Transformative Learning Emerging From Challenges First-Year Students Experienced.

INTRODUCTION: Doctor of physical therapy (PT) (DPT) programs are rigorous, and students report facing overwhelming challenges. Faculty may not be cognizant of the extent of these challenges and miss opportunities to support student learning. The purpose of this article is to describe factors affecting student coping abilities and the lessons they learned from managing their self-identified challenges. REVIEW OF LITERATURE: Given the growing body of evidence surrounding mental health issues in DPT students, educators are exploring ways to support student well-being and promote their professional development. SUBJECTS: This study is a component of a larger multisite study of first-year DPT students from 3 private universities. METHODS: Participants submitted written narratives in response to a critical incident questionnaire designed to better understand first-year challenges. Responses were deidentified, researchers were blinded to participation, and confidentiality was maintained throughout. A consensus-driven interpretivist approach to qualitative data analysis was used. Strategies to ensure trustworthiness included triangulation of researchers, peer review, prolonged engagement, and use of thick rich descriptions. RESULTS: Seventy responses were analyzed. Two major themes are presented: (1) students described factors internal and external to the learning environment that inhibited and facilitated their ability to cope with challenges and (2) students shared academic successes and lessons learned from overcoming challenges, including the development of new behaviors, enhanced self-awareness, and personal and professional growth. DISCUSSION AND CONCLUSION: Building on previous work, analysis of the lived experiences of first-year DPT students revealed a process of transformational learning through challenge. This process highlights the importance of recognizing and supporting the significant incidental learning that occurs in our students during their journey through PT school. Faculty focusing solely on content knowledge, skills, and even critical thinking may not recognize and support the incidental learning occurring and may be missing significant transformational learning opportunities.

Learning Impact of Armed Forces Medical Background on Military Nursing Students in an Accelerated Bachelor of Science in Nursing Program.

ABSTRACT: The study examined differences between military students enrolled in an accelerated bachelor of science in nursing (BSN) program with and without medical experience and/or a previous bachelor's degree on graduation grade point average (GPA) and NCLEX®-RN first-time pass rates. Significant differences were found between groups with/without military medical experience on NCLEX-RN, but not graduation GPA. Significant differences were found between groups with/without prior degree on GPA, but not on NCLEX-RN. Having both medical experience and a prior degree did not make a difference on GPA or NCLEX-RN. Findings offer guidance on admission criteria to accelerated programs for this unique group of students.

Identifying requisite learning health system competencies: a scoping review.

OBJECTIVES: Learning health systems (LHS) integrate knowledge and practice through cycles of continuous quality improvement and learning to increase healthcare quality. LHS have been conceptualised through multiple frameworks and models. Our aim is to identify and describe the requisite individual competencies (knowledge, skills and attitudes) and system competencies (capacities, characteristics and capabilities) described in existing literature in relation to operationalising LHS. METHODS: A scoping review was conducted with descriptive and thematic analysis to identify and map competencies of LHS for individuals/patients, health system workers and systems. Articles until April 2020 were included based on a systematic literature search and selection process. Themes were developed using a consensus process until agreement was reached among team members. RESULTS: Eighty-nine articles were included with most studies conducted in the USA (68 articles). The largest number of publications represented competencies at the system level, followed by health system worker competencies. Themes identified at the individual/patient level were knowledge and skills to understand and share information with an established system and the ability to interact with the technology used to collect data. Themes at the health system worker level were skills in evidence-based practice, leadership and teamwork skills, analytical and technological skills required to use a 'digital ecosystem', data-science knowledge and skill and self-reflective capacity. Researchers embedded within LHS require a specific set of competencies. Themes identified at the system level were data, infrastructure and standardisation; integration of data and workflow; and culture and climate supporting ongoing learning. CONCLUSION: The identified individual stakeholder competencies within LHS and the system capabilities of LHS provide a solid base for the further development and evaluation of LHS. International collaboration for stimulating LHS will assist in further establishing the knowledge base for LHS.

Faculty Perceptions in Facilitating Success for Accelerated BSN Student Veterans.

