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 2014 Volume 28 - Number 1

Editorial: In Search of Cultural Competence
by Jan Gwyer and Laurie Hack
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We have failed to understand that teachers are first and foremost cultural workers, not neutral professionals exercising pedagogical or psychological skills on a culturally-detached playing field.1(p306) The winter issue of the Journal of Physical Therapy Education provides several articles that give us an opportunity to reflect on some of the more difficult and complex issues that face physical therapy education.
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Creating a Culturally Sensitive and Welcoming Academic Environment for
by Hiba Wehbe-Alamah and Donna Fry
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Background and Purpose. There are a number of cultural competence models in health care delivery; however, specific application to health care education is limited. The purpose of this paper is to:

(1) describe a model for developing and maintaining a culturally sensitive and welcoming academic environment for students, faculty, and staff of culturally diverse backgrounds; and

(2) apply the model to a study of Muslim students in a Doctor of Physical Therapy degree program at the University of Michigan–Flint as an exemplar.

Position and Rationale. Development of a culturally sensitive and welcoming academic environment is a multifaceted process that embodies

(1) student centeredness;

(2) ongoing cultural assessment and evaluation of students, faculty, staff, and the academic environment;

(3) educational and curricular adaptation and accommodation;

(4) ongoing cultural competence training; and

(5) programmatic adaptation, accommodation, and revision. Due to the dynamic evolution of society, it is necessary that any model of cultural competence within the academy employs ongoing continuous review and revision.

Discussion and Conclusion. The model described provides a framework for assessment and development of a culturally competent academic environment for students, faculty, and staff populations with diverse religious, cultural, physical, social, and other needs.
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Reflections on an International Immersion Experience: A Doctor of Physical
by Camille Reuter Grzelak and Leslie Glickman
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Background and Purpose. This case report presents the perspective of a Doctor of Physical Therapy (DPT) degree student on the qualitative value of a short-term international immersion experience. The need for culturally competent practitioners in a society of growing diversity is evident. Activities in low-resourced, international locations during entry-level training increase cultural competence and broaden perspectives. Very little has been published from a student’s perspective on an international experience. Therefore, this case report provides one such vantage with comparisons to the methods and findings from other authors.

Case Description. The student used an ethnographic approach to gather data from an immersion experience in the Republic of Suriname. Data resulted from formal classroom learning with host students, observation of physical therapy practice in several settings, formal and informal social gatherings, visits to important local sites, and participation in a wellness dance program for seniors. Information was extracted through student observation, reflective journaling, artifact collection, faculty-guided feedback sessions, and emotional recall. Major themes were identified by prevalence and compared to relevant literature.

Outcomes. After immersion, both personal and professional growth were noted with the following themes: (1) genuine warmth of hosts, (2) similarities between the practice of physical therapy in Suriname and the United States (US), (3) ease of acknowledging, accepting, and talking about diversity, and (4) enhanced appreciation for the value of a US education.

