Accessibility in health professions education: The Flexner Report and barriers to diversity in American physical therapy.

Health professionals do not reflect the broader racial/ethnic diversity of the United States. Historical barriers to accessing health professions education have played a major role in initiating and perpetuating these disparities. Sociologists of professions have highlighted the role of educational reform in professions' efforts to enhance their status, but have overlooked the central role of government bodies in facilitating or impeding these strategies. The Flexner Report (1910) enhanced the status of medicine, but only after state medical boards adopted its recommendations, leading to the closure of half of the nation's medical schools and limiting opportunities for marginalized populations to enter the medical profession. Physical therapy leaders have espoused Flexner's precepts in seeking to advance their field's professionalization. In doing so, they consistently overlooked the more insidious impacts of Flexnerian approaches on student and practitioner diversity. This article examines how physical therapy's Flexnerian ambitions disrupted its parallel efforts to increase the field's racial/ethnic diversity. I argue that physical therapy leaders' focus on enhancing their profession's status and indifference toward facilitating educational access and mobility played a significant role in the field's racial/ethnic homogeneity. To increase practitioner diversity in the future, especially following the 2023 US Supreme Court decision (600 U.S. 181) restricting race conscious affirmative action, health professions must do more to address barriers to student access. This will involve moving away from the Flexnerian model and pursuing approaches that have helped more diverse and inclusive health professions, like nursing, to achieve greater educational opportunity and mobility.

Evidence-based practice confidence and behavior throughout the curriculum of four physical therapy education programs: a longitudinal study.

BACKGROUND: Evidence-based practice (EBP) is a foundational process taught in health professional education, yet it is unclear when EBP confidence and skills are obtained. Increases in EBP confidence and behaviors from the start of physical therapy programs to post graduation have been reported in studies that evaluated a single program or used non-valid questionnaires. This study aimed to describe changes in EBP confidence and behavior using validated questionnaires of students from four physical therapy education programs throughout their curriculum and one year post graduation. METHODS: One hundred and eighty-one students from a potential pool of 269 (67.3%) consented to participate. Students completed the Evidence-Based Practice Confidence (EPIC) Scale and the Evidence-Based Practice Implementation Scale (EBPIS) at 6 timepoints: start of the program, prior to first clinical experience, after first clinical experience, at the end of classroom instruction, graduation, and one year post. Medians (Mdn) and 25th and 75th percentiles (P25, P75) were calculated for 42 (23.2%) students with complete data across all timepoints. Change between timepoints was assessed using Friedman's test and Wilcoxon signed rank test with a Bonferroni correction for post hoc analysis. RESULTS: There were significant changes in EPIC scores (p < 0.001) from enrollment (Mdn 50.0, P25, P75 35.5, 65.9) to prior to first clinical experience (Mdn 65.5, P25, P75 57.3, 72.5) and after the first clinical experience (Mdn 67.3, P25, P75, 58.9, 73.2) to the end of classroom instruction (Mdn 78.6, P25, P75, 72.0, 84.1). Significant increases on the EBPIS (p < 0.01) were only seen from after the first year of training (Mdn 15, P25, P75, 10.0, 22.5) to end of the first clinical experience (Mdn 21.5, P25, P75 12.0, 32.0). CONCLUSIONS: EBP confidence increased significantly after classroom instruction but remained the same after clinical experiences and at one year post graduation. EBP behavior significantly increased only after the first clinical experience and remained the same through graduation. Confidence and behavior scores were higher than were previously reported in practicing professionals. Ongoing assessment of EBP confidence and behavior may help instructors build appropriate curricula to achieve their outlined EBP objectives.

Physical therapists' perspectives of patient values and their place in clinical practice: a qualitative study.

