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An Integrative Curriculum Model Preparing Physical Therapists for Vision 2020 Practice
... 2 Various models of ICE exist in the literature. [3][4][5][6][7][8][9][10][11][12][13][14][15] They vary by sequencing and placement within the curriculum, frequency, format, setting, and by who supervises the students. A commonality in ICE experiences is that they follow experiential learning practices by providing students with an early link to patients and the realities of clinical practice. ...
... The current literature specific to ICE in physical therapy education consists of a position paper, 11 model descriptions, 5,8 or program assessment data 4,6,7,9,12,13 from surveys, group debriefings, exit interviews, or class discussions. A literature review revealed that students' thoughts fit into four overarching categories: positive impact on didactic learning, positive impact on skills application, positive impact on the patient, and ICE as a positive environment. ...
... A literature review revealed that students' thoughts fit into four overarching categories: positive impact on didactic learning, positive impact on skills application, positive impact on the patient, and ICE as a positive environment. Students reported that ICE was essential to learning, 7 motivated them in their studies, 4 provided context for didactic coursework, 4,7,9 and helped deepen the understanding of didactic material. 4,13 Students stated the experience improved their communication skills, 6 clinical reasoning skills, 6,9,14 and documentation skills 6 and helped prepare them for full-time clinical experiences. ...
Purpose: Integrated Clinical Education (ICE) complements didactic material within educational programs, providing an in- person, hands-on experience in coordination with traditional instruction. Different models of ICE are described in the literature, which consists primarily of descriptions and program assessments of these experiences. The purpose of this study was to enhance the literature by applying rigorous methodology to gain a rich understanding of the student’s perspective of the process and impact of ICE on Doctor of Physical Therapy (DPT) students working with older adults, a population not yet rigorously studied. Methods: A convenience sample of 19 DPT students participated in this study. A descriptive phenomenological approach obtained the perspectives of DPT students engaged in this ICE. Researchers conducted six focus groups using a video chat format following the ICE. Results: Five themes emerged from the thematic analysis of focus group transcriptions: transformation, circular learning, role of relationships, rollercoaster of emotions, and perceived perks for older adults through the students’ perspective. Conclusion: Findings are consistent with the literature and support ICE as a complement to didactic learning, especially for those skills that are challenging to teach in the classroom. This study added to the literature by identifying relationship building and circular learning as essential components of ICE. Students also identified and resolved implicit biases previously held about older adults. Further research is warranted to deepen an understanding of these findings, with a mixed-method approach to gather quantitative data to link the ICE process with outcomes.
... 27 (p 14) eir curriculum included students' taking 1 course at a time, each for 5-6 weeks. 27 eir courses are organized around practice setting, whereas curricular content is organized into streams (medical and behavioral science; practice environment; examination, evaluation, diagnosis; and plan of care) that are integrated into all courses. 27 As we considered a model for our new curriculum, we had the opportunity to meet and consult with the faculty at Saint Catherine University. ...
... 27 eir courses are organized around practice setting, whereas curricular content is organized into streams (medical and behavioral science; practice environment; examination, evaluation, diagnosis; and plan of care) that are integrated into all courses. 27 As we considered a model for our new curriculum, we had the opportunity to meet and consult with the faculty at Saint Catherine University. We also met with colleagues at Arcadia University who have an integrated curriculum organized into 20, 3week, patient-based units that incorporate content from biomedical sciences, physical therapy, patient examination and intervention, and integrative care. ...
... As noted by Kulasegaram et al, 32 integration is more than the structure of the curriculum but reflects the process of learning as students develop understanding of how concepts fit together. 2,23,24,27,28,[32][33][34] We intentionally started this process at the beginning of the curriculum, as training broad concepts leads to improved retention and transfer of information. 13,[16][17][18] As infusing context and accounting for the environment are important components of constructivism, 16,35 foundational, behavioral, and clinical sciences and our curricular threads were integrated and contextualized through the use of patient narratives and traditional cases. ...
Background and Purpose
In 2016, faculty at the MGH Institute of Health Professions implemented a new physical therapist education curriculum based on contemporary theoretical models of learning to address shortcomings of the existing, traditional curriculum. Course content was siloed, students were spending too much time in class to the detriment of self-directed learning, and there was unwarranted repetition of content. Students seemed to emphasize superficial learning in an effort to pass numerous examinations across multiple courses, and they were learning factual knowledge in isolation. The purpose of this article is to describe a new curricular model framed within theoretical perspectives on learning, including cognitive load theory and constructivism. We also describe how we structured decisions about curriculum at the program, course, session, and assessment levels.
Method/Model Description and Evaluation
We developed a curriculum that represents spiral integration, including integration of the foundational, clinical, and behavioral sciences at the program, course, session, and assessment levels. Courses employ increasingly complex patient narratives that present patients holistically. Course objectives focus on the higher levels of the learning taxonomies.
Outcomes
The curriculum not only integrates content within and across courses but also uses constructivist learning theory by explicitly engaging students in iterative learning with emphasis on depth versus breadth of information.
Discussion and Conclusion
The approach to teaching is focused on stimulating curiosity and motivating learning through patient narratives and early focus on clinical reasoning. Cognitive load is addressed by reducing in-class time and having students take only 1 course at a time. An ongoing process of critical study, review, and revision of the curriculum will continue to improve students’ learning experiences, environment, and outcomes.
... 3,4 Scholars of education philosophy have found that early, authentic experiences enhance student learning. 2,[5][6][7] These learning experiences provide students with a mechanism to attach a real-life experience with theoretical knowledge, resulting in more complex insight of basic concepts, 8 such as designing an exercise program for children with disabilities. The inclusion of CE experiences throughout a student's academic program appears to provide an environment for transformative practice, where students can focus on actual experiences during immersion activities. ...
... Two studies originated in Australia 31,32 and 20 from the United States. 2,7,8,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] Design and Rigor of Literature Table 2 describes research type, research design, and final methodological critical appraisal score. In the aggregate, 27% (n = 6) of the studies achieved a moderate to high quality, with a low risk of bias and a methodological quality score of 11 or higher 26 ; 73% (n = 16) had a low methodological quality and a high risk of bias score. ...
... Integrated clinical education is a curriculum design model whereby clinical education experiences are purposively organized within a curriculum. [3,4,7] In physical therapist education, these experiences are obtained through the exploration of authentic physical therapist roles, responsibilities, and values that occur prior to the terminal full-time clinical education experience. [1] Integrated experiences are coordinated by the academic program and are driven by learning objectives that are aligned with didactic content delivery across the curricular continuum. ...
Background:
Clinical education curricular models specifically related to integrated clinical education (ICE) vary across physical therapist education programs. The interconnectedness of ICE to the advancement of a shared vision for clinical education in professional physical therapist education needs investigating.
Purpose:
The purpose of this scoping review was to: (1) define ICE, (2) define baseline expectations and parameters of ICE, and (3) discern and describe current ICE models.
Data sources:
Databases accessed included Medline, MedlinePlus with Full, CINAHL, and CINAHL Plus with full text.
