Jennifer Furze

Essential competencies in entry-level pediatric physical therapy education

Background: The Section on Pediatrics (SoP) convened an Education Summit in July 2012 to examine, discuss, and respond to documented inconsistencies and challenges in teaching pediatric physical therapy (PT) content in entry-level professional education programs. Despite previous attempts by the SoP to provide guidance around teaching pediatric PT, variability continued to be extensive across programs. Key Points: This article presents the core competencies developed out of the Summit to inform pediatric content in the entry-level PT curriculum. In addition, the core competencies were linked to teaching strategies, learning activities, assessment outcomes, and curricular structures. Statement of Conclusions: Consensus was reached on 5 core competencies that represent a knowledge base essential to all graduates of PT programs. In contrast to prior SoP documents, these competencies were specifically designed to focus on knowledge and skills unique to pediatric practice but essential for all graduates of accredited entry-level PT education programs. Video Abstract: For more insights from the authors, see Supplemental Digital Content 1, at http://links.lww.com/PPT/A50.

Reflections from an interprofessional education experience: evidence for the core competencies for interprofessional collaborative practice.

The Core Competencies for Collaborative Practice identify the skills needed by every health care provider to be successful in implementing interprofessional practice. Health professions students need to build skills for interprofessional practice as emerging professionals. Reflection is a core skill needed for successful interprofessional practices. This study identifies themes from an interprofessional education research project and discusses their congruency with the Competencies.

Exploration of Students' Clinical Reasoning Development in Professional Physical Therapy Education

Background and Purpose. Given the complexity of the current health care environment, effective clinical reasoning skills are fundamental to making critical patient care decisions. The purpose of this study was to explore the clinical reasoning abilities of students across time in 1 professional Doctor of Physical Therapy (DPT) curriculum. Methods. Qualitative methods were used to describe the longitudinal development of students’ clinical reasoning skills. Ninety‐eight students from 2 consecutive class cohorts participated. Low inference data from the Clinical Reasoning Reflection Questionnaire (CRRQ) and narrative comments from the Clinical Performance Instrument (CPI) were analyzed using the constant comparative method. Open coding was used to initially categorize the data followed by axial coding to identify resulting themes. Results. Three categories (beginning, intermediate, and entry‐level) and 8 themes emerged from the data describing student development of clinical reasoning skills. The following themes surfaced under the beginning clinical reasoning process category: focus on self, compartmentalized thinking, and limited acceptance of responsibility. Themes in the intermediate category were: procedural performance, initial stages of recognition and using context, and improved reflection on performance. Themes in the final entry‐level category were: dynamic patient interaction and integrating situational awareness. Discussion and Conclusion. The results of this study demonstrate a progression in the development of these students’ clinical reasoning process around the dimensions of self, context, and responsibility across the curriculum. Outcomes reveal these key aspects of the clinical reasoning process: (1) it is a gradual developmental process across time; (2) the Dreyfus model of skill acquisition may apply to the development of clinical reasoning skills in physical therapy students; and (3) increasing intensity and depth of the reflective process may be a critical component in the advancement of the clinical reasoning process. Further research is needed to determine the best strategies to assess clinical reasoning abilities in physical therapy students and to discern approaches to enhance this learning process.

Experiential Learning With Children: An Essential Component of Professional Physical Therapy Education.

Purpose: The Section on Pediatrics of the American Physical Therapy Association has developed a number of resources to support and improve the consistency of professional pediatric physical therapy education, including a set of core competencies that all graduates must attain. The purpose of this article is to advocate for the inclusion of experiential learning activities with children, including children with participation restrictions, as a necessary component to achieve the core competencies. Key Points: Experiential learning is a form of practice-based education that provides exposures and opportunities for students to explore the work, roles, and identities they will encounter as future professionals. Experiential learning is learning by doing, and occurs within a relevant setting. Six representative curricular exemplars are presented to provide readers with a variety of suggestions for development and integration of experiential learning. Summary: Recommendations for future research are provided and 4 key recommendations are provided.

Describing the clinical reasoning process: Application of a model of enablement to a pediatric case

Background and purpose: Clinical reasoning is a core tenet of physical therapy practice leading to optimal patient care. The purpose of this case was to describe the outcomes, subjective experience, and reflective clinical reasoning process for a child with cerebral palsy using the International Classification of Functioning, Disability, and Health (ICF) model. Case description: Application of the ICF framework to a 9-year-old boy with spastic triplegic cerebral palsy was utilized to capture the interwoven factors present in this case. Interventions in the pool occurred twice weekly for 1 h over a 10-week period. Outcomes: Immediately post and 4 months post-intervention, the child made functional and meaningful gains. The family unit also developed an enjoyment of exercising together. Each individual family member described psychological, emotional, or physical health improvements. Discussion: Reflection using the ICF model as a framework to discuss clinical reasoning can highlight important factors contributing to effective patient management.

Physical Therapy Residency and Fellowship Education: Reflections on the Past, Present, and Future

The physical therapy profession continues to respond to the complex and changing landscape of health care to meet the needs of patients and the demands of patient care. Consistent with this evolution is the rapid development and expansion of residency and fellowship postprofessional programs. With the interested number of applicants exceeding the number of residency and fellowship slots available, a “critical period” in the educational process is emerging. The purposes of this perspective article are: (1) to analyze the state of residency and fellowship education within the profession, (2) to identify best practice elements from other health professions that are applicable to physical therapy residency and fellowship education, and (3) to propose a working framework grounded in common domains of competence to be used as a platform for dialogue, consistency, and quality across all residency and fellowship programs. Seven domains of competence are proposed to theoretically ground residency and fellowship programs and facilitate a more consistent approach to curricular development and assessment. Although the recent proliferation of residency and fellowship programs attempts to meet the demand of physical therapists seeking advanced educational opportunities, it is imperative that these programs are consistently delivering high-quality education with a common focus on delivering health care in the context of societal needs.

