Planning and Implementation of Physical Therapy Services in an Athletic Training Pro-Bono Clinic: An Administrative Case Report

Background & Purpose Athletic Training and Physical Therapy students have overlapping, yet unique aspects of clinical competencies and scopes of practice, offering rich potential for interprofessional partnership. University of Nebraska Medical Center (UNMC) Doctor or Physical Therapy Education expanded its program to the University of Nebraska-Kearney (UNK) campus, which boasts a Division II athletic training (AT) program. To create meaningful IPE experiences for both programs (1,2), campus leaders from the UNMC College of Allied Health Professions and UNK sought to create an interprofessional clinic by adding PT care to an existing AT-led pro-bono clinic serving the University intramural recreation community. This project describes the process of integrating services with a focus on educating students in a team-based care model. Methods An administrative case report framework allows description of the development phases of the collaborative clinic. Details including AT and PT scope of practice, supervision requirements, liability coverage, and clinic resource needs are addressed. Operational considerations regarding student orientation, scheduling and programmatic outcomes assessment are also described. Results & Outcomes The outcomes of this clinic partnership are categorized in three key areas. Clarification of roles and responsibilities occurs as students work side-by-side to reach patient goals and lead different aspects of care. Relationships between clinicians, students and referral sources (in and out of clinic) build trust necessary for effective team function, improved communication and patient care. Relationship-building is key for continued clinic success and viability, simultaneously providing a springboard for both programs to meet the IPEC Core Competencies (3). Continued development of assessment of student learning is ongoing. Impressively, the clinic has experienced 157% growth in patient visits and an unexpected impact, reaching students representing ethnic minorities and a student population that is transitioning from school-based IEPs – and is underserved in this region and across the US (4). Conclusion Clinic growth and legal practice standards have highlighted the need to implement several new policies and procedures for clinic operations. Scheduling preferences for AT:PT ratios and pairing of Year 1/2 PT students are recommended to establish mentoring relationships and teaching opportunities for upper-level students. Developing a student board will help with scheduling, standardization of documentation and communication between disciplines to ensure well-rounded coverage, facilitating hand-offs and continuity of care. Providing students with ownership of clinic operations may enhance professional responsibility and learning (5)

Creating Patient Context: Empathy and Attitudes Toward Diabetes Following Virtual Immersion.

BACKGROUND: Pandemic circumstances created challenges for doctor of physical therapy (DPT) students to understand social determinants of health (SDH) in clinical rotations. Instead of canceling clinical rotations, a virtual reality cinema (cine-VR) education series was implemented. The purpose of this project is to describe the effect of this simulated immersion on student empathy and attitudes toward diabetes. METHOD: The DPT students (n=59) participated in 12 cine-VR education modules, completing surveys at three time points as part of coursework. The students completed baseline measures of the Diabetes Attitude Scale-Version 3 (DAS-3) and Jefferson Empathy Scale (JES), and then were immersed in 12 cine-VR modules. One week after module completion, students participated in a class discussion about the modules. The students repeated the JES and DAS-3 scales at postclass and six weeks later. Three subscales from the Presence Questionnaire (PQ) were used to measure the virtual experience. RESULTS: Student scores on three DAS-3 subscales significantly improved on posttest: Attitude toward patient autonomy, Mean: 0.75, SD: 0.45; DISCUSSION: These modules can allow for a shared student experience that improves diabetes attitudes, increases empathy, and fosters meaningful classroom discussion. The cine-VR experience is flexible, and modules allow students to engage in aspects of a patient\u27s life that were not available otherwise

Zoom in to Fitness: A Novel Way of Bringing Fitness Experts to Seniors

Participants will discover a how a local educational institution was able to think creatively and bring much-needed programming to local seniors during the height of the COVID-19 pandemic restrictions. Participants will also experience first-hand how a virtual physical activity session can be delivered safely and effectively in the comfort of the senior’s own living environment or a group fitness room environment. Participants will be asked to think creatively of possible community partners, as well as possible barriers and facilitators to implementing this innovative wellness strategy. Information will be presented regarding additional activities that could be presented in this format such as nutrition, Be prepared to engage in a variety of physical activities presented at various levels of intensity modification, as you see how this could be implemented in your setting! 1) Discuss the positive impact of physical activity on senior wellness, cognition and social connectedness. 2) Discuss an innovative strategy for senior activity amidst COVID-19 facility restrictions. 3) Identify design considerations for implementing a physical activity event in your facility, including possible community partners, facilitators and barriers. 4) Experience segments of a physical activity program at various intensity modification levels. 5) Explore additional modalities for senior engagement in a virtual environment to impact healthy lifestyle

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

Developing Interactive Curricular Elements with Teams of Faculty, Staff and Students

