Improving Health through Action on Economic Stability: Results of the Finances First Randomized Controlled Trial of Financial Education and Coaching in Single Mothers of Low-Income.

OBJECTIVES: Evaluate the health impact of a novel financial education and coaching program in single mothers of low-income in Omaha, Nebraska. METHODS: Employed, single mothers earning no more than 200% of the 2017 Federal Poverty Level (n = 345) enrolled in the study between April 2017 and August 2020 and were randomized to receive a novel financial education and coaching program, the Financial Success Program (FSP) or no intervention control. Demographics, biometrics, financial strain, health behaviors and healthcare utilization were assessed at baseline and the 12-month study visits. RESULTS: Participants who completed the FSP demonstrated significantly reduced financial strain, an increased rate of smoking cessation, and a reduction in avoidance of medical care due to cost compared to participants in the control group. CONCLUSIONS: The FSP represents an effective model in promoting economic stability in vulnerable individuals through a reduction in financial strain. Health behavior changes including an increased rate of smoking cessation were demonstrated within the first 12 months of intervention.

Excellence in Pediatric Physical Therapy Education: Recommendations and Action Items.

PURPOSE: This special communication identifies evidence-based recommendations and offers action items to facilitate the uptake of new knowledge from the National Study of Excellence in Pediatric Physical Therapy Education (NSE-Peds). SUMMARY OF KEY POINTS: The NSE-Peds identified a conceptual framework consisting of 4 key dimensions and associated elements that dynamically interact to prepare future physical therapists to meet the needs of society. The conceptual framework serves as the Knowledge Creation component of the knowledge to action (KTA) framework, but translation into practice requires the Action Cycle, the second component of the KTA framework. Recommendations and action items provide tangible products derived from the NSE-Peds conceptual framework for application in the Action Cycle. CONCLUSIONS: Using the KTA framework, implementation of the recommendations at the level of the individual, program, and organization should enhance pediatric physical therapy education and ultimately physical therapy care provided to children and families.

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.

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.

Clinical narratives in residency education: Exploration of the learning process.

Background: Post-professional residency educational programs aim to advance the knowledge and skills of therapists in a clinical specialty area, however, little is known about the process, outcomes, or effectiveness of residency education. Purpose: The purpose of this study was to use narrative as a teaching and learning tool to gain insight into the progressive development of the residents' learning process. Design: Qualitative methods including a retrospective analysis of residents' narratives were used to explore the professional development and thought process of residents. Methods: Six physical therapy residents wrote reflective narratives across 4 time placements during their one-year residency. Qualitative content analysis was used to analyze the data for types of reflection across time frames and to construct themes based on meaning statements. Results: Four main themes evolved from the residents' clinical narratives: 1) developing clinical reasoning skills; 2) developing professional formation and identity; 3) moral agency; and 4) emerging characteristics of expertise Conclusions: In this study, clinical narratives served as a pedagogical tool to enhance aspects of clinical expertise. The utilization of clinical narrative may be used as one tool to help to create reflective practitioners with improved skills foundational to clinical practice.

Clinical Reasoning: Survey of Teaching Methods, Integration, and Assessment in Entry-Level Physical Therapist Academic Education.

Background: Although clinical reasoning abilities are important learning outcomes of physical therapist entry-level education, best practice standards have not been established to guide clinical reasoning curricular design and learning assessment. Objective: This research explored how clinical reasoning is currently defined, taught, and assessed in physical therapist entry-level education programs. Design: A descriptive, cross-sectional survey was administered to physical therapist program representatives. Methods: An electronic 24-question survey was distributed to the directors of 207 programs accredited by the Commission on Accreditation in Physical Therapy Education. Descriptive statistical analysis and qualitative content analysis were performed. Post hoc demographic and wave analyses revealed no evidence of nonresponse bias. Results: A response rate of 46.4% (n=96) was achieved. All respondents reported that their programs incorporated clinical reasoning into their curricula. Only 25% of respondents reported a common definition of clinical reasoning in their programs. Most respondents (90.6%) reported that clinical reasoning was explicit in their curricula, and 94.8% indicated that multiple methods of curricular integration were used. Instructor-designed materials were most commonly used to teach clinical reasoning (83.3%). Assessment of clinical reasoning included practical examinations (99%), clinical coursework (94.8%), written examinations (87.5%), and written assignments (83.3%). Curricular integration of clinical reasoning-related self-reflection skills was reported by 91%. Limitations: A large number of incomplete surveys affected the response rate, and the program directors to whom the survey was sent may not have consulted the faculty members who were most knowledgeable about clinical reasoning in their curricula. The survey construction limited some responses and application of the results. Conclusions: Although clinical reasoning was explicitly integrated into program curricula, it was not consistently defined, taught, or assessed within or between the programs surveyed-resulting in significant variability in clinical reasoning education. These findings support the need for the development of best educational practices for clinical reasoning curricula and learning assessment.

