Instructing to Impact: Exploration of Doctor of Physical Therapy Education Instruction of Social Determinants of Health and Health Equity for People With Disabilities.

OBJECTIVE: The aim of this study was to explore the instruction of social determinants of health (SDOH) for people with disabilities (PWD) in doctor of physical therapy (DPT) education programs. METHODS: A sequential mixed methods study informed by a five-member disability community advisory panel was conducted. Qualitative semi-structured interviews with educators (n = 10) across 4 DPT programs in the Midwest were conducted and analyzed thematically. The qualitative findings formed the basis of the quantitative phase. An online survey was conducted with faculty of DPT programs in the United States (n = 254) with the most knowledge of instruction of SDOH and health equity for PWD (n = 74; 29% response rate). Quantitative data were analyzed with descriptive statistics and triangulated with qualitative data. RESULTS: SDOH for PWD is an emerging component of instruction in DPT curricula. Five themes included: emerging instruction of SDOH for PWD; conceptual frameworks informing instruction; instructional strategies; barriers to integration of SDOH for PWD; and facilitators to integration of SDOH for PWD. Quantitative analysis revealed that 71 respondents (95.9%) included disability in health equity discussions primarily focused on health care access. Limited time (n = 49; 66.2%) was the most frequently reported barrier, and educator interest in disability health equity was the most frequently reported facilitator (n = 62; 83.7%) to inclusion of the SDOH for PWD in health equity discussions. CONCLUSION: Opportunities exist in DPT curricula to build on instructional strategies, integrate SDOH frameworks, and amplify facilitators to integration of SDOH for PWD. IMPACT: To meet the needs of the 67 million Americans living with disabilities, students must have the knowledge and skills to address the complex needs of this historically marginalized population. Understanding the DPT education landscape around SDOH for PWD can guide DPT educators to more fully prepare their students to recognize and ameliorate health disparities faced by PWD.

Exploring the Characteristics of Doctor of Physical Therapy Students Intending to Work in Medically Underserved Areas.

Health professions educators, including physical therapist educators, are striving to be more socially accountable by graduating clinicians who work in underserved communities. To achieve this, understanding factors associated with student practice intentions is vital. PURPOSE: The purpose of this study was to identify characteristics of Doctor of Physical Therapy (DPT) students associated with intention to work in medically underserved areas or with underserved populations upon graduation. METHODS: An exploratory descriptive study using survey methodology targeted first, second, and third-year DPT students. RESULTS: A total of 201 students participated. Using a logistic regression model, two variables demonstrated statistically significant associations with the intention to work in medically underserved areas upon graduation: students who grew up in medically underserved areas and students who participated in service learning while in PT school. DISCUSSION AND CONCLUSION: Educators should use targeted student recruitment, admission strategies, and service-learning experiences to address workforce needs in medically underserved areas.

Preparing Students to Serve a Refugee Population Through a Health-Focused Interprofessional Education Experience.

Refugees may arrive to their destination country with complex mental and physical health challenges. However, healthcare providers often are unprepared to manage refugees' health-related challenges. An interprofessional team of faculty developed an interprofessional education (IPE) training to help prepare health professions students to address refugees' health needs. This paper describes the development and assessment of the training. A three-hour case-based training was created with the following format: online pre-assessment; introduction; radio story about the experience of local refugees; pre-recorded presentation about healthcare in a detention facility; interprofessional group work in small teams; large group discussion; profession-specific group reflections; and online post-assessment. The training was implemented twice (across two successive years), and an investigation of the study participants' self-perceived learning was completed after each training. In the first training, 62 participants (representing medicine, occupational therapy, pharmacy, physical therapy, and social work) completed the assessments. In the second training, 151 participants (representing medicine, nursing, occupational therapy, physical therapy, public health, and social work) completed the assessments. In each study, a statistically significant increase in each of four outcome variables was found at post-assessment. The findings of each study suggested that perceived learning about refugees' health and health care improved after participation in a three-hour IPE training.

Improving Patient-Provider Communication: Evolution of a Tool to Assess Physical Therapist Students' Spanish-Language Proficiency.

