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 

Spring 2015 Volume 29 - Number 2

Editorial: Exploring
by Jan Gwyer and Laurita Hack
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Once again, we have an array of articles that demonstrate the breadth of current educational research in physical therapy. Bayliss et al, Greenfield et al, and Pignataro and Huddleston explore aspects of development of the behavioral skills so necessary for successful practice. Cohn et al and Hoglund explore specific topics in pedagogy. Hayward et al and Wise et al explore issues in the wider world in which we educate our students. And Hake et al explore the impact on our patients of care provided by students.
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Editorial: A Challenge
by Jan Gwyer and Laurita Hack
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This past February, at the Combined Sections Meeting (CSM) of the American Physical Therapy Association (APTA), the Editorial Board of the Journal of Physical Therapy Education led an exciting discussion on the development of an educational research agenda for the profession of physical therapy. It is the editors’ perspective that, just as is true for our clinical research colleagues, those engaged in educational research need to pursue research that results in the best evidence for policy makers. Research conducted with the best possible design and methodology can inform good educational decisions in many areas, including education for learners in the classroom and the clinic, across entry and post-professional education, patient education, curriculum development, and institutional processes for education.
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Measurement of Empathy Changes During a Physical Therapist’s Education and Beyond
by Amy J. Bayliss, PT, DPT, and Valerie A. Strunk, PT, MSPT
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Background and Purpose. Empathy is a vital communication skill capable of enhancing therapeutic relationships. Empathy is valued by patients and when communicated effectively, is shown to enhance the ability to improve patient compliance and patient outcomes. Therefore, it is an important skill to foster in physical therapy students. However, studies in other disciplines have shown empathy to decrease over the course of health care professional training. The aims of this study were to: (1) measure empathy in physical therapist (PT) students and new graduates, (2) compare empathy between sexes, and (3) compare empathy between year of study and new graduates via a longitudinal approach. Subjects. PT students (n = 169) who completed surveys in their first (n = 101 surveys), second (n = 101 surveys), and third (n = 101 surveys) year of study, and at 6 months post-graduation (n = 29 surveys). Methods. Empathy was measured twice during the academic year in each year of study cohort and once in new graduates using the Jefferson Scale of Empathy (JSE) Health Care Provider Student version. The JSE is an established and valid tool for measuring empathy and is comprised of 20 statements answered on a 7-point Likert scale. The possible range of scoring is between 20–140 points. Empathy scores were collected over a 3 and a half year period to capture data from multiple classes. The data was analyzed between years of study (first versus second versus third versus new graduate), at 2 assessment points for each year (baseline and final), and by sex. Results. There was no statistical interaction between year of study and sex on empathy scores in the initial 2-way analysis of variance (ANOVA) (P = .17), although sex had a significant main effect (P < .001) with scores being 6.3 points (5.6%) higher in females (118.1 ± 10.0) than males (111.8 ± 11.3). Empathy scores at assessment time points differed (P < .02). Final empathy scores were 2.9% greater than baseline scores in the first year of study (P < .02). Final scores for the third year of study were 2.8% lower when compared to final scores from the first year of study (P = .03). Graduates had 5.1% higher empathy scores than students at the end of their third year of study (P < .01). Discussion and Conclusion. The results of this study show a difference in empathy across the 3 years of the education program, with the first-year students being significantly more empathetic at the end of the academic year compared to the beginning and third-year students significantly less empathetic than their first-year and new graduate counterparts. Female PT students were significantly more empathetic than male PT students, a finding consistent with the effect of sex observed in other health care disciplines. Key Words: Empathy, Sympathy, Caring, Physical therapist education.
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A Case-Based Reasoning (CBR) Model for the Integration of Insurance Policy and Regulations in Professional Physical Therapist Education
by Rhea Cohn, PT, DPT, Kenneth J. Harwood, PT, PhD, CIE, Heather Richards, and Karen Schlumpf, MA
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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. Key Words: Case-based reasoning, Documentation, Insurance, Regulation, Financial management.
