Higher-Order Clicker Questions Engage Students and Prepare Them for Higher-Order Thinking Activities.

Previous research has shown that the use of clickers in the classroom enhances student engagement. However, few studies have investigated how the type of clicker question may influence learning outcomes. To explore this, we compared the effects of lower-order cognitive skill (LOCS) and higher-order cognitive skill (HOCS) clicker questions on later exam performance in a biology course. During class time, students were presented with clicker questions directly related to unit content. Half of the content units were taught with LOCS, the other half with HOCS. To ensure that type of content did not influence results, the cognitive level of the clicker questions was counterbalanced across two semesters. The exams included a mix of LOCS and HOCS for each content unit. We also investigated the possible moderating effects of student perceptions on the relationship between type of clicker question and exam performance using student surveys. We found that using HOCS clicker questions significantly affects student learning. Practice with HOCS clicker questions improved performance on LOCS exam questions but not on HOCS exam questions. Students ranked lecture with clickers as a preferred and most helpful teaching methodology. Overall, these results suggest that practice with HOCS questions is engaging and gives students practice recalling content to "solve" a problem, thereby encoding low-level information and preparing them for higher-order thinking activities.

National Study of Excellence in Pediatric Physical Therapy Education: Design, Methods, and Results.

OBJECTIVE: The purposes of this study were to identify and describe the attributes of excellence and innovation in professional pediatric physical therapy education and develop a conceptual framework identifying dimensions of excellence. METHODS: A multimethod case study design based on a grounded theory framework was used. Data collection included review of artifacts and field interviews (individual and focus group). A constant-comparative method for within case and across case was used for data analysis to verify and revise coding schemes, identify categories and subcategories, revise emerging themes, and develop a conceptual framework. RESULTS: Based on results of a predetermined grading rubric, 6 of 17 self-nominated academic sites were selected representing diverse institution types (public/private, Carnegie classification, size) and geographic locations. Pedagogical approaches and method of content delivery varied among programs; all used the essential core competencies. The core pediatric faculty member(s) were Board Certified Clinical Specialists. A conceptual framework was developed based on 4 key dimensions: Culture of Excellence, Exemplary Pediatric Faculty, Pedagogy, and Child and Family as Teacher (CFT), and 16 related elements. CONCLUSIONS: CFT is a unique and nonnegotiable dimension of excellence in pediatric physical therapy education, highlighting the partnership between the learner, child, family, and pediatric faculty member. CFT intersects with the other dimensions and integrates their elements (ie, faculty characteristics, contributions from the child and family, use of instructional strategies) to effectively prepare future pediatric physical therapists. Based on the pervasiveness of this dimension in teaching and learning across all programs, this may be the signature pedagogy of pediatric physical therapy education. IMPACT: Results of this study are important to professional physical therapist education administrators, pediatric academic faculty, and clinical educators because they represent an understanding of the attributes of excellence. The model can serve as a guide for best practice in pediatric physical therapy education.

Utilization of the Pediatric Modified Dynamic Gait Index: Issues Related to Child Development.

Aims: This cross-sectional study investigated how typically developing children performed on a version of the Dynamic Gait Index, modified for children (Pediatric Modified DGI). Methods: Seventy-four typically developing children, ages 7-18 years, were evaluated using the Pediatric Modified DGI. Scores were analyzed in three age groups using descriptive statistics for age-related performance. The Kruskal-Wallis and Mann-Whitney U tests were used to evaluate group differences. Results: Children performed differently on the Pediatric Modified DGI between the three groups (Kruskal-Wallis H(2) = 18.819, p < .05). Mann-Whitney U post hoc testing identified significant differences between the 7 to 10 and the 15 to 18-year-old groups (U = 128.5, p = .000, r = -.54) and between the 11 to 14 and the 15 to 18-year-old groups (U = 139, p = .001, r = -.46). Pediatric modified DGI scores were notably different between the three age groups on three of the items: horizontal head turn, vertical head turn, and pivot turn. Conclusions: Children's age appears to impact performance on the pediatric modified DGI, which should be considered when using this tool to examine functional mobility. Future studies should explore functional mobility assessments that consider sensory system development.

Moving Toward Excellence in Pediatric Physical Therapy Education: A Scoping Review.

PURPOSE: The purpose of this scoping review was to identify and map current evidence that underpins excellence in pediatric physical therapy education. METHODS: An extensive review was conducted of literature published over a 27-year period regarding pediatric physical therapy/medical/allied health education. RESULTS: Thirty articles were reviewed and analyzed. Articles were classified as levels of evidence 4 to 7. Three major overarching concepts emerged: faculty characteristics, curriculum, and pedagogy. CONCLUSIONS: Few published studies with methodological rigor exist on this topic. More research and higher quality studies are needed to identify exemplar programs, curriculum, and pedagogy. The key concepts identified in this review will help inform the definition of excellence, as it is perceived through the lens of pediatric physical therapy educators, clinicians, and students.

