Competency-Based Education and Practice in Physical Therapy: It's Time to Act!

Competency-based education (CBE) is a concept, a philosophy, and an approach to educational design where learner progression occurs when competency is demonstrated. It assumes a set of standard defined performance outcomes for any level of professional practice-students, residents, or practicing physical therapists. Those outcomes are based on the health needs of society and guide the curricular design, implementation, and evaluation of health professions education programs. Lack of a CBE framework-with no required demonstration of competence throughout one's career-has the potential to lead to variation in physical therapists' skills and to unwarranted variation in practice, potentially hindering delivery of the highest quality of patient care. CBE requires a framework that includes a commonly understood language; standardized, defined performance outcomes at various stages of learner development; and a process to assess whether competence has been demonstrated. The purpose of this perspective article is to (1) highlight the need for a shared language, (2) provide an overview of CBE and the impetus for the change, (3) propose a shift toward CBE in physical therapy, and (4) discuss the need for the profession to adopt a mindset requiring purposeful practice across one's career to safely and most efficiently practice in a given area. Utilizing a CBE philosophy throughout one's career should ensure high-quality and safe patient care to all-patient care that can adapt to the changing scope of physical therapist practice as well as the health care needs of society. The physical therapy profession is at a point at which we must step up the transition to a competency-based system of physical therapist education.

Contemporary Practice as a Board-Certified Pediatric Clinical Specialist: A Practice Analysis.

PURPOSE: The purpose of the 2019 practice analysis was to identify the elements of contemporary practice as a board-certified pediatric clinical specialist. METHODS: Consistent with the processes of the American Board of Physical Therapy Specialties (ABPTS), a subject matter expert panel used consensus-based processes to develop a survey to gather information concerning the knowledge areas, professional roles and responsibilities, practice expectations, and practice demographics of board-certified pediatric clinical specialists. The web-based survey was divided into 3 parts and administered to 3 separate groups of board-certified pediatric clinical specialists. RESULTS: Survey responses from 323 clinical specialists provided data to support confirmation and revision of the Description of Specialty Practice (DSP) for pediatrics. CONCLUSIONS: The revised DSP will provide contemporary practice information to inform the ABPTS specialist examination blueprint and the curricula of credentialed residency programs in pediatric physical therapy.

Civic-Mindedness Sustains Empathy in a Cohort of Physical Therapy Students: A Pilot Cohort Study.

BACKGROUND: Empathy is critical to patient-centered care and thus is a valued trait in graduate health-care students. The relationship between empathy and civic-mindedness in health professions has not previously been explored. OBJECTIVES: (a) To determine whether significant differences occurred on the Jefferson Scale for Empathy-Health Professions Student Version (JSE-HPS) and Civic-Minded Professional scale (CMP) and its subscales across the curriculum, (b) to explore a potential relationship between civic-mindedness and empathy in a cohort of graduate physical therapy (PT) students at regular intervals, and (c) to explore the predictive ability of civic-mindedness on empathy scores. METHODS: This study was a convenience sample of a cohort of 48 PT students who completed both the JSE-HPS and the CMP at 4 points of a service-learning intensive curriculum. Statistical analysis included descriptive statistics, a Friedman's analysis of variance with Wilcoxon signed-ranks post hoc testing, and Spearman correlations with stepwise linear regressions. RESULTS: Statistically significant differences were not found for the JSE-HPS. Civic-Minded Professional scores increased across the curriculum. The JSE-HPS, the CMP, and various CMP subscales were significantly correlated. The JSE-HPS pretest scores were predictive of the year 1 and 2 posttest JSE-HPS scores. CONCLUSION: This study's findings indicate that service-learning and the resulting development of civic-mindedness supports empathy. Programs could use JSE-HPS pretests to identify individual graduate students need for empathy mentorship upon program entrance or as one admission criterion.

Assimilation of the Pediatric Essential Core Competencies by Professional Physical Therapist Education Programs.