ABSTRACT: Student veterans enrolled in nursing programs often experience challenges transitioning to higher education environments. This study investigated faculty perspectives regarding the strengths and challenges of student veterans in an accelerated bachelor's of science in nursing program; faculty (N = 21) participated in focus groups. Four themes emerged: No Man Left Behind, Acclimating to the Higher Education Environment, Not Wanting to Be Different, and Professionalism/Maturity. Faculty perceived student veterans possess strengths and approaches to learning different from students without a military background. Integrating these strengths into the curriculum, with strategies such as team-based learning and group assignments, will leverage their skills and facilitate academic success.

Constraint Induced Movement Therapy: Impact of Setting on Outcomes.

AIMS: Constraint induced movement therapy improves upper extremity (UE) function in children with unilateral cerebral palsy (CP). Impact of intervention setting is unknown. The current investigation aimed to determine impact of therapy setting on UE function in children with unilateral CP. METHODS: Children were assigned to either center-based (CB) or home-based (HB) interventions using a single-blind cross-over design. RESULTS: UE function improved significantly in all children; greater improvements were found in the CB group. After the HB group received 10 additional weeks of CB intervention, between-group scores were not different but within-group changes were also not significant. CONCLUSIONS: Dose may be more important than setting but CB may be more effective than HB in the short term.

The Effects of a Divided-Attention Timed Stepping Accuracy Task on Balance, Strength, Endurance, and Functional Performance in Healthy Older Adults: A Pilot Study.

The aim of this study was to investigate whether a 6-week Divided-Attention Stepping Accuracy Task (DATSAT) intervention improved the primary outcome measure, maximal step length; other balance measures (Berg Balance scale and Timed Up and Go test); leg strength; endurance (6-min walk test); and functional tasks in 15 community-dwelling healthy older adults ( x¯ age: 71.5 years, female: 46.7%) compared with 15 community-dwelling healthy older adults in a Bike and Strength (B&S) program ( x¯ age: 73.8 years, female: 33.3%). Participants trained 3× per week, 30-60 min per session. Stepping-group differences were significant for all measures. B&S group improved in maximal step length (anterior and lateral), strength, and one functional task. Stepping group outperformed B&S group in Timed Up and Go and maximal step length posterior. B&S group outperformed stepping group in two strength measures. Exertion scores were lower for the stepping group. Overall, Divided-Attention Timed Stepping Accuracy Task training resulted in more within-group improvements and two between-group measures with less perceived effort and shorter intervention times.

Attitudes Toward Academic Dishonesty in Health Profession Students.

INTRODUCTION: Academic dishonesty of health profession students may negatively impact the clinical environment. This study examined the attitudes, experiences, and behaviors of nursing, physician assistant, and physical therapist students towards academic dishonesty and explored differences based on demographic variables. METHODS: A survey was administered to health profession students in their last semester of the program. RESULTS: 120 students responded. Most reported never observing or participating in activities of academic dishonesty. Collaborating on assignments when instructed not to and falsifying aspects of patient encounters were the two most frequent activities reported. CONCLUSIONS: Teamwork and peers may negatively influence academic integrity in some circumstances. Educators should consider strategies to promote individual accountability as well as integrity when reporting clinical findings.

Validation of the 2-Minute Walk Test with the 6-Minute Walk Test and Other Functional Measures in Persons with Multiple Sclerosis.

