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 

Fall 2015 Volume 29 - Number 3

Editorial: Learning
by Jan Gwyer and Laurita Hack
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As educators in physical therapy, we have many learning needs if we are to successfully provide the foundation for the future practice of physical therapy. As so often happens with JOPTE, this issue provides us opportunities for learning that can help meet these needs.
Are you a classroom teacher seeking teaching methodology? Consider Greenberger and Dispensa’s study of student preferences about using video podcasts to teach orthopaedic special tests. Student preference for short videos that can be downloaded to mobile devices indicates a potential trend in the future of instructional technology.
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Editorial: The Next Big Idea!
by Jan Gwyer and Laurita Hack
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Cecilia Graham, in the 2015 Cerasoli lecture, shared her passion for a new curricular model, the concept-based curriculum. Big ideas are the focus of this type of curriculum development and the instructional goal is to develop a deep understanding of these ideas in the learner by exploring linkages between the concepts and active learning.
A big idea is certainly embodied in the vision statement for the physical therapy profession: "Transforming society by optimizing movement to improve the human experience."
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18th Pauline Cerasoli Lecture: Coming Into Focus: The Need for a Conceptual Lens
by Cecilia Graham, PT, PhD
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This is such an incredible honor. I want to thank all of my colleagues who were involved in the nomination process, with a special thank you to Dr David Morris, who coordinated the nomination packet. I also want to thank the Education Section Awards Committee for selecting me for this honor, and Pauline Cerasoli’s family members, who were instrumental in designating funds for this lecture. Finally, I want to recognize all of the previous Cerasoli lecturers for their inspiring thoughts about physical therapy education.
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The Preprofessional Degree: Is It a Predictor of Success in Physical Therapy Education Programs?
by Nancy Fell, PT, PhD, NCS, Renee Mabey, PT, PhD, Thomas Mohr, PT, PhD, and Debbie Ingram, PT, EdD
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Background and Purpose. Admitting physical therapist (PT) students to professional programs based on predictors of future academic, clinical, and licensure examination performance has been the subject of a number of studies. The best known predictor of student performance is the admission grade point average (GPA). Although the Commission on Accreditation in Physical Therapy Education (CAPTE) indicates a preference for an undergraduate degree at admission to physical therapy programs, there is little research that supports a preadmission undergraduate degree as a predictor of academic performance or success on the national licensure examination. The purpose of this study was to determine whether the preprofessional baccalaureate degree is a significant predictor of student outcomes. Subjects. Two geographically diverse professional physical therapy doctoral degree programs, admitting students with either a bachelor’s degree or at least 3 years (90 credits) of prephysical therapy coursework, contributed study data. The records of 290 graduates from the programs were reviewed. Methods. A retrospective observational cohort research design was applied. Variables included admission undergraduate degree status, admission science grade point average and cumulative grade point average (SGPA and CGPA), professional program grade point averages (PGPA), first attempt National Physical Therapy Examination (NPTE) scale scores, and the number of attempts to pass the NPTE. Nonparametric and parametric tests were used to analyze differences between the 2 PT programs, as well as between students with or without a degree. Logistic regression was applied to identify variables that might predict student ability to pass the NPTE on a first attempt. Multiple regressions were used to identify predictors of PGPA and first attempt NPTE scale score. Results. The admission SGPA and PGPA were predictors of passing the NPTE on the first attempt. Degree status was not a significant predictor. Admission CGPA and degree status predicted the PGPA with R2 values of .275 and .052, respectively. Admission SGPA, PGPA, and degree status predicted the first attempt NPTE scale score with R2 values of .078, .316, and .012, respectively. Conclusion. The degree status was not a meaningful predictor of student outcome. Statistically significant predictors were found for (1) passing the NPTE on the first attempt (admission SGPA and PGPA); (2) PGPA (admission CGPA and degree status); and (3) first attempt NPTE scale score (admission SGPA, PGPA, and degree status). While degree status contributed to the PGPA and NPTE scale score outcomes, only 5% and 1% of the variability were attributed to degree status, respectively. Key Words: Doctoral education, Admissions, Professional education, Multiple regression.