PURPOSE: This study examined the degree to which pediatric essential core competencies (ECCs) are meeting their intended purpose to provide guidance to pediatric educators in professional physical therapy (PT) education programs and to determine facilitators, barriers, and recommendations to implementation of ECCs in curricula. METHODS: Pediatric PT educators from professional PT education programs were recruited to participate in a survey. Descriptive statistics were used to analyze close-ended questions for frequency of responses and content analysis to generate themes. RESULTS: Of the 162 completed surveys, most participants were aware of the ECCs (96%) and used them to inform pediatric curriculum (88%). A mean proportion (86%-95%) of participants perceived their program curricula addressed the ECCs very or moderately well. Multiple themes of facilitators/barriers/recommendations to ECC implementation were determined. CONCLUSIONS: Most pediatric educators are aware of and using the ECCs to guide pediatric education to prepare graduates for pediatric patients/clients.

Educational Research Priorities for Pediatric Physical Therapy: A Consensus Study.

PURPOSE: This study engaged stakeholders internal and external to pediatric physical therapy education in a consensus exercise toward determining and refining priorities and considerations for educational research for pediatric physical therapy. METHODS: The Delphi method was used to survey 54 physical therapists from 5 stakeholder groups drawn from experts in the field of physical therapy education and from Academy of Pediatric Physical Therapy members invested in educational leadership, research, and/or pediatric physical therapy clinical and residency education. RESULTS: A 4-round survey process revealed 12 educational research priorities and 13 educational research considerations that reached 80% consensus, with clear and consistent top ranking of 4 of these priorities and 4 considerations across all stakeholder groups. DISCUSSION: As the Academy of Pediatric Physical Therapy continues to develop and advance its capacity and support for educational research, knowledge of these priorities and considerations might be used to guide an educational research agenda.

Uptake of the Congenital Muscular Torticollis Clinical Practice Guideline Into Pediatric Practice.

PURPOSE: This study describes survey responses about implementation of the congenital muscular torticollis clinical practice guideline (CMT-CPG) by pediatric physical therapists (PT) and successes and challenges with knowledge-brokering activities. METHODS: An online survey was distributed to pediatric PTs who self-identified with practice experience with congenital muscular torticollis. Data were analyzed for implementation frequency of guideline recommendations and differences pre and postpublication of the CMT-CPG. RESULTS: After publication, guideline recommendation implementation improved such that no recommendation was being implemented by less than 50% of respondents, and most were implemented by greater than 90%. The majority of respondents participated in knowledge brokering; however, many indicated minimal effectiveness of those activities. CONCLUSIONS: The CMT-CPG has successfully aided in changing practice. Participants identified areas of challenge and success in translating recommendations into practice and in knowledge brokering that may be helpful for the development of future CPGs.

Perspectives of academic faculty and clinical instructors on entry-level DPT preparation for pediatric physical therapist practice.

BACKGROUND: To prepare students for pediatric practice, the professional (entry-level) curriculum must reflect the essential knowledge, skills, and abilities (KSA) required for pediatric physical therapist practice. OBJECTIVES: The aim of this study was to develop consensus concerning the pediatric-specific KSA that should be expected of doctor of physical therapy (DPT) students at various points in the curriculum: prior to a pediatric clinical education experience, after a pediatric clinical education experience, and at the end of a DPT program. DESIGN AND METHODS: The study was conducted using the Delphi method. Purposive and snowball sampling were used to recruit pediatric academic faculty and pediatric clinical instructors. Three Web-based survey rounds were used to achieve consensus, defined as agreement among ≥70% of informants. The first round identified pediatric-specific KSA that were essential for DPT students to demonstrate at the identified points in the curriculum. In the second round, informants indicated their level of agreement with each item identified in the first round. Items that achieved consensus were included in the third round, in which informants rated the level of proficiency that DPT students should demonstrate related to pediatric-specific KSA. RESULTS: Consensus revealed the informants' perspectives concerning pediatric-specific KSA that a DPT student should be able to demonstrate at the identified curricular points. Consensus was reached on items in the curricular categories of basic science and foundations for practice; common pediatric diagnoses/pathologies, examination, interventions/plan of care/documentation; and general skills and abilities. LIMITATIONS: Limitations included the small sample size and the potential for informants to feel uncomfortable prioritizing KSA. CONCLUSIONS: This study is an initial step toward identifying pediatric-specific KSA that should be demonstrated by DPT students.