BACKGROUND: In physical therapy practice patients and therapists exchange their perspectives on musculoskeletal health problems and their meaning for both of them. However, literature indicates that physical therapists find it difficult to enquire about the patients' values during clinical encounters. OBJECTIVES: The aim of this study was to gain deeper insight into the perspectives of physical therapists about patient values. DESIGN: Explorative qualitative focus group study. METHOD: Twenty-three physical therapists were interviewed in the Netherlands from March to May 2021. Two researchers analyzed the interviews and derived relevant codes. After an iterative process of comparing, analyzing, conceptualizing and discussing the codes, themes were identified through a thematic framework, illustrated with meaningful quotes. RESULTS: Three major themes were identified: Humane, Tacit, and Responsive. It appeared that patient values play unconsciously a major role in daily practice and are associated with humanity, not technical or procedural aspects of the encounter. Responsive denotes that all values require interaction in which aligning with the individual patient forms the basis of treatment. Barriers for being responsive are identified as subthemes: Choices, Trust, Diverseness, and Boundaries. CONCLUSION: The concept of patient values appeared to be implicit. The professional intuitively attunes as a fellow human being to values and expectations of the individual patient. This study contributes to finding a balance and mutual reinforcement of implicit and explicit knowledge. With all found experiences and insights the concept of patient values became more explicit in physical therapy to create a framework for education and research in the future.

Anatomic donor surgeries increase self-efficacy in physical therapy education: Use of live versus recorded viewing.

Anatomy serves as a foundational course in physical therapy education, but, due to its early placement in the curriculum, may have limited clinical application at that point of a student's education. Thus, augmenting a standard dissection course with surgical procedures can enhance the clinical relevance and knowledge of the anatomical structures involved in those surgeries. Doctor of Physical Therapy students viewed a variety of cadaveric orthopedic and cardiothoracic surgeries performed by a surgeon. Students unable to participate live viewed the recorded surgeries. Participants completed a 10-point Likert scale survey, developed by the researchers, pre- and post-viewing, on self-efficacy of knowledge, patient intervention and communication. Data analysis revealed improved self-efficacy of knowledge of the anatomy and the surgical procedures, confidence in treating patients undergoing those surgeries, and confidence communicating with surgeons, regardless of whether students viewed the surgeries live or recorded. Students participating in this experience expressed a clear value enhancement on their education. Programs should feel confident that this type of experience in the curriculum, whether live or recorded, will have a positive effect on student self-efficacy as related to the relationships and pertinence of anatomical structures involved in the surgeries, the surgical procedures, treating patients having undergone those surgeries, and interprofessional communication.

Barriers, facilitators and implementation strategies for guideline-adherence in physiotherapy: a scoping review protocol.

INTRODUCTION: Guideline-adherent physiotherapy can improve patient outcomes and reduce costs in the healthcare system. However, although there are numerous guidelines for physiotherapy practice, services are not consistently based on clinical practice guidelines. While various systematic and scoping reviews have highlighted barriers, facilitators and implementation strategies for guideline-adherent practice in other health professions, this scoping review aims to explore the barriers and facilitators for guideline-adherent physiotherapy and summarises the strategies used to implement such practice. METHODS AND ANALYSIS: This scoping review will be based on Arksey and O'Malley's scoping review methodology and the methodological guidance for conducting scoping reviews published by Joanna Briggs Institute. Relevant publications will be first searched from the beginning of June 2023 on the MEDLINE and CINAHL databases before we expand the search to other databases such as EMBASE, the Cochrane Library and PEDro at the end of June 2023. Two reviewers will independently screen the titles and abstracts of all retrieved citations for inclusion against the eligibility criteria before conducting an independent full-text screening. The criteria will be tested on a sample of abstracts before beginning the abstract review to ensure that they are robust enough to capture any articles that may relate. The extracted data will finally be collated and charted to summarise key findings regarding our research question. ETHICS AND DISSEMINATION: This scoping review will provide an extensive overview of the barriers, facilitators and implementation strategies for guideline-adherent physiotherapy. As scoping reviews are a form of secondary data analysis, ethical review is not required. Results will be disseminated through a peer-reviewed publication and stakeholder meetings. TRIAL REGISTRATION NUMBER: This scoping review has been registered on 3 April 2023 on the Open Science Framework under https://doi.org/10.17605/OSF.IO/SEUW6.

Barriers and Facilitators to the Adoption of Evidence-Based Interventions for Adults Within Occupational and Physical Therapy Practice Settings: A Systematic Review.

