Reaching the Summit: From exposure to immersion in quality improvement in physical therapy education

Following the release of its 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine (IOM) convened a summit of 150 interprofessional healthcare educators to reform health professions education. As a result, in 2002, the IOM established an overarching vision to achieve care that is safe, effective, patient-centered, timely efficient, and equitable: “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.” Physical Therapy educators have expanded curricula to teach three of these five competencies. We routinely teach that physical therapists practice in interprofessional teams to provide care that is patient-centered and evidence-based. However, we lag behind other health professions in teaching quality improvement concepts and skills in entry-level education. This session will describe the five IOM competencies and use key frameworks to engage small groups of learners to develop and evaluate quality improvement curricula appropriate for academic and clinical settings. These frameworks include: Kern’s six steps of curriculum design University of Toronto framework of curriculum development, and Kirkpatrick’s Four Levels of Training Evaluation

Enhancing the Patient Experience through Innovative Quality Improvement Education

The “Patient Experience” arm of the Institute for Healthcare Improvement’s Quadruple Aim is defined by the Institute of Medicine (IOM) as quality care that is safe, effective, patient-centered, timely efficient, and equitable. The IOM called for a uniform approach to health professions education utilizing five core competencies to achieve high-quality care. “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.” Physical Therapy educators have expanded curricula to teach three of these five competencies. We routinely teach that physical therapists practice in interprofessional teams to provide care that is patient-centered and evidence-based. However, we lag behind other health professions in teaching quality improvement concepts and skills in entry-level education. This session will discuss how the IOM defines quality in the context of “The Patient Experience,” describe the five IOM competencies for health professions education, identify the gaps in teaching of quality improvement in physical therapy education, and use key frameworks to engage small groups of learner equality improvement curricula and develop new approaches in academic and clinical settings

Click Here! E-Learning Modules for Innovative Instruction and Learning

Purpose: Re-designing all or portions of a course with a fresh perspective can re-energize faculty and make the content more engaging for the learner. Teaching the millennial generation is also prompting faculty to revisit educational strategies. The use of electronic learning platforms, such as eLearning modules, is an innovative learning strategy with several reported benefits including flexibility and convenience for usage, ability for learners to study at their own pace and adaptability to different learning styles. Using technology that is free or already available to faculty, even the novice designer can begin development of these useful study tools. The key to effective eLearning modules is in their design, implementation and subsequent evaluation for effectiveness. Methods and/or Description of Project: Learn from the practical experience of early adopters who will review the evidence supporting this type of delivery, the decision making process utilized to identify appropriate content areas, and provide a step-by-step template of how module development goes from a sketch and brainstormed idea to a tangible product with input from students, clinical instructors and an interprofessional peer faculty team. In addition, ideas for evaluating effectiveness will be shared based on the Pillars of Learning Effectiveness. Several exemplars of E-learning modules will be demonstrated on selected topics such as cardiopulmonary evaluation, range of motion assessment, bariatric equipment overview, and clinical education faculty development. Results/Outcomes: Use of e-learning modules has been implemented in several classes throughout the curriculum on a variety of educational topics including cardiopulmonary evaluation, range of motion examination, and overview of bariatric equipment. A module is also being developed for clinical education faculty regarding methods for providing meaningful student feedback during clinical education experiences. The preliminary data supports that learning outcomes have been achieved with high student usage and satisfaction, an improved first time lab practical pass rate with less faculty time needed for student remediation, and overall faculty satisfaction with the implementation of e-learning modules. Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education: In the pursuit of excellence in physical therapy education, instructors are always looking for innovative, evidence-based instructional methods to enhance student learning and meet the needs of the millennial student. E-Learning modules utilizing interactive technology have been shown to be an effective method for improving student performance in the classroom and the clinic and overall are well received by students. These study aides are individualized, flexible, available any time on any device, align directly to learning objectives and assessment, and provide immediate feedback to facilitate student learning. This supports the APTA Education Section’s strategic plan of supporting the educator role with “evidence based teaching and learning principles, methods and strategies.