Student experiences in creating and launching a student-led physical therapy pro bono clinic: a qualitative investigation.

BACKGROUND: The physical therapy profession has called for the provision of pro bono services. Little is known about the impact on students involved in sustainable pro bono leadership. One physical therapy program established a pro bono physical therapy clinic under the direct leadership of a board of students. OBJECTIVE: The purpose of this study was to describe the experiences of the inaugural members of the Chester Community Physical Therapy Clinic Student Board in creating and launching the student-led pro bono physical therapy clinic. METHODS: A purposive sample of the 18 members participated in semistructured interviews. Content analysis was conducted using a commercially available software program. Trustworthiness was enhanced with credibility, transferability, and confirmability. RESULTS: The emergent categories were: (1) leadership skill development, (2) competency in hands-on clinical and administrative skills, and (3) commitment to both the community and the clinic. Pride emerged as a strong and overarching theme throughout the experience. CONCLUSIONS: The student-led pro bono clinic meets several Commission on Accreditation in Physical Therapy Education criteria in a sustainable manner and serves as a means for measuring and meeting program mission and goals. Participation in the program was a meaningful experience and developed ownership, leadership skills, and pride among the students. There are also possibilities for expanding aspects of the program so that all physical therapist students can benefit from pro bono service opportunities.

The effect of knowledge translation procedures on application of information from a continuing education conference.

PURPOSE: This study investigated the effect of knowledge translation procedures as part of a continuing education conference for pediatric physical therapists on knowledge and frequency of use of tests and measures. METHODS: All attendees (28) were invited to complete a baseline self-report survey on knowledge and frequency of use of skills related to the use of standardized measures. Eleven attendees participated in the additional knowledge translation activities, including a 90-minute session during the conference and follow-up online interaction. RESULTS: On the baseline survey, conference attendees rated themselves higher on frequency of use compared with knowledge. The 8 conference attendees who completed the follow-up survey rated themselves higher in some aspects of knowledge and frequency of use of the skills related to standardized assessment. CONCLUSIONS: The knowledge translation activities were easy to implement and led to positive changes in level of knowledge and frequency of use of tests and measures.

A case report of a student-led pro bono clinic: a proposed model for meeting student and community needs in a sustainable manner.

BACKGROUND AND PURPOSE: The Chester Community Physical Therapy Clinic (clinic) is a student-led pro bono clinic that provides physical therapy services to uninsured and underinsured community members. The purposes of this administrative case report are to describe the creation and implementation of a student-led pro bono clinic model designed to meet student and community needs and to consider its potential for sustainability. CASE DESCRIPTION: Students and faculty created an organizational model with a Student Board at the center of clinic leadership. A Faculty Board provides oversight to the Student Board. State-licensed faculty and alumni provide the direct supervision of the treating student physical therapists. Evaluation of our clinic model was performed using strategies for the creation of sustainable community engagement initiatives. OUTCOMES: This model of a student-led pro bono clinic has elements of all 8 steps to sustainable community engagement. The model of a student-led pro bono clinic is feasible and sustainable. DISCUSSION: A student-led pro bono clinic serving the physical therapy needs of the uninsured and underinsured residents in an urban community presents an innovative educational and leadership development opportunity for students and alumni as well as partnership opportunities with the community.