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Reflective Narratives by Physical Therapist Students on Their Early Clinical Experiences: A Deductive and Inductive Approach
by Bruce Greenfield, PT, MA, PhD, Patricia Bridges, PT, EdD, Tami Phillips, PT, DPT, NCS, Emily Adams, PT, DPT, DeAndrea Bullock, PT, DPT, Kristen Davis, PT, DPT, Carla Nelson, PT, DPT, and Brady Wood, PT, DPT
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Background and Purpose. Clinical experiences are essential for a physical therapist (PT) student to develop practical knowledge and critical thinking in the context of the uncertainty and unpredictability of clinical practice. The written narrative provides a method to reflect on experiences and develop practical knowledge. The aims of this study were 2-fold: (1) Apply a framework, developed by Hatton and Smith, to evaluate the highest level of reflection attained in written narratives, and (2) use a process of phenomenological analysis to explore themes and subthemes embedded in the narratives. Methods. A retrospective analysis examined PT student experiences encountered during initial clinical experiences. The first step of analysis used a deductive process to identify the presence and level of reflection in the initial sample of 47 narratives. Written narratives absent of reflection were excluded, leaving 30 narratives for the second and final step of phenomenological analysis. Results. The retrospective inductive analysis identified 6 themes: patient-centered care, ethical conflict, confidence, professional identity, student-clinical instructor communication, and classroom to clinic integration. Of the initial sample of narratives, 68% met Hatton and Smith’s criteria for reflective writing. Of those that did meet the inclusionary criteria (n = 30), 80% fell below the critical and critical/ dialogic reflection levels. Discussion and Conclusion. The themes were similar to those found in previous studies of novice PT or student therapist early clinical experiences. Although some students possessed reflective abilities, based on the results of this study, we recommend that the principles and skills of writing reflective narratives be implemented and integrated in physical therapy educational programs and residency programs. Key Words: Clinical education, Patient care, Physical therapy, Narrative, Reflection.
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Evaluating Physical Therapist Students’ Clinical Performance in Acute Care: A Retrospective Analysis Comparing Student-Treated and Staff-Treated Patient Outcomes After Total Knee Arthroplasty
by Melissa P. Hake, PT, DScPT, Leslie B. Glickman, PT, PhD, Bradley A. King, PT, DScPT, MA, and John H. Hollman, PT, PhD
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Introduction. The ultimate goal and primary responsibility of physical therapist (PT) education is to produce graduates who can function as competent practitioners. However, clinical effectiveness and efficiency of patient care provided by PT students are not well established. Subjects/Methods. We identified 160 patients who received primary unilateral total knee arthroplasty at a single acute care hospital in the Midwest between March 2009 and August 2010. Next, we used a retrospective cohort design to compare the outcomes for those treated by licensed PTs and physical therapist assistants (PTAs) (n = 80) to those treated by PT students (n = 80) in a collaborative clinical education model. Outcomes. Primary outcomes were the improvement in functional mobility at discharge as measured by the Functional Outcome Measure (FOM), and improvement of the provider’s efficiency as measured by the change in FOM score from initial visit to final visit in relation to the number of therapy visits. Results: There were no significant differences between the functional gains achieved by each group (P = .955) or in provider efficiency (P = .594). Discussion and Conclusion: In the acute care setting, functional outcomes following primary total knee arthroplasty were similar for patients, whether treated by the physical therapy staff or PT students in a collaborative clinical education model. These results need confirmation with prospective randomized studies. Key Words: Clinical education, Student performance, Patient outcomes, Total knee arthroplasty, Collaborative clinical education model.