Filling the gap. Clinical skill acquisition with interactive online modules to supplement traditional instruction

PURPOSE The purpose of this study was to assess the effectiveness of interactive e-learning modules to supplement traditional instruction for range of motion (ROM) clinical skill acquisition in a doctor of physical therapy(DPT) curriculum. BACKGROUNDS/SIGNIFICANCE Online resources have become highly favored to augment learning especially by millennials for convenience, self-paced content, and versatility in learning styles. It has been reported that elearning platforms are as effective as traditional face-to-face instruction, but may be best utilized as an adjunctive resource for teaching psychomotor skills. Student confidence has also been analyzed with reports of increased self-efficacy with use of online learning materials. There are deficiencies in the literature related to the use of e-learning and student outcomes. There are no studies investigating the use of online technologies to supplement ROM skill acquisition and an overall deficiency regarding interactive learning platforms in DPT curriculum. During the last two years at one institution, only about half of the class passed the ROM lab practical on the first attempt. Requests by students for a supplemental resource beyond the textbook as well as faculty searching for an option that would appeal to the millennial generation and address common errors lead to the development of interactive e-learning modules to fill in the gap. This study aims serve as a comprehensive evaluation of modules by analyzing pass rates, confidence, usage, and student satisfaction. We hypothesized the modules would be highly regarded, utilized by students, and result in increased lab practical pass rates. SUBJECTS 52/53 first-year DPT students consented to participate. METHODS AND MATERIALS This was prospective cohort study about supplemental modules created by a faculty-student team to be highly-engaging and media rich where the learner decides the pace and order of content delivered. Embedded quizzes provided immediate feedback for the learner to reflect on their understanding. Modules supplemented 4 labs with faculty demonstrations, peer practice and lab assistant feedback. Students were assessed by a high-stakes lab practical of ROM measurements on a standardized patient: upper extremity (UE), lower extremity(LE) and spine. At the beginning of the semester, students were randomly divided into 2 groups with 1 group receiving access to the UE modules and the other having access to the LE modules. To reduce the crossover effect between the groups and maintain the integrity of the study, students were educated on the importance of only viewing the modules they had access to and faculty were blinded to group assignment. Mid-way through the semester all students had the option to choose if they wanted access to the last set of modules focused on the spine. Students rated confidence on a 10-point Likert scale and self-reported module usage was confirmed by the learning management system. Student satisfaction was assessed by an end of semester course evaluation. ANALYSES Chi-square tests were used to determine associations between groups for lab practical pass rates. Logistic regression was used to analyze differences between cohorts by year (α= 0.05). RESULTS Data was analyzed from 44/52 students. 8 students were excluded (6 for not using modules, 1 had previously taken the class, 1 viewed modules not of their assigned group). There were 34 females and 10 males with a mean age of 23 years (21-28), who reported race as Caucasian (n=41), Asian (n=2) and Hispanic (n=1). There were no significant differences between groups for gender, age or race. The average module usage per person was 2.4hours (10 min-7 hours). The average self-reported confidence for both groups combined increased from 4.3/10 to9.0/10 at the end of the semester. There was no significant difference between groups in the first time lab practical pass rate (p=0.30) and no significant differences in passing the UE (p=0.23) or LE (p=0.66) measurement. The first time lab practical pass rate for all students in 2015 was 71%. Without modules available, first time pass rates were 63% in 2013 and 47% in 2014.Individual year effects show a significant difference between 2015 and 2014 (p=0.02), but no difference for 2015 and2013 (p=0.40).All students requested access to the spine modules. Student satisfaction results of the modules: 78% reported appropriate interactivity, 80% wanted access beyond the semester, 76% said it helped them learn, and 85%recommended using them in the future. CONCLUSIONS The results support the use of interactive e-learning modules to supplement ROM clinical skill acquisition in a DPT curriculum. It appears that the interactive modules were well utilized by the students, increased confidence, and had a high rate of satisfaction as indicated by the course evaluation and students wanting access to the spine modules. Additionally, there were significant improvements in first time pass rates from the previous year when the modules were not available. Our results are congruent with previous studies that reported online technologies are best used to supplement traditional instruction. Limitations include a small sample size from a single institution and the inherent inaccuracies in students’ recall of self-reported data. Strengths include outcomes that went beyond student satisfaction. Furthermore, this interactive module served as a readily accessible resource and allowed students to study at their own pace and learning style. This platform for supplemental materials should be strongly considered for attainment of ROM psychomotor skills and could be valuable for instruction of other foundational clinical skills in physical therapy. FUNDING SOURCE University of Nebraska Medical Center College of Allied Health Professions and the Office of the Vice Chancellor for Academic Affairs