Discussion and Conclusion. Identified themes were similar to those reported by other authors. This student perspective adds to the international immersion literature and strengthens the potential support for programs considering international integration.
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Promoting and Assessing Cultural Competence, Professional Identity, and Advocacy in Doctor of Physical Therapy (DPT) Degree Students Within a Community of Practice
by Lorna M. Hayward and Li Li
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Background and Purpose. Cultural competence is a criterion for a Doctor of Physical Therapy (DPT) degree professional and reference to it is contained in many American Physical Therapy Association (APTA) core documents. Possession of cultural competence is critical for health care providers, where regard for individual patient differences is quintessential for attaining positive health outcomes. With the globalization of society, academia has responded through increasing the number of study abroad opportunities for students. While physical therapy educators can use study abroad to promote DPT student exposure to diverse cultures, they are challenged to design pedagogy that prepares and assesses learning outcomes (eg, profession identity, advocacy) that are related to the development of cultural competence. The purpose of this article is to describe an innovative educational model designed to facilitate and assess the development of cultural competence, professional identity, and advocacy in DPT students. Method/Model Description and Evaluation. The model, embedded in a 2-semester capstone, enabled 14 DPT students to prepare academically and participate in a 9-day study abroad experience at the For His Children (FHC) orphanages, located in Quito and Latacunga, Ecuador. A blending of the cultural competence frameworks developed by Purnell and Campinha-Bacote informed the model. Academic preparation included study about the Ecuadorian culture, cultural awareness activities, research on the diagnoses affecting the children at FHC, and design of appropriate therapeutic interventions. Assessment of DPT students’ learning was accomplished using 3 methods: the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals–Student Version (IAPCC-SV), 2 reflective papers completed pre and post study abroad, and 2 posttravel focus groups. Outcomes. Paired t tests were run for aggregate data and for the 5 constructs comprising the IAPCC-SV. All comparisons were statistically significant (P < .05) indicating an increase in overall cultural competence and for each construct: (1) cultural desire, (2) cultural awareness, (3) cultural knowledge, (4) cultural encounters, and (5) cultural skill. Qualitative analysis of reflective papers and focus group data resulted in 5 themes: (1) strength of the community, (2) integration of clinical skills within an uncluttered environment, (3) inner beauty of the child, (4) becoming a professional, and (5) cultural shift. Discussion and Conclusion. Our model allowed 14 DPT students to integrate academics and experience, problem-solve collaboratively, advocate for the underserved, and develop as a professional. IAPCC-SV posttest scores documented a significant increase in cultural competence. Reflective data illuminated student realization of the contextualized nature of learning that occurs within a community of practice. In addition, students recognized application of the core values in action. Cultural competence is relevant for positive health outcomes. Study abroad experiences are popular strategy for promoting cultural competence in students, and models that include assessment and reflection are important for documenting learning outcomes.
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Leadership Retention in Physical Therapy Education Programs
by Martha Hinman,Claire Peel, and Ellen Price
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Background and Purpose. Program leadership is a key to achieving program outcomes and meeting the program’s mission. The Commission on Accreditation in Physical Therapy Education (CAPTE) requires that programs have qualified and effective academic administrators. In recent years, CAPTE has noted a high rate of attrition among academic administrator positions for physical therapist (PT) and physical therapist assistant (PTA) education programs. Therefore, a survey was developed to help identify the reasons program directors were leaving their administrative positions. Subjects. The survey was sent to individuals who had vacated positions as directors of PT or PTA education programs during the 3-year time period from 2008 to 2011. Seventy-nine individuals returned surveys for a response rate of 59%. Methods. The survey was developed by the members of CAPTE’s Central Panel. Members of the other 2 panels (PT and PTA) reviewed the survey for clarity and face validity. The survey was sent electronically to former program directors. Survey items included demographic information, institutional classification, years of academic experience, and reasons for leaving an administrative position. Results. Individuals who had directed PT programs comprised 58% of the sample versus 41% who had directed PTA programs (1% directed both). The most frequently cited reasons for leaving administrative positions included: (1) a perceived lack of resources or support from university administration or some type of internal conflict; (2) excessively high/ demanding workloads; (3) inadequate compensation; (4) promotion to a higher administrative position; and (5) inability to hire or retain adequate faculty to operate the program. A greater proportion of PT program directors had prior academic experience compared to PTA program directors. Program directors who had at least 5 years of prior academic experience stayed in their administrative positions longer. Individuals who were hired to direct developing programs were less likely to have had prior academic experience than those who were hired to direct established programs, especially in PTA education. Retention was higher at public and nonprofit private institutions compared to proprietary institutions. Discussion and Conclusion. To enhance retention of program administrators, institutions should consider structuring a development program to support program directors; such a program could include formal or informal mentoring, networking with experienced colleagues in similar positions, and regular communication with supervising administrators (deans and/or chairs). Because most PT and PTA program directors enter their administrative positions without any formal management training, continuing education courses or workshops on topics such as strategic and long-term planning, fiscal and personnel management, and accreditation issues may be particularly beneficial. Prospective program directors may also benefit from exploring the institutional expectations of an administrative position prior to accepting such a position.
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Commentary on Wehbe-Alamah, Grzelack, and Hayward
by Kim Nixon-Cave and Johnette Meadows
