Using active learning strategies to teach DPT students how to assertively address inappropriate patient sexual behavior (IPSB)

PURPOSE/HYPOTHESIS Inappropriate sexual behavior is defined as a “verbal or physical act of an explicit, or perceived, sexual nature, which is unacceptable within the social context in which it is carried out.” In a survey of U.S. PTs, 86% of the respondents reported experiencing at least one type of IPSB. PT education programs are required to teach concepts of professional duty, communication skills, and cultural competency, however, management techniques of IPSB in the clinic are not uniformly taught in schools. The use of active learning methods such as role play simulation and small group discussion has been successful with other healthcare professionals allowing students to practice behaviors in a safe place. The aim of this study was to use flipped and active learning methods to effectively teach DPT students assertive approaches to managing IPSB. This study describes the effects on students’ knowledge and attitudes pre- and post-instruction. NUMBER OF SUBJECTS Forty-five first-year DPT students participated as part of a course on psychosocial issues. MATERIALS/METHODS Faculty developed eight case scenarios for the in-class discussion and role play. Students completed pre- and post-class paper surveys about their beliefs and knowledge on IPSB. The flipped model involved reading an assigned article on the topic prior to the class, brief instruction by faculty, interactive small-group discussion, role play, and a large group debrief in class. RESULTS: Forty-three students reported reading the preparatory article prior to class. Significant improvements were observed in students’ perceptions including: 1) the ability to address sexuality with young patients (p CONCLUSIONS The students responded well to the learning experience and believed they improved their ability to address IPSB. There was an interaction between males and females on the self-efficacy question. Females perceived their abilities to be lower than the males initially, but they scored higher post-instruction. While both groups’ perceptions changed, we observed that the females gained more from the experience. We recommend using the flipped classroom model and simulation methods to instruct DPT students in assertive behaviors. CLINICAL RELEVANCE PT’s may encounter IPSB in the clinic. Practicing strategies for these situations could lead to more appropriate therapist-patient interactions and fewer adverse effects. FUNDING SOURCE UNMC Division of Physical Therapy Educatio

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

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

Health Information Seeking on Behalf of Others: Characteristics of ‘Surrogate Seekers’

Understanding the health information seeking behaviors of surrogate seekers (those who seek health information for others) may guide efforts to reach disadvantaged populations. We used 2011-2012 data from the Health Information National Trends Survey to describe the behaviors of online surrogate seekers. Respondents were asked about their use of the Internet for surrogate seeking over the prior 12 months. Data were weighted to calculate population estimates. Compared to those who sought health information online for only themselves, surrogate seekers were more likely to live in households with others (weighted percent 89.4% vs. 82.5% of self-seekers; p \u3c 0.05); no significant differences in gender, race, income or education were observed. Surrogate seekers were more likely to report: visits to social networking sites to read and share about medical topics; participation in online health support groups and downloading of health information to electronic devices. On multivariate analysis, those who had looked online for a healthcare provider were more likely to be surrogate seekers (OR 1.67, 95% CI 1.08-2.59). Our results offer insight for leveraging health communication efforts to reach populations who rely upon surrogate seekers for health information

Designing a course to acculturate professional behaviors of international students in physical therapy education

The University of Nebraska Medical Center DPT program has a Global Health Opportunity track in which international students work on a master’s degree and complete a DPT. The current students are from China and meet all requirements of the DPT and graduate admissions, including a high proficiency in English (e.g. TOEFL ³ 90). All students have undergraduate degrees in medicine, rehabilitation therapy or medical sciences from universities in China. While these students have performed well in the didactic DPT curriculum, we noted a trend in professional interactions and communication which interfered with clinical performance and required remediation. To proactively circumvent these issues, we designed a course to develop an understanding of American culture, the US healthcare system, and professional behaviors required of physical therapists. Topics focused on themes of personal development, professionalism, interprofessional relationships, and communication. The course used self-reflection learning methods including mind maps, personal learning plans, and reflection papers to facilitate self-awareness and develop capacity for self-directed learning. Innovative Improv techniques and exercises taught communication skills related to body language and listening. Several experiences occurred in the community and the university setting to encourage practice of learned skills. This included interacting with an older adult fitness client and receiving feedback on this interaction from a DPT-2 student and engaging with stroke support group participants. The final project was an oral presentation with an impromptu question and answer session