Study selection:
A multimodal data collection scoping review was completed. Data collection included survey research, a systematic review of the literature, and a series of focus groups. The McMaster Critical Appraisal Tool assessed methodological study quality. A qualitative, metasynthesis approach was used for data synthesis. Consensus agreement produced results.
Data extraction:
Twenty-two articles were included in the literature review from the health disciplines of medicine, nursing, physical therapy, occupational therapy, and speech-language pathology. Data synthesis produced 8 parameters defining the factors essential to categorizing clinical education experiences as ICE in physical therapist education. The 8 parameters and ICE definition are supported by a description of models of ICE that currently exist within health profession curricula.
Data synthesis:
Data synthesis followed a qualitative, metasynthesis approach. Themes emerged from the surveys, literature review, and focus group data. Patterns were compared, analyzed, and synthesized to generate the themes and ICE parameters.
Limitations:
Selection bias from the literature search could have limited the richness of the model descriptions by unintentional exclusion of articles, and might limit the applicability of results beyond the United States. Sampling bias from survey and focus groups, although purposeful, might have limited a broader description of current viewpoints about ICE. However, the data sources, including multiple health profession perspectives coupled with consensus agreement, provide sound evidence in development of profession-based parameters.
Conclusions:
The results of this scoping review provide the profession with a standard definition of ICE and parameters that can guide a program in designing a curriculum using ICE experiences as a foundation. A recommended next step is to design education research studies using reliable and valid outcome measures across programs to determine impact and effectiveness of ICE as an educational intervention.
... 10 Other programs incorporate ICE into didactic or clinical courses of varying length and frequency. [11][12][13][14][15][16] Often, ICE is designed to address specific curricular objectives related to clinical skills such as examination, intervention, patient management, clinical reasoning, 16,17 interpersonal skills, [12][13][14][15][16] or to increase awareness of different patient populations 12,18,19 or practice areas. 11,16 Generally, ICE experiences occur early in the curriculum, prior to FTCEs, and consist of one or more 2-to 4-hour clinical experiences. ...
... [11][12][13][14][15][16] Often, ICE is designed to address specific curricular objectives related to clinical skills such as examination, intervention, patient management, clinical reasoning, 16,17 interpersonal skills, [12][13][14][15][16] or to increase awareness of different patient populations 12,18,19 or practice areas. 11,16 Generally, ICE experiences occur early in the curriculum, prior to FTCEs, and consist of one or more 2-to 4-hour clinical experiences. ...
... Additional ICE experiences for first-and second-year students have been held in clinical settings, with and without faculty as clinical instructors (CIs). 6,13 Integrated experiences have been overseen by core faculty in clinics off and on campus in a 7-8:1 model (faculty : students) 6,14 with focus on clinical skills practice concurrent with coursework. 14 Pedagogically, integrated experiences assist students in translating knowledge through abstract conceptualization. ...
... While variability in DPT curricula is evident across the nation, ICEs have been utilized in a variety of models. 1,6,10,13,14,24,27 Despite the recognition of ICE in allowing students to link didactic knowledge with clinical application, 10 clinical sites are still burdened. To support our clinical partners, DPT programs must guarantee student readiness to enter CE experiences. ...
Rationale: A variety of clinical education (CE) exist. Models emphasizing full-time clinical experiences (FTCE) have higher number of full-time hours (high-hours) with less prior didactic preparation and integration with the curriculum. Models including integrated clinical experiences (ICE), part-time ICE (PTICE), and in-class patient experiences (IcPE) integrate experiences with didactic content but include a lower number of full-time hours (low-hours). The purpose of this study is to determine if a re-designed CE curricular model that emphasized IcPEs and ICE with low-hours better prepares students than a version that emphasized FTCEs with high-hours as measured by scores on the Clinical Performance Instrument (CPI). Methods: A retrospective cohort study was conducted on a data set of 183 Doctor of Physical Therapy students who participated in an initial and final terminal CE experience. Data included student pre-admission data, demographics, and evaluation type, period, and rating for all 18 CPI criteria for the initial and final terminal CE experiences. Data were analyzed using SPSS Statistics. Results: A statistically significant difference was found between cohorts for the initial terminal CE experience midterm assessment. One CPI factor was significant on the initial terminal CE experience final assessment and the final terminal CE experience midterm assessment (p < .05). Within cohort analysis for all three CPI factors at all assessment periods were statistically significant. Conclusion: All students significantly improved from midterm to final assessment periods of the initial and final terminal CE experiences. Therefore, IcPE, allowing faculty to mentor and provide feedback to students should be considered an alternative to FTCE prior to students’ initial terminal CE experience. MeSH Terms: curriculum, education, students
... 11 Literature regarding the use of ICE experiences in physical therapy education is relatively sparse. [12][13][14][15][16][17][18][19][20][21][22][23][24][25] us, the ACAPT work panel's investigation also incorporated evidence from other health professions. Several articles from the work panel's systematic literature review reported the logistically successful incorporation of either a single or series of part-time ICE experiences into existing physical therapy courses ranging from pediatrics and neurology to administration. ...
... Several articles from the work panel's systematic literature review reported the logistically successful incorporation of either a single or series of part-time ICE experiences into existing physical therapy courses ranging from pediatrics and neurology to administration. 18,19,[21][22][23] Relatively few articles described stand-alone ICE courses designed to meet objectives specifically tied to the curricular content of the program. 12,14,16,17,20,24 Although each of the stand-alone ICE courses described in the literature were concurrent with the academic curriculum and coordinated by academic faculty, they ranged from a single ICE course to a series of 3 sequential courses. ...
Background and Purpose
The evolving nature of clinical education requires program evaluation to inform intentional curriculum development. However, descriptions of the application of curriculum development frameworks in physical therapy are sparse. We used the context/input/process/product (CIPP) model to guide a didactic and clinical education curriculum reorganization that included the creation of a series of five integrated clinical experience (ICE) courses threaded throughout the first two years of a Doctor of Physical Therapy (DPT) program.
Method/Model Description and Evaluation
The CIPP model guided comprehensive program evaluation. Context evaluation summarized strengths, weaknesses, opportunities, and threats. Input evaluation of information from multiple stakeholders and external influences, including accreditation standards, practices at other academic institutions, and published literature, was used to guide changes in the clinical education curriculum. Goals, objectives, and themes were developed for intentional alignment of didactic and clinical education curricula, alongside clinical site development and logistical planning. Process evaluation monitored the implementation of the new clinical education program to identify and address problems. The program is currently in the process of detailed product evaluation.
Outcomes
ICE courses were initially implemented at eight clinical sites. Course assessments were selected and administered at established intervals. Program outcome measures were identified and administered to 2 control cohorts from the original DPT curriculum, and the first cohort in the new DPT curriculum.
Discussion and Conclusion
The process used a structured approach to curriculum development. It emphasized the necessity of engaging multiple stakeholders, developing strong clinical partnerships, and intentional design and placement of courses within the overall curriculum to ensure the quality of ICE courses.