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Exploration of Students’ Clinical Reasoning Development in Professional Physical Therapy Education
by Jennifer Furze, PT, DPT, PCS, Lisa Black, PT, DPT, Julie Hoffman, PT, DPT, CCS, JB Barr, PT, DPT, OCS, Teresa M. Cochran, PT, DPT, GCS, MA, and Gail M. Jensen, PT, PhD, FAPTA
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Background and Purpose. Given the complexity of the current health care environment, effective clinical reasoning skills are fundamental to making critical patient care decisions. The purpose of this study was to explore the clinical reasoning abilities of students across time in 1 professional Doctor of Physical Therapy (DPT) curriculum. Methods. Qualitative methods were used to describe the longitudinal development of students’ clinical reasoning skills. Ninety-eight students from 2 consecutive class cohorts participated. Low inference data from the Clinical Reasoning Reflection Questionnaire (CRRQ) and narrative comments from the Clinical Performance Instrument (CPI) were analyzed using the constant comparative method. Open coding was used to initially categorize the data followed by axial coding to identify resulting themes. Results. Three categories (beginning, intermediate, and entry-level) and 8 themes emerged from the data describing student development of clinical reasoning skills. The following themes surfaced under the beginning clinical reasoning process category: focus on self, compartmentalized thinking, and limited acceptance of responsibility. Themes in the intermediate category were: procedural performance, initial stages of recognition and using context, and improved reflection on performance. Themes in the final entry-level category were: dynamic patient interaction and integrating situational awareness. Discussion and Conclusion. The results of this study demonstrate a progression in the development of these students’ clinical reasoning process around the dimensions of self, context, and responsibility across the curriculum. Outcomes reveal these key aspects of the clinical reasoning process: (1) it is a gradual developmental process across time; (2) the Dreyfus model of skill acquisition may apply to the development of clinical reasoning skills in physical therapy students; and (3) increasing intensity and depth of the reflective process may be a critical component in the advancement of the clinical reasoning process. Further research is needed to determine the best strategies to assess clinical reasoning abilities in physical therapy students and to discern approaches to enhance this learning process. Key Words: Clinical reasoning, Student learning, Professional education.
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Clinical Reasoning: Development of a Grading Rubric for Student Assessment
by Jennifer Furze, PT, DPT, PCS, Judith R. Gale, PT, DPT, MPH, OCS, Lisa Black, PT, DPT, Teresa M. Cochran, PT, DPT, MA, GCS, and Gail M. Jensen, PT, PhD, FAPTA
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Background and Purpose. Clinical reasoning is a complex but vital skill required for professional physical therapy practice. Experts agree that clinical reasoning is both difficult to define and challenging to assess. In order to facilitate the development of clinical reasoning skills in physical therapist (PT) students, educators need to be able to evaluate this process. The purpose of this paper is to describe the development and revision of a tool to assess PT student clinical reasoning skills across the curriculum. Method/Model Description and Evaluation. A Clinical Reasoning Grading Rubric was created using the following multistep process: (1) Initial pilot research exploring the clinical reasoning process students used in a performance-based examination, (2) use of theoretical constructs from cognitive learning theory and learner skill acquisition, (3) content expert review, and (4) feedback from key stakeholder groups (clinicians, faculty, and students). Outcomes. The rubric was developed to assess student clinical reasoning skills across the curriculum and evaluate student readiness for the clinical setting. The tool allows faculty and students a structure to identify and track the progression of student reasoning skill development. Discussion and Conclusion. The Clinical Reasoning Grading Rubric is 1 tool that can be used to evaluate the clinical reasoning of students at multiple points in time across the curriculum. This instrument has applicability for assessment of clinical reasoning skill development from clinical to residency education. The rubric also provides insight into the teaching and learning environment and may be helpful in informing pedagogical strategies and curriculum change. Key Words: Clinical reasoning, Student outcomes, Teaching methods, Teaching and learning.