Developing a Rapid Assessment Program for Student Success in Clinical Education

Successful management of the struggling student in the clinic relies heavily on the early identification of clinical performance deficits. CIs who directly observe student performance, actions and behaviors should aim for early and precise identification of difficulties, which should lead to initial discussions with the student. If the student\u27s struggles require involvement from the educational institution, the CI should promptly contact and collaborate with the DCE. Early communication with the DCE is beneficial, as they can provide support for CIs overwhelmed by the difficulties that accompany working with a challenging student. The DCE provides guidance on determining the depth of deficiencies, the student’s needs, and options for remediation. The Rapid Student Assessment and Review (R-STAR) Program was designed to facilitate a thorough and timely review of students’ Clinical Performance Instruments (CPIs)through partnership with expert clinical education faculty. With the increasing number of students in programs and the competing demands on Clinical Instructors (CIs), the successful management of the struggling student in the clinic relies heavily on the early identification of clinical performance deficits. Judicious review of CPI ratings and narratives is essential to identify discrepancies between the scores given and narrative comments. The R-STAR Program utilizes clinical partners who were carefully selected and specifically trained to review and provide feedback to students and CIs, while identifying those individuals with issues requiring the DCE to prioritize and address. This session describes how to develop an efficient and effective program that may be implemented to help facilitate the timely management of student assessments in clinical education to enhance success

Does Implementation of a Lifestyle Medicine Curriculum Affect Student Wellness During Doctor of Physical Therapy Education?

Background Current healthcare environments amplify the need for educational systems to forge healthy workforces to withstand stressors. Our study examines the effects of embedding a lifestyle medicine curriculum on student wellness in a Doctor of Physical Therapy (DPT) Program, simultaneously preparing students to implement lifestyle medicine with future patients and communities. Methods In a DPT program, we implemented a lifestyle medicine curriculum grounded within the Social-Ecological Model. This framework emphasizes student success in the program’s pre-clinical phases, creates a purposeful “ripple effect” threading wellness strategies among peers, patients, and communities, and emphasizes wellness as a clinician over the 32-month curriculum. The Five Factor Wellness (FFW) Inventory and Psychological Capital (PC) Questionnaire measured student wellness at matriculation, mid-program, and graduation. We used Social Network Analysis (SNA) to examine the strength and types of peer connections. Results The response rate for two cohorts across the four-year study for the FFW was 100% and 80% (n=100/125) for PC and SNA. Race composition was White (84.0%, n=105), Asian (9.6%, n=12), Native Hawaiian or Pacific Islander (2.4%, n=3), Hispanic or Latino (2.4%, n=3), other-not described (.8%, n=1), and preferred not to answer (.8%, n=1); and 61.6% (n=77) were female. SNA: The average number of close classmate connections increased from 4.7 (0-28) to 12.9 (0-39) at mid-program and to 19.7 (3-43) at graduation. A repeated-measures ANOVA (Bonferroni correction) revealed significant increases in scores: matriculation-mid-program - FFW-coping (1.6, .2-3.0, p=.024), FFW-leisure (3.2, .8-5.5, p=.004), FFW-self-care (2.3, .7-3.9, p=.002), PC-efficacy (2.1, 1.3-2.9, p\u3c.001), PC-optimism (1.6, .5-2.6, p=.002); mid-program-graduation - PC-efficacy (2.3, 1.5-3.0, p\u3c.001), PC-hope (2.4, 1.4-3.4, p\u3c.001), PC-resilience (1.7, .7-2.7, p\u3c.001); matriculation-graduation - FFW-leisure (3.5, .6-6.4, p=.013), PC-efficacy (4.4, 3.3-5.4, p\u3c.001), PC-hope (3.4, 2.4-4.3, p=\u3c.001), PC-resilience (2.2, 1.3-3.1, p\u3c.001), PC-optimism (2.0, 1.0-3.0, p\u3c.001). Conclusion Implementing a lifestyle medicine curriculum contributed to DPT graduates developing close connections among peers for support and friendship, being empowered with coping strategies to regulate responses and manage negative effects of life events, taking responsibility for self-care measures, and improving psychological capital to persevere confidently toward goals. Funding Funding was provided by the College of Allied Health Professions Interprofessional Education Grant and the Physical Therapy Program of the University of Nebraska Medical Center