... Physical therapists often rely primarily on a specific reasoning strategy; however, both deductive and inductive strategies may be used in different clinical scenarios or when a preferred strategy is not effective for a given situation. 9,18 Although the importance of helping students develop clinical reasoning skills is well documented in the literature, [18][19][20] PT education, and education in general, often emphasizes evaluation of student performance that is focused on the single correct answer. This is in contrast to preparing students to identify and solve problems through the inherent uncertainties of clinical practice. ...
... 21 Academic faculty and clinical instructors may lack the tools necessary to assist students in developing the processes and abilities for clinical reasoning to occur. 19,20 When working with students, the focus is often more on The novice PT gathers relevant patient history and asks the mother questions focused on the following areas: ...
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.
... Adequate knowledge of how the human body is organized (i.e., gross anatomy) is, therefore, considered a foundational course for entry-level physical therapist education [6]. It has long been established that it is necessary to organize and present content in a meaningful way to maximize retention [7]. Even though physical therapy is taught around the globe, a review of published literature revealed only one study that has undertaken development of a core syllabus for physiotherapy practice [8]. ...
Anatomical knowledge is the foundation of the educational curricula in most healthcare programs. The varying scopes of practice between healthcare professions require anatomy educators to determine what content is essential to cover in a finite time with learners. When possible, the anatomy educator bases this decision on clinical experiences; this is a more significant challenge for the non-clinician educator teaching in a health profession curriculum. Although studies have determined essential anatomy content in many healthcare professions, no study has been undertaken in physical therapist education. This study was designed to determine what anatomical concepts are considered essential in physical therapist education in one doctor of physical therapy program. Faculty (n = 28), recent graduates (n = 134), and clinical instructors (n = 247) of a doctor of physical therapy program were invited to respond to a survey focused on rating the essential nature of 46 learning objectives. Consensus for learning objectives was determined using Lawshe's content validity method. One hundred forty-seven respondents completed the survey (36% response rate). Respondents represented a diversity in years of experience, highest physical therapist degree earned, specialty training, and setting of physical therapist practice. Of the 46 learning objectives presented, 10 were most frequently rated essential, 20 as useful but not essential, and 16 as not necessary. These results offer guidance for anatomy instructors at other institutions to make an informed decision on what anatomical content to focus on in their anatomy courses in order to increase time dedicated toward mastery of essential core anatomical knowledge for physical therapist practice.
Supplementary information:
The online version contains supplementary material available at 10.1007/s40670-022-01574-1.
... A number of programs have moved toward integrating the didactic portion of the curriculum with part-time, clinical experiences within local physical therapy clinics prior to sending students out on their full-time experiences. [23][24][25][26] Others have established fully functioning clinics within their program and have their students participate in those experiences prior to their full-time experience off campus. 27 These strategies all call upon students to be actively engaged in their learning process moving from a faculty-centered teaching paradigm toward a more student-centered learning paradigm as espoused by Barr and Tagg and Lave and Wenger. ...
Purpose: Physical therapist education programs strive to prepare their students for full-time clinical experiences in a variety of ways. Experiential and service learning in authentic contexts reportedly help students make connections between the classroom and the clinic. The purpose of this study was to explore the influences that service in a physical therapy pro bono clinic has on a first full-time clinical education experience. Methods: Participants were all third year doctoral physical therapy students at Widener University who were entering their first full-time clinical education experience. Sixteen participants kept journals throughout their first full-time clinical experience regarding the impact of their previous pro bono experience. Upon completion of the 10-week full-time clinical experience, the sixteen participants answered a Likert-scale survey to further delineate the influence of the pro bono experience, and fifteen of the participants participated in focus group discussions to further explore themes that emerged from the journal and survey data. Data from the focus group and journals were analyzed qualitatively. The responses from the surveys provided quantitative data. In addition, the researchers looked at the Clinical Instructors (CI) midterm comments on the APTA’s Clinical Performance Instrument (APTA PT CPI WEB) to further corroborate or disconfirm the findings. Results: Triangulation of the data points revealed 9 categories of positive impact that the pro bono experience had on their first full-time clinical experience. The strongest three categories in order were client interaction, clinical instructor interaction, and professional communication. The next five categories were of relative equal strength and related to specifics areas of competency. They were competency in documentation, evaluation, intervention, clinical reasoning and cultural competency. A final overarching category was increased confidence. CI comments on the midterm CPI corroborated these findings. Participants also shared ways in which the pro bono experience could have better prepared them for their full-time clinical experience. Conclusions: Regular participation in a pro bono clinic throughout the didactic portion of the physical therapy curriculum contributed to student confidence and competence in their first full-time clinical experience. Future research should include interviews with the clinical instructors to further corroborate the student perceptions. The findings of this study also serve to inform how the pro bono clinical experience can be enhanced to further contribute positively to the students’ first full-time clinical experiences.
... A major challenge toward the successful acquisition of this knowledge is the reduction of contact hours dedicated to anatomy content from 2002 to 2014 as revealed by our colleagues in medicine [2,3]. Additionally, there are reports of reduced anatomy laboratory hours in PT curricula, [4] and this trend can be extrapolated to other programs due to the increasing adoption of integrated curriculum models in PT education [5]. The use of donor dissection has been shown to be a popular teaching method employed in PT anatomy courses [6,7]. ...
Anatomical knowledge is requisite for effective physical therapy (PT) practice. Cadaver dissection is a popular teaching method employed in PT anatomy courses. Limited time in the laboratory requires effective dissection instructions. Several limitations of a printed, non-discipline specific dissection guide have been identified by students and instructors in anatomy curricula. The objective of this project was to evaluate the effect of using a digital, PT specific dissection guide on examination performance and student satisfaction. A digital guide was developed that incorporated improvements based on observations of student experiences using a printed guide. The digital guide covered two lower extremity regional dissections and was distributed for use during the summer 2017 course. Enhancements included clarification of dissection procedures, formative quizzes, image galleries, embedded videos, and a glossary of terms. Students used a printed guide for all other dissections in the course. The percentage of correct answers from practical examinations was calculated and compared between summer of 2015 (print) and 2017 (digital) courses. A survey consisting of nineteen five-point Likert items was distributed. The percentage of correct answers was significantly higher for the digital guide (91.7 ± 7.11%) compared with the print guide (84.2 ± 9.51%, P < 0.0001). On the survey, the median item rating was strongly agree for two, agree for fifteen, and neither agree or disagree for two. These results suggest that developing a curriculum specific, digital guide was effective in improving student knowledge and satisfaction. These results encourage development of additional content specific guides in a digital format.
... Conversely, personal experiences and previous knowledge such as entrepreneurship activities, entrepreneurship clubs and internship program remains at 14% (17/120), 10.7% (13/120) and 3.3% (4/120) respectively. According to Weddle &Sellheim (2009), entrepreneurs that are motivated by interest from personal experiences and knowledge learn to relate to new ideas with previous knowledge with the intention of seeking meaning and understanding. Since the study aimed to examine local entrepreneurs' opinion on the integrated entrepreneur's curriculum, entrepreneurs from various business sectors were investigated to achieve the mission. ...