Communication is at the foundation of safe and effective health care. When patients with limited English proficiency (LEP) have healthcare providers who do not speak their language, the communication barrier can lead to poor outcomes. Responding to the high number of Spanish-speaking individuals with LEP, a Doctor of Physical Therapy (DPT) program has integrated Spanish-language training in the curriculum. This paper describes their development and pilot testing of the Physical Therapy Spanish Proficiency Measure (PT-SPM). The PT-SPM was developed for English-Spanish bilingual faculty or clinicians to assess DPT students' clinically relevant Spanish communication. The PT-SPM has 11 total items with four subscales: verbal proficiency, aural proficiency, written proficiency, and cultural competence. Twenty-three pairs of DPT students and their bilingual clinical instructors were recruited for an interrater agreement study; each used the PT-SPM to independently rate the student's Spanish communication with Spanish-speaking patients with LEP in clinical settings. Cohen's weighted kappa was calculated to evaluate interrater agreement between the students and clinicians on item level, using linear incremental weights. The weighted kappa coefficients ranged from 0.35 (fair agreement) to 0.80 (substantial agreement). All weighted kappa coefficients were statistically significant. Two items had fair agreement; four items had moderate agreement, and five items had substantial agreement. These results support that the PT-SPM may have value as an assessment tool for DPT students in clinical settings. Educators in other health professions may consider adapting the PT-SPM. This paper contributes to the broader interprofessional dialogue about how to assess and improve patient-provider communication.

Improved Knowledge Following an Interprofessional Interpreter-Use Training.

INTRODUCTION: Language barriers between patients and their healthcare providers are associated with negative outcomes. One approach to bridge language discordance is to offer interpreter-use training. This study's purpose was to evaluate the effects of an interprofessional interpreter-use training on speech-language pathology (SLP), doctor of physical therapy (DPT), and master of occupational therapy (MOT) students. METHODS: Seventy-one students (18 SLP, 32 DPT, and 21 MOT) participated. Participants first completed an online module and then participated in a 3-hour interprofessional training consisting of lecture, role-play, and reflection. Each completed an interpreter-use knowledge assessment and the Readiness for Interprofessional Learning Scale (RIPLS) before and after training and a program evaluation. A subsample participated in focus groups and completed the interpreter-use knowledge assessment and RIPLS 5 months later. RESULTS: The participants improved in interpreter-use knowledge and self-assessed readiness for interprofessional learning, and they maintained these gains at follow-up. Themes included new interpreter knowledge, ethical practice, and new interprofessional knowledge. CONCLUSION: The training was completed in a short period of time at no financial cost, possibly making the structure feasible for other educators to duplicate. A unique element of our training was the semi-structured reflection questions highlighting ethical complexities related to serving as untrained interpreters for others.

Development and Preliminary Assessment of Interprofessional Education Focused on Vulnerable Populations.

With the current state of the U.S. healthcare system, interprofessional collaborative practice (IPCP) has never been more important. Health professions educators are increasingly incorporating interprofessional education (IPE) in their curricula in order to prepare students for IPCP. The Health- Focused IPE Community of Practice (representing nursing, occupational therapy, pharmacy, physical therapy, rehabilitation counseling, social work, and speech-language pathology) at the University of Texas at El Paso has created a unique IPE model centered on vulnerable populations. The purposes of this paper are to describe the early development of this innovative IPE model and present findings from an evaluation of an IPE learning experience focused on a case involving a transgender individual. The evaluation of the first IPE activity demonstrated that the students' knowledge and attitudes related to interprofessional collaboration improved for all participating professions. Additionally, the post-training evaluation revealed that students were more comfortable providing services to transgender individuals than interacting with them. This IPE model has leveraged the strengths of community-engaged faculty in order to infuse content related to vulnerable populations across multiple curricula. This holistic approach models to the students that complex problems require multifaceted solutions generated by IPCP.

Global Health Competencies for Physiotherapist Education in the United States.

