Christine McCallum

Quality in Physical Therapist Clinical Education: A Systematic Review

Background Many factors affect student learning throughout the clinical education (CE) component of professional (entry-level) physical therapist education curricula. Physical therapist education programs (PTEPs) manage CE, yet the material and human resources required to provide CE are generally overseen by community-based physical therapist practices. Purpose The purposes of this systematic review were: (1) to examine how the construct of quality is defined in CE literature and (2) to determine the methodological rigor of the available evidence on quality in physical therapist CE. Methods This study was a systematic review of English-language journals using the American Physical Therapy Associations Open Door Portal to Evidence-Based Practice as the computer search engine. The search was categorized using terms for physical therapy and quality and for CE pedagogy and models or roles. Summary findings were characterized by 5 primary themes and 14 subthemes using a qualitative-directed content analysis. Results Fifty-four articles were included in the study. The primary quality themes were: CE framework, CE sites, structure of CE, assessment in CE, and CE faculty. The methodological rigor of the studies was critically appraised using a binary system based on the McMaster appraisal tools. Scores ranged from 3 to 14. Limitations Publication bias and outcome reporting bias may be inherent limitations to the results. Conclusion The review found inconclusive evidence about what constitutes quality or best practice for physical therapist CE. Five key constructs of CE were identified that, when aggregated, could construe quality.

Education Research in Physical Therapy: Visions of the Possible

Education research has been labeled the “hardest science” of all, given the challenges of teaching and learning in an environment encompassing a mixture of social interactions, events, and problems coupled with a persistent belief that education depends more on common sense than on disciplined knowledge and skill. The American Educational Research Association specifies that education research—as a scientific field of study—examines teaching and learning processes that shape educational outcomes across settings and that a learning process takes place throughout a persons life. The complexity of learning and learning environments requires not only a diverse array of research methods but also a community of education researchers committed to exploring critical questions in the education of physical therapists. Although basic science research and clinical research in physical therapy have continued to expand through growth in the numbers of funded physical therapist researchers, the profession still lacks a robust and vibrant community of education researchers. In this perspective article, the American Council of Academic Physical Therapy Task Force on Education Research proposes a compelling rationale for building a much-needed foundation for education research in physical therapy, including a set of recommendations for immediate action.

Access to Physical Therapy Services Among Medically Underserved Adults: A Mixed-Method Study

Background and Objectives This mixed-method case study examined access issues related to physical therapy services among medically underserved adults within an Ohio community. Design Three community health care clinics served as the units of analysis. Methods Eleven health care providers and 110 patients participated in the study, and documents from local, state, and national resources were reviewed. Results Results revealed that structural, utilization of care, and outcome barriers existed. A lack of accessible physical therapy providers for medically underserved adults and a lack of standardized screening or assessment processes to identify physical mobility problems among people with chronic health conditions were found. Inadequate knowledge about the full scope of physical therapist practice existed, which may impede access to those individuals most in need of services. Conclusions Opportunities are present for physical therapist involvement in screening, wellness and prevention, consultation, education, and program development among medically underserved adults. However, challenges exist due to a lack of human and financial resources and the current structure of our health care system, which focuses on acute and chronic care rather than prevention.

Direct Access: Factors That Affect Physical Therapist Practice in the State of Ohio

Background Direct access to physical therapist services is permitted by law in the majority of states and across all practice settings. Ohio enacted such legislation in 2004; however, it was unknown how direct access had affected actual clinical practice. Objectives The purpose of this study was to describe physical therapist and physical therapist practice environment factors that affect direct access practice. Design A 2-phase, mixed-method descriptive study was conducted. Methods In the first phase, focus group interviews with 32 purposively selected physical therapists were completed, which resulted in 8 themes for an electronically distributed questionnaire. In the second phase, survey questionnaires were distributed to physical therapists with an e-mail address on file with the Ohio licensing board. An adjusted return rate of 23% was achieved. Data were analyzed for descriptive statistics. A constant comparative method assessed open-ended questions for common themes and patterns. Results Thirty-one percent of the respondents reported using direct access in physical therapist practice; however, 80% reported they would practice direct access if provided the opportunity. Physical therapists who practiced direct access were more likely to be in practice 6 years or more and hold advanced degrees beyond the entry level, were American Physical Therapy Association members, and had supportive management and organizational practice policies. The direct access physical therapist practice was generally a locally owned suburban private practice or a school-based clinic that saw approximately 6% to 10% of its patients by direct access. The majority of patients treated were adults with musculoskeletal or neuromuscular impairments. Limitations Nonresponse from e-mail may be associated with sample frame bias. Conclusions Implementation of a direct access physical therapist practice model is evident in Ohio. Factors related to reimbursement and organizational policy appear to impede the process.

