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 

2017 Volume 31 - Number 1

Editorial: Building Our Knowledge Base
by Jan Gwyer, PT, PhD, FAPTA, and Laurita Hack, PT, DPT, PhD, MBA, FAPTA
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Once again, the array of topics addressed by the authors in this issue represents many of the challenges we face each day in our classrooms and clinics as physical therapy educators. Dutton and Selheim explore a long-standing issue about the dissonance between academic preparation and clinical practice. Two papers focus on the growing phenomenon of international education experiences; Audette offers a model for structuring those experiences and Haines et al describe the inclusion of such experiences in physical therapist assistant education. Pullen et al continue to explore the theme of addressing vital, but often neglected, aspects of the curriculum in their article about inclusion of HIV/AIDS content.
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Letter to the Editor: The Diversity Our Work Brings…
by Susan S. Deusinger, PT, PhD, FAPTA, and Maiko Morotani, PT, DPT
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We are indebted to Nicole Copti and her colleagues for the powerful and compelling messages put forth in their position paper published recently in the Journal of Physical Therapy Education.1 Of their many important messages, these authors (1) reinforced the disturbing persistence of negative attitudes in society and in health care toward those who identify as LGBTQ, (2) reminded us that the policies and laws enacted to address these attitudes still fail to ensure the health and safety of these individuals, and (3) explicated the risks to physical and mental health experienced by our patients and our students who have declared their personal identity to be LGBTQ. The belief in “just like everyone else”1(p13) ignores the unique issues faced by this at-risk group of individuals who have every reason to expect from physical therapists a safe and sensitive professional environment that is devoid of derogation. The health and health care issues experienced by transgender people, in particular, illustrate how the landscape of health continues to shift, making it imperative for health professions education and practice to develop a genuine acceptance (not just tolerance) of the spectrum of individual differences presented in our work by patients, students, and colleagues.
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Perspective: (How) Can We Understand the Development of Clinical Reasoning?
by Susan Flannery Wainwright, PT, PhD, and Janet Gwyer, PT, PhD, FAPTA
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Clinical reasoning is a topic that has received significant attention over the last decade, within both the academic and clinical communities. The numerous and varied publications in the Journal of Physical Therapy Education (JOPTE) reflect the profession’s interest in studying clinical reasoning in physical therapy education and practice. In this issue, 4 papers address the topic of clinical reasoning. Drs Huhn and Parrott present a research report exploring the use of the Health Sciences Reasoning Test (HSRT) and academic measures (GPA and GRE scores) at the time of admission to predict physical therapist (PT) student success on the NPTE.1 This paper builds on Dr Huhn’s prior work examining the utility of the HSRT in demonstrating development of critical thinking skills across PT education programs.2 Drs Venskus and Craig have developed and validated a tool to measure the degree of selfefficacy with respect to the development of clinical reasoning skills reported by PT students. This paper adds to the growing body of literature about the development of clinical reasoning, specifically addressing the student’s capability to reason.3
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Exploration of Relationships Among the Health Sciences Reasoning Test, the National Physical Therapy Licensing Examination, and Cognitive Admission Variables
by Karen Huhn, PT, PhD, and J. Scott Parrott, PhD
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Background and Purpose. Identifying variables that can predict success on the National Physical Therapy Examination (NPTE) and help determine who should be admitted to physical therapist education programs has been an area of interest for many years. The Graduate Record Examination (GRE) and the grade point average (GPA) have been found to correlate with the NPTE, but they explain less than 50% of the variance in performance. The purposes of this study were to determine whether there is a relationship between performance on the Health Sciences Reasoning Test (HSRT) and NPTE scores and to explore HSRT, GRE, and undergraduate GPA data for relationships that might enhance the admissions process. Methods. This study was a retrospective analysis of academic records of 4 cohorts. Results. A moderate bivariate correlation between the HSRT and the NPTE was identified, and a multivariable model in which the undergraduate GPA, the GPA at the end of the first year in a Doctor of Physical Therapy program, and GRE and HSRT scores were used to predict NPTE scores was demonstrated to improve model fit over that of a similar model without the HSRT. The models were used as the basis for creating an admissions decision tool. Discussion and Conclusion. Additional studies are required, but the HSRT may prove to be a valuable tool for predicting success in Doctor of Physical Therapy programs, especially for applicants whose GRE and undergraduate GPA scores are marginal. Key Words: Admissions, Student outcomes, Research content areas.
