Ensuring Quality: Are We Doing Enough to Protect Our Profession? No abstract available

Developing Habits of the Heart: 22nd Polly Cerasoli Lecture No abstract available

Exploring Experiences of Organizational Socialization Among Physical Therapy and Athletic Training Junior Faculty Members Introduction. Organizational socialization is a process by which institutions assist new faculty members' transition to their expected roles. These may include orientation sessions, mentoring pairings, and ongoing faculty development opportunities. There is a paucity of research identifying the experiences and perceptions of organizational socialization for physical therapy and athletic training junior faculty members. The purpose of this study is to gain a better understanding of the organizational socialization process for these two groups. Subjects. Junior faculty members in the fields of physical therapy (13) and athletic training (13) participated in this phenomenological qualitative study. Methods. Data were collected in a single phone interview, which was digitally recorded and transcribed verbatim. Transcripts were analyzed following the steps of Interpretive Phenomenological Analysis. Expert review, multiple analyst triangulation, and member checking served to ensure trustworthiness of the findings. Results. Organizational socialization of junior faculty in athletic training and physical therapy revolves around the components of orientation activities and collegial workplace environments. Orientation activities are part of the onboarding process and usually include a formal session to learn about roles and responsibilities. Orientation can positively impact a faculty member's understanding of their role and integration to the culture of their institution. Collegial work environments are those where experienced faculty play an active role in supporting junior members. Because they provide junior faculty some freedom and flexibility in choice of mentor, informal mentoring relationships seem to be integral to this collegial environment. Conclusion. Though these areas may form an important foundation for organizational socialization, additional solutions are needed to optimize the processes by which new faculty are trained. Administrators and institutions should strive to create innovative orientation and onboarding programs that aid newly hired educator's integration.

The Utilization of Spinal Thrust Manipulation by Physical Therapists in New York State Introduction. The purpose of this study was to evaluate the utilization of spinal thrust manipulation in the management of patients with low back pain (LBP) among physical therapists from New York State (NYS), as well as to evaluate physical therapist knowledge of a lumbar spine manipulation clinical prediction rule (CPR) and whether their NYS physical therapy practice act allows for spinal thrust manipulation to be performed. Materials and Methods. We invited the 300 physical therapy clinics from NYS who serve as clinical instruction sites for the Department of Physical Therapy at Daemen College in Amherst, NY, to participate in this survey-based study. One hundred fifty physical therapists completed the survey and were included in the analysis (54% were female and 45.3% were male; 1 respondent did not answer); the mean number of years of physical therapy practice of the participants was 13.3 ± 9.9 years (range, 1–44 years). Participants were invited to complete a survey that was comprised of questions relative to demographics, the use of thrust manipulation in the treatment of patients with LBP, their knowledge of a manipulation CPR, and the NYS physical therapy practice act and its ability to allow physical therapists to perform thrust manipulation. Chi-square tests, 1-way analyses of variance, and t tests were used for analyses. Results. Of the sample population, 41.3% reported performing spinal thrust manipulation, and the majority of those physical therapists (77.4%) use the intervention between 0% and 25% of the time. Thirty-seven percent of clinicians who reported manipulating patients with LBP reported using a CPR to determine candidates for manipulation; the remainder of the respondents (63%) did not provide an answer or were unsure. Of the sample population, 63.9% correctly answered the survey question regarding the NYS physical therapy practice act and an ability to legally perform thrust manipulation. Physical therapists who are board certified in orthopedics through the American Physical Therapist Association (P = .005) or residency/fellowship trained in manual physical therapy (P = .03) are significantly more likely to perform thrust manipulation than those who are not. Physical therapists who understand the NYS physical therapy practice act (P = .014), attend continuing education regarding the management of patients with LBP (P = .007), and are male (P < .00001) are also significantly more likely to perform thrust manipulation for patients with LBP. Conclusions. Despite emerging evidence to support the use of thrust manipulation in the management of patients with LBP, utilization of thrust manipulation among physical therapists still remains relatively low. Physical therapists who are board certified in orthopedics and/or residency/fellowship trained, attend continuing education, and better understand the NYS physical therapy practice act are more likely to perform thrust manipulation. The results of this study may have implications for professional development and educational efforts regarding the training of physical therapists in the utilization of thrust manipulation.