EASE-ing DPT Students into the Acute Care Environment

Purpose: The Early Acute Service Experience program (EASE) is a dual-purpose program that prepares physical therapy students to transition from the academic setting to the acute clinical environment while providing a helpful service to key clinical partners. Methods/Description: This program requirement begins as students are assigned a weekend in the second semester of the DPT curriculum to work with a physical therapist in the hospital. As the first step in their orientation, students complete an e-learning module which focuses on the knowledge, skills, and abilities required in the acute care clinical environment. Once a student has completed the module and successfully passed the quiz, they complete the second step of preparation - a simulation experience led by a faculty member and a clinician from the hospital. After EASE, students complete a written reflection about their experience. Results/Outcomes: The inaugural cohort of students participating in EASE completed their first full-time clinical education experience in May 2021. Objective results regarding student performance and CI perspectives will be shared about their transition to the acute environment following participation in EASE. Anecdotally, reflections from students indicate that EASE has had a positive impact and the goals of the program were accomplished

From Zoom to the Clinic: Unique Student Challenges in Physical Therapy Clinical Education

While the abrupt shift in PT education (PTE) brought on by the pandemic created opportunities for educational innovation, it also brought relational separation and fragmented learning due to lockdowns, social distancing, face masks, and communication limited to virtual platforms. Academic programs increased use of virtual learning, rearranged curriculum, reduced lab and simulated learning time, and provided fewer, if any, opportunities for service learning and patient contact. Clinic sites paused clinic education experiences or hosted fewer students to maintain social distancing and limit disease exposure. As PTE returns to more typical curricular schedules and practices, it is important to be aware of the current challenges students may be facing. Common challenges include not only increased levels of anxiety and depression, but also problems with self-esteem and confidence, resilience, a growth mindset, and metacognition. This session will investigate the implications of the rise in prevalence of issues in internalizing professional identity and clinical competency for clinical education; the characteristics of unique mental health challenges, such as impostor phenomenon, compassion fatigue, and burnout; screening tools; and suggestions for successfully mentoring students who have low self-esteem, a lack of confidence, decreased resiliency, and imposter feelings

Student wellness during curriculum implementation of a lifestyle medicine approach within the Social-Ecological Model: a longitudinal study

