Equitable Grading Practices in Physical Therapist Education: A Case Report.

OBJECTIVE: To optimize learning in physical therapist education, learners need opportunities to grow from their unique starting points. Traditional grading practices like A to F grades, zero grades, and grading on timeliness and professionalism hinder content mastery and accurate competency assessment. Grading should focus on mastery of skill and content, using summative assessments for final grades, a no-zero policy, and actionable feedback. Equitable grading supports learners from all backgrounds and identities and promotes academic success. This case study provides guidance and recommendations for implementing equitable grading practices in academic physical therapist programs. METHODS: Over a 2-year period, a doctor of physical therapy program began implementing 5 strategies to create more equitable grading practices: (1) eliminating zero grades, (2) allowing late assignment submissions without penalty, (3) using low-stakes formative assessments throughout the semester, (4) weighing end-of-course assessments more heavily than initial ones, and (5) offering a no-stakes anatomy prep course before matriculation. RESULTS: Outcomes from implementing equitable grading practices varied. Some learners felt increased stress from fewer points opportunities, while others appreciated the reduced anxiety from low-stakes assessments. Some saw multiple attempts for peers as unfair. Faculty faced higher workloads due to detailed feedback and remediation but believed it benefited learners. Median final grades improved in some courses, remained stable in others, and slightly decreased in one. Overall, the changes had minimal impact on most learners' grades but significantly improved outcomes and retention for struggling learners. CONCLUSION: This case report documents the implementation of equitable grading practices in a Doctor of Physical Therapy program, offering valuable insights and recommendations for other institutions aiming to adopt similar practices. IMPACT: Inequity in assessment widens the gap between learners entering professional programs. Equitable assessment practices level the playing field, enabling learners from diverse backgrounds and identities to succeed. Increased diversity benefits everyone, especially patients, by reducing health disparities for historically marginalized groups.

Culturally Responsive Pedagogy in Physical Therapy Education.

The push for holistic admissions practices in physical therapy education has evoked concerns that learners who are culturally and linguistically diverse might be less qualified than the predominant demographic traditionally admitted into programs. The implications are that culturally and linguistically diverse learners struggle academically and experience challenges passing the National Physical Therapy Examination. However, as the academic preparedness of learners is discussed, rarely does the conversation include the capabilities of faculty to teach these learners. As cohorts continue to include learners from a greater variety of backgrounds and identities, the largely homogenous professorate, with more than 80% identifying as White, might need training in culturally responsive pedagogy to best serve learners from all backgrounds and identities. Educators often use a "one-size-fits-all" approach in which learners are expected to use the same resources and pace for assignments, readings, and assessments, regardless of their learning strengths or academic preparation. That approach fails to empower educators to design curricula and instruction to position all learners to excel in the classroom. This Perspective explores strategies to support all learners through three dimensions of culturally responsive pedagogy: institutional, personal, and instructional. To truly transform society, we must first transform physical therapy education. Culturally responsive pedagogy advances and supports all student achievement by recognizing, fostering, and using their strengths in the learning environment.

A Community Development Approach in Physical Therapist Education.

Physical therapists should be able to screen patients for social determinants that impact health and refer to community resources as appropriate. To make appropriate referrals, physical therapists must equip themselves with skills to connect patients and clients to community resources outside the walls of their respective institutions, starting with developing these practices in physical therapist education programs. Experienced community builders recommend a community development approach where residents initiate and agree upon decisions, and outside stakeholders work as partners to elevate the community. The community should be supported to determine the desired outcomes in ways that enhance equity, inclusion, and social justice. Communities play a substantial role in health outcomes. Studies indicate that 85% of one's health is connected to community and economic resources, while only 15% is affected by medical interventions. Connected communities are potent tools to enhance health. Connected communities are places where residents nurture neighborhood relationships that enable them to work together to create a good life supporting their collective well-being. The community-builder approach recenters people and their communities as fundamental health leaders; institutions can use their resources to elevate communities by relocating authority back to communities. Communities have assets and resources largely unrecognized, disconnected, and not mobilized by residents. Institutions are positioned to support citizens and their associations in discovering, connecting, and mobilizing these assets. This asset-based community development approach focuses on 5 principles: place-based, citizen-led, relationship-oriented, asset-based, and inclusion-focused. This perspective paper will describe ways institutions can elevate communities; the benefits of community development practices in physical therapist education programs; and explore examples of community partnerships and best practices to develop equitable alliances with residents in the community. IMPACT: A large part of one's health is directly related to where one lives. Physical therapists and physical therapist assistants can play a vital role in improving the health of society by engaging in their local communities through community development. Community development is a practice where community members and outside stakeholders, such as physical therapists, come together to meet the needs of a community.

Diversifying the Physical Therapist Workforce Through Holistic Hiring, Admissions, and Retention Processes.

