JOPTE

The Journal of Physical Therapy Education (JOPTE) is peer reviewed and published four 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 

2016 Volume 30 - Number 4

Editorial: Diversity Reconsidered
by Jan Gwyer, PT, PhD, FAPTA, and Laurita Hack, PT, DPT, PhD, MBA, FAPTA
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We all have probably seen this quote before. And we most likely saw it as guidance to help children understand the need to welcome racial and ethnic diversity into their lives. It could just as easily be a reminder to us as faculty to help students recognize the importance of putting aside biases. But what biases would we consider? The changes we have seen in society in the past few years have broadened our concept of diversity—and of bias. The LGBT community has reminded us that recognition of the needs of these individuals is the next great civil rights crusade. Copti et al have given us much to consider on this topic as we prepare to help our students learn more about how to recognize bias, respect diversity, and honor each of our patients. We are pleased that our authors have led the way in addressing this important change in our society.
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Critical Thinking Skills and Learning Styles in Entry-Level Doctor of Physical Therapy Students
by Tracy J. Brudvig, PT, DPT, PhD, D. J. Mattson, PT, DPT, EdD, and A. J. Guarino, PhD
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Introduction. The Commission on Accreditation in Physical Therapy Education emphasizes the development of critical thinking skills in physical therapy students. Although educators assess knowledge and skills, they do not directly measure the development of critical thinking skills. A student’s learning style may affect his or her critical thinking ability. The purpose of this study was to monitor the acquisition of critical thinking skills in entry-level Doctor of Physical Therapy (DPT) students as they progress through the curriculum and to examine the relationship between learning styles and the acquisition of critical thinking skills. Subjects. The study sample consisted of 61 students in a DPT program located in the northeast United States. Methods. A repeated measures design was used to study student outcomes on critical thinking across the curriculum over a 2-1/2-year period. Students completed an online version of the Health Science Reasoning Test (HSRT) and the Kolb Learning Style Inventory, version 4 (KLSI) at the beginning of their program. The students completed the HSRT 3 additional times: at the end of their first academic year, at the end of their second summer semester after their first full-time clinical experience, and again at the time of graduation at the completion of the student portion of their program. Results. Results of the repeated-measures analysis of variance (ANOVA) on the composite overall scores on the HSRT indicated a statistically significant increase in composite scores between times 1 and 4. There was also a statistically significant increase in subscale scores in the area of deduction and inference between times 1 and 4. Students’ learning styles were distributed over 7 of 9 learning styles on the Kolb Learning Style Inventory. There was a statistically significant but weak correlation between the learning modes of abstract conceptualization and the combination of abstract conceptualization and concrete experience. Discussion and Conclusion. The HSRT detected statistically significant changes in students’ critical thinking skills over the course of the curriculum that appear to be “clinically” important. Based on normative data, the students started at the lower end of a strong HSRT composite score and improved to the upper end of the strong range. Three of the 5 subscales on the HSRT showed a ceiling effect. The correlation between HSRT scores and abstract conceptualization was significant but weak and warrants further study. Students in a DPT program showed an increase in critical thinking skills at the completion of their program. Learning modes had a significant but weak relationship to critical thinking skills. Various components of the curriculum may be related to these gains. The students in this cohort exhibited a variety of learning styles and had no one predominant style. Key Words: Critical thinking, Learning styles.
