JOPTE

The Journal of Physical Therapy Education (JOPTE) is peer reviewed and published three times each year by theEducation Section of the American Physical Therapy Association. The Journal is indexed by Cumulative Index to Nursing & Allied Health Literature and in Physiotherapy Indexditor:

Editors:
Jan Gwyer, PT, PhD
Laurita M. Hack, PT, DPT, MBA, PhD 

Winter 2015 Volume 29 - Number 1

Editorial: In Pursuit of Best Practice in Physical Therapy Education
by Jan Gwyer and Laurita Hack
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The concern about quality in physical therapist education is everywhere! The profession as a whole, particularly members of the profession committed to academic and clinical teaching roles, is engaged in several major projects to identify best practice in physical therapist education. The American Physical Therapy Association (APTA), Education Section, American Council of Academic Physical Therapy (ACAPT), Commission on Accreditation of Physical Therapy Education (CAPTE), and Federation of State Boards of Physical Therapy (FSBPT) have been supportive of several profession-wide projects over the past few years that will contribute to the debate surrounding best educational practice for physical therapist education. Consider the macro-level focus of several of these projects:
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Memorial to Otto Payton
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Otto Payton, PT, PHD, FAPTA 1930–2014 We have much to remember about Otto Payton, PT, PhD, FAPTA, who served as editor of the Journal of Physical Therapy Education (JOPTE) from 1988 to 1996. In these formative years for JOPTE, Otto’s gentle and wise leadership never failed to make a noticeable difference. He made a host of other contributions to our profession, including chairing the Department of Physical Therapy at Virginia Commonwealth University, serving as chair of the Editorial Board of Clinics in Physical Therapy for 33 volumes, and serving as the chair of the PT Fund. He was honored for his contributions to physical therapy with the Golden Pen Award, the Lucy Blair Service Award, and by being named a Worthingham Fellow. He is perhaps best known for his groundbreaking work, Research: the Validation of Clinical Practice. This, coupled with his early work in post-professional graduate education, places Dr Payton in the vanguard in moving our profession toward the research base it enjoys today. We, and all future generations of physical therapists, owe him immense gratitude for a debt we can never repay. We thank Dan Riddle, PT, PhD, FAPTA, the Otto D. Payton Professor, and Mary Shall, PT, PhD, department chair, both of the Department of Physical Therapy, Virginia Commonwealth University, for sharing thoughts about Dr Otto Payton.
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Commonly Used Statistical Methods in the Journals Associated With Physical Therapy and Physiotherapy
by James Roush, James W. Farris, Lori M. Bordenave, Samantha Sesso, Ali M. Benson, and Carissa Millikan
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Background and Purpose. Developing the skill of critical appraisal of the literature is essential to clinical practice. This premise is reflected in the accreditation standards for physical therapist education. Critical appraisal includes evaluation of the statistical methods used by authors. Identification of common statistical methods utilized in Physical Therapy has previously been explored, but there are a wide range of journals used by physical therapists. Therefore, knowledge and appreciation for the current common statistical methods used by authors in the core journals related to physical therapy may provide physical therapist educators with valuable information for use in planning curricular content related to statistical methods. The purpose of this study is to explore the frequencies and percentage of occurrence for statistical methods used by authors in the core journals of physical therapy and physiotherapy. Methods. From the 16 core journals associated with physical therapy and physiotherapy, we calculated the most common statistical methods or categories of statistical methods in physical therapy research from 2009 to 2010. Frequencies, cumulative frequencies, percentages, and cumulative percentages were calculated for all statistical methods encountered during the review. From there, the 25 most common statistical methods or categories were identified and ranked. Results. The top-10 statistical methods or categories of statistical methods identified were (1) descriptive statistics, (2) confidence intervals, (3) t tests, (4) epidemiology, (5) regression, (6) nonparametrics, (7) analysis of variance (ANOVA), (8) chi-square, (9) survival statistics, and (10) multiple comparison tests. This accounted for 82.56% of all statistical methods currently used in the core journals for physical therapy and physiotherapy. Discussion and Conclusion. This study describes commonly used statistics by authors of research published in core journals of physical therapy and physiotherapy. The top statistical methods used by authors in these journals were similar to those found previously in Physical Therapy. An appreciation of the statistics utilized by authors of physical therapy and physiotherapy research will allow physical therapy educators to evaluate critical inquiry curriculum taught in physical therapist education programs while determining which statistical methods are important for students to understand. Key Words: Entry-level education, Evidence- based practice, Curriculum design.
