Year Of Licensure Research Articles

How Do Physical Therapists Perceive Anatomy Education?

INTRODUCTIONThere is a significant gap in the existing literature as to the long‐term retention or sufficiency of anatomical knowledge learned in physical therapy school. The purpose of this investigation is to explore the perceptions of the sufficiency and relevancy of the anatomy education received in physical therapy school, with a specific focus on its sufficiency and relevancy for clinical practice among early, mid, and late‐career physical therapists. Similar studies have been conducted among medical doctors and medical students (Ahmed et al., 2010; Rowland et al., 2011), but to our knowledge, there have been no studies surveying physical therapists in the United States focused on post‐graduate outcomes.METHODSThis survey was approved by the Moravian University IRB, #20‐0061. The survey was distributed via email through multiple clinical networks in the greater Mid‐Atlantic region, through the American Physical Therapy Association Pennsylvania chapter (APTA‐PA) and through the American Council of Academic Physical Therapy (ACAPT) Educational Research division. The survey included demographic questions, questions regarding how the survey respondents learned anatomy in physical therapy school, and a series of Likert scale questions to investigate their opinions about the sufficiency and relevancy of their anatomy education. Participants who were teaching or previously taught anatomy were not asked to participate in the study. Descriptive statistics were performed on the demographic variables and frequencies were calculated to determine the methods of anatomy education and Likert scale responses. One‐way Analysis of Variance (ANOVA) was performed to compare the Likert scale responses from the groupings of survey participants. Participants were classified by their year of licensure: early‐career (2015‐2021), mid‐career (2005‐2014), and late‐career (2004 and earlier).RESULTSEighty‐seven percent of respondents participated in dissection in their anatomy courses and 62.4% studied from prosected materials. Surface anatomy/palpation was included in 76.3% of anatomy courses. Less than 7% of respondents utilized newer methods such as a virtual cadaver table, augmented reality headsets, clay modeling, and body painting. There were no significant differences in Likert scale responses among early, mid and late‐career physical therapists. Respondents all agreed that dissection helps to develop practical clinical skills, is superior to prosection, and that the use of cadavers for anatomy education is essential (4.37, 4.13, and 4.32 on a 5‐point Likert scale, respectively).CONCLUSIONPhysical therapists’ perceptions should be a key component in the development of standard learning objectives for physical therapy (PT) anatomy education. In this investigation, length of time in practice did not influence the opinions on the sufficiency or relevancy of anatomy education. Dissection continues to be included in most physical therapy anatomy courses and perceived to be essential for learning. We intend to further this research by conducting focus groups and by examining the relationship between methods of learning anatomy, PT specialty, and opinions of anatomy education.

Comparison of older and younger novice driver crash rates: Informing the need for extended Graduated Driver Licensing restrictions

BackgroundFew previous studies have directly compared crash rates of older and younger novice drivers. To inform discussion about whether Graduated Driver Licensing (GDL) policies that are applied in the US for younger novice drivers should be applied to older novice drivers, we conducted a longitudinal study to examine overall, nighttime, and multiple passenger crash rates over the initial four years of licensure differ for novice drivers licensed at different ages. MethodsUsing data from the New Jersey Traffic Safety Outcomes (NJ-TSO) data warehouse, we selected all NJ drivers who obtained their initial intermediate driver’s license from 2006 through 2014 and had at least one month of follow-up from the date of licensure to study end or death (n=1,034,835). Novice drivers were grouped based on age at licensure: age 17; 18–20; 21–24; and 25 or older. We estimated monthly rates for overall crashes (per 10,000 licensed drivers) as well as: late night crashes (11:01 p.m.–4:59 a.m.); early night crashes (9:00 p.m.–11:00 p.m.); and multiple passenger crashes (two or more passengers). Average monthly rates were calculated for specific relevant time periods and Poisson regression models were used to compare rates: (1) between novice driver groups with the same time since licensure; (2) over the first 48 months of licensure within each novice driver group; and (3) between same-aged 21-year-old drivers with varying lengths of licensure. ResultsAlthough initial (three months post-licensure) overall crash rates of novice NJ drivers age 21 and older were higher than rates of same-aged experienced drivers, they were substantially lower than initial rates for 17- to 20-year-old novice drivers, who are licensed under GDL policies. Moreover, older novice drivers experience much less steep crash reductions over the first year of licensure than younger novice drivers. Nighttime crash rates among the 21- to 24-year old and aged 25 and older novice driver groups were stable over the first year of licensure. For novice drivers under age 21, early night crash rates declined rapidly over the course of licensure, while changes in late night crashes were much smaller. First-year multiple passenger crash rates were highest for drivers licensed at age 18–20, and novice driver groups experienced varying amounts of reduction in multiple passenger crashes over time. ConclusionsStudy findings support NJ’s current GDL policies for 17- to 20-year-old novice drivers and the potential for added benefits from beginning the nighttime restriction at 9:00 p.m. Conversely, there was a lack of compelling evidence for additional policies for drivers licensed at age 21–24 and no evidence to indicate a need for additional GDL policies for NJ novices aged 25 years and older.