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Lesbian, Gay, Bisexual, and Transgender Inclusion in Physical Therapy: Advocating for Cultural Competency in Physical Therapist Education Across the United States
by Nicole Copti, PT, DPT, Raad Shahriari, PT, DPT, Linda Wanek, PT, PhD, and Amber Fitzsimmons, PT, DPTSc, MS
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Background and Purpose. People who are lesbian, gay, bisexual, transgender, or queer (LGBTQ) should be considered in the discussion of improving cultural competency within physical therapy education to improve both culturally competent health care and the classroom learning environment. It is important to recognize the health care disparities affecting the LGBTQ community because people who are LGBTQ have higher risks of certain types of cancer, substance and tobacco use, sexually transmitted infections (such as human immunodeficiency virus and hepatitis B), and mental health issues (such as depression, anxiety, eating disorders, and suicidal ideation). Along with these health risks, patients who are LGBTQ typically face discrimination and bias, insensitivity of providers, a lack of knowledge about LGBTQ health care issues among providers, and decreased access to care; these problems may lead to substandard care.Position and Rationale. Current events in the news about the rights of lesbian, gay, bisexual, and transgender people bring to light the discrimination faced by this community. The topic of LGBTQ health care disparities has not been well researched or discussed in the profession of physical therapy. We assert that the inclusion of LGBTQ content in health care professional education programs will lead to better care for people who are LGBTQ. Although patient care is a primary concern, it is also crucial to create safe learning environments for students who are LGBTQ and enrolled in health care professional education programs because this population has higher rates of mental health disorders, weight-related issues, and suicide as well as higher self-reported levels of perceived emotional stress. Discrimination and disparaging comments directed at students who are LGBTQ are common in health care professional education programs and need to be addressed to provide these students with the same opportunities as their counterparts who are heterosexual and/or cisgender. Discussion and Conclusion. This position paper provides recommendations to health care educators for improving cultural competency and outcomes for patients who are LGBTQ as well as suggestions for creating an inclusive learning environment and climate for students who are LGBTQ. Specifically, curriculum content should highlight the appropriate usage of language and terminology for people who are LGBTQ, evidence of health care disparities and challenges faced by people who are LGBTQ, and active training in understanding the unconscious (implicit) bias of health careproviders and how bias can affect both the treatment of patients and students. Furthermore, we recommend adding “sexual orientation” and “gender identity” to the nondiscrimination policies of physical therapist education programs, LGBTQ training for faculty and staff, concerted efforts to hire faculty members who are LGBTQ, orientation events for students who are LGBTQ, and targeted programs for students and staff members who are LGBTQ. Key Words: Cultural competency, Disparities, LGBT, Minority groups.
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The Physical Therapist’s Expertise in the Emergency Medicine Residency Curriculum: An Academic Model for Integrated Health Care Education
by Kathleen Geist, PT, DPT, Douglas S. Ander, MD, Melissa White, MD, MPH, Ainsley Rossi, PT, DPT, Marie A. Johanson, PT, PhD, and Beth Davis, PT, DPT, MBA
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Background and Purpose. Patients presenting with acute musculoskeletal diagnoses comprise 15%-20% of emergency room visits annually. Data suggest that musculoskeletal training is lacking in medical education curricula, and more formalized training is needed to increase the knowledge and proficiency of residents practicing in an emergency department (ED) setting. This paper describes a novel musculoskeletal training session for emergency medicine (EM) residents implemented by board-certified orthopaedic clinical specialist physical therapy faculty, and their evaluation of the impact of the intervention on EM residents’ performanceon written and clinical examinations. Method/Model Description. The intervention was a 1-day hands-on training session for EM first-year and second-year residents provided by the Emory physical therapy faculty with assistance from third-year physical therapist students. Knowledge was assessed using written examinations pre- and post-session. Skills and patient education were assessed using objective standardized clinical examinations (OSCEs) pre- and post-session. Outcomes. The EM residents’ scores on the written examination increased from 10.1 (50.7%) pre-session to 15.2 (76.0%) post-session, P<.001. Although there was not a statistically significant difference between residents’ OSCE scores pre- and post-session, there was a statistically significant improvement in the residents’ performance of special tests for the foot and ankle region. Discussion and Conclusion. The integration of physical therapists into the provision of musculoskeletal education within the emergency medicine curricula is a novel concept. This paper emphasizes the role of physical therapists in providing a musculoskeletal training session and contributing to the integration of health care education via collaboration across health profession programs. Key Words: Integrated health care education, Musculoskeletal clinical examination skills, Residency training.