BACKGROUND: Persons with multiple sclerosis (MS) commonly have difficulty walking. The 6-Minute Walk Test (6MWT) assesses functional capacity but may be considered burdensome for persons with MS, especially those with higher disability levels. The 2-Minute Walk Test (2MWT) may be an alternative measure to the 6MWT. The purpose of this study was to investigate the validity of the 2MWT in persons with MS. METHODS: Twenty-eight ambulatory persons with MS aged 18 to 64 years participated in this cross-sectional study. Participants completed five measures of walking performance (2MWT, 6MWT, usual and fast gait speed, and Timed Up and Go test) and two functional measures (Berg Balance Scale and five-times sit-to-stand test) during a testing session. Participants were classified into two subgroups based on Disease Steps scale classification. RESULTS: The 2MWT was significantly correlated with the 6MWT (r = 0.947), usual gait speed (r = 0.920), fast gait speed (r = 0.942), the Timed Up and Go test (r = -0.911), and other functional measures. The 2MWT explained 89% of the variance seen during the 6MWT. The distances completed on the 2MWT and 6MWT accurately distinguished the subgroups. CONCLUSIONS: This study demonstrated good construct and discriminant validity of the 2MWT in persons with MS, providing an efficient and practical alternative to the 6MWT. Validation of the 2MWT with other functional measures further supports these findings.

Using a divided-attention stepping accuracy task to improve balance and functional outcomes in an individual with incomplete spinal cord injury: A case report.

A spinal cord injury (SCI) frequently results in impaired balance, endurance, and strength with subsequent limitations in functional mobility and community participation. The purpose of this case report was to implement a training program for an individual with a chronic incomplete SCI using a novel divided-attention stepping accuracy task (DASAT) to determine if improvements could be made in impairments, activities, and participation. The client was a 51-year-old male with a motor incomplete C4 SCI sustained 4 years prior. He presented with decreased quality of life (QOL) and functional independence, and deficits in balance, endurance, and strength consistent with central cord syndrome. The client completed the DASAT intervention 3 times per week for 6 weeks. Each session incorporated 96 multi-directional steps to randomly-assigned targets in response to 3-step verbal commands. QOL, measured using the SF-36, was generally enhanced but fluctuated. Community mobility progressed from close supervision to independence. Significant improvement was achieved in all balance scores: Berg Balance Scale by 9 points [Minimal Detectable Change (MDC) = 4.9 in elderly]; Functional Reach Test by 7.62 cm (MDC = 5.16 in C5/C6 SCI); and Timed Up-and-Go by 0.53 s (MDC not established). Endurance increased on the 6-Minute Walk Test, with the client achieving an additional 47 m (MDC = 45.8 m). Lower extremity isokinetic peak torque strength measures were mostly unchanged. Six minutes of DASAT training per session provided an efficient, low-cost intervention utilizing multiple trials of variable practice, and resulted in better performance in activities, balance, and endurance in this client.

Perceived effectiveness and barriers to physical therapy services for families and children with Friedreich ataxia.

PURPOSE: To describe the frequency, type, and perceived effectiveness of physical therapy interventions for children with Friedreich ataxia (FA); identify barriers to therapy; and solicit advice from parents. METHOD: Parents of 30 children with FA participated in semistructured interviews. Qualitative and quantitative methods were used to analyze the data. RESULTS: Sixty-seven percent of children received direct physical therapy service. Stretching and strengthening exercises were used most frequently, and their perceived usefulness increased as the children aged. Seventy-three percent received home exercise programs; 9% implemented these consistently. External barriers included a lack of expert providers and limited reimbursement. Internal barriers included limited time and energy, lack of awareness of services, and children's preferences not to be treated differently. Parents advised therapists to become experts, advocates, and use approaches based on family and child preferences. CONCLUSIONS: Outcomes provide a starting point for developing further research, education, and effective interventions for children with FA.

Validating functional measures of physical ability for aging people with intellectual developmental disability.

Unlike the aging population without intellectual and developmental disabilities (IDD), few standardized performance measures exist to assess physical function and risk for adverse outcomes such as nonfatal, unintentional injuries. We modified 3 selected standardized performance tools in the areas of general fitness (2-Minute Walk Test), balance and gait (Performance-Oriented Mobility Assessment I), and functional independence (Modified Barthel Index) for administration with people with IDD. The modified tools were piloted with 30 participants. Results indicated the measures are strongly associated and successfully distinguished between participants with an adverse health event in the previous year. The modified tools have potential to provide clinicians with quantitative measures that track physical performance changes associated with aging in people with IDD.

Characterizing gait, locomotor status, and disease severity in children and adolescents with Friedreich ataxia.