The concept of ethical attitude and standard in business dealings has long been argued in the academic world. The current implication on skills and ethical concepts and ideas of Malaysian entrepreneurs from Islamic practices is briefly outlined in the study. Capitalizing on a comprehensive set of questionnaire containing information on respondent’s profile, characteristics and educational background, one hundred twenty one (121) entrepreneurs were surveyed using convenience sampling. The practices of Islamic skills and ethics among Malaysian entrepreneurs in numerous business sectors are discussed in the study. The study postulates that the awareness gained from well-being (falāh) in life and excellence (itqān) in work from business organisation can be derived from the pursuit of Tawhidic principle. A set of close ended questions that contains individual’s characteristics and principles are distributed to entrepreneurs from various business sectors and work experiences for the purpose. Providentially, the study managed to collect 121 completed questionnaires from Malaysian’s entrepreneurs. The study contributes significant information to the academic world as well as to the corporations and governments in conducting business. Finally, the study concludes with the discussion on the proposed business practices and recommended future implementation in achieving entrepreneur’s career success. Keywords: skills, ethics, entrepreneurship, Tawhidic paradigm
... Essentially, a good number of strategies, such as demonstration, discussion, feedback and formative assessment have been perceived as key elements to facilitate teaching and learning in the clinical learning settings [5,7]. In more recent times, interests in clinical education have led to the integration of multiple strategies and methods into more complex structures and guidelines to facilitate, more efficiently, clinical education experiences [3,4,[8][9][10][11][12][13][14][15]. Unlike most developed countries [4], there is no evidence to suggest that physiotherapy clinical education in Nigeria is similar across all entry-level physiotherapy training programmes in terms of structure, approach and curriculum. ...
Purpose: This study identified physiotherapy students' and interns’ views on clinical educator characteristics, teaching/learning opportunities and conditions essential to facilitate clinical education experiences in eastern Nigeria.
Methods: The roles and attributes of a clinical educator, teaching/learning opportunities and conditions to facilitate learning were assessed utilising a self-administered questionnaire. Respondents’ perceived learning values for selected teaching/learning opportunities were further explored. Data were analysed utilising descriptive statistics of frequencies and percentages.
Results: The response rate was 85.3%. The roles and attributes of a clinical educator most rated for effective learning include mentorship, knowledge provider, facilitator of learning, good communication and respect for students. Activities perceived as vital for effective clinical education include demonstration, linking theory to practice and giving guidance on patient management. The majority of the respondents preferred small group learning to one-on-one learning. Respondents further varied in their perceived learning values for the selected teaching/learning opportunities.
Conclusions: Physiotherapy students and interns believe that clinical educators play key roles and expect them to display a wide range of professional attributes to facilitate students’ learning experiences. Possible deficiencies in clinical education experiences based on responses regarding the selected teaching/learning opportunities are also highlighted and warrant investigation to enhance clinical education experiences.
... A proposta concentra-se em soluções eficientes e inovadoras, as quais serão aqui detalhadas como âmbito geral, descrevendo aspectos considerados no Projeto Político Pedagógico Institucional da Faculdade de Ceilândia, no que se refere às diretrizes balizadoras para todos os cursos ofertados; complementar, descrevendo estratégias andragógicas de aprendizagem (15); e específico, descrevendo aspectos considerados no Projeto Pedagógico do Curso de Fisioterapia (16,17). ...
INTRODUCTION: The visible exhaustion of the traditional teaching model for physiotherapy, along with a new professional profile and a change in the approach to the health-illness process (which has come to include functionality), has stimulated the need for new pedagogical projects for teaching physiotherapy. This should include a perspective of social and economic transformation of the regional population (in this case, the administrative region of Ceilândia, in the Federal District, Brasília, Brazil). OBJECTIVE: To present a pedagogical project for the undergraduate course in physiotherapy stressing education focused on human functionality in scenarios of professional practice,e proposed by the Brazilian public healthcare system. METHODS: The curriculum is being constructed in an innovating perspective with proposals regarding the general realm (lifestyle centers, biological systems, physiotherapy skills and scenarios of physiotherapy practices), specific realm (health maintenance, health-illness process, healthcare, human functionality, process of permanent education) and complementary realm (research and extension activities). RESULTS: The pedagogical project proposal was carried out in such a way as to complement the expected general and specific goals as well as professional and social profiles. The indissociability of teaching-research-extension presumes a reference in the professor-student relationship for the comprehension of research and extension activities as fundamental elements of the teaching-learning process linked to experience in the actual context, thereby concretizing the relationship between theory and practice, focusing on the public healthcare system. CONCLUSION: The diversification of practices in the context of the public healthcare system includes a perspective of social and economic transformation in the population within the social and political scenario of the Federal District. In this context, priority is given to the education/training of generalist, reflexive, critical physiotherapists, involved from the beginning with community service on different levels of healthcare, addressing aspects of human functionality in accordance with the needs of the Brazilian public healthcare system.
Introduction.
In 2016, faculty at the MGH Institute of Health Professions implemented a new Doctor of Physical Therapy (DPT) curriculum based on constructivist and cognitive load theories. There is recognition that faculty too often overlook the importance of students' perceptions on the effectiveness of teaching methodologies and that student “buy-in” is particularly pivotal in curricula based on contemporary learning theories. Thus, students' perceptions have become a focus in the higher education research literature. The purpose of this article is to explore the perceptions of the first cohort of DPT students in our new curriculum across their academic studies.
Participants.
Nineteen of 70 students from the first cohort of our new curriculum participated in 1 of the 3 focus groups in year 1 (round 1) and 1 of the 2 focus groups in year 2 (round 2), with 4 students participating in both rounds.
Methods.
Qualitative thematic analysis was used to identify, summarize, and interpret students' perceptions regarding their experiences in this new curriculum.
Results.
Six themes emerging from round 1 were class preparation; plusses and minuses of group learning; usefulness of assessments; managing faculty/course differences; finding life balance; and student performance outcomes. A seventh theme emerged from round 2, namely, evolving and adapting approaches to learning.
Discussion and Conclusion.
Themes and subthemes are discussed in the context of other studies on students' perceptions of courses and curricula applying contemporary learning theories in higher education. Some of the themes emerging from our study are not unique to DPT curricula based on constructivist theories. However, our findings reflect both positive aspects of such approaches from the students' viewpoints and challenges that should be considered in supporting student engagement when designing or modifying such curricula. Findings may inform DPT programs considering similar curricular shifts toward contemporary learning practices, facilitating program curricular planning and transition processes.
Introduction
Faculty perceptions of organizational change and culture shifts created by major curricular revision in higher education have been described. However, there are no similar descriptions for faculty in physical therapist education.
Methods
All faculty from one Doctor of Physical Therapy program were recruited and agreed to participate in this study ( n = 19). A qualitative thematic approach was applied to deidentified transcripts of faculty interviews conducted at the end of the first year (round 1) of a new curriculum and again after all academic courses had been taught at least once (round 2). Independently coded themes were discussed and further refined iteratively. All data and themes were sent to an external reviewer with feedback incorporated into findings.