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Development and Validation of a Self-Efficacy Scale for Clinical Reasoning in Physical Therapists
by Diana G. Venskus, PT, PhD, and Jason A. Craig, PT, DPhil
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Background and Purpose. Contemporary physical therapist (PT) practice assigns greater responsibility, accountability, and autonomy to the PT than ever before. Achieving accuracy in clinical reasoning is more complex and is associated with greater risk. Self-efficacy contributes, positively or negatively, to clinical reasoning. At present there is no tool for measuring self-efficacy in clinical reasoning among PTs or PT students. The purpose of this study was to develop and present a PTspecific self-efficacy scale for measuring clinical reasoning among students. Methods. The 5-item Physical Therapist Self-Efficacy (PTSE) scale was developed with model indicators available in the literature and expert opinion related to expectations in clinical reasoning. Seventy- one students enrolled in the 3-year Doctor of Physical Therapy degree program at Marymount University, Arlington, Virginia, completed both the New General Self-Efficacy scale and the PTSE scale described in this study. Results. An initial factor analysis revealed that 2 independent component factors accounted for 95.6% of the variance in the data, namely, general self-efficacy and PT self-efficacy. A planned comparisons analysis of variance demonstrated that increases in PT self-efficacy among students across years of enrollment in the Doctor of Physical Therapy curriculum were statistically significant (F = 22.134; df = 2; P = .000). Discussion and Conclusion. The evidence in this study supports the initial validation of the newly developed PTSE scale for measuring self-efficacy in clinical reasoning among PT students, with potential application for practicing PTs. physical therapist self-efficacy is developmental, that is, responsive to environmental inputs such as educational experiences. Changes in perceived general self-efficacy that were observed in this study may be related to the homogeneity associated with the academic environment. Key Words: Clinical reasoning, Physical therapist, Self-efficacy.
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Impact of Case-Based Learning and Reflection on Clinical Reasoning and Reflection Abilities in Physical Therapist Students
by Rachel D. Trommelen, PT, DPT, Aryn Karpinski, PhD, and Sheila Chauvin, PhD
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Introduction. Clinical reasoning and reflection are vital skills for physical therapists (PTs) to become autonomous practitioners of choice for movement disorders. This study addresses the impact of the combination of case-based learning (CBL) and external reflective articulation on the development of clinical reasoning and reflective abilities in physical therapist students. Review of Literature. The current CBL literature in health care education is mixed regarding its effectiveness in promoting clinical reasoning, with less literature that specifically relates to physical therapist education. The literature also recommends use of reflection to increase clinical reasoning; however its direct impact on promoting clinical reasoning and reflective abilities in PT students is unknown. It is also unknown if the combination of CBL and use of explicit reflection using a technique labeled external reflective articulation increases clinical reasoning over use in isolation. Participants. Participants were secondyear PT students (N = 27) participating in a course on the strategies used by PTs in the examination, evaluation, and treatment of a variety of neuromuscular disorders. Methods. The intervention was the use of written external reflective articulation assignments with the Physical Therapy Clinical Reasoning and Reflection Tool as well as posed questions relating to clinical reflection on CBL activities. Five CBL activities were completed before the addition of external reflective articulation. Participants completed the Diagnostic Thinking Inventory (DTI) and the Self- Assessment of Clinical Reasoning and Reflection (SACRR) 3 times during the course: at the beginning of the course, before implementation of the intervention, and at the conclusion of the course. Results. Seventeen participants (63.0%) were women and 10 (37.0%) were men, with a mean age of 24.63 years (SD = 2.53 years) and a grade point average of 3.52 (SD = 0.24). There were no significant differences in DTI and SACRR scores with respect to sex, age, and grade point average. The main effect of SACRR scores was significant (P < .001). There were significant differences across the 3 SACRR and DTI scores, with no statistically significant differences (P > .05) before the reflection was implemented (from time 1 to time 2) and statistically significant increases in SACRR (P = .001) and DTI (P = .01) scores after the reflection was implemented (from time 2 to time 3). Discussion and Conclusion. The results of this study support the addition of external reflective articulation to CBL activities for PT students to increase clinical reasoning and reflection abilities. Purposeful use of CBL and reflection promoted improvement in clinical reasoning skills, a critical factor in clinical decision-making. The results provide useful information to guide educators and administrators in selecting learning activities that improve reflection and clinical reasoning abilities in PT students. Key Words: Case-based learning, Clinical reasoning, Physical therapist education, Reflection.