Validity and reliability pilot study of a tool for assessing ambulatory care pharmacist practice.

PURPOSE: The reliability and validity of a survey tool that aims to assess and stratify patient care services provided by ambulatory care pharmacists were evaluated. METHODS: The Tool for Assessing Ambulatory Care Pharmacist Practice (TAAPP) was developed by updating the Pharmaceutical Care Clinical Pharmacist Questionnaire. The TAAPP is organized into 2 sections that include 5 domains derived from the Pharmacists' Patient Care Process (PPCP). The first section of the TAAPP gathers the demographic information of the respondents as well as practice site characteristics. The second section aims to assess the activities that ambulatory care pharmacists participate in when providing direct patient care, stratified by PPCP domains. After the TAAPP was created, face validity was established by the study investigators and content validity was confirmed by 5 experts in ambulatory care pharmacy. Lastly, a reliability study was conducted and included pharmacists providing ambulatory care services in outpatient clinics who had been working at their clinical practice site for at least 2 years. The survey was disseminated electronically through a national pharmacy organization listserver. RESULTS: The results of this pilot study support both face and content validity of the TAAPP survey as well as internal consistency reliability of the TAAPP scores when used to evaluate pharmaceutical practices of ambulatory care pharmacists practicing in outpatient clinics throughout the United States. CONCLUSION: Internal consistency reliability testing demonstrated that the TAAPP scores were reliable with a Cronbach's α of >0.7 for each domain and the TAAPP overall.

Innovation in pediatric clinical education: application of the essential competencies.

BACKGROUND: At the Section on Pediatrics Education Summit in July 2012, consensus was achieved on 5 essential core competencies (ECCs) that represent a knowledge base essential to all graduates of professional physical therapist education programs. KEY POINTS: This article offers suggestions for how clinical instructors (CIs) might use the ECCs to identify student needs and guide student learning during a pediatric clinical education experience. Pediatric CIs potentially might choose to use the ECCs as a reference tool in clinical education to help (1) organize and develop general, clinic-specific clinical education objectives, (2) develop and plan individualized student learning experiences, (3) identify student needs, and (4) show progression of student learning from beginner to intermediate to entry level. CONCLUSIONS: The ECCs may offer CIs insights into the role of pediatric clinical education in professional physical therapist education.

Heterogeneity and plasticity in the development of language: a 17-year follow-up of children referred early for possible autism.

BACKGROUND: Delayed, abnormal language is a common feature of autism and language therapy often a significant component of recommended treatment. However, as with other disorders with a language component, we know surprisingly little about the language trajectories and how varied these might be across different children. Thus, we know little about how and when language problems might resolve, whether there are periods of relative stability or lack of change and what periods might offer more favourable circumstances for intervention. METHODS: Expressive and receptive language was measured on six occasions between age 2 and 19 on a cohort of 192 children initially referred for autism. Latent class growth models were fitted to characterize the patterns of heterogeneous development. RESULTS: Latent class growth analysis identified seven classes. Between age 6 and 19, all classes tracked in parallel. Between ages 2 and 6, development was more heterogeneous with considerable variation in relative progress. In all groups, receptive and expressive language developed very largely in tandem. CONCLUSIONS: The results confirmed previous analysis of children with specific language impairment where progress beyond age 6 was remarkably uniform. Greater variation was evident before this age with some groups making clearly better or worse progress compared to others. While this developmental heterogeneity may simply be a reflection of variation in preexisting and unchanging biological disposition, it may also reflect, at least in part, greater sensitivity in the early years to environments that are more or less supportive of language development. These findings contribute to the case for the importance of early intervention.

Predicting young adult outcome among more and less cognitively able individuals with autism spectrum disorders.

BACKGROUND: The range of outcomes for young adults with Autism Spectrum Disorders (ASD) and the early childhood factors associated with this diversity have implications for clinicians and scientists. METHODS: This prospective study provided a unique opportunity to predict outcome 17 years later for a relatively large sample of children diagnosed with ASD at 2 years old. Diagnostic and psychometric instruments were administered between 2 and 19 with data from 2, 3, and 19 included in this study. Clinicians administered tests without knowledge of previous assessments whenever possible. Caregivers provided additional information through questionnaires. RESULTS: Significant intellectual disabilities at 19 were predicted by age 2 about 85% of the time from VIQ and NVIQ scores together, though prediction of young adult outcome for youths with average or higher intelligence was more complex. By 19, 9% of participants had largely overcome core difficulties associated with ASD and no longer retained a diagnosis. These youths with Very Positive Outcomes were more likely to have participated in treatment and had a greater reduction in repetitive behaviors between age 2 and 3 compared to other Cognitively Able youths (VIQ ≥70) with ASD. Very Positive Outcome youths did not differ phenotypically from Cognitively Able ASD individuals at 2 but both groups differed from Cognitively Less Able individuals (VIQ <70). CONCLUSION: Those most at risk for intellectual disabilities and ASD can be reliably identified at an early age to receive comprehensive treatment. Findings also suggest that some cognitively able children with ASD who participate in early intervention have very positive outcomes, although replication with randomized, larger samples is needed. In order to improve understanding of very positive outcomes in ASD, future research will need to identify how variations in child characteristics and environmental factors contribute to the nature and timing of growth across individuals and areas of development.