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Testing Accommodations: Implications for Physical Therapy Educators and Students
by Debbie Ingram, Thomas Mohr, and Renee Mabey
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Background and Purpose. Academic programs in physical therapy prepare students to assume clinical roles, assuming these roles require the students to take the National Physical Therapy Examination (NPTE). Nationally, more students with disabilities are graduating from these programs and requesting accommodations for the NPTE. The purpose of this article is to review learning disability issues within higher education, accommodations provided on the NPTE, and recommendations for academic programs, licensing boards, and clinical sites. Position and Rationale. One percent of NPTE candidates received accommodations between the years 2000 and 2009. The majority of those candidates tested with at least 2 accommodations. Extra time and testing in a separate room were the most frequent requests granted. Accommodated exams doubled during the 10-year study period, as did the total cost of providing the accommodations. The pass rate on the NPTE was significantly lower for physical therapist (PT) and physical therapist assistant (PTA) candidates who took the exams with accommodations. Documentation of a disability and the accommodations that were granted during physical therapist education programs will help support the need for accommodations when taking the NPTE. It will not, however, guarantee that the jurisdictional board will approve special accommodations when sitting for the NPTE. We believe that with the increasing number of students with disabilities, educators should have a proper understanding of the Americans with Disabilities Act of 1990 (ADA) and be aware of the implications when providing special accommodations. Recommendations. Physical therapy is a profession that promotes the abilities of people with disabilities, and as such, physical therapy educators should prepare PT and PTA students who have disabilities by using the accommodations that are likely to be provided on the NPTE. For those students who self-identify with a disability during the academic program, faculty need to encourage them to seek early testing and implementation of approved accommodations during the academic program. Key Words: Testing accommodations, National Physical Therapy Examination, Disability.
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Purposeful Error as a Diagnostic Tool to Assess Student Understanding and Determine Teaching Needs in the Neuromuscular Curriculum
by Therese E. Johnston
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Background and Purpose. Entry-level physical therapist (PT) students tend to make common errors when learning critical examination skills. Instructors often provide feedback on these errors during laboratory activities to enhance learning and knowledge of performance. Purposeful error by the instructor may also be used as a learning tool and as a tool for instructors to understand areas of difficulty for students. The purpose of this case report is to describe the development, implementation, and outcomes of a neurologic examination demonstration and discussion that included purposeful error to assess student weaknesses. Instructor reflections and student feedback following the session were then used to inform teaching priority areas. Case Description. Upon reflecting on performance during practical examinations, common mistakes were being made. To address these issues early in Neuromuscular 2 (NM2), the second course in a 3-part series, a plan was developed to simulate an examination. The instructors served as the patient/PT team and simulated an examination in which some items were performed correctly and others incorrectly. Students observed and identified correct/incorrect components. Areas of confusion were discussed as each error was identified. The simulation served several purposes: (1) to act as a diagnostic test to understand areas in which students were struggling, (2) to allow clarification of points of confusion, and (3) to allow instructor reflection on student weaknesses to guide teaching. Outcomes. This simulation lab has been conducted for 3 years. Each year, the instructor reflected on the examination demonstration lab and used these reflections to modify teaching of difficult concepts throughout the course. Students were pleased with the demonstration activity and felt that it was beneficial. Throughout the course, the instructor felt that student decision making improved at the midterm practical examination and scores on the final practical examination steadily increased. Discussion and Conclusion. This demonstration laboratory activity led to changes within the neuromuscular courses that were successful in improving student performance. Through a process of identifying the problem, conducting the exam as a diagnostic test, assessing immediate outcomes, altering teaching, and assessing student outcomes, the instructor was able to address the initial concern about student difficulty with some aspects of the neurologic examination. In the process, the instructor also developed as a teacher through reflection and application of change. Key Words: Teaching methods, Student learning, Entry-level education.