Virtual Grand Rounds: A Curricular Model for Translating Evidence-Based Practice From the Classroom to the Clinic Background and Purpose. The physical therapy profession supports educating physical therapist graduates to use evidence-based practice (EBP) skills in the clinical environment. Educational interventions to teach EBP include a variety of formats, but most focus on changing student and clinician knowledge and skills rather than changing actual clinician behavior. The literature suggests that for clinician behavior to change, educational interventions must be integrated into clinical practice. To describe the restructuring of the ATSU research and EBP curriculum including the development of a course, Virtual Grand Rounds (VGR), that focused on EBP skills and took place during clinical experiences. Method/Model Description and Evaluation. The curriculum and VGR course were designed for students to learn EBP skills, develop tolerance for uncertainty, implement EBP within time demands of the clinic, and use workplace supports. All physical therapy students completed both the Evidence-Based Practice Beliefs (EBPB) scale and the Evidence-Based Practice Implementation (EBPI) scale at program entry and at the end of years 1, 2, and 3 (graduation). Outcomes. A total of 727 EBPB and 719 EBPI surveys were completed and analyzed. Using an analysis of variance with Scheffe post hoc analyses, significant differences (P < .05) were found between the EBPB and EBPI scores for each year of data collection with the exception of a nonsignificant change between year 1 and year 2 (P = .998 and P = .702). The overall EBPI score at graduation indicated that during the final clinical year, students performed each EBP skill somewhere between 1 and 5 times during the clinical experience. Changes in individual question scores indicated increases in students' skills, knowledge, and application throughout all years. Discussion and Conclusion. Evidence-based practice implementation increased throughout the 3 years and was at the highest following the final clinical year when students participated in the newly developed VGR. By situating practice of EBP within the time constraints of the clinical environment, the setting where EBP takes place, students are equipped to move away from the reliance on clinical expertise to evidence-based physical therapy. The development of the VGR course described in this article shifts EBP from an academic exercise in the classroom to an activity imbedded in real clinical practice. Other programs may find this integrated course helpful in removing barriers to EBP and developing graduates equipped to integrate EBP in the clinical environment.

Implementation and Experiences of Participating in a Neurologic Service Learning Clinic in a Physical Therapist Entry-Level Program: An Educational Case Report Background and Purpose. The integration of service learning (SL) in physical therapist entry-level education is a way of serving the community while also meeting curricular demands. Educational programs have successfully implemented service learning clinics (SLCs) while positively affecting the development of professionalism. Research examining specialized SLCs in programs is only just emerging. This case report describes the implementation and experiences of participating in a neurologic-specific SLC. Case Description. Through a partnership between the program and a local hospital, faculty, students, and members of the hospital rehabilitation leadership developed and implemented a neurologic SLC. Over the first year, 37 first- and second-year students participated. Twice a week, student dyads (first- and second-year pairs) treated patients with a neurologic diagnosis. Student reflection papers were qualitatively examined to understand the students' experiences. Outcomes. Three themes emerged: 1) “Find my ‘PT Self’”: Professional Growth, 2) “Out of my comfort zone”: Challenges for Novices, and 3) “Out of the books and into the real world”: Bringing Curriculum to Life. Discussion and Conclusion. The SLC afforded students the opportunity to treat individuals with neurological disorders, reinforce coursework, and further prepare for patient care in a neurological setting. Data regarding the value of student learning and the perceived challenges for novices will inform other programs interested in integrating SL into the curriculum, particularly a neurologic-specific experience.

Implementation of a Hospital-Based Orthopaedic Physical Therapy Residency Program: A Case Report Describing Clinical Outcomes, Productivity, and Perceived Benefits Background and Purpose. Currently, there are 264 credentialed physical therapy residencies across the United States. Most residency programs take a limited number of residents per year, thus the opportunity for the projected 10,721 physical therapy students graduating in 2019 was relatively small. One of the challenges to developing a new physical therapy residency is convincing the host institution that it will be beneficial in the long-term. The purpose of this case report was to describe the effect of implementing a hospital-based orthopaedic physical therapy residency program on clinical outcomes, productivity, and the perceived benefits of the residency program by staff physical therapists and hospital administrators. Case Description. The Patient-Specific Functional Scale (PSFS) was used to assess treatment outcomes for 2 years before the start of the residency program (2007–2008) and for each of the 4 years after the inauguration of the first resident (2009–2012). A total of 3,717 patient outcome scores were used in the analysis. Productivity, measured in “patient visits” and zip code data, representing the service area, was also collected. In addition, staff physical therapists and administrators completed a survey to determine their perceived benefits of the residency program. Outcomes. There was a steady improvement in clinical outcomes from 2007 to 2012. In 2007, the average change in the PSFS was 3.81 and in 2012, 4 years after the start of the residency program, the average change in PSFS increased 37% to 5.21. The number of patient visits increased to 60,983 (+17,071), and patients were travelling from outside the service area (41 additional zip codes) to receive treatment at the hospital from staff physical therapists with specialized training. Survey results indicate that both staff physical therapists and hospital administrators had a very positive view of the impact of the residency program on job satisfaction, professional development, staff retention, and success of the department. Discussion and Conclusion. The results of this study suggest that hospital-based orthopaedic physical therapy residency programs have the potential to improve clinical outcomes, increase productivity, and create a “culture of excellence.” It provides some justification for hospitals and other physical therapy facilities to invest in residency training.