Clinical Reasoning: Survey of Teaching Methods, Integration, and Assessment in Entry-Level Physical Therapist Academic Education

Background Although clinical reasoning abilities are important learning outcomes of physical therapist entry-level education, best practice standards have not been established to guide clinical reasoning curricular design and learning assessment. Objective This research explored how clinical reasoning is currently defined, taught, and assessed in physical therapist entry-level education programs. Design A descriptive, cross-sectional survey was administered to physical therapist program representatives. Methods An electronic 24-question survey was distributed to the directors of 207 programs accredited by the Commission on Accreditation in Physical Therapy Education. Descriptive statistical analysis and qualitative content analysis were performed. Post hoc demographic and wave analyses revealed no evidence of nonresponse bias. Results A response rate of 46.4% (n=96) was achieved. All respondents reported that their programs incorporated clinical reasoning into their curricula. Only 25% of respondents reported a common definition of clinical reasoning in their programs. Most respondents (90.6%) reported that clinical reasoning was explicit in their curricula, and 94.8% indicated that multiple methods of curricular integration were used. Instructor-designed materials were most commonly used to teach clinical reasoning (83.3%). Assessment of clinical reasoning included practical examinations (99%), clinical coursework (94.8%), written examinations (87.5%), and written assignments (83.3%). Curricular integration of clinical reasoning-related self-reflection skills was reported by 91%. Limitations A large number of incomplete surveys affected the response rate, and the program directors to whom the survey was sent may not have consulted the faculty members who were most knowledgeable about clinical reasoning in their curricula. The survey construction limited some responses and application of the results. Conclusions Although clinical reasoning was explicitly integrated into program curricula, it was not consistently defined, taught, or assessed within or between the programs surveyed-resulting in significant variability in clinical reasoning education. These findings support the need for the development of best educational practices for clinical reasoning curricula and learning assessment.

Connecting Classroom, Clinic, and Context: Clinical Reasoning Strategies for Clinical Instructors and Academic Faculty.

Background: Clinical reasoning is an essential skill in pediatric physical therapist (PT) practice. As such, explicit instruction in clinical reasoning should be emphasized in PT education. Key Points: This article provides academic faculty and clinical instructors with an overview of strategies to develop and expand the clinical reasoning capacity of PT students within the scope of pediatric PT practice. Achieving a balance between deductive reasoning strategies that provide a framework for thinking and inductive reasoning strategies that emphasize patient factors and the context of the clinical situation is an important variable in educational pedagogy. Teaching Implications: Consideration should be given to implementing various teaching and learning approaches across the curriculum that reflect the developmental level of the student(s). Deductive strategies may be helpful early in the curriculum, whereas inductive strategies are often advantageous after patient interactions; however, exposure to both is necessary to fully develop the learners clinical reasoning abilities. Video Abstract: For more insights from the authors, see Supplemental Digital Content 1, available at http://links.lww.com/PPT/A87.

Clinical Reasoning: Development of a Grading Rubric for Student Assessment

Background and Purpose. Clinical reasoning is a complex but vital skill required for professional physical therapy practice. Experts agree that clinical reasoning is both difficult to define and challenging to assess. In order to facilitate the development of clinical reasoning skills in physical therapist (PT) students, educators need to be able to evaluate this process. The purpose of this paper is to describe the development and revision of a tool to assess PT student clinical reasoning skills across the curriculum. Method/Model Description and Evaluation. A Clinical Reasoning Grading Rubric was created using the following multistep process: (1) Initial pilot research exploring the clinical reasoning process students used in a performance‐based examination, (2) use of theoretical constructs from cognitive learning theory and learner skill acquisition, (3) content expert review, and (4) feedback from key stakeholder groups (clinicians, faculty, and students). Outcomes. The rubric was developed to assess student clinical reasoning skills across the curriculum and evaluate student readiness for the clinical setting. The tool allows faculty and students a structure to identify and track the progression of student reasoning skill development. Discussion and Conclusion. The Clinical Reasoning Grading Rubric is 1 tool that can be used to evaluate the clinical reasoning of students at multiple points in time across the curriculum. This instrument has applicability for assessment of clinical reasoning skill development from clinical to residency education. The rubric also provides insight into the teaching and learning environment and may be helpful in informing pedagogical strategies and curriculum change.

Clinical narratives in residency education: Exploration of the learning process

ABSTRACT Background: Post-professional residency educational programs aim to advance the knowledge and skills of therapists in a clinical specialty area, however, little is known about the process, outcomes, or effectiveness of residency education. Purpose: The purpose of this study was to use narrative as a teaching and learning tool to gain insight into the progressive development of the residents’ learning process. Design: Qualitative methods including a retrospective analysis of residents’ narratives were used to explore the professional development and thought process of residents. Methods: Six physical therapy residents wrote reflective narratives across 4 time placements during their one-year residency. Qualitative content analysis was used to analyze the data for types of reflection across time frames and to construct themes based on meaning statements. Results: Four main themes evolved from the residents’ clinical narratives: 1) developing clinical reasoning skills; 2) developing professional formation and identity; 3) moral agency; and 4) emerging characteristics of expertise Conclusions: In this study, clinical narratives served as a pedagogical tool to enhance aspects of clinical expertise. The utilization of clinical narrative may be used as one tool to help to create reflective practitioners with improved skills foundational to clinical practice.