Selectivity of physiotherapist programs in the United States does not differ by institutional funding source or research activity level

Purpose: This study aimed to compare selectivity characteristics among institution characteristics to determine differences by institutional funding source (public vs. private) or research activity level (research vs. non-research). Methods: This study included information provided by the Commission on Accreditation in Physical Therapy Education (CAPTE) and the Federation of State Boards of Physical Therapy. Data were extracted from all students who graduated in 2011 from accredited physical therapy programs in the United States. The public and private designations of the institutions were extracted directly from the classifications from the ‘CAPTE annual accreditation report,’ and high and low research activity was determined based on Carnegie classifications. The institutions were classified into four groups: public/research intensive, public/non-research intensive, private/research intensive, and private/non-research intensive. Descriptive and comparison analyses with post hoc testing were performed to determine whether there were statistically significant differences among the four groups. Results: Although there were statistically significant baseline grade point average differences among the four categorized groups, there were no significant differences in licensure pass rates or for any of the selectivity variables of interest. Conclusion: Selectivity characteristics did not differ by institutional funding source (public vs. private) or research activity level (research vs. non-research). This suggests that the concerns about reduced selectivity among physiotherapy programs, specifically the types that are experiencing the largest proliferation, appear less warranted.

Development of Regional Core Networks for the Administration of Physical Therapist Clinical Education

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.

A Systematic Review of Physical Therapist Clinical Instructor Demographics and Key Characteristics: Impact on Student Clinical Education Experiences

Background. The clinical instructor (CI) plays a significant role in a physical therapist (PT) students clinical education (CE) experience. Authors have reported previous systematic reviews concerning effective teaching behaviors and communication styles across the allied health professions, but physical therapist CIs have not been closely analyzed. Purpose. To identify key CI demographics/characteristics that impact PT students’ CE experiences. Data Sources. PubMed, PEDro, Pro‐Quest, Google Scholar, CINAHL, and ERIC were searched up through September 2015. Data Extraction. Quantitative data extracted included CI demographics, CI teaching behaviors, and fundamental characteristics that have an effect on CI teaching effectiveness. Data Synthesis. Eight articles were selected. Three elements emerged from a qualitative descriptive thematic analysis: CI demographic data, CI credentialing status, and communication/teaching styles. The most effective communication skills exhibited by CIs included giving timely feedback to the student, using clear and concise communication, and clearly explaining responsibilities to the student. It is unclear from this review whether American Physical Therapy Association (APTA) credentialing influences CI effectiveness. Limitations. Publication bias and regional bias may limit generalizability of results. Conclusions. The data from this review identified key CI demographic and personal/environmental characteristics that positively impacted student outcomes. Higher level evidence and using reliable standard outcome measures is recommended to determine if CI effectiveness correlates with being an APTA‐credentialed CI or any other demographic data. Innovative training programs could be designed to highlight the personal and environmental characteristics related to positive student outcomes.

Modifiable variables in physical therapy education programs associated with first-time and three-year National Physical Therapy Examination pass rates in the United States

Purpose: This study aimed to examine the modifiable programmatic characteristics reflected in the Commission on Accreditation in Physical Therapy Education (CAPTE) Annual Accreditation Report for all accredited programs that reported pass rates on the National Physical Therapist Examination, and to build a predictive model for first-time and three-year ultimate pass rates. Methods: This observational study analyzed programmatic information from the 185 CAPTE-accredited physical therapy programs in the United States and Puerto Rico out of a total of 193 programs that provided the first-time and three-year ultimate pass rates in 2011. Fourteen predictive variables representing student selection and composition, clinical education length and design, and general program length and design were analyzed against first-time pass rates and ultimate pass rates on the NPTE. Univariate and multivariate multinomial regression analysis for first-time pass rates and logistic regression analysis for three-year ultimate pass rates were performed. Results: The variables associated with the first-time pass rate in the multivariate analysis were the mean undergraduate grade point average (GPA) and the average age of the cohort. Multivariate analysis showed that mean undergraduate GPA was associated with the three-year ultimate pass rate. Conclusions: Mean undergraduate GPA was found to be the only modifiable predictor for both first-time and three-year pass rates among CAPTE-accredited physical therapy programs.

Scholarly research productivity is not related to higher three-year licensure pass rates for physical therapy academic programs

BackgroundIn the domain of academia, the scholarship of research may include, but not limited to, peer-reviewed publications, presentations, or grant submissions. Programmatic research productivity is one of many measures of academic program reputation and ranking. Another measure or tool for quantifying learning success among physical therapists education programs in the USA is 100 % three year pass rates of graduates on the standardized National Physical Therapy Examination (NPTE). In this study, we endeavored to determine if there was an association between research productivity through artifacts and 100 % three year pass rates on the NPTE.MethodsThis observational study involved using pre-approved database exploration representing all accredited programs in the USA who graduated physical therapists during 2009, 2010 and 2011. Descriptive variables captured included raw research productivity artifacts such as peer reviewed publications and books, number of professional presentations, number of scholarly submissions, total grant dollars, and numbers of grants submitted. Descriptive statistics and comparisons (using chi square and t-tests) among program characteristics and research artifacts were calculated. Univariate logistic regression analyses, with appropriate control variables were used to determine associations between research artifacts and 100 % pass rates.ResultsNumber of scholarly artifacts submitted, faculty with grants, and grant proposals submitted were significantly higher in programs with 100 % three year pass rates. However, after controlling for program characteristics such as grade point average, diversity percentage of cohort, public/private institution, and number of faculty, there were no significant associations between scholarly artifacts and 100 % three year pass rates.ConclusionsFactors outside of research artifacts are likely better predictors for passing the NPTE.