INTRODUCTION: Increasingly global health education is being incorporated into health professions' curricula. Various disciplines have defined global health competencies (GHC) for their areas of professional practice. However, physiotherapist educators have not delineated GHC for physiotherapist education. This study's purpose was to develop GHC for United States (US)-based physiotherapist education. METHODS: We developed an online survey using 30 GHC from a nursing study and 4 GHC that we developed. We recruited physiotherapists who were clinicians and/or faculty employed in the US, or who had been employed as clinicians and/or faculty in the US within the past 5 years to complete the survey. We examined descriptive data for Likert responses and used content analysis for analysis of open-ended responses. The University of Texas at El Paso Institutional Review Board granted exempt status for the study. RESULTS: One hundred eighty-eight participants completed the survey. A majority agreed or strongly agreed that 33 of the total 34 GHC were relevant to physiotherapist education. Four major categories emerged from open-ended responses: beyond entry level, greater relevance to physiotherapy, emphasis on US concerns, and value of understanding international issues and perspectives. DISCUSSION: Although most participants agreed with the GHC, open-ended responses indicated the need for revision of the GHC to make them more relevant to entry-level physiotherapist education. We plan to revise the GHC and then validate the modified GHC through a future Delphi study. Study limitations include the limited number of participants and that the lack of an operational definition of 'global health' may have created confusion. IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE: The study's results may inform physiotherapist educators inside and outside of the US as they contend with determining how to most effectively prepare physiotherapist students for competent practice in a globalized world. Copyright © 2015 John Wiley & Sons, Ltd.

How should we prepare rehabilitation sciences students to work with low English-proficient Spanish-speaking patients?

Misinterpretations or lack of compliance with national standards established to guide health professionals working with low-English-proficient (LEP) patients continue to negatively impact patient care. Most of the literature on training health professionals to work with interpreters focuses on physicians. We reviewed this current literature and propose an interprofessional educational module to extend the interpreter training to other health professions. Our module trains rehabilitation science students from different health disciplines (physical therapy, occupational therapy, and speech-language pathology) using strategies from the literature. The educational module is tailored to student's bilingual proficiency, suggests relevant outcomes measures, and highlights unanswered questions and areas for future research.

Integrating Spanish language training across a Doctor of Physical Therapy curriculum: a case report of one program's evolving model.

BACKGROUND AND PURPOSE: As the Hispanic population continues to expand in the United States, health professionals increasingly may encounter people who speak Spanish and have limited English proficiency. Responding to these changes, various health profession educators have incorporated Spanish language training into their curricula. Of 12 doctor of physical therapy (DPT) programs identified as including elective or required Spanish courses, the program at The University of Texas at El Paso is the only one integrating required Spanish language training across the curriculum. The purpose of this case report is to describe the development, implementation, and preliminary outcomes of the evolving educational model at The University of Texas at El Paso. CASE DESCRIPTION: The University of Texas at El Paso is situated immediately across the border from Mexico. Responding to the large population with limited English proficiency in the community, faculty began to integrate required Spanish language training during a transition from a master-level to a DPT curriculum. The Spanish language curriculum pillar includes a Spanish medical terminology course, language learning opportunities threaded throughout the clinical courses, clinical education courses, and service-learning. Forty-five DPT students have completed the curriculum. OUTCOMES: Assessment methods were limited for early cohorts. Clinically relevant Spanish verbal proficiency was assessed with a practical examination in the Spanish course, a clinical instructor-rated instrument, and student feedback. Preliminary data suggested that the model is improving Spanish language proficiency. DISCUSSION: The model still is evolving. Spanish language learning opportunities in the curriculum are being expanded. Also, problems with the clinical outcome measure have been recognized. Better definition of intended outcomes and validation of a revised tool are needed. This report should promote opportunities for collaboration with others who are interested in linguistic competence.

Proposed guidelines for international clinical education in US-based physical therapist education programs: results of a focus group and Delphi Study.

BACKGROUND: Physical therapist students are increasingly engaging in international clinical education (ICE). The growth of international engagement has been accompanied by appeals to ensure that these experiences are conducted in an ethical manner. Although detailed guidelines have been developed to guide global health training in general, they do not specifically address all aspects relevant to ICE in physical therapist education. OBJECTIVE: The purpose of this study was to systematically develop recommendations for the implementation of ICE in physical therapist education to promote ethical practice. METHODS: An initial virtual focus group of 5 physical therapist faculty with expertise in ICE provided input to review and revise global health training guidelines previously developed by non-physical therapists. The revised guidelines were distributed to a pool of 19 physical therapist faculty with ICE experience for additional review and revision through 3 online Delphi survey rounds. RESULTS: The participants accepted 31 of the original guidelines with or without revisions, rejected 2 guidelines, and developed 10 new guidelines or subguidelines. Most notably, they rejected a guideline related to students pursuing training outside of a structured program, stressing that ICE should never be done outside of a formal program. LIMITATIONS: The primary limitation is that the study included only faculty from sending institutions and thus lacked the voices of the host institutions, students, partner organizations, or funders. CONCLUSIONS: This study systematically produced guidelines for ICE in physical therapist education using a range of ICE experts from sending institutions. The recommendations may be used by educators and other decision makers to optimally design new ICE opportunities or to improve existing ones. Additional validation should be done to ensure relevance for all stakeholders.