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Physical Therapist Students’ Development of Diagnostic Reasoning: A Longitudinal Study
by Sarah Gilliland, PT, DPT, PhD
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Background and Purpose. Clinical reasoning is a complex problem-solving process that is necessary for effective clinical practice in physical therapy. Within the process of clinical reasoning, a physical therapist’s diagnostic reasoning should address the patient’s functional movement abilities and the impact of the patient’s condition on his or her ability to participate in life activities. This longitudinal study examined the development of entry-level physical therapist students’ diagnostic reasoning processes across time in their doctor of physical therapy education. Methods. Qualitative methods were used to analyze participants’ diagnostic reasoning during a simulated patient case scenario. Six physical therapist students completed a think-aloud patient case scenario at 3 points during their entrylevel education (first-year, second-year, and postclinical). Low-inference data (verbatim transcripts) from the students’ think-aloud work on the patient cases and postcase interviews were analyzed using a 2-stage process of thematic analysis. Structural coding was followed by pattern coding to categorize students’ diagnostic reasoning processes. Results. Students’ hypotheses focused on anatomical structures during their first year and shifted to medical diagnoses and biomechanical contributing factors during the second year and following clinical affiliation. Students consistently focused on the anatomical and biomechanical (impairment level) aspects of the patient’s condition and gave minimal attention the patient’s life context (participation level). Discussion and Conclusion. Students demonstrated consistent development toward the movement and biomechanical elements of the specific physical therapist diagnostic process, yet they demonstrated no consistent patterns of development toward identifying or addressing the impact of the patient’s life context on his or her level of disability. Further research should examine the curricular factors that influence students’ patterns of development in diagnostic reasoning. Key Words: Clinical reasoning, Entrylevel physical therapist education, Student learning.
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International “Broadening Experiences”: A Method for Integrating International Opportunities for Physical Therapist Students
by Jennifer G. Audette, PT, PhD
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Background and Purpose. Today’s health care providers must be prepared to work with patients and clients from a wide variety of backgrounds and places. Therefore, educators are challenged to develop and provide opportunities for students to achieve a wider worldview. Many physical therapist education programs are adding international opportunities to meet this challenge. The purposes and formats of these programs vary widely. Method/Model Description and Evaluation. This article describes a unique program called “Broadening Experiences” (BEs), which provides students with multiple, unique international opportunities. This program has been evolving over the past 11 years to provide students with unique opportunities to explore physical therapist education and practice around the world. It is now a 2-credit required course that is an integral part of the curriculum. Each BE is highly structured and has specific requirements, goals, and objectives. Measuring outcomes is important, and over the evolution of the program, various measures have been used to evaluate the BE program and student outcomes. They include assessment of students, host sites, and the overall program. Outcomes. The program is very successful and has become a recruitment tool.Outcomes have been overwhelmingly positive. Although detailed outcome data are beyond the scope of this article, samples of program and student outcome data are provided. The purposes of this article are to describe a method for increasing the availability of international opportunities for physical therapist students and to provide various important qualitative and quantitative outcomes that might be considered and measured by institutions considering similar programs. Discussion and Conclusion. The BE model is an example of how physical therapist education programs can develop international experiences. The model exemplifies that it is possible to develop a dynamic program that can accommodate many students. Key Words: International experiences, Physical therapist education, Outcome measurement.
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Academic and Clinical Dissonance in Physical Therapist Education: How Do Students Cope?
by Lisa L. Dutton, PT, PhD, and Debra Ough Sellheim, PT, PhD
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Introduction and Review of Literature. A recent study of the informal and hidden curriculum in physical therapist education found that students experience areas of dissonance between what they learn in the classroom and what they experience in clinical practice. In other health professions, research suggests that curricular dissonance can lead to indifference or a negative view of a particular value, undermine explicit curriculum content areas, or create the expectation that students will be the kind of practitioners that their teachers are not. It may also lead to negative emotional reactions, such as stress, frustration, and cynicism. Students may respond to dissonance with direct or indirect action; however, some literature suggests that few students take action in the face of potential negative consequences. The purpose of this research study was to explore how physical therapist students experience and cope with dissonance between the didactic curriculum and clinical practice. Subjects. A total of 528 third-year physical therapist education students from 13 educational programs were invited to participate in the study, and 122 responses were received, for a response rate of 23.1%. Methods. Qualitative data were gathered via an online survey asking students to share personal incident narratives describing their experiences of didactic curriculum and clinical practice dissonance. Data were coded by use of an inductive approach, with no predefined coding criteria or hypotheses, to generate categories from the raw narrative data. Results. Two primary categories of academic- clinical dissonance emerged from the student narratives. A small percentage of students described academic-clinical dissonance experiences related to professionalism and, in particular, to the core value of integrity. The remainder of the experiences were associated with patient/ client management in the context of the current health care environment. Dissonance in the category of patient/client management included 3 subcategories: physical therapy examination, intervention, and documentation. Emotions evoked from the dissonance experience were primarily negative and, in nearly all cases, students took no or little action in response to curricular dissonance and deferred to the clinician’s or clinic’s standard of practice. Discussion and Conclusion. These results suggest that there are opportunities for academic faculty to better educate students for the realities of clinical practice, particularly in the areas of examination and documentation. Also needed are improvements in students’ preparation to take substantive action when indicated and the creation of academic and clinical cultures that support appropriate challenges to existing structures and practices. A greater understanding of how physical therapist students experience and cope with cognitive dissonance caused by competing curricular factors has the potential to provide the basis for targeted educational approaches, reduced student emotional stress and, in some cases, improved health care. Key Words: Curricular dissonance, Physical therapist education, Ethical issues, Professional standards, Narrative inquiry.