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Usage and Perceived Value of Video Podcasts by Professional Physical Therapist Students in Learning Orthopedic Special Tests
by Hilary B. Greenberger, PT, PhD, OCS, and Marilyn Dispensa, MA
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Background and Purpose. Several studies have shown that the use of supplemental video resources can be an effective strategy for learning orthopedic special tests. To date, it is not clear if and how students are accessing such supplementary resources to aid in learning. The purpose of this descriptive study was to determine student usage, perceived value, and learning and delivery preferences using short video podcasts to teach orthopedic special tests. Participants. Two hundred fifty-four students (74% female; mean age=21.8 years) in the Doctor of Physical Therapy (DPT) degree program at Ithaca College participated in the study. All students had completed a course that used video podcasts on orthopedic special tests to supplement course material. Methods. Sixty video clips were produced and distributed on iTunes U that demonstrated orthopedic special tests. An online survey was sent to all students who had just completed a 15-week course in musculoskeletal examination and evaluation. Descriptive statistics were used to analyze data. Results. Four successive cohorts of students (2009-2012) completed the survey (response rate = 77%). Ninety-nine percent of the students accessed the video clips, with 79% using them extensively. The majority of the students watched the videos on their computer, but the number of students who used them on a mobile device doubled from 23% in 2009 to 50% in 2012. The majority of students used the videos to prepare for labs (80%) and laboratory practical exams (77%). Ninetythree percent of students reported that watching the clips improved their performance on practical exams. Students preferred iTunes clips over other forms of media, such as DVDs. Discussion. Students utilized and found value in watching short video clips. Easily accessible and portable videos were preferred over other media delivery formats. Students utilized the video podcasts to prepare for peer-learning lab sessions, as well as for reinforcement and studying for practical exams. Students felt these video clips were one of the most valuable resources for learning, studying, and reviewing the special tests while textbooks were found to be least valuable. Conclusion. Our study showed that short video clips that were easily viewed and downloadable to a mobile device were perceived as highly valuable in learning orthopedic special tests. Due to the convenience and flexibility of this format, students were able to use these clips for multiple course activities and preferred them to other available resources. Key Words: Physical therapy education, Orthopedic special tests, Computerassisted instruction, Teaching methods, Podcasting, Video.
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To Supervise or Not to Supervise a Physical Therapist Student: A National Survey of Canadian Physical Therapists
by Mark Hall, PT, PhD, Cheryl Poth, PhD, Patricia Manns, PT, PhD, and Lauren Beaupre, PT, PhD
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Background and Purpose. Clinical education is a critical component of physical therapist (PT) training. However, clinical coordinators both in Canada and abroad report increasing difficulty in securing sufficient, appropriate placements. The barriers to student placements and factors that contribute to PTs’ decisions to supervise a student have been identified in exploratory studies. These include personal and professional, workplace and contextual, student, and evaluation factors. The goal of this study was to determine the generalizability of the factors contributing to PTs’ decisions to supervise a student and identify additional variables specific to the Canadian context. Participants. All practicing Canadian PTs (N = 18,110) were invited to participate in the study. The total number of participants was 3,148. Methods. A web-based, 53 closed-item survey was developed and validated with experts in clinical education using standard survey development methodology that included an expert panel review and pretesting. The survey inviting participation was circulated via email through member contact lists of the provincial regulatory colleges. Exploratory factor analysis was conducted on survey responses using principal axis extraction. Direct oblimin transformation was then performed to assess reliability of the factor structure. Results. Analysis from a cross-sectional, representative sample of 3,148 PTs suggests a 6-factor structure contributing to the decision to supervise students: (1) clinical instructor feelings of stress, (2) student contribution to workplace efficiency, (3) dislike of assessment instrument, (4) clinical instructor preparation to evaluate, (5) student preparation and attitude, and (6) professional role and responsibility. Discussion and Conclusion. Stress emerged as the most influential contributor to the decision to supervise a PT student. The complexities of today’s health care environment, coupled with the responsibilities of student supervision, appear to compound this stress. This cross-sectional study confirms the generalizability of constructs previously identified in exploratory studies, including a dislike of the evaluation instrument and the professional role and responsibility of PTs to supervise students. Enhanced supervisor training workshops may enable PTs to better manage the clinical placement experience and mitigate the stresses associated with student supervision. A multipronged approach that includes consultation and partnership with all stakeholders is needed to resolve the issues of physical therapist student placement capacity. Key Words: Clinical education, Clinical instructor, Barriers, Factor analysis, Questionnaire.
