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 1

Editorial: Innovation, Risk, and Reward
by Jan Gwyer, PT, PhD, FAPTA, and Laurita M. Hack, PT, DPT, PhD, FAPTA
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Every time an author puts pen to paper, or more likely fingers to the keyboard, he or she takes a risk. Every time a researcher conceives and conducts a study, he or she takes a risk. Every time that study is about something innovative, the risk increases. Thank goodness for the risk takers! All of the papers in this issue are the result of physical therapists being willing to take these risks to help the rest of us improve our ability to educate the best possible practitioners.
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Simulation in Physical Therapy Education and Practice: Opportunities and Evidence-Based Instruction to Achieve Meaningful Learning Outcomes
by Carla Sabus, PT, PhD, and Kelly Macauley, PT, DPT, CCS, GCS
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Background and Purpose. The last decade has seen the proliferation of simulation in health care education. This trend has reached physical therapy education and is redefining experiences for physical therapy learners. Simulation has great potential for controlled, experiential learning that can be scripted to elicit essential competencies that may not be predictable encounters during clinical internships. Simulation can also engage novice learners in high risk/low frequency clinical events that have low tolerance of error within a learning experience that does not impose risk to actual patients. Within clinical practice, simulation can support skill development, continued competency, and be part of a risk management approach to revisit a breakdown of care, evaluate a near miss event, or rehearse new workflow procedures. Simulations must be thoughtfully designed, executed, and followed with effective, structured debriefing to achieve the positive learning that will translate to improved clinical practice. Position and Rationale. Health care simulation is a powerful instruction method grounded in learning theory and behavior change theory that can be implemented in physical therapy education and practice development to achieve learning outcomes. Simulation is not designed around lab or mannequin capability; it is an instructional method grounded in learning objectives centered on learners’ needs and readiness. The experience must be thoughtfully scripted to expose the learners’ clinical decision-making that guides action or inaction. The debriefing approach is an essential instructional element in simulation that serves to uncover learners’ decision frameworks so instruction can be strategically tailored to build positive experiential learning. Discussion and Conclusion. Simulation can be a highly effective instruction tool, but it is resource and time consuming. To realize positive, experiential learning through simulation, proven, evidencebased strategies can be tailored to the physical therapy practice context. Simulation opens the door for rich learning experiences that have potential to achieve the highest quality, safe, and interprofessional practice that future health care demands. Key Words: Simulation, Reflective practice, Debriefing.
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High Fidelity Human Simulation Improves Physical Therapist Student Self- Efficacy for Acute Care Clinical Practice
by Nicki J. Silberman, PT, DPT, PhD, Bini Litwin, PT, DPT, PhD, Karen J. Panzarella, PT, PhD, CHSE, and Alicia Fernandez-Fernandez, PT, DPT, PhD
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Purpose. High fidelity human simulation (HFHS) is a pedagogical tool implemented in physical therapy curricula to prepare students for acute care clinical experiences. While evidence in nursing and medical education supports implementing HFHS in preparation for clinical practice, there is limited literature related to efficacy of HFHS in physical therapy education. The purpose of this study was to compare selfefficacy between physical therapist (PT) students who did and did not participate in HFHS training prior to acute care clinical experiences. Methods. In this randomized, exploratory study, using a mixed quantitativequalitative methodology, 16 PT students were randomly assigned to either the control or the experimental groups. The experimental group participated in 6 HFHS experiences prior to an acute care clinical experience. Self-efficacy was measured using the Acute Care Confidence Survey (ACCS) on 3 occasions: baseline, after HFHS training, and midterm of the clinical experience. A focus group was conducted with the experimental group upon completion of the clinical experience to examine the students’ perceived value of HFHS training. Baseline demographics were compared using the Mann- Whitney test for continuous data and the chi-square test for categorical data. Self-efficacy scores on the ACCS were analyzed using Friedman’s analysis of variance (ANOVA) and the Mann-Whitney test. Qualitative methods were utilized in analysis of the focus group. Results. Significant difference between groups was found on self-efficacy scores following HFHS and on total change in self-efficacy from baseline to midterm of the clinical experience. Focus group qualitative analysis revealed 4 themes: (1) Simulation provided a safe, nonjudgmental, and productive learning environment; (2) students gained confidence in preparation for acute care clinical experience in initial interaction with clinical instructor, patient, and interprofessional team communication, and knowledge of the clinical setting; (3) simulation fostered clinical reasoning skills; and (4) simulation facilitated skills in multitasking in a complex setting. Themes were triangulated and supported by quantitative self-efficacy scores. Conclusion. HFHS in physical therapy education leads to increased self-efficacy for acute care clinical practice. Academic programs may consider the curricular integration of HFHS experiences when preparing PT students for acute care clinical experiences. While further research is warranted, this study indicates students may be better prepared for acute care clinical practice when given exposure in the academic setting through HFHS, allowing them to enter clinical practice in the acquisition stage of learning. Key Words: Simulation, Physical therapy education.