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Recent Graduates’ Perceptions of the Impact of a 1-Month International Service Learning Experience in Kenya During Their Physical Therapist Assistant Education
by Jamie Haines, PT, DScPT, Christine H. Stiller, PT, PhD, Kristine A. Thompson, PT, PhD, and Deb Doherty, PT, PhD
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Introduction. International service learning (ISL) is being used in physical therapist education to help faculty prepare physical therapists who are globally minded. The purposes of this study were to explore the perceptions of recent graduates of a physical therapist assistant (PTA) education program about participating in an ISL experience while they were students and to develop a conceptual framework that illustrates the impact of ISL experiences on PTA students. Review of Literature. Studies have demonstrated immediate benefits of 1- to 2-week ISL experiences in physical therapist students. The immediate benefits of ISL included an improvement in the participants’ abilities to apply and modify professional knowledge, problem solve, and think critically; the development of cultural awareness; and an increased appreciation and formation of their professional role. To our knowledge, there is no literature on PTA students’ perceptions of an ISL experience.Subjects. The study subjects were 3 PTA graduates who participated as students in a month-long ISL experience in Kenya. Methods. In this longitudinal, phenomenological qualitative study, course written assignments, a newspaper article, and data from interviews conducted 2 years after the ISL experience were used. The data were reviewed with the constant comparative method for concept and theme generation. Results. Overall growth in personal maturity, professional development, and cultural competence was found. Changes experienced by participants were first centered on themselves, expanded to their practice of physical therapy after graduation, and ultimately extended into their life philosophy and perspectives 2 years later. Engagement, courage, and reflection were 3 factors thought to promote longterm growth. Discussion and Conclusion. The shortterm benefits of ISL for PTA students were similar to those found in other studies conducted with physical therapist students. In addition, the present study provided a deeper understanding of the long-term benefits of ISL, such as growth over time. A conceptual framework describing how ISL can facilitate both shortterm growth and long-term growth in multiple areas and how to structure ISL experiences to facilitate the greatest development possible in students who participate in these types of experiences was developed. Key Words: Cultural competence, International service learning, Long-term impact, Physical therapist assistant.
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HIV-Related Content in Physical Therapist Education Programs: A Curricular Needs Assessment
by Sara D. Pullen, PT, DPT, MPH, Elise L. Bruns, PT, DPT, Natasha G. Dawkins, PT, DPT, Heaven V. Powell, PT, DPT, Catherine M. Miller, PT, DPT, and Christina R. Sperle, PT, DPT
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Introduction and Review of Literature. Increased life expectancy for people living with HIV (PLH) has led to HIV-related chronic impairments involving the cardiopulmonary, musculoskeletal, and neurological systems. Because of the high prevalence and chronicity of the disease, physical therapists may treat PLH of all ages and in various clinical settings. The aims of this study were to answer 3 questions: What percentage of physical therapist education programs cover HIV in their curricula? In what contexts is HIV covered in the programs surveyed? What needed teaching materials related to the inclusion of HIV are identified by surveyed faculty? Subjects and Methods. An original, 12- item email survey was administered to all 213 entry-level physical therapist education programs accredited by the Commission on Accreditation in Physical Therapy Education. Data were analyzed with computer software. Results. Sixty-six surveys were completed and returned. Most respondents (n=60) stated that their program addresses HIV in some context. Most respondents (n=59) indicated that including HIV-specific information in a physical therapy curriculum is extremely important or moderately important. The contexts in which HIV was discussed in their curricula were disease epidemiology and pathophysiology (59%, n=39), physical therapy–treatable impairments in PLH (51.5%, n=34), and physical therapy–specific interventions for PLH (39.4%, n=26). Discussion and Conclusion. Only slightly more than half of the respondents reported teaching physical therapy–specific interventions for PLWLA, highlighting an important area for curricular focus. Some respondents expressed interest in additional HIV information; this finding suggests that HIV experts may serve as a beneficial resource. The present study highlights the need for physical therapist education programs to equip graduating students with the knowledge and skills to treat PLH. Key Words: AIDS, Curriculum, HIV.
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