In 2002, the Institute of Medicine's recommendations emphasized diversifying the health care workforce to reduce racial and ethnic health disparities. Despite these efforts, the physical therapist profession remains predominantly White. The College of Saint Mary Doctor of Physical Therapy (DPT) program employs deliberate strategies through 2 committees, faculty search and admissions, to foster diversity in both faculty and student populations. The DPT Program Faculty Search Committee, in collaboration with the human resource department, devised a comprehensive 3-phase recruitment process aimed at attracting qualified candidates from diverse backgrounds. Through purposeful mission-driven and equity-focused strategies, this approach has yielded a faculty body characterized by diversity, with 80% of faculty members self-identifying as belonging to historically excluded groups. Similarly, the Admissions Committee has adopted proactive measures to ensure a diverse student body. By implementing a holistic admissions process recommended by the Association of American Medical Colleges, including evaluating prerequisite courses and eliminating the Graduate Record Examination requirement, the committee has facilitated more equitable access to the program. Virtual interviews and thorough candidate assessments are conducted to mitigate potential biases in the selection process. As a result, these efforts have allowed us to maintain diverse cohorts, with 20% to 30% of our student body identifying as members of historically excluded groups. IMPACT: Developing and sustaining a physical therapist workforce that reflects the communities it serves necessitates purposeful, mission-driven, and equitable strategies. These strategies aim to broaden the diversity of both faculty and student populations. Through such initiatives, we aim to foster an inclusive environment that reflects our society's richness, enabling us to better understand society's complex needs and mitigate health disparities.

How Integrating the 5 Pillars of Community Practice Can Transform Physical Therapist Education and Reduce Health Disparities.

Patient history assists clinicians in determining the most appropriate tests to identify the symptoms' source and select appropriate interventions. Therefore, a subjective history is an essential component of patient management. When physical therapist practitioners transition into academia, they must understand how the history of the education system may affect learners. Health disparities are related to the lack of workforce diversity and skills in cultural responsiveness, and the education system is critical in addressing the impact of future providers on health disparities. Developing a doctor of physical therapy program to address health disparities requires an analysis of the historical context of the US educational and health care systems, along with traditional components of physical therapist education. This country's education system was built upon a 2-tiered system, where minoritized individuals struggled to overcome barriers imposed by legislation and societal beliefs. Jim Crow laws continued this unequal access to education, and the recent Supreme Court ruling to deny race-based affirmative action continues these inequities. This historical context informed the construction of the College of Saint Mary Doctor of Physical Therapy Program. The program's mission led to using less traditional educational approaches; thus, the pillars of practice took form. The 5 pillars evolved to include social determinants, inclusive faculty and student recruitment and retention practices, equitable grading, culturally responsive pedagogy, and community development. The purpose of this paper is to present a historical overview of the US education system and its influence on physical therapist education. Furthermore, it will illustrate how this historical context inspired the 5 Pillars of Community Practice from College of Saint Mary and discuss the challenges and interventions related to these pillars. There are tremendous disparities in educational outcomes and patient services in the United States. Disparities are most significant in those with historically marginalized identities. If those disparities are to improve, a change is required in the people providing care to patients. The best way to accomplish this is by transforming how future providers are educated.

Rejecting the Status Quo: A Call to Action Using Culturally Responsive Pedagogy in Health Professions Programs.

Modern healthcare must reconcile its past and address the longstanding disparities becoming more prominent in the public consciousness. Shortcomings exist on personal and institutional levels, impacting the care people receive. In 2002, the Institute of Medicine (IOM) made three recommendations to reduce health inequities: integrating research to identify and reduce disparities, promoting cross-cultural education throughout health, and healthcare workforce diversification. In the last 20 years, marginal changes have been made to address IOM's recommendations. Cultural responsiveness is essential in meeting these recommendations by changing who enrolls in healthcare education programs and the people responsible for their educational experience. Culturally responsive practices help dismantle the paradigm of traditional healthcare education by promoting a flexible mindset that actively seeks the strengths and assets of every individual. Furthermore, those practices capitalize on diversity by finding creative ways to connect with learners, granting them the freedom to show up as their authentic selves. Three calls to action are presented to support IOM's recommendations, including developing place-based community engagement programs, embracing holistic admissions processes, and using culturally responsive pedagogy in health professions programs to teach and socialize future healthcare providers. Creating an inclusive learning environment in health professions programs will help reduce healthcare inequities by developing future healthcare providers endowed with values and practices that offer optimal care to serve all patients.

White Faculty as True Allies in the Classroom: The JEDI Code.

Healthcare education practices need to integrate values of justice, equity, diversity, inclusion (JEDI), and belonging to address the racism that continues to infiltrate society. The myths and incorrect assumptions about race in healthcare perpetuate patient care practices that are racially discriminatory and grow the inequitable healthcare crisis in the U.S. The response to abolish racism in healthcare begins with professional health education, and white allies are called to action by creating anti-racist classrooms. White allies in education can lead their classrooms to respond to racism by developing a JEDI Code that creates a learning environment of belonging. There are five aspects of leadership to create change that are investigated and applied to the development of anti-racist classrooms. The educator, as an anti-racist leader, serves as a change agent, role model, and ethical healthcare practitioner. A "classroom of practice" encourages a culture of belonging among students and creates a structure for all students to grow and develop in the anti-racist space. This commentary aims to acknowledge the culture of racism in healthcare and how it is propagated by current education practices in professional health education programs while investigating teaching and learning strategies that support the evolution of an anti-racist classroom.