Purpose The student-life experience is an ideal time to implement lifelong wellness behaviors needed for the professional role. The ongoing effects of the COVID pandemic have amplified the need for Doctor of Physical Therapy (DPT) educational programs to train an emerging workforce that can, through personal wellness, withstand the stressors of personal and professional lives. The study purpose is to: a) evaluate the change in student wellness from matriculation to mid-program to completion after implementation of a curriculum based on a lifestyle medicine approach within the Social-Ecological Model, and b) compare student wellness between cohorts that matriculated before and during the COVID pandemic. Methods/Description We implemented curricular interventions to promote student wellness and professional formation in the fall of 2019. Students first study healthy behaviors for themselves, followed by learning experiences around the professional formation as a healthy clinician, and finally health promotion for patients and communities. We also modified program policies (e.g., holistic admissions, attendance, tutoring, faculty advising) to be student-centered. Three student cohorts in the DPT program at a Midwest academic medical center agreed to participate. Cohort19 (C19, n = 66) matriculated in 2019, Cohort20 (C20, n=66) in 2020, and Cohort21 (C21, n=64) in 2021. Participants completed the Five Factor Wellness Inventory (FFW) at matriculation into the 32-month program. C19 and C20 completed the FFW midway through the program as planned. Remaining assessments will occur as scheduled at program midpoint and completion. The FFW inventory is the gold standard for identifying central factors for healthy living. The wellness score is composed of 5 “Selfs” (Essential, Social, Creative, Physical, and Coping) made up of 17 domains where the acceptance of personal responsibility and choice have positive effects on well-being. A one-way ANOVA was used to compare FFW scores of all 3 cohorts at matriculation. Paired sample t-tests were used to compare results of C19 and C20 at mid-program and over time (matriculation and mid-program). Results/Outcomes The curriculum revisions and policy modifications were implemented in fall 2019. There were unexpected COVID-directed health measures beginning in March 2020 resulting in a move to more virtual activities that were not planned in our curriculum and new pressures related to student wellness. Three cohorts of DPT students (C19, C20, C21) completed the FFW at matriculation. Additionally, C19 and C20 completed the FFW at mid-program. The response rate for the FFW across all cohorts and time points was 100%. Comparison across cohorts: At matriculation, one of 17 FFW domain scores was found to be significantly different across cohorts. The score for the exercise domain (physical self) was significantly higher (p=.046) for C19 (pre-COVID) compared to C21. However, at mid-program for C19 and C20 (both during COVID), scores were significantly lower in C19 compared to C20 in five domains: culture (p=.004) and gender identification (p=.005) (essential self), nutrition (p=.037) (physical self), leisure (p=.020) and self-worth (p=.035) (coping self). Comparison over time: A comparison of FFW scores between matriculation and mid-program for C19 showed a significant increase in self-care scores (p\u3c.001 ) (essential self). For C20 scores significantly increased at mid-program in the coping self domains of leisure (p=.001) and stress management (p=.025), friendship (p=.018) (social self), and nutrition (p=.001) (physical self) leading to a significant improvement in overall FFW score (p=.037). Conclusions To optimally train a health workforce, faculty are studying methods to promote student wellness as part of student professional formation along with the curriculum for the PT of the future. Our study shows higher wellness scores in several domains in cohorts matriculating after COVID compared to before. This finding is interesting as it could indicate students entering professional school were potentially more prepared in terms of healthy behaviors due to the public health news surrounding COVID . Our study shows that components of student wellness may be improving due, in part , to the curriculum interventions and policies supporting wellness. These are important findings especially given the intended curriculum delivery was interrupted by directed health measures beginning in March 2020. The future direction is to continue to assess outcome measures through the end-of-program. In addition, we are analyzing additional measures of wellness such as psychological capital of hope, confidence, resilience and optimism, and social capital measuring connections with others for a sense of belonging. Our curriculum and supportive policies could be a model to demonstrate how student wellness can be aligned with a lifestyle medicine approach within the individual, relationship, community and society components of the Social-Ecological Model. REFERENCES Bezner JR. Promoting Health and Wellness: Implications for Physical Therapist Practice. Phys Ther. 2015; 95(10):1433-1444. Brooke, T., Brown, M., Orr, R., & Gough, S. (2020). Stress and burnout: exploring postgraduate physiotherapy students’ experiences and coping strategies. BMC Medical Education, 20(1), 1-11. Centers for Disease Control.Social Ecological Model. https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html; Materials developed by Dahlberg LL, Krug EG. Violence: a global public health problem. In: Krug E, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, eds. World Report on Violence and Health.Geneva, Switzerland: World Health Organization; 2002:1-21. Coffey DS, Eliot K, Goldblatt E, et al. A multifaceted systems approach to addressing stress within health professions education and beyond [discussion paper]. National Academy of Medicine website. https://nam.edu/wp-content/uploads/2017/01/Multifacted-Systems-Approach-to-Addressing-Stress-Within-Health-Professions-Education-and-Beyond.pdf Published January 30, 2017. Dean D. (2009) Physical therapy in the 21st century (Part II): Evidence-based practice within the context of evidence-informed practice, Physiotherapy Theory and Practice, 25:5-6, 354-368. Douris, P. C., D\u27Agostino, N. A., Mathew, S. K., Anderson, R. P., Bauman, K. M., Tiangtham, S. A., ... & Hall, C. A. (2020). The physiological and psychological effects of the first year of an entry-level physical therapist education program on students. Journal of Physical Therapy Education, 34(3), 186-191. Myers JE, Sweeny TJ. Five Factor Wellness Inventory. Mindgarden https://www.mindgarden.com/99-five-factor-wellness-inventory. Accessed 3.15.202