Practice Analysis Study: A Method for Residency Curriculum Development Background and Purpose. Postprofessional residency education intended to advance specialty practice is common across health professions. Accrediting bodies use a variety of methods to define competencies and develop curricula. This paper describes the practice analysis survey used to determine advanced practice specialty competencies in physical therapy (PT), and the implications for the results of that process on residency curricula. The recently updated neurologic Description of Specialty Practice (DSP) is presented as an example. Method/Model Description and Evaluation. A nine-member Subject Matter Expert (SME) panel used a consensus process to develop knowledge and skill statements that represent contemporary neurologic specialty practice to construct a practice analysis survey. Survey respondents rated each statement along 3 dimensions: frequency and importance of the knowledge/skill, and the required level of judgment. The survey was sent to 995 neurologic certified specialists and an equal number of nonspecialists. Decision rules on data analysis DSP revision were determined by the SME panel a priori. Outcomes. One hundred thirty-one neurologic clinical specialists completed the survey (response rate = 13%). The revised DSP reflects new emphasis on: complex clinical decision making, judicious use of outcome measures, and prioritization of interventions; differential diagnosis and medical management; neuroplasticity and neural recovery; movement and task analysis; social responsibility and advocacy; and the role in health, wellness, and prevention. These changes represent the evolving knowledge, practice skills, and expanded role of the neurologic specialist, which must be incorporated into neurologic residency curricula. Discussion and Conclusion. This paper describes a method to guide curricula and learning outcomes for postprofessional residencies that is different from those used in entry-level PT programs. However, the practice analysis method is consistent with that used by other health professions. Systematic assessment of performance standards across the spectrum of PT education will continue to be important to distinguish specialists and support residency curricula.

Development and Validation of the Self-Efficacy of Student Physical Therapist Outcomes Survey Introduction. Self-efficacy is believed to be a link between knowledge and the application of knowledge and skills to specific situations. No previously published survey comprehensively measures the self-efficacy of student physical therapists for the outcomes expected of entry-level physical therapists. Methods. The Self-Efficacy of Physical Therapist Student Outcomes (SEPTSO) survey was designed according to the recommended guidelines for tools measuring self-efficacy. Each of the 25 items was linked to published outcomes expected of entry-level physical therapists. Students in 3 cohorts of a 3-year Doctor of Physical Therapy (DPT) program completed the online SEPTSO 3 times over the course of 1 academic year. Results. There was a statistically significant difference among the 3 cohorts in self-efficacy. 05F74 = 51.93, ρ < .0001, with significant differences between self-efficacy scores in the classes of DPT 3 and DPT 1 (ρ < .001) and DPT 2 and DPT 3 (ρ < .001). A 2 × 4 Analysis of Variance (ANOVA) examining the effect of age or sex found no significant main effects for age (ρ = .059) or sex (ρ = .113) and no significant interactions (ρ = .843). Cronbach's alpha was .983 for the 25 items, demonstrating excellent and significant internal validity, and the item-to-total correlation was high for each item, ranging from .981 to .983. A factor analysis resulted in a model in which 2 factors explained 71% of the variance within the factors of patient management and professionalism. Discussion. The SEPTSO survey possesses excellent content validity without bias for age or sex. The potential uses of the SEPTSO survey include program evaluation, curriculum evaluation to identify program weaknesses, accreditation, and self-reflection in students.

Utilization of the Clinical Reasoning Assessment Tool Across a Physical Therapy Curriculum: Application for Teaching, Learning, and Assessment Introduction. Clinical reasoning is a multifaceted skill set crucial to optimal patient care. The ability to assess development of clinical reasoning skills in entry-level physical therapist students continues to be challenging. The Clinical Reasoning Assessment Tool (CRAT) was developed in order to assess students' progress in the essential link between clinical reasoning and the development of knowledge. Based on a previously published tool (Clinical Reasoning Grading Rubric), the CRAT considers 3 domains representing clinical reasoning and knowledge development (content knowledge, procedural knowledge and psychomotor skills, and conceptual reasoning). The purpose of this study was to determine whether the use of the CRAT would reliably reflect student progress in acquisition and application of clinical reasoning skills across didactic and clinical components of physical therapist education and to determine whether case context impacts performance. Methods. A cross-sectional study was performed using the CRAT to assess student performance at 4 specific time points across 2 years of a physical therapy curriculum. Fifty-five students from 2 consecutive class cohorts were assessed using the CRAT. Eleven assessors scored 172 completed tools using a visual analog scale representing a learner continuum (beginner, intermediate, competent, and proficient). Analysis of variance (ANOVA) was used to determine whether time and case context were predictors of performance in each of the 3 clinical reasoning domains. Results. Mean scores in each of the 3 domains steadily increased at each performance assessment point, and results of the ANOVA showed that each specified time point was significantly predictive of performance in each of the 3 domains of interest (P < .0001 for each). In addition, case context is predictive of procedural knowledge (P = .007) and conceptual reasoning (P = .0297). Discussion and Conclusions. The results of this study, and observations related to use of the tool, demonstrate the utility of the CRAT in measuring the performance of physical therapy students.