Effect of hippotherapy on perceived self-competence and participation in a child with cerebral palsy.

This case report highlights changes in self-competence and social acceptance, along with changes in functional skills, after an 8-week program of hippotherapy. A 6-year-old girl with mild ataxic cerebral palsy, level I Gross Motor Functional Classification System, exhibited typical impairments in body systems and functions that affected her participation in age-appropriate functional and leisure activities. The child's performance on the Gross Motor Function Measure-66, the Pediatric Outcomes Data Collection Instrument, and the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children were examined at baseline, after the 8-week intervention, and at a 2-month follow-up session. Data at 8 weeks demonstrated positive changes in all areas, with improvements continuing for 2 months after the program's completion. Hippotherapy not only may be an effective intervention to improve functional gross motor development but also may affect perceived self-competence and social acceptance, which may lead to increases in participation for children with mild cerebral palsy.

Students mentoring students in a service-learning clinical supervision experience: an educational case report.

BACKGROUND AND PURPOSE: Service-learning projects present the opportunity to combine academic skill practice and peer mentorship with meaningful community service. Implicit learning outcomes include an enhanced understanding of social responsibility and professional development-concepts difficult to teach in the classroom. The purpose of this educational case report is to describe the development, application, and outcomes of a service-learning project designed to facilitate peer mentorship and the development of social responsibility. DEVELOPMENT OF THE PROCESS: Widener University mandated that all programs offer student community service opportunities on Martin Luther King Day. In response, the physical therapy program developed a plan to clean and screen assistive and mobility devices and provide blood pressure screening at designated community sites. APPLICATION OF THE PROCESS: All faculty and all members of the first-year and third-year Doctor of Physical Therapy (DPT) classes participated. The students and a faculty member traveled to designated community sites in teams. First-year students were able to practice newly acquired skills under the supervision and peer mentorship of third-year students. OUTCOMES: Outcomes of the service-learning project were assessed through a tally of services rendered, measurement of curricular goal achievement, a survey of the community partners' satisfaction with the event, and consideration of both first-year and third-year DPT student reflection papers. DISCUSSION: The service-learning project was effective in meeting a community need, enhancing community partner relationships, fostering student understandings of social responsibility, and creating a valuable peer mentorship experience.

Interactive metronome training for a 9-year-old boy with attention and motor coordination difficulties.

The purpose of this case report is to describe a new intervention, the Interactive Metronome, for improving timing and coordination. A nine-year-old boy, with difficulties in attention and developmental delay of unspecified origin underwent a seven-week training program with the Interactive Metronome. Before, during, and after training timing, accuracy was assessed with testing procedures consistent with the Interactive Metronome training protocol. Before and after training, his gross and fine motor skills were examined with the Bruininiks-Oseretsky Test of Motor Proficiency (BOTMP). The child exhibited marked change in scores on both timing accuracy and several BOTMP subtests. Additionally his mother relayed anecdotal reports of changes in behavior at home. This child's participation in a new intervention for improving timing and coordination was associated with changes in timing accuracy, gross and fine motor abilities, and parent reported behaviors. These findings warrant further study.

Consensus among experts in pediatric occupational and physical therapy on elements of individualized education programs.

PURPOSE: The aim of this study was to establish consensus among a sample of expert occupational therapy and physical therapy practitioners on characteristics necessary for individualized education program (IEP) objectives to be educationally relevant, measurable, and appropriate in content. METHODS: The Delphi technique was used to survey 38 board-certified clinical specialists from New Jersey, Pennsylvania, and New York. Nine physical therapists and 29 occupational therapists agreed to participate. RESULTS: The results of a three-round survey process revealed six characteristics of measurability, six characteristics of educational relevance, and seven characteristics related to content that were agreed on by 75% or more of the respondents. CONCLUSIONS: While IDEA is being readied for its next reauthorization, knowledge of these characteristics may be helpful to related service professionals in their participation for developing higher quality IEPs.