Student Pedagogical Consultants: A Strategy for Increasing Diversity, Equity, Inclusivity, and a Sense of Belonging in Curricular Approaches in Physical Therapist Education.

BACKGROUND AND PURPOSE: Diversity within the physical therapy profession lags in comparison to the United States population. As the profession strives to diversify, faculty must pay attention to diversity, equity, inclusion, and belonging (DEI-B) in curricular approaches, including classroom materials, instruction, and assessment. With critical application, students from equity-deserving groups (EDGs) can provide unique perspectives to faculty about curricular approaches. Case study purposes were to 1) enable students from EDGs to partner with faculty, as student pedagogical consultants (SPCs), in 2 courses in a Doctor of Physical Therapy program to provide feedback on DEI-B efforts related to curricular approaches and 2) describe the outcomes of SPCs experience. CASE DESCRIPTION: Eight female students from EDGs partnered with 3 White, female, faculty members in 2 courses: pediatrics and neurorehabilitation. Two SPCs teams observed the classrooms, met with faculty, and administered two-minute papers to classmates to gather feedback on DEI-B curricular approaches. Faculty and student SPCs wrote reflective papers, postproject, documenting their experiences. OUTCOMES: Themes informed a conceptual framework describing SPCs: 1) motivation for engaging in partnership; 2) creation of a pedagogical partnership space to promote dialogue and problem-solve barriers to DEI-B; 3) deeper understanding of teaching; 4) transfer of learning from the SPC experience to future work locations; and 5) faculty modification of teaching. DISCUSSION AND CONCLUSION: Students raised awareness regarding the pain of exclusion and provided suggestions for modifying curricular approaches to consider DEI-B. Curriculum redesign using innovative strategies can meet the contemporary needs of students from EDGs.

Exploring the integration of diagnostic musculoskeletal ultrasound imaging into clinical practice by physical therapists.

BACKGROUND: Musculoskeletal ultrasound (MSK-US) use for diagnostic purposes is expanding in physical therapy practice. Identifying and describing physical therapy-specific approaches to incorporating MSK-US into the evaluation process is needed. Musculoskeletal ultrasound extends the physical exam to allow clinicians to visualize anatomy and pathophysiology both statically and dynamically. Purpose: To document 1) weekly use of diagnostic MSK-US; and 2) clinical reasoning approach used in challenging patient cases by physical therapists (PTs) registered by Inteleos in musculoskeletal sonography (RMSK-certified). METHODS: Longitudinal, observational, cohort study using mixed methods for data collection and analysis. All 23 currently RMSK-certified PTs using MSK-US in clinical practice across the United States were contacted, and 16 participated. Data were collected using an online survey created with the Research Electronic Data Capture System. Participants documented MSK-US clinical use and significant cases using weekly, reflective, online journals for three months. Demographic data were summarized using descriptive statistics. Case data were analyzed thematically. RESULTS: Participating RMSK-certified PTs performed 1110 MSK-US examinations over 110 weeks. Clinicians averaged 7 (range 1-25) MSK-US examinations weekly, representing 28% of an average caseload. Examinations contributed significant anatomical/ pathological information 100% of the time. The most common joints scanned were the knee (n = 281), shoulder (n = 254), and wrist (n = 228). Case data revealed three themes: 1) augmenting the clinical evaluation to extend or narrow a diagnosis; 2) outcomes guiding action; and 3) lessons learned from clinical findings. CONCLUSION: RMSK-certified PTs regularly used MSK-US to validate and refine their clinical diagnoses and treatment. Ultrasound imaging directly influenced patient care by informing the diagnostic process, guiding treatment, and appropriately identifying referrals.

Sustaining and improving an international service-learning partnership: Evaluation of an evidence-based service delivery model.

BACKGROUND: International service learning (ISL) is an instructional method used by physical therapist educators in the United States (US) to prepare students for rendering culturally competent care. ISL is a faculty led student learning opportunity that includes academic instruction and community service in an international context. Research exists that explores student experiences with ISL, but studies that evaluate ISL partnerships and include global stakeholder feedback are lacking. The purposes of this study were to: 1) integrate a partnership evaluation component into an existing curriculum-based ISL model and 2) through evaluation identify benefits, drawbacks, and suggestions for improving and sustaining the academic-community partnership. METHODS: Community-based participatory research design using a mixed methods approach was used to evaluate a ISL partnership between a US-based physical therapy program and a service site in Ecuador. Participants were 31 staff working at the global service site. Over three years, 11 interviews were conducted and 26 surveys were administered to global partner staff. Data were analyzed using qualitative thematic content analysis and descriptive statistics. RESULTS: Partnership benefits included the following: continuity of ISL team leadership, targeted rehabilitative efforts, sensitivity to cultural norms, respectful communication, and interaction with local community. Drawbacks were as follows: deficits in cultural awareness, language barriers, and poor treatment carryover. Suggestions for sustaining the relationship incorporated: additional pre-trip communication, education of staff, and improved language skills. CONCLUSION: As more US teams deliver clinical services abroad, intentional evaluation approaches must include the global stakeholder in the planning, implementation, and evaluation phases to maximize partnerships benefits.