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Educating Physical Therapist Students in Tobacco Cessation Counseling: Feasibility and Preliminary Outcomes
by Rose M. Pignataro, PT, PhD, DPT, CWS, CHES, Matthew Gurka, PhD, Dina L. Jones, PT, PhD, Ruth E. Kershner, EdD, RN, MCHES, Patricia J. Ohtake, PT, PhD, William Stauber, PT, PhD, FACSM, and Anne K. Swisher, PT, PhD, CCS
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Background. Smoking is the leading preventable cause of chronic disease and premature morbidity. People with physical disabilities experience elevated smoking prevalence when compared with their nondisabled peers. The physical therapy profession is dedicated to meeting needs of people with physical disabilities, yet most physical therapists (PT) do not typically provide tobacco cessation interventions. Similar deficits exist among other health professions, creating a demand for improved services to address smoking-related health burdens. Within other health professions, insufficient tobacco cessation counseling (TCC) education has been linked to a lack of interventions and may account for similar deficits in physical therapy practice. Study Purpose. Goals were to assess feasibility, implementation, and results of a tailored TCC educational program for entry- level physical therapist (PT) students. Subjects. Two cohorts of entry-level PT students (n = 12 and n = 17). Methods. Educational objectives were established based on prior review of the literature, a survey of national PT education programs, and clinical guidelines for TCC established by the United States Public Health Service (USPHS). Based on these objectives, the team designed a 3-hour workshop involving didactic content and problem-based skills practice. A pre and posttest survey was used to measure 6 dimensions: knowledge, perceived barriers, perceived facilitators, self-efficacy, outcome expectations, and self-rated skill in TCC. Within each cohort, changes in score were compared using a paired t test. The ability to apply clinical guidelines for TCC was assessed using case scenarios and structured observation. These outcomes were selected based on the Theory of Reasoned Action, which states that future behavior is determined by intention to act. Intention to act is a product of knowledge, a positive balance between perceived barriers and facilitators, strong self-efficacy, favorable outcome expectations, and necessary skills. Student satisfaction with training was assessed through anonymous written feedback. Feasibility was based on cost analysis, including material resources, as well as faculty time and effort. Results. Following participation, both cohorts improved in knowledge, perceived facilitators, outcome expectations, and self-rated skill. Cohort 2 also showed an increase in self-efficacy (P < .01). Structured observation revealed competencies in application of clinical guidelines for case-based scenarios. Mean student satisfaction ratings for the educational experience were 5/5, and cost-estimate for delivery of the 3-hour educational intervention was approximately $32 per student. Conclusions. This research study demonstrated feasibility and impact of an evidence- based curricular model designed to increase likelihood of TCC by future PTs by enhancing factors known to promote TCC behaviors. The program was wellreceived by students, and objectives were achieved through efficient use of faculty time and resources. Subsequent research should examine the effects of training on the provision of TCC within clinical settings, as well as the impact of TCC on smoking quit rates for patients who have received this intervention as a component of their physical therapy plan of care. Key Words: Smoking cessation, Physical therapist education, Curricular design for tobacco cessation counseling education.
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Genetics Education Is Viewed as Important, but Not a Priority in Physical Therapist Education
by R. Scott Van Zant, PT, PhD, Genward Hwang, PT, DPT, Mandee Kerns, PT, DPT, Kim Lindblade, PT, DPT, Carlton McFarlane Jr, PT, DPT, and Julie Toney, PT, PhD
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Background and purpose. Little is known about genetics education in physical therapist (PT) education programs. The purpose of this study was to assess the status and perception of genetics education in accredited United States (US) PT education programs. Methods. Two electronic surveys were sent to the following recipients: (1) 205 program directors of PT education programs (PD), and (2) 3,177 subjects drawn from faculty lists of PT education programs and American Physical Therapy Association (APTA) Education Section members (PTED). The 18-item PD survey sought to identify the status of genetics education in PT education programs. The 32-item PTED survey sought to assess genetics perspectives relative to the National Coalition for Health Professional Education in Genetics (NCHPEG) core competencies in genetics. Results. There were 118 respondents (57.6%) to the PD, and 602 respondents (18.9%) to the PTED. Respondent exposure to genetics literacy came primarily from outside reading (PD and PTED = 53%), while 19% of PD and 26% of PTED had no exposure to genetics literacy. Genetics information was included in courses of 85% of programs, while 15% reported no genetics instruction as a part of the curriculum. Over 60% of respondents believed that genetics literacy was important in the treatment of patients, but > 50% believed genetics education was a priority for PT students and clinicians. PTED respondents noted a mean agreement of 73.7% to the 3 NCHPEG baseline competencies, 83% to the 11 NCHPEG knowledge competencies, 60% to the 5 skill competencies, and 96.5% to the 2 attitude competencies. Discussion and Conclusion. PT educators agree about the importance of genetics literacy in rehabilitation, but most don’t see genetics education as a priority for PTs. Increasing PT educator awareness about the impact of genetics on rehabilitation is necessary to alter the apparent disparity between genetics literacy and education among PTs. Key Words: Genetics, Genomics, Genetics education.
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