Results
Ten themes emerged from the analysis of the interviews—7 from round 1 interviews and 3 additional themes from round 2 interviews, including Convoluted Planning Process, Challenging Management Processes & Structure, Overwhelming Workload, New Pedagogy, Integrated Curricular Structure, Crucial Teamwork and Communication, Insufficient Resources, Evolving Attitudes and Approaches, Personal & Professional Growth, and Cautious Optimism.
Discussion and Conclusion
The themes that emerged from this study—as well as faculty observations, insights, and concerns—parallel those experienced by non-PT faculty going through similar changes to innovative curricula although with greater levels of angst than evident elsewhere in the literature. The themes also fit the framework by Armenakis and Bedeian that identified 4 common issues across the organizational change literature. Most of our faculty remained hopeful that the original goal of a patient-centered, integrated, active learning curriculum could be reached with continued curricular development and faculty growth. There are increasingly urgent calls to rethink physical therapy education to better prepare graduates for a dynamic health care environment, to respond to emerging biopsychosocial research and pandemic demands, and to reduce graduate indebtedness. These will likely lead to extensive curricular change across programs in the near future. Our findings may facilitate more realistic expectations of physical therapy faculty when facing the challenges of major curriculum change.
Background and Purpose
The need for physical therapist (PT) students to graduate with strong teamwork knowledge and skills has never been greater. Although many PT educational programs are preparing graduates to work effectively in an interprofessional team environment, attention to the corresponding importance of collaborative intraprofessional (PT/PT assistant [PTA]) preparation for efficient, cost-effective patient care must not be lost.
Method/Model Description
Starting in the first course of the program, learning experiences on the preferred PT/PTA relationship are woven throughout multiple courses over the 3-year Doctor of Physical Therapy (DPT) curriculum. Students practice components of effective teaming, make decisions about the direction and supervision of a PTA, and deepen their understanding of the legal and ethical complexities of PT/PTA teams in practice. Specific learning activities on the PT/PTA relationship are described.
Outcomes
Survey data and class learning experience and assignment feedback on the PT/PTA curriculum reveal multiple themes related to PT student learning using this model. Themes include increased understanding and confidence in PTA knowledge, skills, and roles; recognition of the potential for increased efficiency and improved patient care with PT/PTA teaming; and the importance of PT/PTA communication and relationship. Most respondents to a 1-year postgraduation alumnae/i survey report the collaborative PT/PTA educational experiences helped prepare them for clinical practice with PTAs.
Discussion
The need for physical therapy services is increasing, and as professionals, PTs have an obligation to meet this need in a cost-effective way. Using the skills of a PTA continues to be an effective strategy to address this issue. PT students are often not prepared to direct and supervise PTAs in the clinic due to insufficient educational preparation.
Conclusion
This curricular thread model incorporates content pertaining to direction and supervision of PTAs and intraprofessional team building across a 3-year DPT program to better prepare clinicians for practice.
Reflective practice is a vital skill of effective teachers and a precondition for professional growth. Lack of time, poorly developed reflective skills, or academic cultures that are not supportive of reflection may curtail reflective practice. This article describes a peer-led course reflection process designed to increase the reflection and teaching skills of faculty as well as support course and curriculum development. Department faculty perspectives on the process were examined via a survey that included open-ended and forced-choice questions (N = 10; 91% return rate). The vast majority of respondents indicated this reflective process had improved administrative aspects of their teaching (90%); enriched and informed course development (100%); was time well spent (100%); and helped faculty see how their course fit into the overall framework of the curriculum (80%). The guided, cyclical, and structured nature of this reflection process appears to be effective. The collaborative, non-hierarchical process became part of the program's culture over time. A systematic course reflection process may be of interest to academic faculty who wish to enhance and document course and curricular development.
Background and Purpose: The proportion of time physical therapists spend with individuals over 65 continues to grow as the population grays. Education programs must respond to this demand by preparing graduates to meet the complex needs of older persons within the productivity constraints of the current health care environment. This paper describes a model for the development of a dedicated geriatrics course in a Doctor of Physical Therapy program grounded in educational theory to optimize learning and preparedness for geriatric clinical practice. Method/Model Description and Evaluation: The geriatrics course incorporates principles of adult learning, experiential learning theory, reflective practice, and active learning strategies. Professional resources such as the Normative Model and Essential Competencies described by the APTA Section on Geriatrics were used to align course content and objectives with contemporary practice expectations. Learner strategies and course content were further refined using a needs assessment as well as formative and summative feedback from students. Quantitative and qualitative data were collected related to student self-efficacy; student perceptions of their knowledge, skills and attitudes; student perception of the course; and measures of attainment of course goals. Descriptive statistics were used to summarize quantitative data and the related groups Wilcoxon signed-rank test was used to analyze pre and posttest scores on self-efficacy scales. Qualitative data were coded and examined for clusters and patterns of meaning. Multiple researchers were used to analyze the raw data, confirm the accuracy of the findings and search for disconfirming information. Outcomes: Student outcomes demonstrate that the process used in course design was effective. Changes in the pre- and post-test efficacy scale indicated students became significantly more confident in their ability to manage the needs of older patients. Students shared aspects of their experiences that surprised them, assumptions they made, challenges they encountered, strategies used to overcome those challenges, and future learning needs. Students passed course assessments, which were mapped to required competencies. Discussion: A model for designing a focused geriatrics course grounded in educational principles and active learning strategies were presented. Outcomes indicate students felt more confident and were actively engaged throughout the course. Student feedback and course outcomes indicate students mastered course competencies mapped to contemporary expectations for physical therapist practice. Although this model was applied specifically to a course on physical therapy management of the older adult, the same process can be applied to a broad range of content areas across the continuum of practice. Conclusion: Educational principles and active learning strategies shaped the development of a geriatric course that optimized student self-efficacy, engagement, reflection and competence in managing the older adult client.
Background
Many factors affect student learning throughout the clinical education (CE) component of professional (entry-level) physical therapist education curricula. Physical therapist education programs (PTEPs) manage CE, yet the material and human resources required to provide CE are generally overseen by community-based physical therapist practices.
Purpose
The purposes of this systematic review were: (1) to examine how the construct of quality is defined in CE literature and (2) to determine the methodological rigor of the available evidence on quality in physical therapist CE.
Methods
This study was a systematic review of English-language journals using the American Physical Therapy Association’s Open Door Portal to Evidence-Based Practice as the computer search engine. The search was categorized using terms for physical therapy and quality and for CE pedagogy and models or roles. Summary findings were characterized by 5 primary themes and 14 subthemes using a qualitative-directed content analysis.
Results
Fifty-four articles were included in the study. The primary quality themes were: CE framework, CE sites, structure of CE, assessment in CE, and CE faculty. The methodological rigor of the studies was critically appraised using a binary system based on the McMaster appraisal tools. Scores ranged from 3 to 14.
Limitations
Publication bias and outcome reporting bias may be inherent limitations to the results.
Conclusion
The review found inconclusive evidence about what constitutes quality or best practice for physical therapist CE. Five key constructs of CE were identified that, when aggregated, could construe quality.
