Identifying Perspectives on Physical Therapist Residency Program Goals: Hallmarks of Success and Excellence.

OBJECTIVE: The purpose of this study was to describe common perspectives important to achieving excellence and success in physical therapist residency education programs. METHODS: Individuals with direct responsibility for creating and revising physical therapist residency program goals participated in a mixed-methods study using Q-methodology. They sorted 31 goal topics based on the level of importance for achieving excellence and success in physical therapist residency education. By-participant factor analysis identified dominant perspectives, which were interpreted based on emergent themes from the topics identified as the most important. Participants' rationale for selecting goal topics as the most important were extracted from the post-survey. RESULTS: Seventy-three individuals responded, representing 9 of the 11 clinical residency areas of practice. Three main perspectives emerged: resident behaviors, resident achievements, and program attributes. One shared perspective emerged across all 3 factors that emphasized the residents' ability to become self-regulated, lifelong learners who integrate learning into practice: preparation for future learning. CONCLUSIONS: Variability in weighting the importance of program goals associated with each perspective may include a program's organization and mission, individual beliefs and experiences related to program leadership, and resource availability. Although respondent emphasis placed importance of some items over others, the findings do not suggest that items ranked lower were unnecessary or unimportant in achieving program excellence. The relative importance of items was weighted differently based on the perspective of program leadership and the individual completing the sorting activity. IMPACT: The results of this study suggest that physical therapist residency programs should have at least 1 or 2 goals in each of the 3 distinct perspectives, as well as the 1 shared perspective identified in our findings. Some consistency in program goals based on the perspectives identified here may enable further research exploring excellence, value, and outcomes in physical therapist residency education.

Comparisons of Clinical Competency and Job Responsibilities of Physical Therapists With and Without Postprofessional Training.

INTRODUCTION: Understanding how educational pathways may influence clinical competence and work responsibilities is important in providing guidance to academic and clinic stakeholders and physical therapists (PTs) on PT career development. The purpose of this paper was to compare perceived clinical competency and job duties between PTs with formal mentored postprofessional clinical education with PTs without formal postprofessional clinical education. REVIEW OF LITERATURE: The understanding of self-perceived clinical competence of PTs overall in the United States is limited, especially as related to the impact of postprofessional education. Furthermore, there is limited understanding of the career pathways and development of job duties of PTs in the United States. SUBJECTS: Two thousand three hundred thirty-four PTs in the United States. METHODS: An online survey was sent to licensed PTs. This survey included items measuring self-perceived clinical competency and questions related to weekly job responsibilities. Participants were categorized as residency trained, fellowship trained, or non-residency/fellowship trained. Frequency analyses and Kruskal-Wallis tests with pairwise post hoc tests were performed comparing the 3 groups. RESULTS: Residency-trained (P < .007) and fellowship-trained (P < .001) groups demonstrated elements of higher self-perceived clinical competency compared with the non-residency-/fellowship-trained group. Both the residency- and fellowship-trained groups spent less time with patient care and more time with other responsibilities (e.g., teaching, mentoring, and research) (P < .02) during an average workweek. Fellowship-trained PTs (P < .001) spent more time with administrative duties compared with the non-residency-/fellowship-trained group. DISCUSSION AND CONCLUSION: Results from this paper demonstrate that residency- and fellowship-trained PTs have elements of higher self-perceived clinical competency and spend more of their job duties outside of direct patient care compared with PTs who were not residency or fellowship trained. These results may help guide PTs, academic institutions, and employers in planning and achieving specific career paths.

Physical Therapist Residency Competency-Based Education: Development of an Assessment Instrument.

OBJECTIVE: The objective of this study was to develop generic domains of competence (DoC) with associated competencies and milestones for physical therapist residency education. This work was intended to culminate in establishing validity evidence to support a competency-based assessment instrument that could be used by residency programs to evaluate resident achievement of the competencies, regardless of specialty area. METHODS: Employing the modified Delphi method, a residency education work group developed an evaluation instrument that included 7 DoC and 31 associated competencies with 6 milestones as rating scales for each competency. The instrument was distributed to mentors and residents in accredited physical therapist residency programs to establish validity evidence. Evaluations (measured by milestones) and demographics were collected at 3 time points (program entry, midterm, and final). Scores across these time points were compared using Kruskal-Wallis tests. Reliability was assessed with kappa statistics (interrater reliability) and alpha reliability coefficients (internal consistency). Construct validity was examined using confirmatory factor analysis via structural equation modeling. RESULTS: Overall, 237 mentors and 228 residents completed 824 evaluations (460 by mentors and 364 resident self-evaluations) across the time points. Scores significantly increased from entry through final time points. The interrater reliability of the associated behaviors ranged from moderate to substantial agreement (κ = 0.417-0.774). The internal consistency was high for all DoC at every time point (α reliability coefficients = .881-.955 for entry, .857-.925 for midterm, and .824-.902 for final). After confirmatory factor analysis with structural equation modeling was performed, a model that included 7 DoC and 20 associated competencies was proposed. CONCLUSIONS: The residency assessment instrument developed demonstrates interrater reliability and validity evidence and therefore supports competency-based assessment of resident clinical performance across specialty areas. Additionally, the instrument aligns the physical therapy profession with other professions, such as medicine, dentistry, and pharmacy, that have transitioned to competency-based education. IMPACT: This study outlines the benefits of moving to competency-based education for physical therapist residents, using a sound evaluation tool that evaluates residents across specialty areas. The instrument will allow for transition to competency-based education in physical therapist residency education programs.