Students are continually searching for new resources to augment their learning. Online resources have become highly favored, especially by the millennial age group, for convenience, self-paced content, and versatility across learning styles. It has been reported that e-learning platforms are as effective as traditional face-to-face instruction, but may be best utilized when used as an adjunctive resource for teaching psychomotor skills.1,2 In a study about student confidence, results showed an increase in self-efficacy following the use of online learning materials.3 Blended learning, the next generation of web-based education, mixes advances in technology with creative faculty to fuse effective delivery methods that promote student engagement and learning. Re-designing all or portions of a course with a fresh prospective can re-energize faculty and render content more engaging for the learner but development can be hampered by limited time and resources. Our academic health science center launched a strategic initiative in 2013 for interprofessional student and faculty teams to build interactive e-learning modules. This presentation will focus on the significant role of medical and allied health science students in the development of interactive curricular elements, which can save faculty time and resources while enhancing student learning. Through this program, a large interprofessional network of collaborators with varying skill sets was created. The network includes nearly 100 students and faculty members from medical and allied health professions that have created over 50 e-learning projects. The greatest benefits of engaging student-faculty teams as e-learning developers have been the trust and cohesion, resource sharing and brokering of information consistent with the social capital theory. In addition, the high quality of e-modules resulting from the creative use of media-rich content in student designs increased peer engagement. With students as e-learning collaborators, faculty as content experts, and instructional design expertise we increased the production of curricular-based e-learning modules within a budget-friendly model while reducing faculty time required for development. More importantly, many additional modules have been created by teams outside of the formal institutional mechanism, suggesting the widespread adoption of this teaching modality in an expanding network. Regardless of educational trends, faculty who implement a novel learning tool should be aware of the learner’s cognitive load, or working memory, which has a limited capacity. Each module is evaluated using a checklist to examine accessibility and educational design. There are content development strategies using visual and auditory channels to maximize learner efficiency and minimize distractions for long-term memory development.4 The presenters will share an overview of this initiative and practical experience. We will a) describe the resultant network structure and composition of faculty, students and staff involved; b) provide a step-by-step timeline of how the e-learning modules went from a sketch and brainstormed idea to a tangible and useful product and the important role of instructional designers and an interprofessional peer-faculty team, c) share resources used for creation, and d) demonstrate exemplars on topics such as joint examination, the cardiopulmonary system, International Classification of Functioning, scanning a hospital room, and reviewing a medical chart

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

Clinicians' Views of Patient-initiated Follow-up in Head and Neck Cancer: a Qualitative Study to Inform the PETNECK2 Trial

Aims Current follow-up for head and neck cancer (HNC) is ineffective, expensive and fails to address patients' needs. The PETNECK2 trial will compare a new model of patient-initiated follow-up (PIFU) with routine scheduled follow-up. This article reports UK clinicians' views about HNC follow-up and PIFU, to inform the trial design. Materials and methods Online focus groups with surgeons (ear, nose and throat/maxillofacial), oncologists, clinical nurse specialists and allied health professionals. Clinicians were recruited from professional bodies, mailing lists and personal contacts. Focus groups explored views on current follow-up and acceptability of the proposed PIFU intervention and randomised controlled trial design (presented by the study co-chief investigator), preferences, margins of equipoise, potential organisational barriers and thoughts about the content and format of PIFU. Data were interpreted using inductive thematic analysis. Results Eight focus groups with 34 clinicians were conducted. Clinicians highlighted already known limitations with HNC follow-up – lack of flexibility to address the wide-ranging needs of HNC patients, expense and lack of evidence – and agreed that follow-up needs to change. They were enthusiastic about the PETNECK2 trial to develop and evaluate PIFU but had concerns that PIFU may not suit disengaged patients and may aggravate patient anxiety/fear of recurrence and delay detection of recurrence. Anticipated issues with implementation included ensuring a reliable route back to clinic and workload burden on nurses and allied health professionals. Conclusions Clinicians supported the evaluation of PIFU but voiced concerns about barriers to help-seeking. An emphasis on patient engagement, psychosocial issues, symptom reporting and reliable, quick routes back to clinic will be important. Certain patient groups may be less suited to PIFU, which will be evaluated in the trial. Early, meaningful, ongoing engagement with clinical teams and managers around the trial rationale and recruitment process will be important to discourage selective recruitment and address risk-averse behaviour and potential workload burden.Members of the PETNECK2 Research Team: A. Karwath; B. Main; C. Gaunt; C. Greaves; D. Moore; E. Watson; G. Gkoutos; G. Ozakinci; J. Wolstenholme; J. Dretzke; J. Brett; J. Duda; L. Matheson; L.-R. Cherrill; M. Calvert; P. Kiely; P. Gaunt; S. Chernbumroong; S. Mittal; S. Thomas; S. Winter; W. Won