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Videotaping Practical Examinations in Physical Therapist Education: Does It Foster Student Performance, Self-Assessment, Professionalism, and Improve Instructor Grading?
by Aimie F. Kachingwe, Beth Phillips, and Janna Beling
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Background and Purpose. Reflection and self-assessment are keystones to professionalism and skill acquisition and are integral components of clinical practice. The purpose of this study was to explore the use of videotaping during student physical therapist (PT) practical examinations as a mechanism to promote self-assessment of skills and reflection on professional communication behaviors. Additionally, using a video to self-assess and improve student exam scores and instructor accuracy in scoring practical examinations live versus using a videotape performance was explored. Participants. Fifty-one PT students enrolled in either an introductory assessment course (n = 24) in the curriculum’s second semester or an orthopedics course (n = 27) in the fourth semester. Methods. This repeated measures design had subjects in both cohorts randomly assigned to 1 of 2 groups: a video group or a non-video group. Groups were asked to self-assess clinical skill and professional behavior immediately following both a midterm and a final practical examination prior to receiving written feedback. All students were videotaped during exams, but only the video group utilized the tapes for self-assessment. All students were graded by the instructor during the exam on total practical score, professional score, and clinical skills score. Video group taped performances were then viewed and graded again by the instructor to compare live versus videotaped grading differences. Data Analysis. The practical exam scores between groups (video versus non-video) were compared over time (midterm and final) with a 2 x 2 mixed analysis of variance (ANOVA) for instructor live scores and student self-scores, respectively. A 2-tailed paired-sample t test was used to determine the effect of the instructor viewing methods (live versus videotaped) on practical exam scores. Changes in scores were calculated by subtracting the student’s score value from the corresponding instructor’s score value on both the midterm and the final. The change in difference between student self-perception of scoring and instructor perception of student performance on practical exam scores between groups (video versus nonvideo) over time was analyzed with a 2 x 2 mixed ANOVA. Results. For the instructor live scoring, there were no significant interaction effects for intervention (video or non-video feedback) or time. For student self-scoring, all students significantly improved between the midterm and final examination in total practical score and in the professional behavior score (P < .05). For the instructor approach of live scoring versus videotaped scoring, all 3 practical exam scores (total, professional, and clinical skills) were significantly lower after viewing a videotaped performance compared to live scoring at the final exam (P < .05). While there was a significant improvement in accuracy in all students regarding the professional behavior score from the midterm to the final (no significant improvement in total score or clinical skills score), no difference in accuracy between groups was reported (P < .05). Discussion and Conclusion. Students using videotapes to self-assess their practical performance, when compared to selfassessing without viewing a video, did not preferentially demonstrate a greater improvement in final exam scores, professional behaviors, or self-scoring accuracy compared with instructor scoring. Therefore, videotaping of practical examinations may not be a beneficial educational tool. Outlining expectations and providing a detailed rubric before practical examinations, along with ample feedback after an examination, may be of greatest benefit to student learning outcomes. Key Words: Student self-assessment accuracy, Videotaping practical examinations, Live-grading versus video-grading, Professionalism.
