World War I. The World Confederation for Physical Therapy (WCPT) has established standards and guidelines for physical therapist entrylevel education that are globally relevant and available to all on its Web site. They include the Policy Statement: and the 5 WCPT guidelines related to physical therapist professional entry-level education (WCPT Guidelines for Physical Therapist Professional Entry-Level Education; for Qualifications of Faculty for Physical Therapist Professional Entry-level Education Programs; for the Clinical Education Component of Physical Therapist Professional Entry-level Education; for Curricula for Physical Therapists Delivering Quality Exercise Programs Across the Life Span; and Guideline for a Standard Evaluation Process for Accreditation/Recognition of Physical Therapist Professional Entry-level Education Program). Consideration of physical therapist education across member organizations in each of the 5 WCPT regions clearly demonstrates that major diversity exists in physical therapist entry-level professional education around the world. THE ROOTS The roots of the profession of physical therapy may have begun as early as 3,000 BC, with evidence that the Chinese practiced massage. Hippocrates (460-377 BC) made reference to friction massage.1 The use of therapeutic exercise and massage in the 16th century occurred when the Greeks realized that physical health and spiritual health were inseparable. An Italian physician, Gerolamo Mercuriale, used exercise both hygienically and curativeIy in the 1500s.2 In Sweden in the early 19th century, Pehr Henrik Ling combined massage and rhythmic exercises for health benefits.3 In the 17th, 18th, and 19th centuries, there are references to correcting childhood deformities with splinting, massage, and prosthetics; treating patients with a stroke by reawakening the weakened control of the brain through motion; and using a regime of and massage to treat scoliosis.4 BEGINNINGS OF PHYSICAL THERAPIST EDUCATION IN SWEDEN The profession of physical therapy developed in Sweden first as an autonomous profession based on the scientific knowledge of the day due to Pehr Henrik Ling (Figure 1), who has been called the Father of Swedish Gymnastics. Ling, originally a graduate of the Vaxjo gymnasium (1792) and a fencing master, went on to study theology at Lund and Uppsala Universities. While traveling abroad after graduation, he met a Chinese individual (Ming) who instructed Ling in martial arts and tui na. Ling acquired further knowledge in England, Germany, and France that expanded Ming's special gymnastics or exercises and were aimed at enhancing stamina, strength, and flexibility- requisites for Ling's fencing. Ling returned to Sweden as a result of overuse injuries and rheumatism and healed himself using the exercises that he had acquired. He was appointed as a fencing master at Uppsala. Appreciating how the exercises had restored his health, he understood the importance of using exercises for the health of others. …

Student Perception of Applying Joint Manipulation Skills During Physical Therapist Clinical Education: Identification of Barriers

Introduction/Review of Literature. A 2004 survey of physical therapist education programs indicated that out of 116 responding programs, 44% were including thrust joint manipulation (TIM) in their curriculums. CAPTE accreditation includes instruction of TJM during physical therapist professional education. TJM has been shown to be effective in certain patient populations and adoption of TJM by graduating students is likely dependent on both didactic and clinical education. The purpose of this study was to identify and describe potential student-perceived barriers to learning and practicing TJM. Subjects and Methods. Students targeted from all professional PT education programs in their final year of graduation and within 3 months following graduation were asked to complete a survey that was sent to program directors to distribute to students. Results. 460 subjects responded from 38 states (all US regions). The median age was 26 and 73% were female. Results indicated a level of didactic education in TIM (95%), but a lesser percentage of opportunities to utilize techniques clinically. When asked about their experience during outpatient orthopedic-based clinical education, 54% of the student respondents indicated that they perceived that their clinical instructors (CIs) were not completely comfortable with students performing TJM. When students did not utilize TIM, despite clinical indication, they cited lack of confidence (55%), personal skill level (48%), and not feeling academically prepared to utilize techniques (26%) as some of the reasons. Discussion and Conclusion. This survey suggests an increase in the number of professional physical therapist education programs teaching TJM. However, the students surveyed perceived barriers to practicing TJM during clinical experiences, which may limit their use of these techniques during their clinical practice. While TIM instruction in academic programs appears to be increasing, full adoption clinically requires practice. Enhanced CI education may increase the opportunity for student TJM practice during internships and may result in adoption of TJM practice after graduation. Key Words: Clinical education, Student learning, Teaching methods, Orthopedics/musculoskeletal, Professional development. INTRODUCTION/REVIEW OF LITERATURE Application of published evidence into clinical practice is an expectation as the profession of physical therapy evolves and grows. In particular, as practitioners with doctoral degrees, physical therapists are increasingly expected to integrate current best evidence into clinical practice. Sackett1 states that an essential tenet of evidence-based practice (EBP) is integrating individual clinical expertise with the best available external clinical evidence from systematic research.?71 Using the Levels of Evidence from the Oxford Centre for Evidence-Based Medicine,2 thrust joint manipulation (TIM) is an intervention that has a growing body of high-level evidence supporting its use.3'5 TIM is included in The Commission on Accreditation of Physical Therapy Education's (CAPTE) evaluative criteria for physical therapy programs, indicating that it is now considered an entry-level skill for physical therapist (PT) education program graduates.6 TIM has traditionally been included in the broad category of manual therapy, and specifically mobilization/manipulation, defined in the American Physical Therapy Association's (APTA) Guide to Physical Therapist Practice7 as ... comprising a continuum of skilled passive movements to the joints and/or related soft tissues that are applied at varying speeds and amplitudes, including a small-amplitude/ high-velocity therapeutic movement.1*80 For the purposes of this research, the term thrust joint manipulation is defined as a high velocity/low amplitude therapeutic movement directed at a joint. TIM has been a component of physical therapy practice since its inception8'9 and has been reported to be effective for numerous musculoskeletal conditions. …