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Interprofessional Collaboration Among Physical Therapy, Speech-Language Pathology, and Engineering Faculty and Students to Address Global Pediatric Rehabilitation Needs: A Case Report
by Lorna M. Hayward, PT, EdD, MPH, Waleed Meleis, PhD, Jeanne Mahanna, MS, CCC-SLP, and Susan H. Ventura, PT, PhD, MEd
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Background and Purpose. The complexity of the health care workplace often transcends the expertise of a single knowledge domain. As a result, problem identification and resolution require collaboration to access the skills possessed by multiple disciplines. The purpose of this case report was to describe an interprofessional, experiential learning module that allowed 5 students in physical therapy and engineering to combine their knowledge with input from a speech-language pathologist to design, create, and deliver 2 low-cost communication devices to 4 children who were nonverbal and living at an orphanage in Ecuador. Case Description. Three physical therapist students were participants in a capstone course, the “Physical Therapy Project,” which included an embedded alternative spring break involving travel to Ecuador. Two students in engineeringwere members of “Enabling Engineering,” a student group that provides to people with disabilities low-cost technology to assist with activities of daily living. A needs assessment conducted by the physical therapy faculty identified 3 children with cerebral palsy and 1 child with autism who would benefit from access to technology to address their communication deficits. Under the direction of 2 faculty members in engineering and physical therapy and a speech-language pathologist, the students in physical therapy and engineering collaborated in the design, development, and implementation of 2 communication devices. Students were provided with opportunities to reflect on their learning and experiences with the project. The global partner provided feedback on the effectiveness of the devices 1 month after implementation. Outcomes. Incorporating knowledge from engineering, physical therapy, and speech-language pathology, the students used 3 dimensional printing to develop a low-technology communication button that provided voice output and allowed a child with autism to communicate basic needs to his caregivers. Three iPad tablets (Apple Inc, Cupertino, California) were customized with GoTalk NOW, a communication application, and a 3-dimensional printed case with a key guard. The iPad tablets were mounted to the children’s wheelchairs with the commercially available Magic ArmTM (Lake Forest, California). The students wrote reflections that revealed positive perceptions about interprofessional collaborative problem solving, interprofessional communication strategies, and focusing on the end user. Limited fluency in Spanish was identified as a concern. The global partner reported appreciation for the students’active collaboration and problem-solving capabilities and noted that the iPad tablets provided an effective means of communication for the children who received them. Discussion and Conclusion. An interprofessional education module allowed physical therapist students to collaborate with other disciplines, translate didactic knowledge to the field, and solve complex, real-world problems. Written reflection illuminated student learning and growth as a result of the process. Future work should focus on assessment of the long-term impact of collaborative efforts on student appreciation for different disciplines and strategies for creating teams that perform at a high level. Key Words: Interprofessional education, International service learning, Pediatrics, Technology.
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Physical Therapist Students’ Perceptions of Effective Clinical Instructor Behaviors: Pathology, and Engineering Faculty and Students to Address Global Pediatric Rehabilitation Needs: A Case Report
by Karen L. Ozga, PT, MMSc, Lisa K. Kenyon, PT, DPT, PhD, Allison J. Engel, PT, DPT, Patricia A. Kool, PT, DPT, Megan E. Sievers PT, DPT, and Paul Stephenson, PhD
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Introduction. Clinical instructors (CIs) are essential in preparing physical therapist (PT) students to assume the roles and responsibilities for contemporary physical therapist practice. The purpose of this pilot study was to determine PT students’ perceptions of the importance and observed frequency of CI behaviors following completion of the clinical education component of their Doctor of Physical Therapy (DPT) program. Subjects. PT students who had completed their final clinical education experience and who were enrolled in the accredited DPT programs in Michigan were targeted for participation in this pilot study. Methods. The study survey included 43 observable CI behaviors in 4 categories as assigned: communication, interpersonal relations, professional skills, and teaching behaviors. For each of the CI behaviors, respondents were asked to rate both how important the CI behavior was in achiev-ing effective clinical education and how frequently the student had observed CIs demonstrating the behavior. Results. Based on weighted average rank, CI behaviors in the category of interpersonal relations were rated by respondents as most important, followed by CI behaviors in communication, then CI behaviors in professional skills, and CI behaviors in teaching. Ranking for frequency of behaviors mirrored the findings for importance. Correlations between perceived importance and observed frequency of each CI behavior were also determined. Discussion and Conclusions. Although mean responses indicated that all 43 of the targeted CI behaviors appeared to be perceived as important by the PT students in the study, rankings of the weighted averages indicated that CI behaviors in the interpersonal relations category were rated as the most important. This finding differs from a previous study involving undergraduate PT students in which respondents rated CI behaviors in the communication category as most important. Key Words: Clinical instructors, Clinical education, Effective