BACKGROUND AND PURPOSE: The purpose of this study was to describe gait parameters in children and adolescents with a diagnosis of Friedreich ataxia (FA) and examine the relationship between disease severity, measured by the Friedreich Ataxia Rating Scale (FARS) and gait parameters. The study examined whether FARS scores can discriminate between those who walk independently and those who require assistance. METHODS: Thirty-eight children (aged 5-11 years) and adolescents (aged 12-17 years) with genetically confirmed FA were divided into two groups based on locomotor status: group 1, subjects who were able to walk independently, and group 2, subjects who required assistance for walking. Temporal and spatial gait parameters were collected using the Stride Analyzer computerized foot switch system and compared with age-matched normative data. The FARS was used to measure disease severity. Correlation coefficients and the Mann-Whitney U test of differences were used to evaluate associations and discern differences between groups. RESULTS: In subjects with FA, gait parameters of velocity and cadence were slower and stride length was shorter compared with age-matched children without disabilities. These parameters were significantly correlated with FARS score (r = 0.696, 0.667, 0.537; respectively, all P values <0.001). Total FARS scores were correlated with locomotor status (ç value r = 0.623; P < 0.01) and could categorize subjects into groups based on independent walking or need for assistance, 73% and 87% of the time, respectively. DISCUSSION AND CONCLUSION: Subjects with FA exhibited specific abnormal gait characteristics relative to age-matched individuals. Disease severity, as measured by the FARS, was associated with gait velocity, stride length, and cadence. FARS scores can be used to categorize subjects by locomotor status and may be a useful screening tool to identify those requiring assistance.

Injury patterns in elite preprofessional ballet dancers and the utility of screening programs to identify risk characteristics.

STUDY DESIGN: Retrospective descriptive cohort study. OBJECTIVES: To describe the distribution and rate of injuries in elite adolescent ballet dancers, and to examine the utility of screening data to distinguish between injured and noninjured dancers. BACKGROUND: Adolescent dancers account for most ballet injuries. Limited information exists, however, regarding the distribution of, rate of, and risk factors for, adolescent dance injuries. METHODS AND MEASURES: Two hundred four dancers (age, 9-20 years) were screened over 5 years. Screening data were collected at the beginning and injury data were collected at the end of each training year. Descriptive statistics were used to characterize distribution and rate of injuries. Inference statistics were used to examine differences between injured and noninjured dancers. RESULTS: Fifty-three percent of injuries occurred in the foot/ankle, 21.6% in the hip, 16.1% in the knee, and 9.4% in the back. Thirty-two to fifty-one percent of the dancers were injured each year, and, over the 5 years, there were 1.09 injuries per 1000 athletic exposures, and 0.77 injuries per 1000 hours of dance. Significant differences between injured and noninjured dancers were limited to current disability scores (P = .007), history of low back pain (P = .017), right foot pronation (P = .005), insufficient right-ankle plantar flexion (P = .037), and lower extremity strength (P = .045). CONCLUSION: Distribution of injuries was similar to that of other studies. Injury rates were lower than most reported rates, except when expressed per 1000 hours of dance. Few differences were found between injured and noninjured dancers. These findings should be considered when designing and implementing screening programs.

Presentation and progression of Friedreich ataxia and implications for physical therapist examination.

Friedreich ataxia, although rare, is the most prevalent inherited ataxia. Recent insight into the disease pathogenesis is creating new hope for effective therapies. The purposes of this update are: (1) to review the etiology, presentation, and progression of Friedreich ataxia and (2) to describe a comprehensive physical therapist examination emphasizing valid and reliable performance measurements associated with disease progression. Early identification of individuals with Friedreich ataxia and precise characterization of impairments and functional limitations gain importance as new drug therapies are considered.

Assessing reflective writing on a pediatric clerkship by using a modified Bloom's Taxonomy.