New nurse graduates continue to experience difficulty balancing their preparation for practice with the expectations of the workplace. Few studies have explored the transition practices of nurse graduates through the challenges that they experience. This article presents the findings of a research study that explored the perceptions of preceptors regarding the clinical practice of nurse graduates using the qualitative multiple case study design. Twenty preceptors, selected from three recognized hospitals in Beirut, Lebanon, underwent semistructured interviews. Interview questions were based on an extensive literature review and on Tanner's (2006) judgment dimensions to categorize transition practices. An exhaustive discussion of the practices led to the identification of major themes that illustrate the clinical experiences of new nurse graduates: (1) inventory of competencies, (2) learning experience, (3) technical and theoretical mysteries, and (4) challenge of one's potential. The themes provide directives that curriculum leaders and executive nurses can use to plan initiatives that assist in the effective transition of new nurse graduates to the professional role.
The conceptions of learning that students hold and how these change are dependent on several factors, including their schooling, personal traits of students and the academic environment of the tertiary institute (e.g. departmental policies, attitudes and behaviour of staff). This document discusses whether the conceptions of learning students (in this case, second year medical students) hold can be related to their academic ability. From a phenomenographic perspective (Marton et al., 1993), it would appear that students who were selected in the present study for their good academic record expressed more transformative conceptions of learning than did their less academically achieving peers, who appeared to rely on memorisation and recall. Based on the results of this study, 'academic ability' might then be a reflection of the conceptions of learning students hold. It would be interesting to extend this study to include students in other disciplines, experiencing other curricula and at different year levels.
Surveys at a university in Hong Kong indicated that graduates of discrete part-time programmes perceived significantly higher development in eight out of nine graduate capabilities than their counterparts in full-time programmes. Several possible explanations are considered and rejected. The conventional view that capabilities are nurtured through immersion in a stimulating campus environment was not applicable, as the part-time students spent less time on campus than the full-time ones. Other data in the survey suggested that the respective teaching and learning envi-ronments might be the principal cause. It appeared that the part-time courses had more teacher– student interaction, and were more likely to employ active learning approaches. Structural equation modelling was used to examine this possible explanation. A model in which the type of teaching and teacher–student relationships impacted upon capability development showed a good fit to the data. The greatest effect was from teaching approaches requiring active student involve-ment and aiming for understanding. There was a mutually reinforcing effect from good teacher– student relationships. The results suggest that a strong effect on the development of graduate capabilities may come through employing active learning approaches.
This paper is concerned with the relationship between students' study processes and the structural complexity of their learning. Study processes are conceived in terms of three independent dimensions — utilising, internalising and achieving — each of which has a cognitive (strategic) and an affective (motivational) component; these are assessed by the Study Process Questionnaire (SPQ). Learning quality is expressed in terms of the complexity of the Structure of the Observed Learning Outcome by applying the SOLO Taxonomy described below. A preliminary study involving 60 undergraduates' responses to education research abstracts is described, in which SOLO levels and short and long term retention of factual material are related to their study processes.
Clinical reasoning remains a relatively under-researched subject in physical therapy. The purpose of this qualitative study was to examine the clinical reasoning of expert physical therapists in 3 different fields of physical therapy: orthopedic (manual) physical therapy, neurological physical therapy, and domiciliary care (home health) physical therapy.
The subjects were 6 peer-designated expert physical therapists (2 from each field) nominated by leaders within the Australian Physiotherapy Association and 6 other interviewed experts representing each of the same 3 fields.
Guided by a grounded theory method, a multiple case study approach was used to study the clinical practice of the 6 physical therapists in the 3 fields.
A model of clinical reasoning in physical therapy characterized by the notion of "clinical reasoning strategies" is proposed by the authors. Within these clinical reasoning strategies, the application of different paradigms of knowledge and their interplay within reasoning is termed "dialectical reasoning."
The findings of this study provide a potential clinical reasoning framework for the adoption of emerging models of impairment and disability in physical therapy.
The retention curve for knowledge acquired in a consumer behavior course is explored in a longitudinal study, tracking individual students from 8 to 101 weeks following course completion. Rasch measurement is used to link tests and to achieve intervally scaled measures of knowledge. The findings indicate that most of the knowledge gained in the course is lost within 2 years. Evidence is provided that knowledge acquired at a deep level of understanding is more likely to be retained than knowledge acquired at a surface level of understanding, and knowledge tested more than once during a course is more likely to be retained than knowledge tested only once. No significant differences in retention were observed related to material covered in a project. Implications are discussed.
Fourth-year medical students were allocated randomly to either problem-based learning (PBL) or case-based learning (CBL) tutorials on the topic of eating disorders during their 6-week psychiatry attachment. All students were evaluated in terms of their tutorial performance and the factual knowledge they had acquired. In turn, students evaluated the performance of the tutors in both the PBL and the CBL process. No significant differences were found between the student groups with respect to their performance or acquired knowledge. Furthermore, there were no significant differences when comparing the PBL format with the CBL format with regard to group functioning or oral interaction between students. Finally, student ratings for tutor performance on feedback, group management skills and personal qualities showed no differences. Implications for education are discussed.
This paper examines the effectiveness of active learning implemented in two undergraduate programmes at the Hong Kong Polytechnic University. Several learning activities were implemented during student seminar sessions. The effectiveness of these activities was investigated using questionnaires and interviews to explore student attitudes as well as the Study Process Questionnaire to measure student approaches to learning. Results showed that active learning made a valuable contribution to the development of independent learning skills and the ability to apply knowledge. It also helped to create interest in the curriculum and to prepare students for their future careers. The activities used affected the quality of student learning by shaping the way that students studied and meeting desired learning outcomes. The results are discussed in the context of student approaches to learning and in relation to the programmes' educational objectives.
Describes an attempt to identify different levels of processing of information among groups of Swedish university students who were asked to read substantial passages of prose. Ss were asked questions about the meaning of the passages and also about how they set about reading the passages, thus allowing for the examination of processes and strategies of learning and the outcomes in terms of what is understood and remembered. It was posited that learning has to be described in terms of its content. From this point differences in what is learned, rather than differences in how much is learned, are described. It was found that in each study a number of categories (levels of outcome) containing basically different conceptions of the content of the learning task could be identified. The corresponding differences in level of processing are described in terms of whether the learner is engaged in surface-level or deep-level processing. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
2,208 students from 66 academic departments in 6 contrasting disciplines from British universities and polytechnic institutions completed an approaches to studying inventory and a course perceptions questionnaire. Factor analyses confirmed that approaches to studying can be described in terms of 3 main factors—Orientations Toward Personal Meaning, Reproducing, and Achieving. In the present analysis, the final factor split into Achieving Orientation and Disorganized and Dilatory, which showed a close relationship with self-rating of academic progress. The course perceptions questionnaire produced 2 main factors. One described formal teaching methods, vocational relevance, and clear goals and standards, and the other represented a favorable departmental evaluation with the highest loadings on good teaching and openness to students. Subsequent analyses examined links between students' perceptions of their main academic departments and their reported approaches to studying. Departments with highest mean scores on meaning orientation were perceived as having good teaching and allowing freedom in learning. Departments with the highest mean scores on reproducing orientation were seen to have a heavy workload and a lack of freedom in learning. (15 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
We sought to obtain through an alternative format some of the well-known benefits of problem-based learning (PBL) during multidisciplinary teaching in a new modular curriculum at a medical school that had previously rejected PBL. To integrate learning within and between systems-based modules, we developed a series of case studies, each lasting 1 or 2 weeks. Key components are small group, case-based tutorials employing non-expert tutors at the start and end of each case study, with discipline-based specialist sessions in-between. Unlike PBL, our programme features tight direction of students'activities, objectives prepared by teaching staff, and extensive feedback/answers provided for the students. The Systems Integration course is the most highly rated component of the new curriculum by the students. Teachers who previously rejected PBL have readily contributed to the case studies and volunteered to act as non-expert tutors. The format offers an attractive alternative for teachers at traditional medical schools that wish to obtain many of the benefits of PBL without adopting full PBL.