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We thank the authors of these 3 articles focused on teaching and learning cultural competence in the physical therapist (PT) curriculum. The 3 articles cover a spectrum of approaches and strategies all with a similar goal—to provide an environment for learning and supporting patients and students from diverse backgrounds. Each article offers different perspectives on instilling the American Physical Therapy Association’s (APTA) core values1 as a part of the student’s professional development. In reviewing the articles, all of the programs incorporated the Commission in Accreditation of Physical Therapy Education (CAPTE) requirements,2 the Normative Model for PT Education,3 and APTA’s Blueprint for Teaching Cultural Competence in Physical Therapy Education.4
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Invited Commentary: Wanted: Effective Academic Leadership
by James Gordon
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In this issue of the Journal of Physical Therapy Education, Martha Hinman, PT, EdD, Claire Peel, PT, PhD, FAPTA, and Ellen Price, PT, MEd, have taken on a critical issue facing the physical therapy academic community: a crisis of leadership. These authors document what everyone in the community is acutely aware of: There is a shortage of highly qualified and effective academic leaders to fill vacancies in established programs and to take the leadership roles in the rapidly increasing number of developing programs. This problem exists both for physical therapist (PT) education programs as well as for physical therapist assistant (PTA) education programs.
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Expected Graduate Outcomes in US Physical Therapist Education Programs: A Qualitative Study
by Troy P. Grignon, Emma Henley, Kayla M. Lee, Megan J. Abentroth, and Diane U. Jette
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Background and Purpose. As part of the accreditation process, physical therapist education programs are required to identify expected outcomes for their graduates. According to accreditation guidelines, expected graduate outcomes are meant to reflect the mission of the program and be consistent with the institutional mission. Therefore, expected outcomes vary across programs, and there are no uniform and consistent guidelines for determining expected outcomes. Methods: The directors of the 187 US physical therapist (PT) education programs, who were members of the American Council of Academic Physical Therapy (ACAPT) of the American Physical Therapy Association (APTA), were contacted in March 2011 to request that they send their list of graduate outcomes. A qualitative conventional content analysis was undertaken to identify core concepts in the statements of expected graduate outcomes. Results. Seventy-five programs responded by sending their documents. Ten common themes emerged from the documents: (1) service and social responsibility, (2) professionalism, (3) professional role, (4) professional commitment, (5) practice management, (6) communication, (7) professional growth and development, (8) evidence-based practice, (9) clinical reasoning, and (10) patient management. The themes suggested that graduates were expected to demonstrate competencies within several related domains, including the individual practitioner; individual practices; the physical therapy profession; health care professions; and society, with communication reflected and integrated through each domain. Discussion and Conclusion. Our analysis suggested 10 fundamental expected graduate outcomes representing expectations that graduates demonstrate excellent communication skills and competence as individual providers of patient care, as participants in the broader practice and profession of physical therapy, and as health care professionals who have obligations for improving the health of society. The themes reflected APTA core documents and were common to other health professions. The commonalities among program documents seemed to demonstrate an unspoken consensus about the outcomes expected of graduates of PT education programs.
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Professionalism in Physical Therapy: An Oath for Physical Therapists
by Denise Wise
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Background and Purpose. The ongoing evolution of physical therapy—from reconstruction aides to doctors of physical therapy—accompanied by increased autonomy and visibility of our profession, reminds us of the high priority we should assign to living our core values and demonstrating professionalism. Position and Rationale. Health professions mark their commitments to professionalism with public recitations of oaths. The American Physical Therapy Association (APTA) supports the use of an oath and the Education Section of APTA has adopted a model oath for use or adaptation by physical therapist education programs. Discussion and Conclusion. Our profession is well served by reciting an oath during white coat or graduation ceremonies because public recitation of an oath marks the transformation of becoming a professional. Appropriate for professional (entry-level) graduates and practicing physical therapists who may be receiving their Doctor of Physical Therapy degree through a transitional program or physical therapists in attendance at the aforementioned ceremonies, the oath is a useful and meaningful rite of passage for new physical therapist professionals and a powerful reminder to practicing physical therapists to live up to the values and duties of our profession.
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Physical Therapists as Practitioners of Choice: Consumer Knowledge of Practitioner Skills and Training
by Matthew Kearns, Nicholas Ponichtera, Tony Rucker, and Greg Ford
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Background and Purpose. Previous research suggests a lack of public knowledge regarding the conditions under which physical therapists (PTs) have the ability to treat patients and the educational requirements for physical therapists. Assessment of the public’s knowledge regarding the different conditions physical therapists can treat and the use of physical therapists as practitioners of choice will be crucial in the continued growth of autonomy in the profession of physical therapy. Subjects. Residents of Western New York were randomly selected through a mailing service Methods. A survey was distributed throughout the Western New York area at random by a mailing service. Surveys were returned by recipients anonymously. Descriptive statistics and frequencies were used to analyze and compare data. A chi-square goodness of fit test was used to determine statistical significance for practitioner of choice. A chi-square test of association was performed to assess differential trends between groups. Results. Physicians were the practitioners of choice and chosen most frequently as possessing the ability to treat 16 of 17 listed conditions. Discussion. Medical doctors continue to be viewed as the practitioner of choice for the majority of medical conditions. The public is most likely to select a PT as their practitioner of choice for an ailment of musculoskeletal origin. The public is unaware of the training PTs receive in school and the settings in which PTs practice. Even in conditions for which the public demonstrated knowledge of PTs’ abilities and training, no correlation was found in an increase rate of selection of the PT as the practitioner of choice for the condition. Conclusion. Physicians are the practitioners of choice for 16 of 17 listed medical conditions. The public demonstrates a basic understanding of the treating abilities of physical therapists solely in musculoskeletal practice, with a distinct lack of knowledge in all other areas.