Crash and traffic violation rates before and after licensure for novice California drivers subject to different driver licensing requirements

IntroductionHow do crash and traffic violation rates for novice 16–17-year-old drivers change over the months before and after licensure under a graduated driver licensing (GDL) program relative to those for older novices who are not subject to GDL? MethodPlots and Poisson regression comparing overall rates and subtypes of crashes and traffic violations among California novice drivers ages 16 to 35years over time before and after unsupervised licensure. ResultsMajorities of 16-year-olds (57%) and 17-year-olds (73%) actually hold their learner permits longer than the required 6months; majorities (67%–81%) of age 18 or older novices hold their learner permits less than 6months. Crash rates of novice 16- and 17-year-olds—as well as most other age groups—are highest almost immediately after they are licensed to drive unsupervised, after which their rates decline quickly during their first year of licensure and at a slower rate for the second and third years. Novice 16- and 17-year-olds' traffic violation rates reach their zenith long after their total crash rates peak and decline, whereas violation rates for older novices peak during their first year of licensure. Over 70% of 16- and 17-year-old novices are crash-free for the first 3years of licensure. ConclusionsWhile novice 16- and 17-year-olds' highest crash rates occur almost immediately after they are licensed, their peak traffic violation rates are delayed until around the time they turn age 18. Both pre-licensure crash rates and post-licensure crash peaks were more pronounced for some older age groups of novices than was the case for 16–17-year-olds. Practical ApplicationsExtending learner permit holding periods for 16–17-year-old novices appears consistent with their actual behavior; requiring older novices—particularly those ages 18 to 20—to hold permits for minimum periods may reduce their initial crash rates.

Perceived Risk and Other Predictors and Correlates of Teenagers' Safety Belt Use During the First Year of Licensure

Objectives. Teenagers have the lowest rate of safety belt use and the highest crash rate compared to other age groups. Past studies on teenagers' belt use have mostly been cross-sectional. The first goals of this study were to examine, at licensure, teenagers' and parents' perceptions of risk of crash/injury for newly licensed teenagers when driving unbelted and teenagers' perceived and parents' intended consequences for safety belt rule violations. In addition, the comparability of these variables to other risky driving behaviors was explored. The second goal was to evaluate the importance of these variables in the prediction of teenagers' belt use during the first year of licensure, relative to other factors related to belt use, including demographics and substance use. Methods. More than 2,000 parent-teenager dyads were interviewed by telephone, parents at permit and licensure and teenagers at permit, licensure, and 3, 6, and 12 months after licensure. Results. Approximately a third of the teenagers reported at least once at 3, 6, or 12 months post-licensure not always using their safety belt in the past week. At licensure, participants' perceived risk of safety belt non-use was high and ranked among the behaviors most related to crash/injury for newly licensed teenagers, behind driving under the influence of alcohol or drugs. Parent-imposed consequences for safety belt rule violations were not as highly rated as parent-imposed consequences for driving under the influence of alcohol or drugs. Sequential logistic regression modeled the relationship between safety belt use and perceived risk and consequences of non-use, as well as other prospective predictors assessed at permit and licensure, and driving correlates measured after licensure. Teenagers' extreme perceived risk and parents' intended sure consequences for non-use were significant prospective predictors of regular use during the first year of licensure. Other significant predictors and correlates were race (White), high school grade average of “A,” not smoking cigarettes, driving a passenger vehicle, and never receiving a traffic citation or engaging in risky driving behaviors, including driving under the influence of alcohol or drugs and running a red light. Conclusions. While the effect size was small for perceived risk of non-use, it is a modifiable factor and focused intervention contrived to enhance perceived risk could increase teenagers' belt use. Perceived risk is discussed as a target for intervention in relation to the Protection Motivation Theory. This theory appears helpful in guiding future research into the modifiable factors studied here as well as other factors, including perceived rewards and costs associated with non-use.

