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 

Special 2014 Volume 28 - Number 1b

Editorial: The Play’s the Thing
by Jan Gwyer and Laurita Hack
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In writing this editorial, we want to focus on the wonderful collaboration that has taken place to produce this special issue of the Journal of Physical Therapy Education (JOPTE). Many months ago, several groups—the American Council of Academic Physical Therapy (ACAPT) of the American Physical Therapy Association (APTA), APTA, the Education Section of APTA, the Clinical Education Special Interest Group of the Education Section, and the Federation of State Boards of Physical Therapy—agreed to work together to help define a new path toward a shared vision for clinical education in physical therapist education. The then-president of ACAPT, Leslie Portney, appointed a steering committee, headed originally by David Sommers, and subsequently by Stephanie Kelly, to guide the process forward.
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Guest Editorial: On the Summit
by Stephanie Kelly, PT, PhD
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I have been a physical therapist long enough to remember a 1994 article in the Wall Street Journal that had a huge impact on our profession. The article, titled “Health: One Bum Knee Meets Five Physical Therapists,” highlighted the variability in physical therapist practice that one patient experienced for a seemingly simple diagnosis.1 Since that time, our profession has made great strides in establishing best practice guidelines for the services we provide, while still enabling every clinician to approach each patient in a personalized manner. Yet, in the world of education, we continue to live with a significant level of variability in how we teach our students. We ask our clinical instructors to teach students who come from a variety of academic programs that have a variety of curricular structures. These students come in with varying levels of preparation and varying expectations for performance.
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Guest Editorial: Clinical Educators on the Summit
by Scott Euype, PT, DPT, MHS, OCS
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I am honored to write an editorial for this special issue of the Journal of Physical Therapy Education focusing on clinical education—a topic I am engaged with on a daily basis in my role as director of education at Cleveland Clinic, and as co-chair of the Clinical Education Special Interest Group of APTA’s Education Section. Through Stephanie Kelly’s editorial you are aware that a Steering Committee has been working to plan and execute the Clinical Education Summit in October 2014. This Summit will be the culminating event of a process focused on developing a shared vision of best practice for physical therapist clinical education.
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How Do We Improve Quality in Clinical Education? Examination of Structures, Processes, and Outcomes
by Diane U. Jette, PT, DSc, FAPTA, Lee Nelson, PT, DPT, MS, CLT-LANA, Mary Palaima, PT, EdD, and Ellen Wetherbee, PT, DPT, MEd, OCS
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Background and Purpose. The current state of clinical education curricula in physical therapist education programs across the United States reflects disparate approaches to clinical education experiences for students. Using Donabedian’s classic conceptual framework for examining health care quality, this position paper describes the structures, processes, and outcomes of the current approach to clinical education in physical therapist education programs and makes recommendations for taking steps toward improving quality. Position and Rationale. Wide variation in the organizational structure and processes of clinical education, and in expected student outcomes may not be advantageous or appropriate. Costs to all stakeholders are a concern and may be unsustainable. Although the problem is complex, to successfully manage clinical education, improve outcomes, and reduce costs, some degree of profession-wide consensus must be reached about best practices related to structure, processes, and outcomes. Discussion and Conclusion. Although published literature is insufficient to support any one structure or process in any aspect of clinical education, scholarly practitioners in any profession must weigh the best available evidence in making necessary decisions. The physical therapy profession must decide if there is a compelling reason to make changes using the existing sparse and flawed evidence, and, if so, what those changes should be. Given the complexity of the problem, a national dialogue should open regarding viable standardized structures, processes, and outcomes measurement, with an eye toward improved quality.
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Application of Educational Theory and Evidence in Support of an Integrated Model of Clinical Education
by Ellen Wruble Hakim, PT, DScPT, MS, CWS, FACCWS, Marilyn Moffat, PT, DPT, PhD, GCS, CSCS, CEEAA, FAPTA, Elaine Becker, PT, DPT, PCS, Karla A. Bell, PT, DPT, OCS, GCS, Tara Jo Manal, PT, DPT, OCS, SCS, Laura Schmitt, PT, DPT, OCS, SCS, ATC, and Cathy Ciolek, PT, DPT, GCS
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Background and Purpose. The integrated model of clinical education has been incorporated into the educational curricula of various professions for decades. Currently, however, there is variability among physical therapist education programs in the use and design of such models. This position paper will not only highlight the pedagogy of early integrated clinical experiences, but also provide 2 examples of integrated clinical education models from successful physical therapist education programs. Position and Rationale. Evidence exists to demonstrate the utility of integrated and experiential learning models of clinical education in reinforcing the cognitive, psychomotor, and/or affective domains of learning. Early patient exposure in genuine clinical environments provides students with critical skills necessary for future professional practice. Further, integrated clinical education stimulates transfer, application, and reinforcement of classroom learning to authentic patient/ client situations; provides exposure to varied service delivery models; and promotes self-assessment and opportunities for skill development and professional growth. Discussion and Conclusion. Successful outcomes from integrated clinical experiences rely upon carefully constructed learning opportunities. Designing models wherein didactic and clinical faculty demonstrate consistent practice philosophies and hold students accountable for learning based upon the extent of didactic education completed provides for a seamless approach to student learning. The integrated model of clinical education allows faculty to control the type, sequence, and duration of clinical experiences, as well as the qualifications of the involved clinicians. To maximize student readiness for patient/client demands within the twentyfirst century and beyond, integrated clinical experiences should be viewed as an essential component of the core curriculum in physical therapist education.
