Implementing and sustaining a breast cancer prospective surveillance rehabilitation program: an institutional perspective.

BACKGROUND: The prospective surveillance model (PSM) is an evidence-based rehabilitation care delivery model that facilitates functional screening and intervention for individuals undergoing cancer treatment. While PSM is empirically validated and feasible in practice, implementation into cancer care delivery has languished. The purpose of this manuscript is to characterize the barriers and facilitators to implementing PSM in a breast cancer center and to share policy and process outcomes that have sustained the model in practice. METHODS: The PSM implementation was undertaken as a quality improvement initiative of our cancer center. We retrospectively assessed barriers to implementation and define those according to the Consolidated Framework for Implementation Research (CFIR). Implementation strategies are defined based on the Expert Recommendations for Implementation Change (ERIC) taxonomy. Breast center policy changes and stakeholder-reported process improvement outcomes at the clinic and system level are described. RESULTS: PSM implementation facilitation was driven primarily by adapting the model to align with the cancer center workflow, engaging interdisciplinary stakeholders as program champions, enhancing knowledge and awareness among cancer care providers, and changing infrastructure to support the model. System and clinic-level policy and process changes included the development of clinical pathways, EHR order sets and automated referrals, new staffing models, and adapted clinical workflows. CONCLUSION: Our report provides insight on implementing the PSM at a single institution in a cancer care delivery setting. Successful implementation strategies addressed individual, clinic, and system-level barriers and facilitated process and policy changes that have enabled PSM sustainment. Improving integration of rehabilitation services into oncology care has significant implications for survivorship care by enhancing proactive management of functional morbidity. IMPLICATIONS FOR CANCER SURVIVORS: Improving integration of rehabilitation services into oncology care has significant implications for survivorship care by enhancing proactive management of functional morbidity.

Physical Therapist Student Readiness for Entrance Into the First Full-Time Clinical Experience: A Delphi Study.

Background: To consistently prepare physical therapist students for their first full-time clinical experience, the entry-level curriculum must provide and assess competency in the essential knowledge, skills, attitudes, and professional behaviors. Objective: The purpose of this Delphi study was to develop consensus on a core set of elements that should be demonstrated by physical therapist students prior to entry into their first full-time clinical experience. A second aim was to obtain the recommended competency levels and assessment methods. Design: The study was conducted using the Delphi method. Methods: Purposive selection and snowball sampling techniques were used to recruit clinical instructors, recent graduates, directors or academic coordinators of clinical education, and academic faculty. Four web-based survey rounds were used to achieve consensus, defined as agreement among ≥80% of respondents. The first round gathered demographic information on respondents and identified elements that were deemed essential; the second collected information about clarity and redundancy in the elements provided; the third asked participants to rank their agreement with elements and themes; and the fourth gathered the level of competency that physical therapist students should demonstrate prior to beginning a first full-time clinical experience. Results: Consensus revealed 95 elements, categorized under 14 themes, which were deemed essential for readiness for the first clinical experience. Levels of competency for each element were identified. Limitations: Participants might not have represented all academic programs, practice settings, and geographic locations. Conclusion: This study identified the specific knowledge, skills, attitudes, and professional behaviors in which all physical therapist students in the United States need to demonstrate competency before their first clinical experience, regardless of school or setting, which would allow learning experiences to be tailored appropriately.

Use of demographic and quantitative admissions data to predict performance on the national physical therapy examination.

BACKGROUND AND PURPOSE: The purpose of this study was to determine whether admissions data could be used to estimate physical therapist student risk for failing the National Physical Therapy Examination (NPTE). SUBJECTS: A nationally representative sample of 20 physical therapist education programs provided data on 3,365 students. METHODS: Programs provided data regarding demographic characteristics, undergraduate grade point average (uGPA), and quantitative and verbal Graduate Record Examination scores (qGRE, vGRE). The Federation of State Boards of Physical Therapy provided NPTE data. Data were analyzed using hierarchical logistic regression. RESULTS: A prediction rule that included uGPA, vGRE, qGRE, and race or ethnicity was developed from the entire sample. Prediction rules for individual programs showed large variation. DISCUSSION AND CONCLUSION: Undergraduate grade point average, GRE scores, and race or ethnicity can be useful for estimating student risk for failing the NPTE. Programs should use GPA and GRE scores along with other data to calculate their own estimates of student risk.

Use of demographic and quantitative admissions data to predict academic difficulty among professional physical therapist students.

BACKGROUND AND PURPOSE: The purpose of this study was to determine whether admissions data could be used to estimate physical therapist students' risk for academic difficulty. SUBJECTS: A nationally representative sample of 20 physical therapist education programs provided data on 3,582 students. METHODS: Programs provided data regarding student demographic characteristics, undergraduate grade point average (uGPA), quantitative and verbal Graduate Record Examination scores (qGRE, vGRE), and academic difficulty. Data were analyzed using logistic regression. Rules for predicting risk of academic difficulty were developed. RESULTS: A prediction rule that included uGPA, vGRE, qGRE, age, and race or ethnicity was developed from the entire sample. Prediction rules for individual programs showed large variation. DISCUSSION AND CONCLUSION: Undergraduate grade point average, GRE scores, age, and race or ethnicity can be useful for estimating student academic risk. Programs should calculate their own estimates of student risk. Academic programs should use risk estimates in combination with other data to recruit, admit, and retain students.

Academic difficulty and program-level variables predict performance on the National Physical Therapy Examination for licensure: a population-based cohort study.

BACKGROUND: Several factors have been shown to influence first-time pass rates on the National Physical Therapy Examination (NPTE). It is unclear to what extent academic difficulty experienced by students in a physical therapist education program may affect NPTE pass rates. The effects of institutional status (public or private) and Carnegie Classification on NPTE pass rates also are unknown. OBJECTIVE: The aim of this study was to quantify the odds of failure on the NPTE for students experiencing academic difficulty and for institutional status and Carnegie Classification. DESIGN: This investigation was a retrospective population-based cohort study. METHODS: Quota sampling was used to recruit a random sample of 20 professional physical therapist education programs across the United States. Individual student demographic, preadmission, and academic performance data were collected, as were data on program-level variables and data indicating pass/fail performance on the NPTE. A generalized linear mixed-effects logistic regression model was used to adjust for confounding factors and to describe relationships among the key predictor variables-academic difficulty, institutional status, and Carnegie Classification-and the dependent variable, NPTE performance. RESULTS: Academic difficulty during a student's professional training was an independent predictor for NPTE failure. The odds of students who had academic difficulty (relative to students who did not experience academic difficulty) failing the NPTE were 5.89 (95% confidence interval=4.06-8.93). The odds of NPTE failure also varied depending on institutional status and Carnegie Classification. LIMITATIONS: The findings related to Carnegie Classification and institutional status should be considered preliminary. CONCLUSIONS: Student performance on the NPTE was influenced by multiple factors, but the most important, potentially modifiable risk factor for poor NPTE performance likely is academic difficulty during professional training.