OBJECTIVE: Synthesize data regarding barriers and facilitators of adoption (ie, adoption determinants) of evidence-based occupational (OT) and physical therapy (PT) interventions within real-world practice. Whether evidence varied across disciplines, settings, and use of theoretical frameworks was also examined. DATA SOURCES: Literature published from database inception to December 9, 2022, in OVID MEDLINE, EMBASE, OVID PsycINFO, Web of Science Core Collection, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and Google Scholar. STUDY SELECTION: Original research including: (1) stakeholder insight into adoption determinants; (2) discrete evidence-based interventions delivered/supervised by an OT and/or PT; (3) intervention recipients aged 18 or older; and (4) data regarding adoption determinants. Two reviewers independently screened and evaluated studies for inclusion, with a third resolving discrepancies. Of the 3036 articles identified, 45 articles were included. DATA EXTRACTION: Data were extracted by a primary reviewer, independently evaluated by a second reviewer, and conflicts were resolved via group consensus. DATA SYNTHESIS: A descriptive synthesis approach was used to categorize adoption determinants according to constructs from the Consolidated Framework for Implementation Research. 87% of studies were published after 2014. Many studies: described PT interventions (82%); were within the outpatient setting (44%); had data gathered after implementing the intervention (71%); and did not report use of a theoretical framework to inform data collection (62%). Lack of available resources (64%) and knowledge/beliefs about the intervention (53%) were the most common barrier and facilitator, respectively. Variability in adoption determinants was observed according to discipline, setting, and use of a theoretical framework. CONCLUSIONS: Findings suggest a recent surge of scientific investment in understanding adoption determinants for evidence-based OT and PT interventions. Such knowledge can inform efforts aimed at improving OT and PT quality, thereby enhancing patient outcomes. However, our review highlighted gaps with significant implications for the delivery of evidence-based OT and PT within real-world practice settings.

Guideline adherent screening and referral: do third year Doctor of Physical Therapy students identify red and yellow flags within descriptive patient cases? a United States based survey study.

INTRODUCTION: The need for early detection and appropriate management of flags in physical therapy has been established. The lack of early detection has been shown to lead to poor outcomes such as serious pathology, increased disability, prolonged symptoms, and increased healthcare utilization. OBJECTIVE: The main purpose of this survey study was to assess third-year Doctor of Physical Therapy (DPT) students' adherence to clinical practice guidelines specifically in the identification and management of red and yellow flags through a case-based approach. METHODS: A survey including three different flag case scenarios was sent to DPT students in 15 geographically diverse physical therapy programs. Previously published case scenarios measuring adherence to practice guidelines were used. Correlational analyses were performed to link student demographic details and guideline adherent management. RESULTS: The survey was completed by 64 students. Guideline adherent management was greater for red flags (85%) than yellow flag cases (25% and 42%). No significant relationship was noted between the student details and guideline adherent management. CONCLUSION: DPT students may need additional educational content related to yellow flag screening. Educators may consider utilizing published red and yellow flag cases to guide decision-making and highlight best screening practices.

Excellence in Pediatric Physical Therapy Education: Recommendations and Action Items.

PURPOSE: This special communication identifies evidence-based recommendations and offers action items to facilitate the uptake of new knowledge from the National Study of Excellence in Pediatric Physical Therapy Education (NSE-Peds). SUMMARY OF KEY POINTS: The NSE-Peds identified a conceptual framework consisting of 4 key dimensions and associated elements that dynamically interact to prepare future physical therapists to meet the needs of society. The conceptual framework serves as the Knowledge Creation component of the knowledge to action (KTA) framework, but translation into practice requires the Action Cycle, the second component of the KTA framework. Recommendations and action items provide tangible products derived from the NSE-Peds conceptual framework for application in the Action Cycle. CONCLUSIONS: Using the KTA framework, implementation of the recommendations at the level of the individual, program, and organization should enhance pediatric physical therapy education and ultimately physical therapy care provided to children and families.

Distance learning in physiotherapy education during the COVID-19 pandemic: students' satisfaction, perceived quality, and potential predictors of satisfaction.