Do Recommended Driving Limits Affect Teen-Reported Traffic Violations and Crashes During the First 12 Months of Independent Driving?

Objectives. Motor vehicle crashes are highly elevated among newly licensed teenage drivers. Limits on high-risk driving conditions by driver licensing policies and parents can protect novice teens from negative driving outcomes, while they experience and driving proficiency. The purpose of this research was to evaluate the effects of strict parent-imposed driving limits on driving outcomes during the first year of licensure. Methods. A sample of 3,743 Connecticut teens was recruited and randomized to the Checkpoints Program or comparison condition. Assessments conducted at baseline, licensure, 3-, 6-, and 12-months postlicensure included parent-imposed driving limits, traffic violations, and crashes. Bivariate and multivariate analyses were conducted to assess the effects of strict parent limits on traffic violations and crashes during the first year of licensure. Results. Thirty percent of teens reported at least one traffic violation and 40% reported at least one crash. More strict parent-imposed limits at licensure, 3-, 6-, and 12-months postlicensure, were associated with fewer violations and crashes in multivariate analyses. Notably, adherence to recommended night curfew was consistently associated with fewer violations and crashes. Conclusions. The findings indicate that strict parent-imposed limits may protect novice teen drivers from negative driving outcomes.

Vehicles Driven by Teenagers in Their First Year of Licensure

Objective. to determine access to vehicles, vehicle ownership and its correlates, and types of vehicles driven by teenagers during their first year of licensure. Methods. About 3,500 Connecticut teenagers and their parents recruited at DMV offices participated in a study aimed at persuading parents to impose and maintain driving restrictions on their sons and daughters. Telephone interviews with teens and parents, which included questions on vehicles driven, were conducted upon licensure and at intervals throughout the year. Results. The majority of both male and female teens owned vehicles immediately upon licensure. Family income and number of vehicles in the family were associated with early ownership. A year later 74% owned vehicles. Small cars, which provide inferior crash protection, were the most popular vehicle; the percent driving small cars increased from 36% to 42% over the year. About 25% were driving SUVs, pickups, or sports cars, which may increase crash risk for young beginners. One year after licensure, only 35% of teens were driving midsize or large passenger cars, the types of vehicles recommended for them, and about one-third of these vehicles were 10 or more years old. Owners were more likely than non-owners to drive older and smaller vehicles, to drive more miles, do more risky driving, and to have more traffic violations and crashes. Discussion. Many teenagers in Connecticut were driving vehicles that rank low in crash protection or may increase crash risk. Attention to the young driver problem has been focused primarily on managing driving risks through graduated licensing systems. More attention needs to be given to the vehicles teens drive, and how decisions about vehicle type and ownership are made. Parents exert control over what vehicles their sons and daughters drive, and may benefit from information on how to make choices that better balance cost, safety, and other factors that go into these decisions.

Support for Buprenorphine and Methadone Prescription to Heroin-Dependent Patients among New York City Physicians

Methadone and buprenorphine are treatments for heroin-dependent patients. Methadone is available through highly-regulated treatment centers while buprenorphine was approved in 2002 for prescription by certified physicians. Just prior to the approval of buprenorphine, we conducted a random postal survey of 770 physicians in New York City to determine willingness to prescribe methadone or buprenorphine for heroin-dependent patients to be picked up at a pharmacy. Among 247 respondents, 36.3% would consider prescribing methadone and 17.9% were unsure, while 25.8% would consider prescribing buprenorphine and 31.8% were unsure. Willingness to prescribe methadone or buprenorphine was associated with more recent year of licensure (p = 0.044; p = 0.033), working in a hospital or clinic as opposed to an office setting (p = 0.009; p = 0.024), and being the director of a clinic or program (p = 0.031; p = 0.008). This preliminary study suggests that a substantial proportion of New York City physicians would prescribe methadone or buprenorphine to heroin-dependent patients.