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A Shared Vision for Clinical Education: The Year-Long Internship
by Mary Jane Rapport, PT, DPT, PhD, FAPTA, M. Kathleen Kelly, PT, PhD, Tara Ridge Hankin, PT, MS, SCS, Jenny W. Rodriguez, PT, MHS, and Susan S. Tomlinson, PT, DPT
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Background and Purpose. There has been much concern and discussion about the lack of standardization in clinical education as an integral component of physical therapist entry-level education. Despite efforts by the American Physical Therapy Association (APTA) to promote greater standardization in clinical education across programs, there continues to be great variability in the delivery of clinical education. Currently, there is not sufficient evidence demonstrating that 1 model is better or more effective than another, nor is there consensus on a preferred model. Aside from lengthening the total time in clinical education, the infrastructure of clinical education has not changed significantly with the transition to the physical therapy clinical doctorate, the Doctor of Physical Therapy (DPT) degree, and integrated clinical education continues to be the dominant model of education in the United States. However, health care delivery and health care systems have changed, and this has led to additional challenges for clinical education sites and concerns around sustainability of the current models of clinical education that support DPT students. The purpose of this paper is to describe the need for, and the proposed benefits of, a clinical education model where the terminal or culminating clinical education experience is a year-long internship. We believe that this is the preferred model necessary to optimally prepare future physical therapists to enter the work force. This extended experience would push students to achieve performance expectations beyond entry level, and students would be supported in their initial transition to new professional. Other stakeholders, including the clinical facility, academic program, physical therapy profession, and health care profession at large will also benefit from the year-long internship. Ideally, the structure of the internship would consist of a pregraduation phase and a postgraduation phase, perhaps of varying lengths. To maximize the benefit for all stakeholders, a longer postgraduation phase and a postlicensure phase is recommended. We believe that the year-long internship should be the shared vision for all physical therapist education programs in developing our future physical therapist colleagues.
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Building Physical Therapist Education Networks
by Donna Applebaum, PT, DPT, MS, Leslie G. Portney, PT, DPT, PhD, FAPTA, Laurie Kolosky, PT, Olga McSorley, PT, DPT, MS, Diane Olimpio, PT, MS, Deborah Pelletier, PT, and Mary Zupkus, PT, MPA
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Background and Purpose. The sustainability of physical therapist education depends on the ability of programs to provide comprehensive and quality learning experiences across the spectrum of academic and clinical settings. Mounting constraints related to costs, clinical instructor resources, and availability of placements have challenged this ability, compounded by schools increasing clinical education time and numbers of students. A collaborative process for aligning academic programs and clinical practice sites is necessary to create a cohesive clinical education structure that supports physical therapist education. Position and Rationale. Physical therapist education networks (PTENs) are a framework to strengthen academic physical therapy. A PTEN would be composed of an individual academic program and a small number of sites—clinical and community organizations representing the full scope of practice. The academic program would recruit sites based on geographic proximity, and a common educational mission and philosophy. Some sites would be shared among a few networks. The networks’ physical therapist education programs and clinics would establish joint appointments, and involve clinical faculty in curriculum planning and decisions. Comprehensive affiliation agreements would address terms of the partnerships, and joint solutions would be developed to address clinical education costs. Discussion. PTENs would require serious cooperation on the part of schools and clinics to develop mutually beneficial systems for all parties. PTEN members would have the opportunity to address the financial issues in clinical education and would need to be prepared to adopt new models for sharing responsibility for supporting this essential component of professional education. Conclusion. With collaboration and a focus on the greater good, physical therapist education programs and their clinical partners can, through PTENs, influence the future of professional education by generating common solutions to overcome clinical education barriers and finding effective mechanisms to support the education of the profession’s future workforce.