BACKGROUND AND PURPOSE: Physiotherapy (PT) is an allied health profession that is generally taught at universities with face-to-face learning to deliver the required knowledge and practical skills of PT. The education sector has transitioned to distance learning (DL) during the COVID-19 pandemic. The study aimed to evaluate PT students' perception of quality of DL and satisfaction with DL, and identify potential predictors of student satisfaction with DL during the COVID-19 pandemic. METHODS: A cross-sectional design was used. An online survey included demographic information, and the Distance Education Learning Environments Survey (DELES) was sent to PT students in Jordan. Regression analyses were used to identify the predictors of student satisfaction with DL. RESULTS: A total of 296 students completed the survey. Most students rated the overall quality of DL as good. However, they were not satisfied with DL. Instructor support for students, personal relevance, previous experience in DL, and being a master's student were the potential predictors of DL satisfaction. CONCLUSION: PT students rated the quality of DL as good with low level of satisfaction. Students' perceptions of and satisfaction with using DL were correlated to several potential predictors that could be considered for improving the DL experience in PT education.

Characteristics of US-based physical therapist education programs cited for core faculty deficiencies in 2019-2020.

INTRODUCTION: Changes in the accreditation standards of physical therapist education have added new levels of rigor to core faculty qualifications. This study aims to determine if any program characteristics exist that are common to core faculty deficiency citations in the 2019-2020 review cycle. Recently, more than half of all accredited physical therapist education programs (51.5%) have earned citations in core faculty standards/elements. SUBJECTS: A total of 266 Commission on Accreditation in Physical Therapy Education (CAPTE) accredited and developing physical therapist education programs were included. METHODS: A review and analysis of programs cited and programs without citation was completed in 2021, to investigate these characteristics in relation to citation status: Campus setting, Regional accreditor, Length of CAPTE accreditation, University control, Carnegie classification, Physical Therapist Centralized Application Service participant, and Program cohort size. RESULTS: A regression model was found to correctly predict with 91.3% accuracy when including common characteristics of campus setting, years of accreditation, university control, and Carnegie class in programs cited for faculty deficiency. CONCLUSION: Our results suggest that programs residing in a town or rural setting, accredited for ten years or less, housed in an institution with a Carnegie classification of Master's or Baccalaureate, within private institutions, and enroll cohorts less than 31 are more likely to receive citations related to the qualifications or adequacy of core faculty than their counterparts. The description of characteristics common to programs cited could provide guidance to other programs in factors that might predispose them to core faculty deficiencies in the future.

Private physical therapy practice implementation of direct referral for radiograph imaging: an administrative case report.

BACKGROUND: Prior research indicates physical therapists make appropriate, judicious diagnostic imaging referrals, but have not described how to implement imaging referral processes in organizations without an imaging department. OBJECTIVE: This administrative case report describes the implementation of a direct referral process for radiographic imaging in a private physical therapy practice. CASE DESCRIPTION: Guided by the Interactive Systems Framework, a collaborative business agreement between a physical therapist-owned practice, musculoskeletal urgent care clinic, and radiology practice provided a clinical process for physical therapists to directly refer patients for radiographic imaging. OUTCOMES: When clinically appropriate, physical therapists signed referrals for radiographic imaging that was acquired by qualified urgent care clinic staff, interpreted by a radiologist, and reported to the physical therapist. The physical therapist, urgent care clinic, and radiologist bill for the physical therapy evaluation, technical component, and professional component, respectively. In the 5 months following implementation, 5 referrals were acquired within 15 minutes, the interpretation was returned within 30 minutes, and all entities received insurance reimbursement. CONCLUSION: This clinical process allows the physical therapist to execute clinical decision making within the scope of physical therapist practice, yet expeditiously acquire imaging studies to facilitate appropriate patient care. Formal collaboration between discrete organizations provided a system to deliver the necessary imaging services.

The prevalence of wound management physical therapist practice in the state of Texas.

INTRODUCTION: Wound management has become one of the ten physical therapy (PT) certification specialty areas. With this advanced clinical designation opportunity, more PT specialists and residencies with integumentary and wound management expertise will be needed for the educational and practice training of future specialists. PURPOSE: The purpose of this study was to characterize wound management practice by licensed physical therapists in Texas. METHODS: A Qualtrics survey was distributed to 19,159 licensed physical therapists. The questionnaire contained 23 questions that inquired into the subject's professional background, clinical experience, and opinions of wound care practice. RESULTS: The response rate was 9.6% (n = 1,839) and 1,643 respondents indicated that they were currently practicing. Although 69.1% of active physical therapists (n = 1,136) stated that they had practiced wound care at some point of their career, most of them do not practice wound care anymore and their reasons were discussed. Of those active physical therapists, 41.3% (n = 679) of them reported wound care was being practiced in their facilities, but only 18.3% (n = 311) directly practiced wound care. The respondents felt that the prevalence of wound management physical therapists practice over the last five years has been decreasing. CONCLUSION: The current prevalence of wound management practice is low and a decreasing trend of PT practice in wound care was observed in Texas. A limitation of this study is the low response rate. Future studies across different regions of the country are warranted.