Specific and Long-Term Effects of Nova Scotia's Graduated Licensing Program

A graduated licensing (GL) program was introduced in Nova Scotia, Canada, in October 1994. Previous research has shown that it reduced collisions in the short term. The present study examined the relative contribution of each stage of the program (i.e., learner and intermediate levels) and the program's impact after beginning drivers graduated to full licensure. The research focused on teenage beginning drivers (age 16-17), but the effects on older beginners also was examined. Per-driver crash rates of two groups of novices selected from driver records in Nova Scotia were compared. One group (pre-GL) received their learner's permits during the 2 years before the program was implemented, and the second group (GL) received their learner's permits during the 2 years after implementation. The findings clearly establish that most of the collision reduction in Nova Scotia's program occurred during the first year of the program, particularly during the first 6 months when the majority of novices were driving under supervision. The collision rate for 16 to 17-year-old GL novices was 50% lower than the rate for pre-GL novices during the 6 months after they received their learner's permits, and about 10% lower during their first 2 years of licensure when unsupervised driving from midnight to 5 A.M. was prohibited. Much of this improvement for 16 to 17-year-olds occurred during restricted night hours. Collision rates also were lower during nonrestricted hours in the initial 6 months of licensure. The 3-month "time discount" for driver education provided no safety benefit, and GL novices with driver education had collision rates that were not lower than pre-GL novices. There was no long-term effect found for the program after 16 to 17-year-olds graduated to full licensure. For older beginning drivers, crash rates during the first year after obtaining a learner's permit showed a 31% reduction. This effect diminished rapidly. There was only a 2% reduction during the first year of licensure, and crash rates increased during the following 2 years. Overall the data indicate substantial benefits of graduated licensing for 16 to 17-year-old beginners, but no benefits beyond the learner stage for older beginners.

How well do parents manage young driver crash risks?

Motor vehicle crashes are extremely high among young drivers during at least the first year of licensure. Crash risks decline with increased experience, but the more newly licensed teenagers drive, the greater their risk exposure. Hence, the dilemma facing policy makers and parents is how to provide young drivers with driving experience without unduly increasing their crash risk. Graduated driver licensing policies serve to delay licensure and then limit exposure to the highest risk conditions after licensure, allowing young drivers to gain experience only under less risky driving conditions. A similar strategy is needed to guide parents. Parents do not appear to appreciate just how risky driving is for novice drivers and tend to exert less control over their teenage children's driving than might be expected. Recent research has demonstrated that simple motivational strategies can persuade parents to adopt driving agreements and impose greater restrictions on early teen driving.

Responses of teenagers and their parents to California's graduated licensing system

In 1998, California adopted a strong graduated licensing system that lengthened the learner's permit stage from 1 month to a mandatory 6 months and introduced passenger and nighttime restrictions for initial license holders. The passenger restriction (no passengers younger than 20 for the first 6 months) is stronger than such restrictions in any other state; the nighttime ban is relatively weak, not beginning until midnight. Surveys were undertaken to learn what teenagers and their parents thought about the new requirements and how they responded to them. Two groups of beginning California license holders were surveyed three times during the first year of licensure; their parents were interviewed twice. One group ( n=543) was subject to the graduated licensing requirements, the other ( n=814) was not. Parents strongly endorsed the new system. The vast majority approved of the new permit requirements and the nighttime and passenger restrictions. Among parents whose children were subject to the new requirements, 79% were strongly in favor of the new system and only 4% were neutral or opposed. Teenagers were less favorable toward the new requirements. Most approved of the new learner's permit rules, and the majority of teenagers favored the night restriction, but only about one-third endorsed the passenger restriction. Compliance with the new rules was not close to universal, but the new licensing system resulted in young people holding their learner's permits longer, accumulating more practice driving prior to licensure and decreased the amount of reported driving after midnight and transportation of teenagers when initially licensed. Most teenagers subject to the new rules said they were able to do the activities they wanted despite the changes; almost three-quarters said they were not affected much by either the nighttime or passenger restriction. Overall the results indicate that the new licensing system is accepted favorably by teenagers and their parents and has substantially increased the types of behaviors that collectively should lead to crash and injury reductions.