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Development of Regional Core Networks for the Administration of Physical Therapist Clinical Education
by Christine A. McCallum, PT, PhD, Peter D. Mosher, PT, DPT, OCS, Janice Howman, PT, DPT, MEd, Chalee Engelhard, PT, EdD, MBA, GCS, Scott Euype, PT, DPT, MHS, OCS, and Chad E. Cook, PT, PhD, MBA, FAAOMPT
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Background and Purpose. Steady growth for physical therapists (PTs) is predicted over the next decade. In turn, enrollment in PT education programs continues to grow, which results in additional clinical education resource needs. The current model to administer clinical education may be unsustainable considering reimbursement rates, productivity demands, staffing, and organizational changes due to health care regulation. Position and Rationale. Compelling evidence supports the context that clinical education is best delivered at a regional level. The collaboration of PT education programs and clinical practice facilities through a regional core network (RCN) should increase efficiency, improve collaboration, and reduce competition amongst stakeholders. The purpose of this paper is to describe the elements and structure of an RCN model for clinical education, and introduce the roles and responsibilities of its stakeholders. Discussion and Conclusion. The development of an RCN would be driven by both efficiency and quality enhancement through the collaboration of 3 associated parties: PT education programs, clinical education sites, and a regional office. The goals for an RCN include streamlining the clinical placement process; building clinical capacity; improving communications; standardizing policies and procedures; advancing use of technology; research development; and improving overall quality of clinical education. Directors of clinical education (DCE) and center coordinators of clinical education (CCCE) are the bridge agents in the development of this new administrative clinical education model. Challenges include funding sources and relinquishing selected elements of individual and institutional autonomy. The RCN model is intended to allow compromise, with the exact design of each network decided by the stakeholders for a shared approach to the delivery of clinical education within a region
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Essential Characteristics of Quality Clinical Education Experiences: Standards to Facilitate Student Learning
by Carol Recker-Hughes, PT, PhD, Ellen Wetherbee, PT, DPT, MEd, OCS, Kathleen M. Buccieri, PT, DPT, MS, PCS, Jean Fitzpatrick Timmerberg, PT, PhD, MHS, OCS, and Angela M. Stolfi, PT, DPT
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Background and Purpose. Clinical education experiences (CEEs) provide physical therapist (PT) students with opportunities to be immersed in clinical practice to develop professional skills and behaviors under the supervision of a clinical instructor (CI). Essential characteristics and qualities of CIs and of the clinical practice environments in which CEEs take place that promote student learning are clearly described in the literature and in professional documents. However, there are currently wide variations in the quality of CEEs. Factors that appear to contribute to this variability include the CIs’ teaching skills, the culture of the clinical site, and supports extended by physical therapist (PT) education programs. The purpose of this paper is to define the baseline qualifications and essential characteristics of CIs and of practice environments that our profession should consider as standards for clinical education and to make recommendations for changes that are needed to promote consistently high quality CEEs. Position and Rationale. It is our position that all stakeholders in clinical education need to engage in a deliberate effort to ensure that all students have access to quality CEEs that demonstrate agreed upon, evidence-based professional standards. We propose that the development of CIs is analogous to the development of a skilled PT, such that CIs move from being novice to expert clinical teachers. Clinical instructors and clinical education sites should be assessed in a standardized manner and the results shared across PT education programs education programs to cultivate high quality CEEs. Directors of clinical education (DCEs), working together through regional consortium, can meet the identified professional development needs of CIs and of center coordinators of clinical education (CCCEs) in an efficient and timely manner. Furthermore, we recommend that the expert CI be recognized as a clinical education specialist in the same way other specialists are recognized by the American Board of Physical Therapy Specialties (ABPTS). Physical therapist education programs, clinical education sites, and the profession at large must acknowledge the benefits of quality CEEs and assume responsibility to foster the development of expert CIs and of learning environments conducive to student learning. Discussion and Conclusion. Physical therapist education programs and clinical sites need to be held accountable to ensure that evidence-based and agreed upon standards for CEEs are available to all students. This will require negotiation and compromise by administrators at both settings. National-level discussion is required to develop a strategic plan to determine how these recommendations might be implemented so that professional standards for all CEEs are realized.
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Meeting Contemporary Expectations for Physical Therapists: Imperatives, Challenges, and Proposed Solutions for Professional Education
by Susan S. Deusinger, PT, PhD, FAPTA, Beth E. Crowner, PT, DPT, MPPA, NCS, Tamara L. Burlis, PT, DPT, CCS, and Jennifer S. Stith, PT, PhD, LCSW
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Background and Purpose. Advances in medical science and shifts in the structure of health care have required adjustment of the realities of practice to fit the changing demographics of health, illness, and disability. Emerging changes in health care policy and regulation require continual response to new expectations and accountabilities in clinical practice. The intimate relationship between practice and professional education demands adoption of new teaching and learning strategies to prepare graduates to respond to the contemporary patterns of health and complexities of health care. This position paper advocates change in physical therapist education to enable practitioners to capture opportunities to promote the health of our patients via new delivery models—and thus lead the evolution of our profession. Position and Rationale. To lead, physical therapists must (1) demonstrate interprofessional competence in what is certain to be an interdisciplinary industry, (2) assume new roles and accountabilities within new structures of the health care system, and (3) devise models of care, particularly for patients with highly prevalent and chronic conditions, that address movement and function across the full continuum of health and life. In turn, professional education must require (1) early and persistent exposure to, and clinical mentorship by, practitioners in other disciplines; (2) accountability for expected treatment outcomes embedded in the Affordable Care Act; and (3) skill development in community health assessments, health promotion, and prevention of disability and disease across the lifespan. Discussion and Conclusion. The mission of health care is to improve the health of individuals and of populations. As science progresses and a more global view of human health emerges, change in professional education is inevitable and essential to meet this mission. Such change will be a catalyst to create and capture opportunities to use new delivery models to optimize the health of our patients.
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