Program-Level Factors Influencing Positive Graduate Outcomes of Physical Therapy Residency Programs.

Background: Physical therapist clinical residency programs vary widely in administrative structure, instructional characteristics, and program design. The impact of program-level factors on resident outcomes such as graduation and board certification is unknown. Objective: The objective of this study was to examine the influence of program-level factors on participant outcomes of physical therapist residency programs. Design: This was a retrospective cohort study using data from accredited programs from 2010 to 2013. Methods: Data were collected on program characteristics such as administrative structure, size, salary, tuition, full- or part-time options, didactic format, and clinical-site structure. The odds ratios were calculated to examine the impact of program characteristics on graduation, board certification, and passing the exam. A logistic regression analysis to determine the combined contribution of these characteristics on the 3 outcomes was performed. Results: Data from 183 residency programs and 1589 residents were analyzed. Participants attending programs that were single site or multifacility, provided live didactic instruction, did not charge tuition, and paid residents ≥ 70% full-time equivalent salary were 9.8 times more likely to graduate, 5.1 times more likely to become board certified, and 3.2 times more likely to pass the specialty board examination. Limitations: This study did not examine the impact of program location, resident attributes, or resident exposure to patient diagnostic volume and variety. Conclusions: This study has identified some program-level factors that appear to influence the odds of graduating, becoming board-certified, and passing the specialty board examination. This information could inform existing and developing residency programs, as well as applicants, on program-level factors that might influence participant outcomes.

Physical therapist management of chronic prostatitis/chronic pelvic pain syndrome.

BACKGROUND AND PURPOSE: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) negatively affects quality of life and sexual function in men of all ages. Typical treatment with antibiotic and antimicrobial drugs often is not successful. The purpose of this case report is to describe a multimodal physical therapy intervention that included manual therapy techniques applied to the pelvic floor in 2 patients who were unsuccessfully treated with the biomedical model of prescription drug therapies. CASE DESCRIPTION: Two men, aged 45 years and 53 years and diagnosed with chronic prostatitis, were referred for physical therapy following unsuccessful pharmacological treatment. The patients were treated with manual therapy techniques applied to the pelvic floor and instructed in progressive muscle relaxation, flexibility exercises, and aerobic exercises. OUTCOMES: Changes in the patients' National Institutes of Health Chronic Prostatitis Symptom Index revealed differences between preintervention and postintervention scores reflecting decreased pain and improved quality of life. One patient improved from a score of 25 (total possible score = 43) before treatment to a score of 0 after treatment, and the other patient improved from a score of 29 to a score of 21. DISCUSSION: Manual therapy techniques applied to the pelvic floor and performed by a physical therapist specially trained in these techniques, along with progressive muscle relaxation, flexibility exercises, and aerobic exercises, appeared to be beneficial to both patients in reducing pain and improving sexual function.

Managing a patient's constipation with physical therapy.

BACKGROUND AND PURPOSE: Constipation is a prevalent condition in the United States, with typical treatment consisting of diet modification, stool softeners, and laxatives. These interventions, however, are not always effective. The purpose of this case report is to describe the use of abdominal massage in physical therapist management for a patient with constipation. CASE DESCRIPTION: An 85-year-old woman with constipation was referred for physical therapy following unsuccessful treatment with stool softeners. The patient was instructed in bowel management as well as a daily, 10-minute home abdominal massage program. OUTCOMES: Upon re-examination, the patient reported a return of normal bowel frequency and function without the need to strain or use digital evacuation. DISCUSSION: Physical therapy incorporating abdominal massage appeared to be helpful in resolving this patient's constipation. Unlike medical management of constipation, no known side effects have been identified with abdominal massage.