Integration and Assessment of Evidence-based Practice Principles throughout a DPT curriculum
Both the knowledge of and implementation of evidenced-based practice (EBP) are lacking in physical therapy. One possible cause is the traditional “siloed” approach used to teach EBP in entry-level doctor of physical therapy programs. Identifying a disconnect between the concepts of research design, statistics, literature review and clinical reasoning, the physical therapy faculty revised the curriculum to integrate the principles of evidence-based practice (EBP) throughout the curriculum.
The faculty established a common language collaboratively, allowing for the discussion of EBP with students across all courses. Faculty also established expected competencies of the program with the goal of graduating “clinician scientists” who would be able to apply the principles of EBP to clinical practice as well as implement structured data collection to assess the outcomes of practice. A curricular review led to the revision of the critical inquiry component of the curriculum. The revisions created 6 critical inquiry courses and a capstone project. Major components included early orientation to the concepts of EBP, the use of the rehabilitation literature to teach research design and statistics, the integration of EBP principles into clinical courses through assignments and in-class activities, and “real time” practical application of EBP on clinical internships. Assignments and activities focus on clinical decision-making using all three components of EBP, the literature, patient values and preferences, and clinical expertise. In the final critical inquiry course, Virtual Grand Rounds, students must implement all five steps of EBP with actual patients encountered in the clinical internships. Additionally, a capstone project allows the students the opportunity to demonstrate the expected competencies through a faculty directed research project or case study.
Assessment of student learning occurs in each course as well as through the capstone project. In the capstone project students demonstrate competencies related to review of the literature, systematic collection of data, interpretation of data analysis, and presentation of findings. During one of their final internships students demonstrate competency in the implementation of an evidence-based intervention. Overall, assessment using the EBP Beliefs Scale and EBP Implementation Scale, demonstrated improved knowledge and implementation of EBP throughout the curriculum.
Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education
Doctors of physical therapy need to be evidence-based practitioners. Understanding EBP is foundational knowledge like anatomy, and critical consumption of evidence is a foundational skill like manual muscle testing. In order to engrain EBP in physical therapy practice, new models of teaching are necessary. Our model demonstrates that threading EBP through the curriculum and having real world applications improve competency and implementation.
Bridges PH, Bierema LL, Valentine T. The propensity to adopt evidence-based practice among physical therapists. BMC Health Serv Res. 2007;7:103.
Coomarasamy A, Khan KS. What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. BMJ. 2004;329(7473):1017.
Jette DU, Bacon K, Batty C, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83(9):786-805.
Menon A, Korner-Bitensky N, Kastner M, McKibbon KA, Straus S. Strategies for rehabilitation professionals to move evidence-based knowledge into practice: a systematic review. J Rehabil Med. 2009;41(13):1024-1032.
Salbach NM, Jaglal SB, Korner-Bitensky N, Rappolt S, Davis D. Practitioner and organizational barriers to evidence-based practice of physical therapists for people with stroke. Phys Ther. 2007;87(10):1284-1303.