Student perceptions and understanding of client-therapist interactions within the inpatient acute care environment: qualitative study.

BACKGROUND: Physical therapists practicing in inpatient acute care settings in the United States work in a 21st century health care system that requires professional competence in clinical reasoning and decision making. For doctor of physical therapy (DPT) students, the development of confidence in the patient evaluation and the professional skills necessary for managing the inpatient environment can be challenging. OBJECTIVE: The study's purpose was to understand whether the early exposure of students to inpatient settings informed their understanding of the thought processes and actions of experienced clinicians during client interactions. DESIGN: A qualitative design was used. METHODS: Thirty-three DPT students working in inpatient settings were recruited from 15 unique inpatient hospital (acute care and rehabilitation) facilities with a convenience sampling technique. Reflective data were collected for 1 month with clinician-facilitated discussion boards. RESULTS: Four themes emerged: environment, communication, evaluation, and client-therapist interaction. The themes informed a conceptual model depicting the observation by DPT students of factors that influenced interactions between clients and experienced clinicians in inpatient settings. Reflection on the what, the how, and the why that informed clinical decisions enabled students to recognize the situated nature of evaluation and treatment approaches. LIMITATIONS: The use of a sample from 1 year of a DPT program at one university reduced the generalizability of the results. CONCLUSIONS: Limited research has examined student perceptions of the interactions of experienced clinicians with clients in inpatient acute care settings. More research is needed to understand the impact of exposing students to the thoughts and actions of therapists working in such settings earlier within DPT curricula.

The first two years of practice: a longitudinal perspective on the learning and professional development of promising novice physical therapists.

BACKGROUND: Physical therapists work in complex health care systems requiring professional competence in clinical reasoning and confidence in decision-making skills. For novice physical therapists, the initial practice years are a time for developing professional identity and practical knowledge. OBJECTIVES: The study purpose was to extend previous research describing the experiences, learning, and professional development of 11 promising novice therapists during their first year of practice. The present study examined the continued development of the same therapists during their second year of clinical practice. DESIGN: Seven researchers from 4 physical therapist educational programs in the eastern and midwestern United States used a longitudinal, qualitative, multiple case study approach. METHODS: Eleven physical therapist graduates identified as "promising novices" were recruited using purposive sampling. Participants ranged in age from 24 to 29 years and entered varied practice settings. Data were collected for 2 years using semistructured interviews, reflective journals, and participant observation. RESULTS: A conceptual model describing the participants' ongoing development during the second year of practice emerged. The 3 themes were formal and informal learning, increasing confidence and expansion of skills, and engagement in an environment characterized by collaborative exchange and opportunities for teaching. The second year represented consolidation and elaboration of practice-based learning and skills. The expansion of confidence, skills, and responsibilities and the externalization of learning the participants experienced promoted professional role formation. Learning previously directed inward and self-focused turned outward, fueled by growing self-confidence. CONCLUSIONS: Research illuminating the professional role formation experienced during early clinical practice is not widely available. The current study and further research into the learning and development of novice practitioners may assist educators in the design of pedagogical strategies and learning environments that enhance the professional development of physical therapists.

Reflective electronic portfolios: a design process for integrating liberal and professional studies and experiential education.

The purpose of this article is to describe the process used to create and pilot-test a customized reflective electronic portfolio (e-portfolio) that integrates learning across three distinct components of an entry-level 6.5 year Doctor of Physical Therapy (DPT) program. During the 2004-2005 academic year, a pilot test was conducted with 10 students, representative of all 6.5 years in the DPT program. Development of our reflective e-portfolio model consisted of four stages: design a paper-based portfolio model to organize and create linkages among the liberal studies, professional, and experiential components of a DPT program; transform the model into an electronic format; create a demonstration e-portfolio tutorial; and evaluate the e-portfolio model via pilot testing. An interdepartmental team of faculty from physical therapy (PT), cooperative education, educational technology, and two PT students developed the e-portfolio model to map, visualize, and create linkages for student learning. Input to assist with the model design process was gathered from PT faculty and students through three focus groups. Data were collected on student experiences with the e-portfolio through written surveys at three points during the project and through face-to-face discussion. Written reflection, integral to the model, required students to reflect on artifacts selected from existing academic and experiential materials. Our project resulted in the generation of a reflective e-portfolio and tutorial customized for DPT students. Evaluation by users indicated that the reflective e-portfolio helped them organize and integrate academic and experiential learning and illuminate developmental transitions. Further research with a larger sample is indicated to examine the impact of e-portfolios on student learning and professional development.