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International Collaboration in Manual Physical Therapy: An Educational Model
by Karen C. Westervelt, PT, MS, ATC, Celia Ellis, PT, DPT, Leighann Ellis, PT, DPT, Amanda Quanstrom, PT, DPT, Kimberly D. Wallingford, PT, DPT, Hendrika Maltby, PhD, RN, and Wayne Hing, DipPhys, PhD, MSc
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Background and Purpose. Internationalization allows the world of higher education to become more connected. International partnerships between physical therapist education programs open new opportunities for learning and cultural exchange. Relatively few international collaborative immersion experiences have been described in the physical therapy literature. The purpose of this article is to describe a model of international educational collaboration between physicaltherapist education programs at 2 universities in different countries. This collaboration was unique because it provided qualitative analyses of data collected from hosts and guests during the experience. Method/Model Description and Evaluation. Eleven physical therapist students, 1 postgraduate student, and 2 faculty members from the University of Vermont (UVM) traveled to Bond University, Gold Coast, Queensland, Australia. While at Bond University, guest participants collaborated with 36 students in the final year of the Doctor of Physiotherapy program and 11 faculty members in a 2-week international manual therapy collaboration. During this experience, students participated in manual therapy course work, seminars, and cultural activities. Journal data were collected from the students from UVM. Students and faculty members from Bond University were surveyed with quantitative and open-ended qualitative questions that were matched with the journal prompts used for the students from UVM. Interpretative phenomenological analysis methodology was used to determine the meaning of this collaborative experience. Outcomes. The following 3 themes emerged from the student data: learning— the acquisition of new skills both professionally and personally; collaboration— the development of new relationships and opportunities with faculty members and students; and experiencing the “other”—observations made from immersion while abroad. Discussion and Conclusion. Themes identified were similar to those established within the literature. Participants gained life experiences from traveling and insight into their personal and professional goals. The international manual therapy collaboration between UVM and Bond University successfully initiated a new di-alogue. The findings support the potential for future collaborative immersion opportunities between education programs to prepare emerging professionals to work in an increasingly global environment. Key Words. Education study abroad, Internationalization, Manual therapy, Physical therapist education.
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Uncovering a Curricular Model of Self-Care in Pediatric Physical Therapist Education
by Annette M. Willgens, PT, EdD, MA, PCS, and Kellie Hummel, PT, MS
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Introduction. Pediatric physical therapists are faced with complex experiences while serving children and families. Amidst a family’s chronic sorrow over the loss of what “might have been,” the pediatric physical therapist may encounter emotional stress in the form of compassion fatigue and burnout. This study’s aim was to uncover a curricular model of evidence- based self-care to offer well-being and resilience to this population. Review of the Literature. Pediatric physical therapy is a unique specialization in that it includes consistent, frequent contact with grieving parents over extended periods of time. Review begins with terminology such as chronic sorrow, ambiguous loss, burnout, cognitive vs. emotional empathy, compassion fatigue. It includes the neurobiological responses to compassion fatigue, and ends with how emotion regulation can be taught in physical therapist education. Subjects. Participants included pediatric physical therapists who serve children from birth to age 5 years. Methods. Grounded theory methods were used to conduct this study. Triangulation was achieved with 2 modes of data collection and 2 investigators. A survey was sent via email to members of the Sec-tion on Pediatrics of the American Physical Therapy Association (APTA) and early intervention program directors across the nation. Participants could respond by using the link, or request an individualized interview in the upstate New York area. Participants were asked to describe emotional stressors and presence of coping mechanisms, compassion fatigue, or burnout. Constant comparative method was used to code data, develop categories, and establish curricular recommendations. Results. Two categories and 8 curricular recommendations were derived from the survey and interview data. Category 1 was emotional empathy, in which participants felt overwhelming emotions as the professional lines were blurred. Category 2 was cognitive empathy, in which participants learned to care for themselves first, make healthy connections with the children and families, and “let go” of self-blame and perfectionism. Conclusion. Curricular recommendations were based on the theory of mindfulness, which was grounded in the data and supported by the literature review. Key Words: Chronic sorrow, Compassion fatigue, Curriculum, Grounded theory, Mindfulness, Self care.
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