Self-assessment of professionalism in physical therapy education.

OBJECTIVE: With the physical therapy (PT) professions' advancement to the clinical doctorate degree and the promotion of autonomous practice, exemplary professional conduct is an expectation of the PT profession. PT education programs are being challenged to develop methods to teach and assess professional behavior. PARTICIPANTS: Forty-three PT students (11 male and 32 female, ages 20-28 years) completed the APTA Professionalism in Physical Therapy: Core Values Self-Assessment (PPTCVSA) after their first 3 week clinical experience and again after their final clinical experience. METHODS: A mixed design ANOVA compared participants' total scores and individual Core Value scores on the Professionalism in Physical Therapy: Core Values Self-Assessment (PPTCVSA) after 3 and 33 weeks of clinical education. The effects of gender, age, and undergraduate area of study on growth in professionalism scores were also investigated. RESULTS: Total PPTCVSA scores and individual Core Value scores on professionalism (accountability, altruism, compassion/caring, excellence, integrity, professional duty, and social responsibility) were higher after 33 weeks compared to scores after 3 weeks of clinical education. Female student's total professionalism scores were higher than male student's scores on both the first and second self-assessments. In addition, female students scored themselves higher than their male peers on accountability, excellence, integrity, and professional duty. CONCLUSIONS: Improved scores on the PPTCVSA indicate that physical therapy education is playing an important role in the development of professional behavior, knowledge, and application in practice.

Changes in maladaptive behaviors from midchildhood to young adulthood in autism spectrum disorder.

The current study prospectively examined trajectories of change in symptoms of irritability, hyperactivity, and social withdrawal, as well as predictors of such behaviors, for ages 9-18 years for youths with autism spectrum disorder and a comparison group with nonspectrum developmental delays. Children with more severe core features of autism had consistently higher irritability and hyperactivity scores over time than those with broader autism spectrum disorder and nonspectrum delays. Across all diagnoses, behaviors related to hyperactivity showed the greatest improvement. Social withdrawal worsened with age for a substantial proportion of youths with autism spectrum disorder but not for the nonspectrum comparison group. Compared with youths without autism spectrum disorder, children with the disorder showed greater heterogeneity in trajectories for maladaptive behaviors.

Patterns of growth in adaptive social abilities among children with autism spectrum disorders.

Adaptive social skills were assessed longitudinally at approximately ages 2, 3, 5, 9, and 13 years in a sample of 192 children with a clinical diagnosis of autism (n = 93), PDD-NOS (n = 51), or nonspectrum developmental disabilities (n = 46) at age 2. Growth curve analyses with SAS proc mixed were used to analyze social trajectories over time. Both individual characteristics and environmental resources emerged as key predictors of adaptive social behavior outcome. The gap between children with autism and the other two diagnostic groups widened with time as the social skills of the latter groups improved at a higher rate. However, within diagnostic groups, improvement ranged from minimal to very dramatic. Children with autism most at risk for problems with social adaptive abilities later in life can be identified with considerable accuracy at a very young age so they can be targeted for appropriate early intervention services.

Patterns of growth in verbal abilities among children with autism spectrum disorder.

Verbal skills were assessed at approximately ages 2, 3, 5, and 9 years for 206 children with a clinical diagnosis of autism (n = 98), pervasive developmental disorders-not otherwise specified (PDD-NOS; n = 58), or nonspectrum developmental disabilities (n = 50). Growth curve analyses were used to analyze verbal skills trajectories over time. Nonverbal IQ and joint attention emerged as strong positive predictors of verbal outcome. The gap between the autism and other 2 groups widened with time as the latter improved at a higher rate. However, there was considerable variability within diagnostic groups. Children with autism most at risk for more serious language impairments later in life can be identified with considerable accuracy at a very young age, while improvement can range from minimal to dramatic.

Leaving an abusive partner: an empirical review of predictors, the process of leaving, and psychological well-being.

Four facets of leaving an abusive relationship are reviewed: (a). factors related to initially leaving an abusive partner; (b). the process of leaving an abusive relationship; (c). the psychological well-being of survivors after leaving; and (d). the predictors of this well-being. The conceptual and methodological limitations of studies in each of these areas are presented. Consistently found predictors of leaving include both material and psychological factors. Because battered women typically undergo several shifts in their thinking about the abuse before leaving permanently, research on leaving as a process is highlighted. A stress-process framework is used to explain the seemingly paradoxical finding that some women just out of the abusive relationship may have greater psychological difficulties than those who are still in it. For those experiencing the most stress, psychological health can worsen over time. Researchers and practitioners need to pay more attention to the plight of women who have left abusive partners.