Exploring international clinical education in US-based programs: identifying common practices and modifying an existing conceptual model of international service-learning.

BACKGROUND: Increasingly physical therapist students complete part of their clinical training outside of their home country. This trend is understudied. The purposes of this study were to: (1) explore, in depth, various international clinical education (ICE) programs; and (2) determine whether the Conceptual Model of Optimal International Service-Learning (ISL) could be applied or adapted to represent ICE. METHODS: Qualitative content analysis was used to analyze ICE programs and consider modification of an existing ISL conceptual model for ICE. Fifteen faculty in the United States currently involved in ICE were interviewed. The interview transcriptions were systematically analyzed by two researchers. RESULTS: Three models of ICE practices emerged: (1) a traditional clinical education model where local clinical instructors (CIs) focus on the development of clinical skills; (2) a global health model where US-based CIs provide the supervision in the international setting, and learning outcomes emphasized global health and cultural competency; and (3) an ICE/ISL hybrid where US-based CIs supervise the students, and the foci includes community service. Additionally the data supported revising the ISL model's essential core conditions, components and consequence for ICE. CONCLUSIONS: The ICE conceptual model may provide a useful framework for future ICE program development and research.

Interprofessional education: a pilot study of rehabilitation sciences students participating in interdisciplinary international service-learning.

Various models of interprofessional education, including service-learning, are used to teach students how to be effective members of healthcare teams. The purpose of this study was to examine pilot data related to the impact of an elective one-credit global health course with an international service-learning experience (ISL) on the student participants. An interdisciplinary team of 3 faculty accompanied 4 students representing occupational therapy, physical therapy, and speech-language pathology programs for an 8-day ISL experience. Students responded to faculty-developed reflection questions pre-travel, during travel, and 2-weeks and 4-months post travel. Content analysis was used to analyze themes that emerged from the students' written reflections. Three major themes emerged: collaboration, satisfaction, and self-discovery. The most prominent theme was related to interprofessional collaboration.

Benefits and challenges of international clinical education from a US-based physiotherapist faculty perspective.

INTRODUCTION: The influence of internationalization on physiotherapist education in at least North American-based programmes has become more apparent. Faculty and students have been involved in various international activities. One category of activities includes international clinical education (ICE), where students earn clinical education credit for their learning activities at international sites. Although this educational strategy appears to be increasingly used in at least the United States and Canada, the related literature is limited in scope. The purpose of this portion of the present study was to investigate the benefits and challenges of ICE for US-based students, US-based physiotherapy programmes and international partners from the perspective of US-based faculty sending students for clinical education internationally. METHODS: Content analysis was used for this qualitative study. Fifteen US-based faculty members who had experience in sending physiotherapist students for ICE were recruited. The primary researcher conducted semi-structured phone interviews, averaging approximately 60 minutes in length. The primary and secondary researchers completed data analysis using NVivo 8 software (QSR International Inc., Cambridge, MA). RESULTS: Benefits of ICE to the students included exposure to alternate health systems, broadening of student perspectives and clinical competence. Challenges consisted of funding and possible language barrier. Increased visibility, expanded global perspective and faculty collaborations were benefits to the programme. Ensuring a quality learning experience was the greatest programme challenge. Benefits to the international site included education and faculty collaborations/exchanges; challenges were language, student clinical preparation and unfamiliarity with the student evaluation tool. Because the sample was limited to 15 US-based faculty members, the results may not be relevant to all programmes inside or outside of the United States. Additionally, the study lacked perspectives from the students or international sites. IMPLICATION FOR PHYSIOTHERAPY PRACTICE: The present study is an early step in the important examination of the impact of this emerging educational trend on physiotherapy education and practice.