Driving experience, crashes and traffic citations of teenage beginning drivers

Teenagers were surveyed by telephone every 6 months from their freshman to senior high school years ( N=911). Self-reported crash involvements and citations were examined for each teenager’s first year of licensure and first 3500 miles driven. Based on survival analysis, the risk of a first crash during the first month of licensure (0.053) was substantially higher than during any of the next 11 months (mean risk per month: 0.025). The likelihood of a first citation during the first month of licensure (0.023) also was higher than during any of the subsequent 11 months (mean risk per month: 0.012). Similarly, when viewed as a function of cumulative miles driven, the risk of a first crash or citation was highest during the first 500 miles driven after licensure. Fewer parental restrictions (e.g. no nighttime curfew) and a lower grade point average (GPA) were associated with a higher crash risk. Male gender, a lower GPA and living in a rural area were associated with a higher citation rate.

A national survey of U.S. pharmacists in 2000: assessing nonresponse bias of a survey methodology.

The first objective of this study was to assess the existence of nonresponse bias to a national survey of licensed pharmacists conducted in 2000. Three methods were used to assess nonresponse bias. The second objective of the study was to examine reasons why sampled licensed pharmacists did not respond to the national survey of licensed pharmacists. We used data from 2204 respondents to a national survey of pharmacists and from 521 respondents to a survey of nonrespondents to the national survey. We made comparisons between respondents for 5 variables: employment status, gender, age, highest academic degree, and year of initial licensure. Chi-square tests were used to examine differences in the 5 variables between respondents to the first mailing and second mailing of the survey, early and late respondents to the survey, and respondents to the survey and respondents to the nonrespondent survey. There were no significant differences between first mailing and second mailing respondents, but there were differences in each variable except year of licensure between early and late respondents. These differences likely were due to regional bias possibly related to differences in mailing times. There were differences between respondents and nonrespondents in terms of employment status and year of licensure. The main reasons for not responding to the survey were that it was too long or that it was too intrusive. Overall, the survey methodology resulted in a valid sample of licensed pharmacists. Nonresponse bias should be assessed by surveying nonrespondents. Future surveys of pharmacists should consider the length of the survey and the address where it is sent.

The rotavirus vaccine's withdrawal and physicians' trust in vaccine safety mechanisms.

To determine how the withdrawal from the market of the rotavirus vaccine has affected physicians' trust in vaccine safety mechanisms, future adherence to vaccine recommendations, and willingness to use a new rotavirus vaccine. National survey mailed to 1228 randomly selected pediatricians and family physicians. Confidence in vaccine safety mechanisms was defined by agreement with the statements that the system for determining vaccine safety before a vaccine is licensed works well and that the system for monitoring vaccine safety after vaccine licensure works well. Physicians who indicated that they would use a new rotavirus vaccine within 1 year of licensure and recommendation by professional organizations were classified as "early adopters." Logistic regression was used to assess the relationship between trust in vaccine safety mechanisms and future early adoption of new rotavirus vaccines. Following the withdrawal of the rotavirus vaccine, 83% of respondents believed the postlicensure surveillance system works well to monitor vaccine safety, while 22% of respondents believed the prelicensure system works well to determine vaccine safety. After adjusting for physician specialty and years in practice, respondents who believed the prelicensure vaccine safety system works well were significantly more likely to be early adopters than those with less confidence in prelicensure studies (adjusted odds ratio, 2.2 [95% confidence interval, 1.3-3.6]). Physicians have different levels of trust in prelicensure studies that determine vaccine safety and postlicensure surveillance systems that monitor vaccine safety. Trust in prelicensure vaccine safety evaluations may be associated with early adherence to new vaccine recommendations.

Long‐Term Follow‐Up of a High School Alcohol Misuse Prevention Program's Effect on Students' Subsequent Driving