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Evaluation of an International Service-Learning/Clinical Education Experience Utilizing an Existing Conceptual Model
by Cheryl M. Petersen, Lois Harrison, and Carolyn Wohlers
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Background and Purpose. In order to foster the development of cultural competence in students, some physical therapist education programs include an international service-learning (ISL) or international clinical education (ICE) experience in the curriculum. The purpose of this paper is to describe the process of evaluation and planned enhancement of an ISL/ ICE experience in rural Nicaragua using Pechak and Thompson’s conceptual model of optimal ISL as a guide. Case Description. The physical therapist education program at our university includes a 3-week pediatric clinical education experience that is completed by a cohort of students in the United States and a cohort in Nicaragua with a faculty member. The process developed by Pechak and Thompson was used to evaluate the international experience, describing the development, design, implementation, evaluation, and planned enhancement of the experience. Outcomes. Analysis of student, community, and program outcomes revealed an acceptable structure for the student experience, the presence of reciprocal and strong relationships with the community, and evidence for sustainability of services. Areas for improvement for the ISL experience were also identified. Discussion and Conclusion. Evaluation of curricular content is an important aspect of educational assessment. We found that the conceptual model developed by Pechak and Thompson was a useful guide in the process of analyzing the strengths, areas for improvement, and planned enhancement of an ISL/ICE experience. Based on the evaluation, the decision was made to transition the experience from a clinical education course to a global education course. Areas of improvement for the ISL experience were also identified. Key words: International service learning, International clinical education, Conceptual model, Cultural competence, Reflection, Global health education.
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Mind Mapping: Teaching and Learning Strategy for Physical Therapy Curricula
by Genevieve Pinto Zipp, Catherine Maher, and Anthony V. D’Antoni
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Background and Purpose. As physical therapist educators, creating an environment that engages students in their learning journey is our primary role. One teaching and learning strategy that has recently emerged in higher education is mind mapping (MM). The purpose of this position paper is to discuss the tenets and theoretical rationale associated with mind mapping, explore current literature on MM, and inform physical therapist educators of this teaching and learning strategy. Discussion/Conclusion. This position paper offers insight that physical therapist educational programs can use to explore mind mapping as a teaching and learning strategy. Key Words: Mind mapping, Teaching, Learning.
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A Novel Approach to Clinical Instructor Professional Development: A Multi-Session Workshop With Application of Skills in a Student Standardized Patient Exam
by Carol Recker-Hughes, Jill Dungey, Sue Miller, Amber Hansel Walton, and Janice Lazarski
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Background and Purpose. Ongoing student assessment is a critical component of effective clinical instruction. Clinical instructors (CIs), however, may lack competence and confidence in providing student feedback. CIs rarely, if ever, have the opportunity to develop and apply these skills in an authentic experience as part of a professional development course. For this reason, we developed a 4-part continuing education program for CIs that included participation in a second-year DPT student standardized patient examination (SPE). Method/Model Description and Evaluation. The initial 2 training sessions included sharing resources and strategies for assessing students, providing feedback, and promoting student reflection and clinical decision making (CDM). During the standardized patient examination, CIs remotely observed the student-patient encounter, then engaged with the student in a clinical decision making question and answer session, subsequently providing the student with feedback. Academic faculty from the DPT program conferred with the CI prior to the CI-student interaction. Students completed a written questionnaire regarding the CI encounter. CIs reviewed the taped feedback sessions, participated in focus group debriefings, and completed a course evaluation. One year after participating in the workshop, CIs completed a brief questionnaire, asking them to reflect on how lessons learned were carried over into the clinic. Outcomes. Themes that emerged across all sources of data indicated that participation in the workshop resulted in clarifying expectations of student performance, facilitating student CDM, sharing student feedback, and promoting reflection. Lastly, the CIs universally described the workshop as a valuable learning experience. Discussion and Conclusion. This unique workshop model afforded CIs the opportunity to receive instruction in student assessment and feedback strategies and apply them in an authentic student- CI encounter during a comprehensive standardized patient examination (SPE). Self-assessment of the recorded session, coupled with feedback from the student, may have contributed to the positive outcomes. This workshop could be readily replicated in programs that already have SPEs in place. Key Words: Clinical education, Professional development, Clinical instructors, Simulation.
