Cultural Responsiveness in Academic Physical Therapy: An Administrative Case Report.

OBJECTIVE: This paper describes how the administrative leadership of 1 physical therapy department curated, implemented, and evaluated a culturally responsive administrative support strategy to foster a positive working environment. Authors summarize participants' perceptions of culturally responsive practices using climate survey data. METHODS: This case occurred in the physical therapy and rehabilitation science department at an American academic medical center. The department administers 5 educational programs, 3 faculty practices, a community clinic, and a robust research enterprise, and employs over 100 employees. After a historic socio-cultural event, administrators implemented a series of actions to understand the needs of department employees and to respond in a culturally responsive manner. Interventions included supportive activities, educational opportunities, and community-building events. The department administered an annual climate survey to assess the employees' perceptions of the working climate, perceived impacts of the culturally responsive interventions, and suggestions for improving department climate. Survey analysis included frequency statistics (STATA Version 17; StataCorp LLC; College Station, Texas, USA) and thematic content analysis with sensitizing concepts from a culturally responsive practice framework previously applied in primary and secondary school settings. RESULTS: A total of 131 employees participated in the annual climate survey from 2020 to 2022. Employees' confidence to identify and address microaggressions in working environments showed trends of overall improvement, and overall self-reported experiences with racial discrimination decreased. Participants reported positive trends in addressing discrimination among colleagues, but difficulty addressing offensive behaviors perpetrated by patients. CONCLUSION: Findings suggest that culturally responsive interventions are associated with positive trends in employee climate. Interventions tailored to the audience and curated to deepen cultural knowledge, enhance self-awareness, and validate others, fostered a shared commitment to cultural equity. IMPACT: Administrative leaders have a role in fostering an inclusive climate by capitalizing on culturally significant teachable moments with sound culturally responsive strategy, bi-directional culturally sensitive communication, individual development, and collective action.

Implementation of High-Value Care for Physical Therapy Residents Through Systems-Based Practice Curriculum Development: Case Report.

BACKGROUND AND PURPOSE: Systems-based practice is a core competency for physical therapy residents, best acquired through experiential learning. Peer health professions are further along than physical therapy in implementing curricula that support systems-based practice. Clinical and practice data in residency programs could provide for education in high-value care (HVC) as a foundation for systems-based practice. Our purpose was to develop and assess a HVC curriculum incorporating reflective practice to help residents achieve competency in systems-based practice. CASE DESCRIPTION: The Logic Model, which evaluates key components needed for success and sustainability, was used to identify resources for a curriculum in HVC. Two orthopedic physical therapy residents and 5 faculty mentors participated in didactic and mentoring sessions. A practice dashboard for each clinician was developed to facilitate resident-mentor discussions. Focus group input was used to refine the curriculum. The validated Systems Thinking Scale, the Quality Improvement Knowledge Application Tool Rubric, and the American Physical Therapy Association Residency Core Competency Score were used to assess residents' progress and to make comparisons to prior years' residents. OUTCOMES: The residents demonstrated increases in systems thinking and quality-improvement knowledge and improvements in clinical outcomes and practice efficiencies. Three themes emerged from semistructured interviews: challenges to HVC, current approach in HVC, and future-oriented thinking in HVC in practice. DISCUSSION AND CONCLUSION: This study demonstrates that HVC activities and a personalized clinical dashboard in a physical therapy residency program can facilitate experiential learning of systems-based practice, a core competency for value-centered, inclusive practice.

Interprofessional peer teaching: The value of a pharmacy student-led pharmacology course for physical therapy students.

BACKGROUND: This report describes the creation, implementation, and evaluation of an interprofessional pharmacy student-led pharmacology course for physical therapy students. The course was designed using a flipped classroom model and a peer-assisted learning framework. INTERPROFESSIONAL EDUCATION ACTIVITY: We describe the development, design, assessment, and evaluation of a pharmacy student-led pharmacology course for physical therapy students. This report focuses specifically on the interprofessional aspect of the course, which was measured using the student perceptions of physician-pharmacist interprofessional clinical education (SPICE) instrument. DISCUSSION: The SPICE instrument was measured across two cohorts in 2015 and 2016. Each cohort consisted of approximately 50 physical therapy students. After implementation of the course, there were significant improvements across all three domains of the SPICE instrument: interprofessional teamwork, roles/responsibilities for collaborative practice, and patient outcomes from collaborative practice (P < .01). Qualitative feedback from the physical therapy students and pharmacy student teaching assistants was positive and emphasized the benefits of interprofessional peer teaching. IMPLICATIONS: Overall, this interprofessional peer teaching model effectively improved interprofessional attitudes while accomplishing didactic needs. This innovative course may serve as a model for interprofessional education in different subject areas or across other health professions programs.

RELIABILITY AND VALIDITY OF THE HALO DIGITAL GONIOMETER FOR SHOULDER RANGE OF MOTION IN HEALTHY SUBJECTS.