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Calculation of Minimal Detectable Change of Construct Subscales of a Cultural Competence Instrument
by David S. Fike, PhD, Jason M. Denton, PT, DPT, Shandra Esparza, EdD, ATC, LAT, and Kerstin Palombaro, PT, PhD, CAPS
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Introduction. Physical therapist (PT) and athletic training education programs are among the health professions programs that include cultural competency components to prepare students for practice in a diverse society and to meet accreditation requirements. The Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Student Version (IAPCC-SV©) is an instrument frequently used to assess cultural competency. The purpose of this study is to calculate the minimal detectable change (MDC) of the tool and each of the 5 construct subscales. Subjects. Seventy-nine Doctor of Physical Therapy (DPT) and undergraduate athletic training and rehabilitation science (ATHP) students completed the IAPCCSV ©.Methods. The IAPCC-SV© was administered to 79 students in Fall 2014, and 52 students completed a retest 1 week later. Test-retest reliability and MDC for the IAPCC-SV© scale and subscales were calculated. Results. For the combined DPT and ATHP groups, the MDC95 of the entire tool was 4.1, internal consistency (Cronbach’s alpha) was .861, and overall testretest reliability was .938. The MDC95 of the individual subscales are as follows: cultural awareness = 1.34, knowledge = 2.02, skill = 1.52, encounters = 1.61, and desire = 1.17. The range of subscale internal consistency (Cronbach’s alpha) was .431 to .798, while the range of test-retest reliabilities was .766 to .936. Discussion and Conclusion. The current results provide MDC values of the IAPCC-SV© in 2 additional student groups. The MDC of the cultural knowledge and cultural desire construct subscales can be used to interpret changes in their respective domains of the IAPCCSV © after an educational intervention. Key Words: Cultural competence, Minimal detectable change, Measurement tool, IAPCC-SV.
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The Role of Dual Degrees in the Physical Therapist Education Program at Emory University
by Zoher F. Kapasi, PT, PhD, Sara D. Pullen, PT, DPT, Brenda Greene, PT, PhD, Susan J. Herdman, PT, PhD, FAPTA, and Marie A. Johanson, PT, PhD, OCS
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Background and Purpose. The increasing complexity of medical care in the United States calls for providers to become leaders in various aspects of health care. Combining clinical skills with knowledge of public health and the business/administrative side of health care allows health care providers, including physical therapists, to effectively manage and navigate the changing health care environment and become leaders in their field. The purpose of this paper is to describe the method and process of succesfully establishing dual degree programs in business and public health and in the physical therapist education program at Emory University. Method/Model Description and Evaluation. The process for institutional level agreements, curricular structure, admissions process, and graduation requirements for dual degree program students in the Doctor of Physical Therapy (DPT) and Master of Business Administration (MBA) or Master of Public Health (MPH) at Emory University is described in this paper. Additonally, 2 surveys were conducted: 1 survey of all students in 3 DPT classes (n = 201) and the other survey of dual degree program graduates as of 2013 (n = 8). The surveys evaluated student awareness of the dual degree programs during the DPT program application process and characteristics and perceptions related to the dual degree programs. Outcomes. Eighty-three percent of all students indicted that they were aware of the dual degree programs while applying to our DPT program and 6% indicated it was a key deciding factor in their decision to apply to our program. The graduating grade-point average (GPA) and first time pass rate on the National Physical Therapy Exam (NPTE) licensure of the dual degree students in the DPT program is at least equal to that of the overall DPT class graduating the same year. Moreover, 86% of dual degree program graduates indicated that it made them a more competitive job candidate. Discussion and Conclusion. In addition to fostering interprofessional education, the dual degree programs at Emory show positive outcomes, as all graduates indicated that their dual degree positively impacted their careers, and the majority reported specifically using their dual degree in their career. Also, the graduating GPA and first time pass rate on the NPTE of the dual degree students in the DPT program is at least equal to that of the overall DPT class graduating the same year, suggesting that the burden of an additional course of study was not adversely impacting their performance in the DPT program. At Emory University, the dual DPT/MBA and DPT/MPH programs have been designed to provide students with the necessary clinical, business, administrative, policy analysis, and public health perspectives required to excel as leaders in the future health care system. Key Words: Dual degree programs in physical therapist education, Master of Business Administration, Master of Public Health.