Rapid sulfurisation of highly branched isoprenoid (HBI) alkenes in sulfidic Holocene sediments from Ellis Fjord, Antarctica

Author Posting. © Elsevier B.V., 2007. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Organic Geochemistry 38 (2007): 128-139, doi:10.1016/j.orggeochem.2006.08.003.Samples of particulate organic matter from the water column and anoxic Holocene sediment layers from the Small Meromictic Basin (SMB) in Ellis Fjord (eastern Antarctica) were analyzed to study the early incorporation of reduced inorganic sulfur species into highly branched isoprenoid (HBI) alkenes. HBIs were not detected in the water column samples from austral winter, whereas compounds containing the C25 HBI skeleton were abundant in all analyzed Holocene sediment layers. The structure of the C25:2 HBI alkene together with its enriched stable carbon isotopic composition suggest that the HBI alkene is produced by a diatom or diatoms probably belonging to the Navicula genus present in the sea-ice which covers the area most of the year. Within just 500 years of deposition, all of the HBI alkene was sulfurised. A mixture of products was formed, including components tentatively identified as a C25 HBI thiane and three S-containing dimers composed of two C25:1 HBI skeletons linked together by a sulfide bond. Most of the HBI alkene, however, was converted to polar S-containing compounds. The observed reaction rate for sulfurisation the C25:2 HBI alkene is the highest observed so far in natural systems. Sterols and other lipids known to be prone to sulfurisation were only minimally sulfurised under these depositional conditions. The reason for this is presently unclear.Funding for the collection of the sediment and water samples (by MJLC and CW) was provided by ASAC grant 1166 to JKV. This work was further supported by a grant from the Netherlands Organization for Scientific Research (NWO; Netherlands Antarctic Research Proposals 851.20.006 to JSSD)

Prospectus, November 2, 2005

https://spark.parkland.edu/prospectus_2005/1025/thumbnail.jp

Resolving subunit degeneracy with nonsymmetric pseudocontact shifts

Protein Science (2002), 11:2464–2470Desulfovibrio gigas desulforedoxin (Dx) consists of two identical peptides, each containing one [Fe-4S]center per monomer. Variants with different iron and zinc metal compositions arise when desulforedoxin is produced recombinantly from Escherichia coli. The three forms of the protein, the two homodimers [Fe(III)/Fe(III)]Dx and [Zn(II)/Zn(II)]Dx, and the heterodimer [Fe(III)/Zn(II)]Dx, can be separated by ion exchange chromatography on the basis of their charge differences. Once separated, the desulforedoxins containing iron can be reduced with added dithionite. For NMR studies, different protein samples were prepared labeled with 15N or 15N + 13C. Spectral assignments were determined for [Fe(II)/Fe(II)]Dx and [Fe(II)/Zn(II)]Dx from 3D 15N TOCSY-HSQC and NOESY-HSQC data, and compared with those reported previously for [Zn(II)/Zn(II)]Dx. Assignments for the 13C shifts were obtained from an HNCA experiment. Comparison of 1H–15N HSQC spectra of [Zn(II)/Zn(II)]Dx, [Fe(II)/Fe(II)]Dx and [Fe(II)/Zn(II)]Dx revealed that the pseudocontact shifts in [Fe(II)/Zn(II)]Dx can be decomposed into inter- and intramonomer components, which, when summed, accurately predict the observed pseudocontact shifts observed for [Fe(II)/Fe(II)]Dx. The degree of linearity observed in the pseudocontact shifts for residues 8.5 Å from the metal center indicates that the replacement of Fe(II) by Zn(II) produces little or no change in the structure of Dx. The results suggest a general strategy for the analysis of NMR spectra of homo-oligomeric proteins in which a paramagnetic center introduced into a single subunit is used to break the magnetic symmetry and make it possible to obtain distance constraints (both pseudocontact and NOE) between subunits

Prospectus, February 15, 2006

https://spark.parkland.edu/prospectus_2006/1004/thumbnail.jp