A conceptual framework for international service-learning course planning: promoting a foundation for ethical practice in the physical therapy and occupational therapy professions.

As physical therapy (PT) and occupational therapy (OT) educational programs endeavor to foster core values of social responsibility, justice, and altruism in an increasingly global community, the incorporation of local and international service-learning (ISL) into the curriculum is growing. Much of the research has focused on the measurement of student learning, with little written about the impact on the host community. Proponents of global health initiatives are calling for consideration of all stakeholders to ensure ethical practice. This paper explores the current literature related to PT and OT ISL and builds a conceptual framework for ISL course planning. The essential phases in the framework include: 1) pre-experience planning/preparation stage, 2) field immersion experience stage, and 3) postexperience stage. The essential elements are: 1) cultural competency training, 2) communication and coordination with community, 3) comprehensive assessment, and 4) strategic planning. The authors suggest this framework as a practical tool to structure ISL courses with an explicit emphasis on ethical concerns. Additionally, they seek to foster more dialogue and action related to the promotion of ethical practices in ISL in PT and OT education programs.

Going global in physical therapist education: International Service-Learning in US-based programmes.

BACKGROUND AND PURPOSE: Internationalization is expanding its presence in higher education in the United States. Reflecting this trend that includes incorporating global perspectives in the curricula, physical therapist education programmes increasingly offer international opportunities such as International Service-Learning (ISL) to their students. Service-learning, a teaching strategy that integrates community service with structured learning activities, has gained broad acceptance in health professions education including physical therapy, and is therefore the focus of this paper. The specific purposes of this paper were to identify and analyse the commonalities that existed among established ISL programmes within physical therapist education programmes in terms of structures and processes, and to consider its broader implications for physical therapist education. METHODS: A descriptive, exploratory study was performed using grounded theory. Snowball and purposive, theoretical sampling yielded 14 faculty members with experience in international service, international learning or ISL in physical therapist education programmes. Faculty were interviewed by phone. Interview transcriptions and course documents were analysed applying grounded theory methodology. Data from eight programmes which met the operational definition of established ISL were used to address the purposes of this paper. RESULTS: Five phases of establishing an ISL programme were identified: development, design, implementation, evaluation, and enhancement. Although no single model exists for ISL in physical therapist education; commonalities in structures and processes were identified in each phase. However, attention to service objectives and outcomes is lacking. CONCLUSIONS: While analysis revealed that each programme shared commonalities and demonstrated differences in structures and processes compared with the other programmes, the study demonstrated a general lack of focus on formal community outcomes which raises ethical concerns. Future research and dialogue is warranted to explore ethics and good practice in ISL and other global health initiatives in physical therapy. This study may facilitate reflections and creative solutions by individual faculty and the profession.

A conceptual model of optimal international service-learning and its application to global health initiatives in rehabilitation.

BACKGROUND: There is growing involvement by US clinicians, faculty members, and students in global health initiatives, including international service-learning (ISL). Limited research has been done to examine the profession's increasing global engagement, or the ISL phenomenon in particular, and no research has been done to determine best practices. This study was intended as an early step in the examination of the physical therapy profession's role and activities in the global health arena within and beyond academics. OBJECTIVES: The purposes of this study were: (1) to identify and analyze the common structures and processes among established ISL programs within physical therapist education programs and (2) to develop a conceptual model of optimal ISL within physical therapist education programs. DESIGN: A descriptive, exploratory study was completed using grounded theory. METHODS: Telephone interviews were completed with 14 faculty members who had been involved in international service, international learning, or ISL in physical therapist education programs. Interviews were transcribed, and transcriptions were analyzed using the grounded theory method. RESULTS: Four major themes emerged from the data: structure, reciprocity, relationship, and sustainability. A conceptual model of and a proposed definition for optimal ISL in physical therapist education were developed. Seven essential components of the conceptual model are: a partner that understands the role of physical therapy, community-identified needs, explicit service and learning objectives, reflection, preparation, risk management, and service and learning outcome measures. Essential consequences are positive effects on students and community. CONCLUSIONS: The conceptual model and definition of optimal ISL can be used to direct development of new ISL programs and to improve existing programs. In addition, they can offer substantive guidance to any physical therapist involved in global health initiatives.