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.

Physical Therapists Use of Diagnostic Ultrasound Imaging in Clinical Practice: A Review of Case Reports.

Objective: Ultrasound diagnostic imaging (USI) is widely utilized in sports medicine, orthopaedics, and rehabilitation. Its use in physical therapy clinical practice is increasing. This review summarizes published patient case reports describing USI in physical therapist practice. Design: Comprehensive literature review. Literature Search: PubMed was searched using the keywords "physical therapy" AND "ultrasound" AND "case report" AND "imaging". In addition, citation indexes and specific journals were searched. Study Selection Criteria: Papers were included if the patient was attending physical therapy, USI was necessary for patient management, the full text was retrievable, and the paper was written in English. Papers were excluded if USI was only used for interventions, such as biofeedback, or if the USI was incidental to physical therapy patient/client management. Data Synthesis: Categories of data extracted included: 1) Patient presentation; 2) Setting; 3) Clinical indications; 4) Who performed USI; 5) Anatomical region; 6) Methods of USI; 7) Additional imaging; 8) Final diagnosis; and 9) Case outcome. Results: Of the 172 papers reviewed for inclusion, 42 were evaluated. Most common anatomical regions scanned were the foot and lower leg (23%), thigh and knee (19%), shoulder and shoulder girdle (16%), lumbopelvic region (14%), and elbow/wrist and hand (12%). Fifty-eight percent of the cases were deemed static, while 14% reported using dynamic imaging. The most common indication for USI was a differential diagnosis list that included serious pathologies. Case studies often had more than one indication. Thirty-three cases (77%) resulted in confirmation of a diagnosis, while 29 case reports (67%) documented significant changes in physical therapy intervention strategies due to the USI, and 25 case reports (63%) resulted in referral. Conclusion: This review of cases provides details on unique ways USI can be used during physical therapy patient care, including aspects that reflect the unique professional framework.

A Continuous Quality Improvement Framework for Sustainable Action and Advancement of Diversity, Equity, Inclusion, and Belonging in Physical Therapy.

BACKGROUND AND PURPOSE: To address racial and ethnic disparities, physical therapy organizations, educational institutions, and clinical practices seek to advance diversity, equity, inclusion (DEI), and social justice in health care. Although our professional organizations have crafted proclamations, resource lists, developed new accreditation standards, and strategic plans, we lack a unifying framework and action tools for substantial and sustained progress. In addition, the DEI acronym is missing the essential element of belonging (B), that is, sharing a sense of purpose and feeling safe to contribute opinions as a valued member of an organization. Therefore, the purpose of this position paper is to propose the utilization of a continuous quality-improvement (CQI) framework using Plan-Do-Study-Act (PDSA) cycles to advance DEI-B in physical therapy education and practice. POSITION AND RATIONALE: The CQI framework and PDSA cycles are data-driven, iterative approaches for identifying areas for improvement, implementing interventions, collecting data, analyzing outcomes, and taking evidence-based next action steps. Application of this framework can enhance sustainability of DEI-B goals and foster progress toward the proposed accreditation criteria of the Commission on Accreditation in Physical Therapy Education in this critical area. Tenants for PDSA team success are presented, and PDSA cycles are described. DISCUSSION AND CONCLUSION: Addressing racism and advancing DEI-B efforts in the physical therapy profession requires bold, sustained, and intentional action that incorporates standards, strategies, and methods for measuring change. Examples of PDSA DEI-B initiatives, interventions, and outcomes are provided to illustrate how this approach can be implemented within a physical therapy education program. Using this CQI framework provides our profession with a DEI-B roadmap for advancing incremental and sustained progress.

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.

Examination of the short-term impact of a disability awareness training on attitudes toward people with disabilities: A community-based participatory evaluation approach.

Background: Worldwide over a billion people live with a disability including 400,000 people in Ecuador. People with disabilities (PWD) face barriers to full participation in society. Barriers are generated by negative attitudes created through socio-cultural experiences. Awareness about disability can be facilitated through disability awareness training (DAT). Studies examining outcomes on DAT exist in high-resourced countries but are nonexistent in Ecuador. Study purposes:1) create a DAT using community input and conduct the training; 2) examine the impact of the DAT on attitudes toward and awareness of PWD; and 3) explore community perceptions regarding the impact of the DAT on action. Methods: Community-based participatory evaluation was employed to design and assess the impact of a DAT with 60 community members from Latacunga, Ecuador. The DAT incorporated a multi-modal approach (interactive discussion, problem-solving, hands-on activities) and was informed by the theory of planned behavior. Data sources were the Multidimensional Attitudes Scale (MAS) (Spanish version) administered pre- and post-DAT and interviews conducted with nine DAT participants. Results: Mann Whitney U revealed significant changes in two of four MAS constructs: emotion p = .005 and cognition p = .003. Five themes emerged from the interviews: 1) view of disability; 2) contact; 3) attitude; 4) training impact; and 5) action. Conclusion: In the short-term DAT may increase awareness of and decrease negative attitudes associated with disability. Effective strategies highlighted for raising awareness and improving attitudes were contact with PWD and education. Education leads to more positive perceptions of the barriers PWD face and their ability to participate in society.