Physical Therapy Residency and Fellowship Education: Reflections on the Past, Present, and Future.

The physical therapy profession continues to respond to the complex and changing landscape of health care to meet the needs of patients and the demands of patient care. Consistent with this evolution is the rapid development and expansion of residency and fellowship postprofessional programs. With the interested number of applicants exceeding the number of residency and fellowship slots available, a "critical period" in the educational process is emerging. The purposes of this perspective article are: (1) to analyze the state of residency and fellowship education within the profession, (2) to identify best practice elements from other health professions that are applicable to physical therapy residency and fellowship education, and (3) to propose a working framework grounded in common domains of competence to be used as a platform for dialogue, consistency, and quality across all residency and fellowship programs. Seven domains of competence are proposed to theoretically ground residency and fellowship programs and facilitate a more consistent approach to curricular development and assessment. Although the recent proliferation of residency and fellowship programs attempts to meet the demand of physical therapists seeking advanced educational opportunities, it is imperative that these programs are consistently delivering high-quality education with a common focus on delivering health care in the context of societal needs.

Experiential Learning With Children: An Essential Component of Professional Physical Therapy Education.

PURPOSE: The Section on Pediatrics of the American Physical Therapy Association has developed a number of resources to support and improve the consistency of professional pediatric physical therapy education, including a set of core competencies that all graduates must attain. The purpose of this article is to advocate for the inclusion of experiential learning activities with children, including children with participation restrictions, as a necessary component to achieve the core competencies. KEY POINTS: Experiential learning is a form of practice-based education that provides exposures and opportunities for students to explore the work, roles, and identities they will encounter as future professionals. Experiential learning is learning by doing, and occurs within a relevant setting. Six representative curricular exemplars are presented to provide readers with a variety of suggestions for development and integration of experiential learning. SUMMARY: Recommendations for future research are provided and 4 key recommendations are provided.

Connecting Classroom, Clinic, and Context: Clinical Reasoning Strategies for Clinical Instructors and Academic Faculty.

BACKGROUND: Clinical reasoning is an essential skill in pediatric physical therapist (PT) practice. As such, explicit instruction in clinical reasoning should be emphasized in PT education. KEY POINTS: This article provides academic faculty and clinical instructors with an overview of strategies to develop and expand the clinical reasoning capacity of PT students within the scope of pediatric PT practice. Achieving a balance between deductive reasoning strategies that provide a framework for thinking and inductive reasoning strategies that emphasize patient factors and the context of the clinical situation is an important variable in educational pedagogy. TEACHING IMPLICATIONS: Consideration should be given to implementing various teaching and learning approaches across the curriculum that reflect the developmental level of the student(s). Deductive strategies may be helpful early in the curriculum, whereas inductive strategies are often advantageous after patient interactions; however, exposure to both is necessary to fully develop the learner's clinical reasoning abilities. VIDEO ABSTRACT: For more insights from the authors, see Supplemental Digital Content 1, available at http://links.lww.com/PPT/A87.

Essential competencies in entry-level pediatric physical therapy education.