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Exploring the Influence of Clinical and Classroom Training on Advocacy for Safe Patient Handling Practices Among Student Physical Therapists
by John Stevenson, Christian Hinsch, Kristen Bartold, Lucas Briggs, and Lindsay Tyler
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Background and Purpose. Practices for patient lifting and transfers in the physical therapy profession have begun to shift from traditional manual methods with a focus on body mechanics to more equipment- assisted patient lifting and transfer techniques. These processes are collectively known as safe patient handling (SPH), which has been shown to better protect against injuries for both the patient and the therapist. The purpose of this study was to examine physical therapist students’ attitudes and intentions toward advocacy for SPH in practice through their education. Subjects. Student physical therapists (PTs) enrolled in programs in the United States (US) accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE) who had been educated in patient transfer skills. Methods. A pilot form of the survey was used to gain feedback from second-year physical therapy students to establish face and content validity. Physical therapy program directors were sent an email link for their students to access a 50-item electronic survey that consisted of 4 sections of 7-point Likert scale questions pertaining to attitudes and intentions regarding patient handling and transfer education, their education and training in their physical therapist education program, and techniques used during their clinical education. A section of forced-choice questions regarding the type of patient handling education they received and demographic questions were also included. Five hypotheses developed from the theory of reasoned action (TRA) were tested using bootstrap mediation analysis. Results. Participants (n = 291) represented 23% of CAPTE accredited programs, as well as 54% of states in the US and Puerto Rico. All hypotheses were supported, indicating: (1) SPH didactic training impacts SPH behaviors through the subject’s attitude toward SPH, (2) SPH classroom training impacts SPH leadership expectations through the subject’s attitude toward SPH, (3) the link between clinical training and SPH was mediated by the subject’s attitude toward SPH, and (4) clinical training impacts a subject’s SPH leadership expectations through his or her attitudes toward SPH. Discussion and Conclusion. Results reinforce previous findings that the TRA model is applicable in health professions research. Student PTs receiving didactic SPH education and training were more likely to express attitudes toward assuming a leadership role in advocacy for SPH in clinical practice. Key Words: Safe patient handling (SPH), Theory of reasoned action (TRA), Survey
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Failure in Clinical Education: Using Mindfulness as a Conceptual Framework to Explore the Lived Experiences of 8 Physical Therapists
by Annette M. Willgens and Ruth Sharf
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Literature Review. Mindfulness, a purposeful and nonjudgmental awareness of internal affective states, is an emerging, evidence-based practice that has not yet gained credibility in physical therapist education. Each year, a small but significant number of graduate students fail a clinical course due to difficulty integrating affective domain skills. These skills are embedded in what is commonly known as generic abilities and include patient safety, professionalism, interpersonal skills, stress management, and communication. To date, it is unknown how they think or why they struggle. Method. This retrospective, phenomenological study explored the lived experiences of 8 physical therapists (PTs) between the ages of 25 and 30 who, at some point, failed a clinical education course. Within the context of mindfulness theory, semistructured interviews were used to explore internal barriers prior to failure and transformative experiences upon successful completion. Results. Three themes emerged from the data. "Disconnect" occurred in the pre-failure phase, representing a lack of communication internally and externally. "Failure as Nothingness" was illustrative of the time that participants learned that they had failed the clinical experience. "Reconnect" occurred post-failure as participants worked with new clinical instructors and began to refocus on affective domain skills and the human side of patient care. Conclusions/Recommendations. In the pre-failure phase, all 8 participants demonstrated behaviors consistent with mindlessness. In the post-failure phase, each participant revealed a significant shift toward an expanded patient focus, but none learned to suspend self-judgment or gain present moment awareness. These elements of mindful practice have been found to reduce medical errors, improve patient-centered care, reduce burnout, and promote well-being. Adding mindful practice to the formal physical therapy curriculum may offer a means to promote intrapersonal awareness for students who struggle in clinical education experiences. Key Words: Mindfulness, Physical therapy, Clinical education, Failure
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