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.

A Cardiopulmonary Instructor's Perspective on a Standardized Patient Experience: Implications for Cardiopulmonary Physical Therapy Education.

PURPOSE: Standardized patients (SP) in Doctor of Physical Therapy (DPT) curricula are increasingly used for students to practice developing clinical reasoning, communication, and professional skills in an authentic learning environment. The purposes of this article are to: (1) describe an instructional model that synthesized SPs, Internet-based communities of practice, and reflection to teach clinical reasoning in DPT students; and (2) a cardiovascular and pulmonary physical therapy (CPPT) instructor's perspective on the educational process and student clinical skill development. SUMMARY OF KEY POINTS: The model, employed in a course: "Integrative Physical Therapy Practice," enabled the instructor to document student clinical performance and reasoning during an SP interaction. For students, clinical reasoning was illuminated through the model's assessment process. Data collected through the assessment process provided important feedback to the instructor on classroom instructional effectiveness. CONCLUSIONS: Examination of student learning experiences enabled the instructor to consider: (1) key aspects of examination and management for persons with cardiovascular or pulmonary disorders, (2) methods for visualizing clinical reasoning, (3) the impact of teaching on student learning, and (4) strategies for teaching CPPT. More research is indicated to investigate pedagogy for the development of clinical reasoning in DPT students.

The first year of practice: an investigation of the professional learning and development of promising novice physical therapists.

BACKGROUND: The goal in studying expertise is not merely to describe ways in which experts excel but also to understand how experts develop in order to better facilitate the development of novices. The study of novice progression helps us to understand what successful versus unsuccessful learning looks like. This understanding is critical, as autonomous practice places increased demands for advanced clinical judgments and the ability to assume professional responsibilities. OBJECTIVES: The purpose of this study was to explore the experiences, learning, and development of promising novice therapists throughout their first year of practice in the United States. DESIGN AND METHODS: A longitudinal, multiple-site qualitative case study method was used for within-case and across-case analysis. A purposive sample of 11 promising new graduates from 4 physical therapist education programs participated. Investigators followed the graduates throughout their first year of practice. Data sources included: (1) semistructured interviews conducted at baseline and every 3 months thereafter for 1 year, (2) reflective journals completed at regular intervals, and (3) review of academic and clinical education records and résumés. RESULTS: Four themes emerged: (1) the clinical environment influenced the novice physical therapists' performance, (2) participants learned through experience and social interaction and learning was primarily directed toward self, (3) growing confidence was directly related to developing communication skills, and (4) therapists were engaged in professional identity formation and role transitions. CONCLUSIONS: The findings suggest there are common experiences and themes that emerge as novice physical therapists develop. Although research has been conducted on expertise in physical therapy, few longitudinal investigations have explored the development of therapists across transitions from graduate to novice to expert practitioner. This study explored and described the learning and development of graduates during their first year of practice.

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.

Nursing students' experiences with and strategic approaches to case-based instruction: a replication and comparison study between two disciplines.

In the classroom and in clinical areas, knowing how to learn, reason, reflect, think creatively, generate and evaluate ideas, make decisions, and solve problems have been identified as key elements of critical thinking. However, to be successful in the current health care arena, caregivers cannot be satisfied with possessing the ability to solve problems and simply meet preestablished "outcomes" (Alfaro-LeFevre, 1998). It is necessary to improve knowledge and practice applications and to explore the best ways to do things within a work group. This qualitative study evaluated the experiences of senior-level nursing students using case-based instruction in a course titled, Leading and Managing in Nursing. It is a replication and extension (Phase II) of an original case-based instruction study, completed with senior physical therapy students (Phase I). Phase III of this study trajectory is the creation of an interdisciplinary case-based course that addresses either or both clinical collaborative care issues or leadership and management issues for health care profession students. From this Phase II study, six thematic groupings emerged as distinct student experiences in case-based instruction-motivation, real world, learning, knowledge development, emerging from within, and group dynamic issues.