Transforming Society Through Critical Service-Learning: A Position for a Justice-Based Approach to Experiential Learning in Physical Therapy Education.

BACKGROUND AND PURPOSE: In response to the numerous calls for the physical therapy profession to position itself as an equity and social justice-centered profession, we are called to provide aspiring physical therapists with the skills to dismantle inequities and injustice in their communities. Exposure to health inequity and injustice through conceptual and experiential learning alone does not prepare students to create positive change and may serve to perpetuate stereotypes and offer simplistic solutions to complex problems. POSITION AND RATIONALE: We argue that a traditional service-learning model lacks transformative potential for bringing about social change. Therefore, we introduce critical service-learning, compare it with the traditional model in the context of physical therapy experiential learning, and provide rationale and guidance on transitioning to this educational approach. We believe critical service-learning is an action-oriented approach that works to identify the root causes of social and structural determinants and accept personal and shared responsibility for acting to ameliorate their effects. Critical service-learning experiences require critical reflection and call for intentional design including teacher training, rich community engagement, student assignments that challenge current paradigms, and use of evaluative measures that assess community goals. These aspects add to the historically practiced traditional model. DISCUSSION AND CONCLUSION: We invite educators to shift to critical service-learning, an approach that has great potential for benefiting all interested parties in meaningful and long-lasting ways. Critical service-learning holds the opportunity for our profession to be better positioned to transform society.

The Experiences of Black Students in Physical Therapy Education in Texas: A Qualitative Study.

INTRODUCTION: Racial or ethnic minorities are underrepresented in many health care professions, including physical therapy. Understanding the experiences of minority students in graduate education provides insight into how physical therapy educational programs can promote diversity, equity, and inclusion, which are factors that have been shown to improve patient outcomes. The purpose of this study is to qualitatively analyze and describe the lived experiences of Black student physical therapists (PT) in Texas. REVIEW OF LITERATURE: Currently, there is a lack of qualitative research that investigates the experiences of Black students in physical therapy education in the United States. SUBJECTS: Nineteen Doctor of Physical Therapy students from 8 different physical therapy educational programs in Texas. METHODS: This qualitative study was conducted using a phenomenological approach. All participants took part in a focus group regarding their academic experiences. Students' dialogues were recorded and transcribed, and the researchers identified recurrent themes. RESULTS: After the analysis of focus group content, it was determined that the following 5 themes characterized the students' experiences: 1) Barriers to enrollment, 2) underrepresentation, 3) implicit and explicit racism, 4) code-switching, and 5) desired image. DISCUSSION AND CONCLUSION: There is evidence to suggest that Black or African American students are subject to unique pressures that negatively affect their experiences during their PT education. Efforts need to be made by higher education institutions and individuals to provide a more inclusive environment to best support those students. By gaining awareness of the results of this study, educators and students can begin dialogues on how to foster inclusivity and cultural understanding in physical therapy education. Ultimately, understanding the experiences of others can improve how individuals coexist in an increasingly diverse society, and how clinicians provide patient-centered, culturally aware care to patients and clients.

Predicting First-Time National Physical Therapy Examination Performance for Graduates of an Entry-Level Physical Therapist Education Program.