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Enhancements to an International Service-Learning Model: Integration of Program Alumni and Global Stakeholder Feedback
by Lorna M. Hayward, PT, EdD, MPH, Li Li, PT, DPT, Kenneth Venere, PT, DPT, and Andrea Pallais, PT, DPT
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Background and Purpose. International service-learning (ISL) is a strategy used by physical therapist (PT) educators to prepare students for rendering culturally competent care. The literature is replete with articles documenting the development and implementation of ISL programs and short-term benefits for student participants. Research is needed that includes evaluation of the long-term benefits and drawbacks of ISL for participants and the global partner. The purpose of this study was to modify an existing ISL educational model to include evaluation by 5 years of ISL program alumni and the global partner. Method/Model Description and Evaluation. Sixty-one PT ISL program alumni and 6 key global partner staff examined the long-term impact of an existing ISL model. The model incorporated an academic study on Ecuador, pediatric physical therapy, a 9-day ISL experience at 2 Ecuadorian orphanages, and multiple opportunities for reflection. Program alumni were queried about the long-term impact of the ISL experience via an online survey distributed using Facebook.TM One-onone interviews were conducted with 6 global partner staff. Outcomes. Online survey results supported ISL program influence on the alumni’s desire to continue to develop cultural competence, provide pro bono physical therapy, and recognize the Core Values. Ninety percent of alumni ranked the ISL program in the top 10% of their college experiences. The global partner was satisfied with the partnership and asserted that pre-trip planning to address ISL site needs was a critical partnership element. Other desired elements included continuity of ISL team leadership, interaction with the local community, and inclusion of the global stakeholder in the partnership assessment process. Areas identified for development included better pre-trip communication, Spanish language competency, cultural competence, more time spent with the children, and feedback gathered from more ISL site staff. Discussion and Conclusion. ISL is an educational strategy with the potential to facilitate long-term cultural competence and professional development in PT students. Developing and maintaining a successful ISL program requires a wellstructured plan for intervention, excellent communication, reciprocal benefits, and continuity of team leadership. Models that include a systematic process to evaluate the long-term impact of ISL on alumni and include the perspective of the global stakeholder are critical for sustaining effective partnerships. Key Words: Global education, Educational assessment, International servicelearning.
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Mobile Devices and Software Applications to Promote Learning in a Musculoskeletal Physical Therapy Class: A Case Report
by Lisa T. Hoglund, PT, PhD, OCS, Cert MDT
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Background and Purpose. Use of mobile devices in higher education to promote learning (m-learning) is growing. Mobile devices, such as iPads and software applications (apps) offer faculty tools to improve student learning. Despite increasing use of mobile devices by consumers and health care professionals, little has been reported of m-learning in physical therapist (PT) higher education. The purpose of this case report is to describe m-learning with iPads and apps for instruction and assessment in a musculoskeletal physical therapy class, challenges to its use, and student and faculty experiences. Case Description. A university provided iPads to students in a professional level PT program for use in coursework. The instructor of record modified the first musculoskeletal course using iPads and m-learning. Laboratory instruction was supplemented with a commercially available musculoskeletal examination measures app. Formative assessment was conducted using an active response system (ARS) app promoting class discussion. Summative assessment was conducted with in-class mobile-compatible quizzes created in a learning management system, allowing students to review graded quizzes anytime, anywhere. Outcomes. Course assessment results for the m-learning cohort were similar to those of the preceding cohort despite a larger class size for the m-learning cohort. Students reported the musculoskeletal measures app was helpful to learn proper technique. Most students did not like inclass mobile quizzes due to technical difficulties, including wireless connectivity problems. Discussion and Conclusion. Students perceived m-learning with musculoskeletal measures and ARS apps to be helpful for learning and for formative assessment. There was no apparent effect on assessment scores. Because technical challenges to m-learning for summative assessment are present, collaboration between academic technology professionals and faculty is necessary for planning and implementing m-learning in PT curricula. Key Words: Mobile learning, Musculoskeletal, Psychomotor skills, Physical therapist education, Technology.
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The Use of Motivational Interviewing in Physical Therapy Education and Practice: Empowering Patients Through Effective Self-Management
by Rose M. Pignataro, PT, DPT, PhD, CWS, and James Huddleston, PT, DPT, MS
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Background and Purpose. As specialists in movement science, physical therapists (PTs) and physical therapist assistants (PTAs) can offer skill and expertise to address inadequate physical activity and other behavioral risk factors for obesity, metabolic disease, cardiovascular illness, respiratory conditions, osteoporosis, low back pain, and other cardiopulmonary, vascular, integumentary, neuromuscular, and musculoskeletal impairments. The purpose of this position paper is to provide an overview of potential barriers and facilitators to including motivational interviewing (MI) as a component of patient education in physical therapy, and to impart a basic framework for incorporating brief MI techniques into physical therapy education and practice. Position and Rationale. Patient education is a central component of physical therapy practice. Frequent, extended communication with patients enables practitioners to develop rapport and insight into contextual factors associated with health-related behaviors. These characteristics place PTs and PTAs in an optimal position to enhance health-related outcomes by encouraging patients to play an active role in effective self-management. MI is an evidence-based, collaborative approach to patient education that incorporates goal setting, treatment planning, self-monitoring, and reassessment. MI techniques assist patients in recognizing discrepancies between their current behavior and personal values, and provide support for self-efficacy by reinforcing an individual’s belief that he or she is capable of initiating and maintaining a healthy lifestyle. Discussion and Conclusion. By providing resources and templates for use in physical therapy education, this article strives to inspire further discussion and consideration of factors involved in MI, thereby encouraging physical therapy practitioners and educators to utilize MI techniques to encourage patients to play an active role in enhancing their own health and wellness. Key Words: Patient education, Health behavior change, Motivational interviewing.