Is There a Relationship Between Performance During Physical Therapist Clinical Education and Scores on the National Physical Therapy Examination (NPTE)?

Background and Purpose. The determination of whether a student physical therapist (PT) has reached entry-level status for graduation purposes is partially determined by the physical therapist education program's evaluation tool used for rating student performance in the clinical setting. The determination of whether a graduate can practice physical therapy depends on graduate performance on the National Physical Therapy Examination (NPTE). Clinical performance as assessed by the clinical evaluation tool used by members of the Texas Consortium for Physical Therapy Clinical Education (Consortium), the Physical Therapist Manual for the Assessment of Clinical Skills (PT MACS), has not been evaluated with regard to the NPTE. Therefore, the purposes of this study were to assess the following: (1) the relationship between PT MACS section scores on the first and final clinical experiences with section scores on the NPTE among first-time test takers, (2) the relationship between PT MACS aggregate scores on the first and final experiences with the overall score on the NPTE among first-time test takers, and (3) the relationship of final PT grade point averages (GPAs) with NPTE scores among first time test takers. Subjects/Methods. This retrospective study used archived academic, clinical, and NPTE performance data collected by the directors of Clinical Education of 8 Texas PT professional education programs for classes graduating between 2004 and 2007. The total number of graduates was 985. Data were analyzed for relationships using Pearson product moment correlation coefficients. Results. Small, but significant, relationships were found between 2 PT MACS sections and corresponding sections on the NPTE (P Discussion and Conclusion. Although-several small, significant relationships were found between the PT MACS sections and corresponding NPTE sections, PT GPA demonstrated the greatest relationship with success on the NPTE, reinforcing the findings of previous studies. Based on results of the inter-item analysis, the PT MACS demonstrated good internal consistency reliability. Results of this study suggest that an assessment tool that tests all domains of learning cannot predict performance on a cognitive instrument such as the NPTE. Key Words: Physical therapy, Clinical education, Licensure examination. BACKGROUND AND PURPOSE Today's health care system requires that newly graduated physical therapists (PTs) enter the workforce prepared to meet the demands of total patient management. Graduates are expected to perform at a level that meets the standards of safe, effective, and efficient practice. The educational preparation of these graduates includes completion of both intense schedules of didactic classroom experience and complex clinical experiences. The combination of didactic preparation and clinical competence in entry-level skills must be assessed in order to determine the eligibility of a student to graduate from the PT education program. Clinical competence is assessed using evaluative tools specific to clinical skills that define entry-level standards. One such evaluative tool is the Physical Therapist Manual for the Assessment of Clinical Skills (PT MACS),1 developed by the Texas Consortium for Physical Therapy Clinical Education. Successful completion of an accredited professional physical therapist education program allows the graduate to apply for and take the National Physical Therapist Examination (NPTE). Entry-level competence is assessed using multiple-choice items that have been constructed based on a formal survey of physical therapists describing their current job activities and responsibilities. …