INTRODUCTION: The National Physical Therapy Examination (NPTE) is a standardized examination designed to assess competence after graduation from an entry-level physical therapist education program. REVIEW OF LITERATURE: Previous studies have identified applicant and student variables that are related to NPTE performance, with applicant variables reflecting performance before admission and student variables reflecting performance after admission. However, there are very few articles describing how these variables can be combined to predict NPTE performance. The purpose of this study was to develop, evaluate, and describe models to predict first-time NPTE scores and NPTE outcomes (pass vs fail), based on various applicant and student variables related to academic performance. SUBJECTS: Pre- and postadmission data and NPTE scores were recorded for 185 individuals who graduated from an entry-level physical therapist education program. METHODS: Multiple linear regression was used to develop a model to predict NPTE scores, and binary logistic regression was used to develop a model to predict NPTE outcomes (pass vs fail). RESULTS: A model including undergraduate prerequisite grade point average, grade point average in basic science courses taken during the program, and comprehensive examination scores combined to explain 30.9% of the variance in NPTE scores and accurately predicted NPTE outcomes (pass vs fail) 81.1% of the time. DISCUSSION: In general, our findings support the notion that prediction of NPTE performance should be based on a combination of applicant and student variables. The models described in this article could be used to identify students who may be likely to struggle on the NPTE, making it possible to provide additional support to these students. CONCLUSION: Various applicant and student variables related to academic performance can be combined to predict NPTE performance. The results of this study provide a framework for programs interested in applying models to predict NPTE performance.

Current State of Entry-level Physical Therapy Oncology Curricula in the United States: A Faculty Survey.

INTRODUCTION: The purpose of this study was to determine the extent of oncology rehabilitation education in current physical therapist educational programs in the United States, including oncology rehabilitation content characteristics, delivery, and instructional resources. REVIEW OF LITERATURE: By 2030, more than 21 million survivors of cancer in the United States (US) will be living with multisystem side effects depending on the treatment delivered. In addition, the sociopsychological factors associated with cancer treatment require that physical therapists are equipped with a unique body of knowledge, skills, and abilities. Insufficient cancer rehabilitation education is problematic across the health care spectrum. SUBJECTS: Program directors at 235 US physical therapist educational programs. METHODS: An online survey was developed in REDCap using the American Board of Physical Therapy Specialist's Description of Specialty Practice: Oncology Physical Therapy as a guide. An electronic link to the survey was sent to the email of the chair/program director at 235 Commission for the Accreditation of Physical Therapy Education-accredited programs. RESULTS: The overall response rate was 40.4% (95/235) and represented 36 of the 50 states. Private universities represented 54.3% of the responses, and 65% of the surveys were completed by core faculty. Four programs reported having an independent oncology course, ranging from 1 to 3 credit hours. Integrated content hours averaged 14.8 contact hours (range: 1-60) in the 69 reporting programs. Fifty-four percent of respondents were aware of published rehabilitation cancer guidelines. The majority of respondents (62%) felt their students received adequate instruction related to oncology rehabilitation. Certified lymphedema therapists (68%) were primarily responsible for teaching the oncology content. Goodmans' Pathophysiology text was most reported (87%), whereas 38% used evidence-based research in Rehabilitation Oncology Journal. About half of the respondents (52%) reported offering students full-time clinical experiences in oncology rehabilitation. DISCUSSION AND CONCLUSIONS: This survey demonstrated how oncology rehabilitation education is incorporated into physical therapist educational programs and highlights areas for improvement. The results from this study lay the groundwork for developing core competencies for prelicensure education in oncology rehabilitation.

Experiences of Underrepresented Racial Minorities in the Entry-Level Physical Therapy Education Application Process: A Conceptual Framework.

INTRODUCTION: The purpose of this study was to explore the experiences of Black and Latinx students as they navigate the entry-level physical therapy education program (PTEP) admissions process and how they made meaning of their experiences. REVIEW OF LITERATURE: Existing literature is focused on quantitative aspects of the admissions process and on the applicant's potential for success within an entry-level PTEP. There is currently not enough evidence to provide the applicant perspective when navigating the entry-level physical therapy education admissions process. SUBJECTS: A total of 11 participants were recruited from all entry-level PTEPs through social media sites and national student organizations for Black and Latinx students enrolled in entry-level PTEPs. METHODS: Three interviews were conducted for each participant. Their responses were combined with a demographic survey received before the first. Interviews were then transcribed and coded with deductive and inductive processes. RESULTS: The study yields a conceptual model for recruitment of Black and Latinx students. Factors for programs to consider include introduction to the profession, challenges and factors of support within the application process, and factors influencing enrollment decisions. DISCUSSION AND CONCLUSION: This exploratory study provides a roadmap to better understand the experiences and journey of Black and Latinx students to the field of physical therapy. Findings could be used by entry-level PTEPs to provide better access to information for prospective students.