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Aches, Pains, Sprains, and Strains: Incorporating Online MP3 Media in Medical Screening for Patient Referral Physical Therapy Curricula
by Alan Chong W. Lee, PT, DPT, PhD, CWS, GCS, and William G. Boissonnault, PT, DHScS
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Background and Purpose. Online media player 3 (mp3) media has the potential to be a user-friendly method for improving student learning of medical screening and patient referral in physical therapy curricula. The purpose of this case report is to describe educational multimedia innovations used in the “Medical Screening for Patient Referral” course at the Mount Saint Mary’s University (MSMU), Los Angeles Doctor of Physical Therapy (DPT) program. Case Description. Physical therapist (PT) students in their final academic year accessed 3 consecutive years of archives from a monthly online national public radio (NPR: The Larry Meiller Show) mp3 media program titled “Aches, Pains, Sprains and Strains – Talk to Your Physical Therapist.” Based on information provided by the callers, PT students determined whether callers required further medical screening in a writing assignment. Upon completion of the assignment and classroom group discussions, a face-to-face videoconferencing between one of the PTs from the NPR program and PT students was conducted to discuss the challenge of screening callers for patient referral and relevance to clinical practice. Outcomes. The archived online mp3 media program was incorporated into a medical screening course with minimal faculty resources and positive student feedback. Overall, PTs on the mp3 media program noted 12.3% of 608 callers in 3 years required a physician referral. In addition, the majority of the callers were not examined by a physician prior to speaking with PTs. Discussion and Conclusion. An online mp3 media program that screens callers with aches, pains, sprains, and strains may provide an additional educational strategy to reinforce decision-making skills necessary for medical screening and patient referral in physical therapy curricula. Classroom discussion with PT students and faculty are warranted to discern medical screening cases from online mp3 media requiring a physician referral. Key Words: Medical screening, Multimedia innovations, Online mp3 media, Videoconferencing.
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Using the PRECEDE-PROCEED Model and Service-Learning to Teach Health Promotion and Wellness: An Innovative Approach for Physical Therapist Professional Education
by Howell Tapley, PT, PhD, OCS, and Rupal Patel, PT
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Background and Purpose. The purpose of this paper is to describe the methods and outcomes of using the PRECEDEPROCEED public health planning model combined with service-learning for teaching health and wellness content to entrylevel physical therapist (PT) students. Method/Model Description and Evaluation. The study was retrospective in nature and was based on the process and outcomes of teaching health promotion and wellness content to Doctor of Physical Therapy (DPT) students using a combination of service-learning and a theory-driven public health planning model. A cohort of 45 DPT students participated in a series of 2 health promotion and wellness courses. Pre and postcourse student surveys were completed along with written reflections. The PRECEEDPROCEED public health planning model is described along with details of how it was utilized in guiding health promotion community projects. Outcomes. DPT students indicated improved interest, confidence, and willingness to participate in health promotion programs for populations in the community after graduation. PT students value both community service and service- learning. Time and scheduling restraints were among the challenges faced. Discussion and Conclusion. The PRECEDE-PROCEED model offers a structured approach for performing service- learning projects in the area of health promotion and wellness within PT professional education. Key Words: Service-learning, Health promotion and prevention, Teaching methods.
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