Two groups of 20 first-year students were asked to read three sections of a textbook. After the first two sections the groups received different types of question. One group received questions which demanded a thorough understanding of the meaning of the passage. The other group was given detailed factual questions. After the final section of reading a common set of questions of both types was asked. Besides providing further evidence of qualitative differences in learning, the experiment showed that students did adapt their way of learning to their conception of what was required of them.
Amidst the considerable literature published on institutional change in undergraduate teaching and learning, an article co-authored by Robert Barr and John Tagg in 1995 stands out. The authors offered a vision and —perhaps most importantly—gave it a memorable name, the Learning Paradigm. From Teaching to Learning—A New Paradigm for Undergraduate Education is the most frequently cited article in the history of Change. In this article, Barr blended his voice with colleagues who helped initiate Learning Paradigm programs at a public university and in a liberal arts college setting. Through multiple forms of inquiry, including discourse and metaphor analysis, they interpreted the shift from teaching to learning and speculate about its future.
This paper examines the effects of the organisation of curricula, teaching, and assessment on student learning and looks at the different demands which different academic environments make on their students. After a brief review of research into learning contexts in higher education, data from a course perceptions questionnaire are presented. The principal dimensions which students themselves use to characterise academic environments are identified. The perceptions of students in six departments at one British university are compared; it is concluded that students in different subject areas see themselves to be studying in markedly different environments. The results also suggest students' evaluations of the teaching and the courses in each department.
Data from the course perceptions questionnaire are supported and amplified by a preliminary analysis of results from semi-structured interviews of students in the six departments. The most important factor to emerge from the item analysis — the degree to which students feel that their teachers provide a facilitant atmosphere for learning — is confirmed. Students' perceptions of their departments and their teachers are shown to exert important influences on their approaches to learning. It is also suggested that a student's perception of a particular learning task influences the level at which he tackles it.
This study investigates the effects of the learning/teaching environment on students' approaches to learning (i.e. combination of intention and learning strategies) and compares a lecture based to a student-activating setting within the first year of elementary teacher education. Data collection (N = 790) was carried out using a pre-test/post-test method by means of the Approaches to Learning and Studying Inventory (ALSI). Though students' approaches were similar at the start of the course, a clear distinction was found after experiencing the lecture based and student-activating teaching/learning environments. However, the direction of change was opposite to the premise that student-activating instruction deepens student learning. Instead, the latter pushed students towards a Surface Approach to learning and students' Strategic Approaches suffered significant lowering.
This essay argues that teachers would be more effective at promoting students' willingness to work hard at course content that seems to them remote and abstract if teachers explicitly presented that content to students more as a means to their education rather than as the aim of their education. Teachers should confront the fact that most of the content they teach will be forgotten by students. Once this fact is accepted, then it follows that teaching content that teachers know will be forgotten as if it should never be forgotten is myopic and perhaps dysfunctional. An alternative teaching model is to use course content to stimulate the flourishing of developmental human skills--rationality, language, aesthetic responsiveness, imagination, introspection, moral and ethical deliberation, sociability, and physicality--in the service of a developmental notion of liberal education that can never go out of date and can never be forgotten because its effects become absorbed as developmentally advanced orientations of life, not crammed into short-term memory for the sake of passing tests. Note: Link is to the article in a subscription database available to users affiliated with Butler University. Appropriate login information will be required for access. Users not affiliated with Butler University should contact their local librarian for assistance in locating a copy of this article.
Summary. Recent studies have provided information about the approaches to studying and learning used by medical students. However, no published work is available on the approaches of practising doctors. The Adelaide Diagnostic Learning Inventory for Medical Students (ADLIMS) was modified and administered to a random sample of 308 physicians (internists). Generally speaking, physicians seem to have lower scores on surface approach and higher scores on deep approach than students. Level of clinical experience did not appear to influence this finding. However, marked differences were apparent between the approaches adopted by physicians with additional postgraduate academic training and those without. The former had a much stronger tendency to use the more desirable deep approach. The latter seemed to rely more on the less desirable surface approach. Further longitudinal studies will be required to determine whether this difference is attributable to self-selection of those who have already developed a deep approach or is causally related to a training in research.
Although these findings must be interpreted with caution, some implications are clear. Physicians should become more aware of the way they learn and about the way they teach. Inappropriate patterns of learning may be entrenched during the undergraduate and immediate postgraduate years. If validated, these findings may provide support for the inclusion of research projects in medical school and during specialist training.
This article discusses why many current physical therapy entry-level programs may not be designed to educate the type of physical therapy practitioner needed for the 1990s. We suggest a framework for analyzing curriculum content to determine how the curriculum is influencing student outcomes. This framework includes three reference points of analysis, as suggested by Eisner's model of implicit, explicit, and null curricula. We also describe a new kind of physical therapy practitioner, the "reflective practitioner" (Schon's model), and suggest how various curricular components can support the development of this type of practitioner.
This paper reviews the empirical evidence in support of the three concepts in the title. To the extent that a skill should be a general strategy, applicable in a variety of situations, and independent of the specific knowledge of the situation, there is little evidence that problem-solving skills, as described and measured in medical education, possess these characteristics. Instead there is an accumulation of evidence that expert problem-solving in medicine is dependent on (1) a wealth of prior specific experiences which can be used in routine solution of problems by pattern recognition processes, and (2) elaborated conceptual knowledge applicable to the occasional problematic situation.
The use of problem-based learning (PBL) as an educational strategy is explored. In particular, the evidence suggesting the compatibility of PBL with this theory of expertise is discussed. Finally, I review some issues in the design of PBL curricula from the perspective of the proposed model of expertise.