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SECTIONS Model: Strategizing Technology-Based Instruction in Physical Therapist Education
by Jeff Hawk, E. Anne Reicherter, and Karen L. Gordes
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Background and Purpose. The purpose of this educational case report is to present an innovative application of Bates and Poole’s SECTIONS model9 to promote the use of web-based videos in a professional physical therapist education curriculum. Case Description. This case report provides a description of the SECTIONS model and its application to the educational endeavor using iTunes U©, in addition to outcomes and recommendations for further areas of study. Outcomes. Hybrid learning was effective and produced the following outcomes for the Department of Physical Therapy and Rehabilitation Science (PTRS) at the University of Maryland School of Medicine: (1) reduced face-to-face class time by 10%-15%, (2) enabled faculty with heavy teaching responsibilities to perform scholarship and service activities, (3) allowed lab time to be used for clinical integration, (4) increased learner responsibility for their own education, and (5) enhanced relationships between core and associated faculty by allowing clinicians access to current information through PTRS’ online resources. Discussion and Conclusion. The SECTIONS model provided a stellar framework with which to plan, implement, and analyze the use of clinical-skill videos posted to iTunes U©. There was very little expenditure risk and much reward gained with implementing this instructional technology.
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The Student-Centered Classroom of the 21st Century: Integrating Web 2.0 Applications and Other Technology to Actively Engage Students
by Alecia K. Thiele, Jennifer A. Mai, and Sherri Post
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Background and Purpose. As technology has evolved, so has the ability to actively engage students inside and outside of the classroom. The primary purpose of this article is to describe implementation of selected web applications to build a 21stcentury, student-centered classroom. Each application will be described, including how the technology has been integrated in the classroom, faculty feedback regarding advantages and disadvantages for each application, data from students, and recommendations for implementation. Case Description. This case report describes various types of technology integrated into a traditional, face-to-face Doctor of Physical Therapy (DPT) degree curriculum. Technologies described and implemented into the classroom include Moodle Learning Management System, Raptivity, Camtasia Studio, Jing, and Triptico. Outcomes. Faculty identified advantages and disadvantages of using technology in courses. Students’ perceptions of educational technology were assessed using a survey developed by the Research and Evaluation Team from the Office of Informational Technology at the University of Minnesota. The survey collected data points in the following categories: portable devices, active use of the web, effects of educational technology, preferences for the amount of technology, usefulness of educational technology, comfort levels with technology, barriers encountered with educational technology, and digital distractions. Outcome data presented include only the aspects of the survey that relate to web applications presented in the case description. Discussion and Conclusion. Three summary points emerged from the survey: (1) Students know basic computer concepts, but are using the web in a limited fashion. (2) Students like the use of educational technology in the classroom. (3) Students recognize the limitations of technology. The implementation of technology can enhance learning by making the classroom more active and student-centered. Considering learning objectives when choosing technology, realizing that it is important to know faculty and student comfort level with technology, planning for distractions, and overcoming barriers to implementation all must be taken into account for successful implementation.
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Student Learning of Cervical Psychomotor Skills Via Online Video Instruction Versus Traditional Face-to-Face Instruction
by Arie J. van Duijn, Kathy Swanick, and Ellen Kroog Donald
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Background and Purpose. Currently, there is very limited evidence in the literature regarding the use of video-based instruction for psychomotor skills in physical therapist education. The purpose of this study was to compare student learning of psychomotor examination and treatment skills of the cervical region via online video instruction versus traditional face to face instruction. An additional purpose was to examine the effect of the addition of online video instruction before or after traditional face-to-face instruction of these skills. Subjects. Fifty-three professional (entrylevel) physical therapist students from 4 consecutive cohorts. Methods. This was a single blind, 2-group, posttest-only, crossover, experimental study. Group A received online video instruction of Skill Set 1 (examination skills) and face-to-face instruction using faculty demonstration of Skill Set 2 (interventions skills). Group B received face-toface instruction of Skill Set 1 and online video of Skill Set 2. Student performance of all skills was evaluated by 1 evaluator, with content expertise blinded to group membership, using a grading rubric. A second laboratory session was held where the groups received instruction of these skills in reverse order, followed by another performance evaluation. Nonparametric and parametric analyses were performed to determine differences in student performance after the 2 instructional sessions Results. Parametric analysis found a statistically significant difference for 1 of the 4 skills (f = .77, P < .05), with the face-toface group performing better. There were no statistically significant differences in group performance after the second instructional session, and student performance was significantly better after this second session compared to after the first instructional session. Additionally, no statistically significant differences in student performance were observed when the order in which students received the 2 methods of instruction was compared. Discussion/Conclusions. The use of online video may serve as an effective method of instruction of advanced clinical psychomotor skills. Benefits of the cumulative effect of using both modes of instruction are apparent in student learning of these advanced psychomotor skills. Online video can be a relatively time-efficient instructional method to enhance traditional classroom experiences and could be especially beneficial in situations where traditional instruction is not possible due to geographic or economic reasons.
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