Impact of an innovative clinical internship model in the US Army-Baylor Doctoral Program in physical therapy.

STUDY DESIGN: Retrospective case-control. BACKGROUND AND PURPOSE: Physical therapy education has been characterized by positive reform including the transition to doctoral level education and the emergence of evidence-based practice as a standard part of the curricula. However, clinical education remains largely unaffected by these advancements and continues as a highly fragmented and ill-equipped model marked by an inefficient 1:1 student to faculty ratio. Current clinical educational models provide highly variable and suboptimal learning experiences for many students, which contribute to disjointed and noncollaborative learning. The purpose of this study is to examine the implications of a one-year collaborative internship model in the US Army-Baylor University Doctoral Program in Physical Therapy in which interns train in groups rather than 1:1 on productivity and efficiency of care. CASE DESCRIPTION: The Army-Baylor program culminates in a 12-month clinical internship conducted at 4 locations within south central Texas (3 military academic medical centers and one multisite outpatient privately-owned physical therapy practice). Each site can accommodate up to 8 (range=4 to 8) students who complete a standardized internship curricula across the full continuum of learning experiences. In this retrospective case-control design, productivity and staffing metrics were extracted for the 3 military sites using the Department of Defense M2 database during the period from 2006-2010. A separate analysis was conducted for each site with descriptive statistics used to assess clinic productivity and efficiency. OUTCOMES: Data from all 3 sites indicate the presence of interns resulted in little variability in clinic productivity and efficiency. Decreased productivity and/or efficiency would bring into question the long term viability and sustainability of the collaborative internship model. Additionally, this model maximized the opportunity for highly engaged mentorship, individual attention, and quality instruction. COMMENT: The findings suggest clinics can accommodate multiple interns and provide high quality education in a collaborative model without a decline in productivity or efficiency. In addition to the standardized curricula across sites, this model facilitates a highly collaborative and peer learning environment in which the intern class supports, challenges, and holds one another accountable to a more standardized and higher level of practice. Each site contributes 1-2 clinical faculty who no longer engage their own patient schedule but rather are able to serve in a full time clinical mentorship role with the interns. In return, the clinical site receives 3-4 full time equivalents of productivity delivered by closely supervised interns who are afforded sufficient time to conduct their examinations and treatments in collaboration with the clinical faculty. Finally, the collaborative internship model supports the mission of each internship site, providing them a critical mass of labor via economies of scale in exchange for an enriched investment into their clinical education.

A prospective study of factors affecting recovery from musculoskeletal injuries.

PURPOSE: Research suggests the importance of psychosocial factors in recovery from musculoskeletal injuries. The objective of this study was to identify predictors of recovery among U.S. Marines who had musculoskeletal injuries of the back, knee, or shoulder. METHODS: A sample of 134 participants was assessed at baseline and followed for 1 year to determine outcome information. RESULTS: The strongest predictor of injury recovery at the 1-year follow-up was recovery expectations. In a multivariate logistic model with key demographic and psychosocial factors controlled, individuals who had high recovery expectations at baseline were over five times as likely to be recovered at follow-up as individuals who had low expectations (OR = 5.18, p\.01). CONCLUSIONS: This finding is consistent with a large body of research that has linked recovery expectations with better recovery outcomes in patients with musculoskeletal injuries as well as with research linking recovery expectations with better outcomes across a wide range of medical conditions.Applied to military populations, interventions designed to modify recovery expectations may have the potential to improve rates of return to duty and to reduce rates of disability discharge.

Behavioral predictors of acute stress symptoms during intense military training.

A better understanding of factors influencing human responses to acute stress is needed to enhance prevention and treatment of stress-related disorders. In the current study, the authors examined predictors of acute stress symptoms during intense military training in 35 men. In univariate and multivariate models, perceived stress, passive coping, and emotion-focused coping during daily living predicted acute stress symptoms in response to realistic survival training, whereas active coping and problem-focused coping did not. Baseline stress levels and coping styles, both of which may be modifiable, appear to play a fundamental role in the human response to acute uncontrollable stress. Additional research is needed to better elucidate the relative and interactive contributions of behavioral predictors of acute stress.

Absolute serum hormone levels predict the magnitude of change in anterior knee laxity across the menstrual cycle.

This study aimed to determine whether absolute sex hormone concentrations predict the magnitude of knee joint laxity changes across the menstrual cycle. Twenty-two females (18-30 years, body mass index

Relationship between sex hormones and anterior knee laxity across the menstrual cycle.

PURPOSE: To comprehensively quantify through daily, serial measures changes in knee laxity as a function of changing sex-hormone levels across one complete menstrual cycle. METHODS: Twenty-five females, 18 - 30 yr, body mass index < or = 30, who reported normal menstrual cycles (28-32 d) over the past 6 months participated. Participants were tested daily across one complete menstrual cycle; 5-7 cc of venous blood were withdrawn to assay serum levels of estradiol, progesterone, and testosterone. Knee laxity was measured as the amount of anterior tibial displacement at 133 N, using a standard knee arthrometer. To evaluate the relationship of knee laxity to changes in sex hormone concentrations, a multiple linear regression model with the possibility of a time delay was performed on each individual subject and the group as a whole. RESULTS: Individual regression equations revealed an average of 63% of the variance in knee laxity was explained by the three hormones and their interactions. All three hormones significantly contributed to the prediction equation, and the amount of variance explained was substantially greater when a time delay was considered. On average, knee laxity changed approximately 3, 4, and 4.5 d after changes in estradiol, progesterone, and testosterone, respectively. When females were analyzed as a group, only 8% of the variance in knee laxity was explained by sex-hormones levels. CONCLUSION: Changes in sex hormones mediate changes in knee laxity across the menstrual cycle. However, the strength of this relationship, the relative contribution of each hormone, and the associated time delay are highly variable between women. This individual variability is consistent with the variability in menstrual cycle characteristics among women.