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Interprofessional Education: An Exploration in Physical Therapist Education
by Holly H. Wise, PT, PhD, Jody S. Frost, PT, DPT, PhD, FNAP, Cheryl Resnik, PT, DPT, Beth P. Davis, PT, MBA, and Z. Annette Iglarsh, PT, PhD, MBA, FNAP
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Background and Purpose. Interprofessional education (IPE) has been a topic of national and international discussion for several decades. The recent development of the Interprofessional Education Collaborative (IPEC) Core Competencies prompted the American Council on Academic Physical Therapy (ACAPT) to consider ways the physical therapy profession could become more involved. In 2013, the ACAPT Board of Directors appointed a 4-person task force to: (1) compile, collect, and analyze data on current and projected IPE initiatives in physical therapist education programs; (2) develop a means to disseminate information on IPE among these programs; and (3) recommend ways for physical therapists to collaborate with other health care practitioners. Outcomes. Data was collected from representatives from each of the 209 ACAPT member institutions. Based upon the findings, at least 62 (58.5%) of the 106 (50.7%) respondents reported that IPE is a focus of their physical therapist education curriculum. Eighty respondents (75.5%) identified up to 3 reasons for the success of their initiatives. Faculty buy-in/champions was the most frequently cited reason followed by institutional support, student support, curriculum, and external factors, respectively. The majority of respondents (n = 56) did not identify a collaborative practice partnership in which their students obtain interprofessional experience. Discussion and Conclusion. Based on the work of national and international organizations and forums, and the results of this survey, physical therapist education programs developing IPE within their institutions typically elect to first target IPE within classroom experiences before integrating IPE within clinical experiences. In order to advance IPE within clinical experiences, development of more formalized clinical partnerships will be needed to better enable the expansion of IPE within patient care experiences for learners. This study raised additional research questions for future investigation. Key Words: Interprofessional education, Collaborative practice, Physical therapist education, Student physical therapist.
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ACAPT First Annual Geneva R. Johnson Innovations in Physical Therapy Education Forum: Doctor of Physical Therapy (DPT): So What? Now What? Educating DPTs as Leaders to Meet Future Societal Needs
by Barbara Tschoepe, PT, PhD, and Carol Davis, PT, DPT, EdD, MS, FAPTA
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The American Council of Academic Physical Therapy (ACAPT) is a component of the American Physical Therapy Association (APTA) and represents the institutions that provide physical therapist (PT) education. The purpose of ACAPT is to advance the enterprise of academic physical therapy by promoting the highest standards of excellence. For the purposes of ACAPT and its activities, academic physical therapy includes all aspects of PT education, including clinical education and post-professional education. ACAPT has a leadership role in establishing the direction of PT education and has the responsibility and accountability to duly reflect the interests and needs of the academic and clinical PT educational community.
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Letter to the Editor
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Dear Journal of Physical Therapy Education editors: The purpose of this letter is to share an academic experience regarding publication ethics. In 2011, we had an original work (A) published in a peer-reviewed journal. In 2014, we had another manuscript (B) in the final stages of publication. An editorial assistant identified a likeness in the citations of B with another manuscript (C) published in 2012. When this issue was investigated, we discovered C plagiarized our work of 2011. Being inexperienced in intellectual property (IP) theft, we were uncertain how to proceed. An internet search for a recommended course of action yielded encouragement of strong and swift action against the offender(s) that ranged from contracting journal editors to informing the offender’s institution to legal recourse.
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Congratulations to the Award Winners
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