This paper reviews the recent literature on learning styles and approaches to learning. It identifies two separate streams of research, one originating from mainstream cognitive and psychometric psychology and one from research undertaken within the everyday learning environment. The latter is dealt with in greater detail as it seems to have more immediate practical relevance. A simple model of the teaching-learning process is presented showing how students learn in different ways which are partly attributable to their preferred learning style and partly to the context in which the learning takes place. Three basic approaches have been identified: surface, deep and strategic, each resulting in a different learning outcome. The most desirable and successful is the deep approach. The way in which the teaching and the policies of the department and school influence the students' approach to learning are reviewed in some detail. A consideration of these characteristics in medical schools suggested that many may hinder rather than assist in the development of the desired approach. The work reviewed here suggests that the remedy will require not only substantial changes in the teaching, curriculum and, particularly, assessment, but also a new strategy based on identifying and assisting individual students whose approaches to study are not those expected of a competent university-educated doctor.
The purpose of this study was to investigate processes used by students in developing conceptual knowledge in physical therapy.
The subjects were 10 first-year physical therapist students enrolled in a professional Master of Physical Therapy degree program.
Qualitative methods were used to collect data during a 15-week kinesiology course. Data were collected using open-ended interviews, observation, and journals kept by the students throughout the course.
Several major themes emerged, including use of discussion, use of visualization, and use of experience by the students as they learned concepts in kinesiology.
The type of learning processes used by students in this study may be enhanced by educational methods such as collaboration and group learning, situated cognition and use of authentic contexts, cognitive apprenticeship, and whole-part-whole learning. Further research is needed to explore the relationship between student learning processes and teaching methods used in physical therapy education.
The purpose of this qualitative study was to identify the dimensions of clinical expertise in physical therapy practice across 4 clinical specialty areas: geriatrics, neurology, orthopedics, and pediatrics.
Subjects were 12 peer-designated expert physical therapists nominated by the leaders of the American Physical Therapy Association sections for geriatrics, neurology, orthopedics, and pediatrics.
Guided by a grounded theory approach, a multiple case study research design was used with each of the 4 investigators studying 3 therapists working in one clinical area. Data were obtained through nonparticipant observation, interviews, review of documents, and analysis of structured tasks. Videotapes made during selected therapist-patient treatment sessions were used as a stimulus for the expert therapist interviews. Data were transcribed, coded, and analyzed through the development of 12 case reports and 4 composite case studies, one for each specialty area.
A theoretical model of expert practice in physical therapy was developed that included 4 dimensions: (1) a dynamic, multidimensional knowledge base that is patient-centered and evolves through therapist reflection, (2) a clinical reasoning process that is embedded in a collaborative, problem-solving venture with the patient, (3) a central focus on movement assessment linked to patient function, and (4) consistent virtues seen in caring and commitment to patients.
These findings build on previous research in physical therapy on expertise. The dimensions of expert practice in physical therapy have implications for physical therapy practice, education, and continued research.
The purposes of this perspective article are to identify areas of need within clinical education, to describe various models and tools that are proposed and utilized in clinical education, and to explore the extent to which these models and tools might meet the identified needs of clinical education. A synthesis of the literature suggests that the clinical education process in physical therapy currently is characterized by 7 primary needs and that 10 models currently exist to guide the general process or to provide specific tools and practices to enhance its effectiveness. Roles and relationships are critical components in successful clinical education. Theory suggests that clinical educators and students should engage in an intentional, structured process of changing roles during the course of the clinical education experience and that nontechnical competencies such as communication, collaboration, and reflection are crucial for effective practice and may be developed in the clinical education setting. Developing a clearer understanding of the current status of physical therapy clinical education can assist clinical educators in the use of the available models and tools or in developing a new model that addresses potentially unique needs.
Contemporary practice environments are complex and require students and new graduates to possess high-level thinking capabilities to ensure patient safety and quality of care. To achieve this goal, many nurse educators are exploring new pedagogies (critical, feminist, phenomenological, and postmodern) to teach students the practices of thinking that contemporary clinical situations demand. These new pedagogies offer alternatives to the predominant use of conventional pedagogies, which emphasize students' memorization of content and its subsequent application in practice situations. This study, using Heideggerian hermeneutics, documents how teachers are using new pedagogies in ways that shift their attention to teaching thinking and away from devising strategies to help students memorize and apply more content. One of the themes that emerged from this study, Teaching Thinking and Reaching the Limits of Memorization, and two subthemes, Thinking AS Memorization and Recall, and Beyond Memorization: Thinking in Context are presented.
This paper reports a study to determine if a reflective contextual learning intervention would improve novice nurses' critical thinking skills during the first 6 months of their practice.
Nursing research evaluating the development of critical thinking in novice nursing practice is limited. The continual struggle by nurse educators to improve critical thinking demonstrates the need for innovative educational interventions that assist in the development of critical thinking as novice nurses enter into practice.
This small case study was conducted in the United States of America in 2004 with six student/preceptor dyads. The contextual learning intervention was the case through which the novice nurses' critical thinking were analysed using Stake's phases of data analysis. Specific questions (i.e. novice nurses' use of reflection, context, dialogue, time) guided the analysis. Repeating patterns were coded and isolated and later collapsed/enhanced as the analysis moved forward.
Three main themes describe the novice nurses' development of critical thinking: (1) influence of anxiety and power on critical thinking; putting pieces together; (2) questioning as critical thinking: sequential thinking to contextual thinking; and (3) emergence of the intentional critical thinker.
Used as a reflective practicum, contextual learning can be a model of clinical learning in nursing education that develops the contextual, reflective nature of critical thinking.
In current renewal of medical education, problem-based learning (PBL) is the predominant approach. PBL is afflicted with limitations, which cause uncertainness about its future. A profoundly different approach is the case method, developed a century ago and today attracting much less interest in developmental work than PBL.
To compare the characteristics of PBL and the case method and ask the question of whether the case method may serve as an alternative approach to student-centred learning.
The comparison was literature-based.
PBL implicates fostering of self-directed learning and its prospects deal with depth and retention of knowledge and clinical reasoning skills. Problems are used to define learning goals and to stimulate students' interest in various aspects of an item, rather than just for problem-solving. In the small-group tutorials of a PBL curriculum, the teacher is assigned to facilitate the process of self-directed learning and needs not necessarily be a subject-matter expert. In spite of its exciting philosophy and an increased input of students' and teachers' time, the superiority of PBL as a mode of learning has not been convincingly demonstrated, either in terms of acquisition of knowledge or in clinical performance. Moreover, dysfunction is a well-recognized phenomenon. In some PBL tutorials, indifference towards the group discussion is encountered, including individual quietness or dominant behaviour and incomplete attendance. To cope with dysfunctional problems, efforts are recommended aiming to increase PBL tutors' and students' understanding of the group process. As opposed to PBL, the case method relies strongly on teacher-directed learning. Students are placed in a dilemma or a problem to be solved. After preparatory work, they meet for a discussion, lead by a subject-matter expert, who preferably has experienced the case in reality. As a chairperson, the teacher is supposed to stimulate the discussion and detect gaps and misunderstandings. Due to its teacher-dependent approach to learning, the case method is less susceptible to group dysfunction. The case method is also less resource consuming, primarily because it can be practised in groups several times larger than those of PBL.
A revival of the case method seems warranted as an alternative means of interactive learning, which is simpler, easier to realize and less time-consuming with regard to both institutions and students.