BACKGROUND: The Section on Pediatrics (SoP) convened an Education Summit in July 2012 to examine, discuss, and respond to documented inconsistencies and challenges in teaching pediatric physical therapy (PT) content in entry-level professional education programs. Despite previous attempts by the SoP to provide guidance around teaching pediatric PT, variability continued to be extensive across programs. KEY POINTS: This article presents the core competencies developed out of the Summit to inform pediatric content in the entry-level PT curriculum. In addition, the core competencies were linked to teaching strategies, learning activities, assessment outcomes, and curricular structures. STATEMENT OF CONCLUSIONS: Consensus was reached on 5 core competencies that represent a knowledge base essential to all graduates of PT programs. In contrast to prior SoP documents, these competencies were specifically designed to focus on knowledge and skills unique to pediatric practice but essential for all graduates of accredited entry-level PT education programs. VIDEO ABSTRACT: For more insights from the authors, see Supplemental Digital Content 1, at http://links.lww.com/PPT/A50.

Describing the clinical reasoning process: application of a model of enablement to a pediatric case.

BACKGROUND AND PURPOSE: Clinical reasoning is a core tenet of physical therapy practice leading to optimal patient care. The purpose of this case was to describe the outcomes, subjective experience, and reflective clinical reasoning process for a child with cerebral palsy using the International Classification of Functioning, Disability, and Health (ICF) model. CASE DESCRIPTION: Application of the ICF framework to a 9-year-old boy with spastic triplegic cerebral palsy was utilized to capture the interwoven factors present in this case. Interventions in the pool occurred twice weekly for 1 h over a 10-week period. OUTCOMES: Immediately post and 4 months post-intervention, the child made functional and meaningful gains. The family unit also developed an enjoyment of exercising together. Each individual family member described psychological, emotional, or physical health improvements. DISCUSSION: Reflection using the ICF model as a framework to discuss clinical reasoning can highlight important factors contributing to effective patient management.

Reflections from an interprofessional education experience: evidence for the core competencies for interprofessional collaborative practice.

The Core Competencies for Collaborative Practice identify the skills needed by every health care provider to be successful in implementing interprofessional practice. Health professions students need to build skills for interprofessional practice as emerging professionals. Reflection is a core skill needed for successful interprofessional practices. This study identifies themes from an interprofessional education research project and discusses their congruency with the Competencies.

Student perceptions of a community engagement experience: exploration of reflections on social responsibility and professional formation.

Physical therapy educators are challenged to emphasize the importance of social responsibility as a vital curricular element of professional development. Through reflection, students are able to identify core values, beliefs, and attitudes as part of the professional development process. The purpose of this study was to explore student perceptions and values of a community engagement experience based upon frequency of participation. This qualitative research report investigated student perceptions of the community experience following participation. Data collection tools included an open-ended questionnaire and focus group interviews. Comparisons were made across data for participants who engaged in the activity one time versus multiple times. Data analysis revealed participation in the community engagement experience had a positive impact on most participants. One time only participants demonstrated increased self-awareness, contemplating change, and capacity to serve while more than one time participants described a deeper understanding of community, impact on others, and professional transformation. Student involvement in community engagement activities combined with structured reflection provided meaningful insight into participants' personal beliefs. The results suggest incorporation of community-based learning experiences into academic curriculum may be beneficial in the students' preliminary understanding of social responsibility.

Impact of an interprofessional community-based educational experience on students' perceptions of other health professions and older adults.

Caring for older adults has become increasingly complex due to multiple health and societal factors. The purpose of this study was to evaluate the impact of an interprofessional community-based educational project on students' attitudes toward other health care professions and older adults. A pretest and posttest quasi-experimental research design was implemented with 64 participating students from four health care professions (nursing, occupational therapy, physical therapy, and pharmacy). These students completed the Interdisciplinary Education Perception Scale (IEPS) and Survey of Attitudes on Aging Scale (SAAS) before and following an educational experience with older adults. Qualitative data were collected through student reflection journals and focus groups with participating students. The results of the study showed that interprofessional community-based learning had a significant impact on some students' attitudes toward older adults. The difference between pretest and posttest reached a statistically significant level on the SAAS in occupational therapy (p = 0.013) and physical therapy students (p = 0.044). No significant differences, however, were found between the pretest and posttest in pharmacy (p = 0.097) or nursing students (p = 0.144). Similarly, the experience also had a positive impact on some students' perceptions of other health care professions as measured by the IEPS. A significant difference was found between the pretest and posttest in occupational therapy (p = 0.000) and physical therapy students (p = 0.028). This study indicates that interprofessional community-based learning can be an effective method for some students to increase their understanding and respect toward other health professionals and older adults.