Alcohol-related injuries, particularly motor vehicle, are an important cause of adolescent mortality. School-based alcohol prevention programs have not been evaluated in terms of driving outcomes. This study examined the effects on subsequent driving of a high school-based alcohol prevention program. The Alcohol Misuse Prevention Study included a randomized test of the effectiveness of an alcohol misuse prevention curriculum conducted among 4,635 10th-grade students. Students were assigned to intervention (n = 1,820) or control (n = 2,815) groups and were followed for an average of 7.6 years after licensure, which typically occurred during or shortly after 10th grade. Outcomes examined included alcohol-related and other serious offenses, and at-fault, single-vehicle, and alcohol-related crashes. Only serious offenses (which included alcohol-related) had a significant treatment effect (statistically marginal) after we adjusted for sex, age, race, alcohol use/misuse, family structure, presence of prelicense offenses, age of driver licensure, and parental attitudes toward teen drinking. The effect was found only during the first year of licensure (estimated adjusted relative risk = 0.80, confidence interval = 0.63-1.01). Two first-year serious offense interactions were found. The positive effect was strongest among the largest subgroup of students, those who were drinking less than one drink per week on average before the curriculum, compared with those who drank more than one drink per week (p = 0.009). The effect was also stronger for the small subgroup of students whose parents had not expressed disapproval of teens' drinking, compared with those whose parents had disapproved (p = 0.004). These findings suggest that a high school-based alcohol prevention program can positively affect subsequent driving, particularly that of students who do not use alcohol regularly. The results highlight the need to start prevention efforts early and extend them beyond the initial exposure to driving. Programs should incorporate the differing backgrounds of the students.

Surgeon characteristics associated with mortality and morbidity following carotid endarterectomy.

To identify surgeon characteristics associated with mortality or morbidity, following carotid endarterectomy (CEA). Data on all inpatient discharges from the 284 nonfederal Pennsylvania hospitals were obtained from the Pennsylvania Health Care Cost Containment Council for the period from 1994 to 1995. Physician data were obtained from the Physicians List of the American Medical Association, including name, gender, specialty, year of birth, board certified, and year of licensure. Cases were selected if any of six procedures codes were ICD-9-CM rubric 38.12, indicating CEA. Among the 12,725 cases studied, in-hospital mortality was 0.7%, nonfatal morbidity was 3.0%, and the total bad outcome rate was 3.7%. Surgeons who performed 1 to 2 CEAs over 2 years had the highest mortality (2.0%) and total bad outcome (9.2%) rates. For surgeons performing three or more cases in 2 years, increased volume was not associated with better outcomes. A greater number of years since the surgeon was licensed was associated with greater mortality (p = 0.001), but not with morbidity or bad outcome rates. In regression analyses that adjusted for patient risk, both years since licensure and specialty predicted surgical mortality rate, but only volume predicted surgical bad outcome rate. More years since licensure and very low patient volume are associated with worse patient outcomes following CEA.

Changes in young adult offense and crash patterns over time

A study of 13 809 young adult drivers in Michigan examined offenses and crashes (‘incidents’) for an average of 7 years after their original license date. During this period, 73% of subjects committed an offense that resulted in a conviction and 58% had a crash that was reported to the police. Forty-two percent had committed an offense classified as ‘serious,’ and 21% had an ‘at-fault’ crash. The odds of an offense being serious decreased approximately 8% per year of licensure, independent of gender or age at licensure. Similarly, the odds of a crash being at-fault decreased overall about 6% per year of licensure, but the decline was more than twice as fast for women as for men. Examining the empirical rates directly, it was found that the rate for minor offenses increased somewhat with time and then stabilized, while the rate for serious offenses declined. Also, offenses were less likely to be serious the later they occurred in the sequence of offenses for an individual. For crashes, the risk of having an at-fault crash declined more rapidly than the risk of a not-at-fault crash, although the rate of decrease began to equalize after approximately 5 years of licensure. The proportion of crashes that were at-fault did not decline over the sequence of crashes for an individual. Although crashes and offenses are positively correlated, they follow different trajectories over the early years of licensure.

Physician attitudes toward confidentiality of treatment for adolescents: Findings from the Upper Midwest Regional Physicians Survey

The provision of confidential medical services to adolescents is an enduring health policy issue in the United States, and the focus of policy statements by several professional medical organizations. Physician attitudes toward confidential service provision to teenagers were examined in the Upper Midwest Regional Physician Survey, a representative sample of community-based pediatricians and family physicians. Overall, three-quarters of participants favored confidential service provision for youths. Multivariate analysis revealed that the most salient reasons for favoring confidentiality were perception of unique needs among adolescents, year of licensure, high self-assessed competency in addressing sexual concerns of adolescence, adequacy of training in interpersonal and sexual issues, frequency of addressing interpersonal issues, and lower self-assessed adequacy of training in traditional medical problems of youths. Implications for state and federal legislation are discussed.