OBJECTIVE: Reflection enables learners to analyze their experiences and capture the wisdom that lies within. Effective teaching requires reliable methods of assessment. Several methods of assessing reflective writing have been described; however, they often require significant training, and reliability has seldom been assessed. This study was designed to determine the interrater reliability of a method of assessing reflective writing by using a modified Bloom's Taxonomy. METHODS: Twenty-one third-year medical students maintained reflective journals throughout their pediatric clerkship. A coding schema based on Bloom's Taxonomy was developed to assess the level of cognitive processing evident in the journals. Journals were independently assessed by 3 raters. Percent agreement, kappa statistics, and intraclass correlation coefficients (ICC [2,1]) were used to assess interrater reliability. RESULTS: Three hundred eight entries from 21 journals were assessed. Percent agreement ranged from 78.2% to 100%. Kappa statistic for each level ranged from 0.57 +/- 0.04 to 0.73 +/- 0.04, and for the highest level of processing evident it ranged from 0.52 +/- .04 to 0.58 +/- 0.04. ICC (2,1) for each level of cognitive processing ranged from 0.62 (F = 6.20; P = .000) to 1.00, and for the highest level of cognitive processing evident, it was 0.79 (F = 12.42; P = .000). Substantial to almost perfect agreement was attained. CONCLUSIONS: Reflective journals allow learners to revisit their experiences for critical analysis and deeper learning. This study describes a reliable method, based on Bloom's Taxonomy, of determining whether learners have achieved higher order thinking through reflective journal writing. This method can provide a baseline for facilitating higher order processing, critical thinking, and reflective practice.

Concurrent validity of the Early Intervention Developmental Profile and the Peabody Developmental Motor Scale-2.

PURPOSE: The purpose of this study was to determine the concurrent validity of the Early Intervention Developmental Profile (EIDP) and the Peabody Developmental Motor Scale-2 (PDMS-2) in examining gross motor delay. METHODS: Thirty children with a variety of developmental delays attending an early intervention program were administered both the PDMS-2 and the EIDP as part of their developmental evaluations. RESULTS: The PDMS-2 and EIDP were strongly correlated (r = 0.91, p < 0.01) but the mean age equivalent scores were significantly different. Age equivalent scores were on average 26% higher on the EIDP. CONCLUSIONS: Differences in age equivalent scores between tests may affect a child's eligibility for services in some states. This study supports the use of norm-based tests when determining a percentage of delay relative to the norm. Developmental tests should not be the sole determinant of the clinical decision making processes.

Acting on reflection: the effect of reflection on students' clinical performance on a standardized patient examination.

BACKGROUND: Little evidence exists to support the value of reflection in the clinical setting. OBJECTIVE: To determine whether reflecting and revisiting the "patient" during a standardized patient (SP) examination improves junior medical students' performance and to analyze students' perceptions of its value. DESIGN: Students completed a six-encounter clinical skills examination, writing a guided assessment after each encounter to trigger reflection. SPs evaluated the students with Medical Skills and Patient Satisfaction checklists. During the last three encounters, students could opt to revisit the SP and be reevaluated with identical checklists. PARTICIPANTS: One hundred and forty-nine third year medical students. MEASUREMENTS: Changes in scores in the Medical Skills and Patient Satisfaction checklists between first visit and revisit were tested separately per case as well as across cases. RESULTS: On the medical skills and patient satisfaction checklists, mean revisit scores across cases were significantly higher than mean first visit scores [12.6 vs 12.2 (pooled SD = 2.4), P = .0001; 31.2 vs 31.0 (pooled SD = 3.5), P = .0001)]. Sixty-five percent of the time, students rated "reflect-revisit" positively, 34% neutrally, and 0.4% negatively. Five themes were identified in the positive comments: enhancement of (1) medical decision making, (2) patient education/counseling, (3) student satisfaction/confidence, (4) patient satisfaction/confidence, and (5) clinical realism. CONCLUSIONS: Offering third year medical students the option to reflect and revisit an SP during a clinical skills examination produced a small but nontrivial increase in clinical performance. Students perceived the reflect-revisit experience as enhancing patient-centered practices (counseling, education) as well as their own medical decision making and clinical confidence.