BACKGROUND: Range of motion (ROM) of the shoulder is an integral component of assessment of musculoskeletal shoulder impairments. ROM is typically measured using a universal goniometer (UG). The UG has demonstrated good intra and inter-rater reliability for measuring shoulder ROM, although limitations exist. In recent years, alternative measurement devices such as smartphone applications and digital goniometers have been introduced, potentially addressing some of the shortcomings of the UG. Limited research is available on the validity and reliability of these alternative devices, including the laser-guided digital goniometer, in measuring shoulder ROM.Purpose: The purpose of this study was to investigate the intra- and inter-rater reliability and concurrent validity of a laser-guided digital goniometer (HALO) for measuring active shoulder ROM. METHODS: A convenience sample of healthy volunteers was recruited. To be eligible, participants were required to be between 18 and 75 years of age and able to actively move at least one shoulder into 90 ° of glenohumeral abduction. Self-report of previous significant shoulder injury; previous shoulder surgery; current bilateral shoulder pain; current neck or upper back pain; or referred pain into the upper extremity were exclusion criteria. Active shoulder flexion, abduction, internal rotation, and external rotation were measured for each shoulder. Two evaluators measured each motion twice with each device (HALO and the UG) per shoulder. The intra-class correlation coefficient (ICC) for reliability and validity/agreement between devices was calculated using a two-way mixed model with a 95% confidence interval. RESULTS: Data were analyzed for 75 shoulders from 41 participants (seven participants had only one shoulder evaluated). Intra-rater reliability ICCs are between 0.82 and 0.91 for the HALO, and 0.83 to 0.95 for the UG. Inter-rater reliability for the HALO was 0.89 to 0.98 and for the UG was 0.90 to 0.98. The ICCs for agreement, comparing the HALO digital goniometer to the UG ranged from 0.79 to 0.99. CONCLUSION: This study provides evidence that the HALO digital goniometer can be a reliable and valid tool for measuring shoulder ROM in individuals with healthy shoulders. However, the two devices should not be used interchangeably to evaluate a single individual's change over time for any motion. LEVEL OF EVIDENCE: Diagnostic Study (clinical measurement), Level 2b.

Integrative Health: An Interprofessional Standardized Patient Case for Prelicensure Learners.

Introduction: Integrative health care and complementary medicine are widely used by the U.S. population, yet health professions learners are typically inadequately educated to counsel patients on the use of these approaches. This interprofessional standardized patient exercise (ISPE) provides learners the opportunity to discuss various health care professionals' roles in caring for a patient interested in integrative health strategies, and to collaborate on a care plan. Utilizing this ISPE format aligns with the principles of integrative health as it requires interprofessional collaboration to address the multifaceted needs of patients. Methods: The ISPE is approximately three hours in duration, and required of all UCSF, third-year dentistry, physical therapy, and medical students; second-year nurse practitioner students, and fourth-year pharmacy students. Social work, nutrition, and chaplain trainees also participated. Working in interprofessional teams of 4-5 learners, team members discuss case information, interview the standardized patient (SP) individually, jointly formulate a care plan, and, discuss the plan with the SP. The experience is debriefed with a facilitator. Results: In 2016-17, 520 learners participated in the ISPE. They agreed that they learned about the roles of other health care professionals (M = 5.24 on a six-point scale, SD = 1.27), and that they would recommend the ISPE to fellow students in their profession (M = 5.25, SD = 1.30). Discussion: Students appreciated the ability to observe learners from other health professions interacting with the SP, and how different perspectives and expertise were integrated to create a comprehensive care plan. The exercise can be adapted to accommodate local health professions learners.

Interprofessional team debriefings with or without an instructor after a simulated crisis scenario: An exploratory case study.

The value of debriefing after an interprofessional simulated crisis is widely recognised; however, little is known about the content of debriefings and topics that prompt reflection. This study aimed to describe the content and topics that facilitate reflection among learners in two types of interprofessional team debriefings (with or without an instructor) following simulated practice. Interprofessional operating room (OR) teams (one anaesthesia trainee, one surgical trainee, and one staff circulating OR nurse) managed a simulated crisis scenario and were randomised to one of two debriefing groups. Within-team groups used low-level facilitation (i.e., no instructor but a one-page debriefing form based on the Ottawa Global Rating Scale). The instructor-led group used high-level facilitation (i.e., gold standard instructor-led debriefing). All debriefings were recorded, transcribed, and thematically analysed using the inductive qualitative methodology. Thirty-seven interprofessional team-debriefing sessions were included in the analysis. Regardless of group allocation (within-team or instructor-led), the debriefings centred on targeted crisis resource management (CRM) content (i.e., communication, leadership, situation awareness, roles, and responsibilities). In both types of debriefings, three themes emerged as topics for entry points into reflection: (1) the process of the debriefing itself, (2) experience of the simulation model, including simulation fidelity, and (3) perceived performance, including the assessment of CRM. Either with or without an instructor, interprofessional teams focused their debriefing discussion on targeted CRM content. We report topics that allowed learners to enter reflection. This is important for understanding how to maximise learning opportunities when creating education activities for healthcare providers that work in interprofessional settings.

A learner developed longitudinal interprofessional education curriculum.

Increased patient safety requires interprofessional collaboration, now critical given rising healthcare costs and an aging population with complex and chronic conditions. One way in which to educate future health care team members about team dynamics is to have them learn through active participation on a team. Six students representing the five health professions programs at the University of California, San Francisco formed a curriculum development team that created a novel yearlong interprofessional education curriculum and assessed its impact on knowledge, skills and attitudes of first-year learners in medicine, physical therapy, dentistry, nursing, and pharmacy (n = 480). Through their participation on the curriculum development team and reflection on their roles, responsibilities, communication and negotiation, the six students developed the inter-personal and intra-personal skills required for successful interprofessional collaboration.