Schreiber, Joe PT, PhD, PCS; Goodgold, Shelley PT, ScD; Moerchen, Victoria A. PT, PhD; Remec, Nushka PT, PCS; Aaron, Carolanne PT, PhD, PCS; Kreger, Alison PT, DPT, PCS
Chatham University, Pittsburgh, Pennsylvania (Dr Schreiber); School of Health Sciences, Simmons College, Boston, Massachusetts (Dr Goodgold); Department of Human Movement Sciences, School of Health Sciences, University of Wisconsin–Milwaukee (Dr Moerchen); Department of Physical Therapy, Phoenix Children's Hospital, Phoenix, Arizona (Ms Remec); School of Health Sciences, Touro College, New York, New York (Dr Aaron); and Department of Physical Therapy, Wheeling Jesuit University, Wheeling, West Virginia (Dr Kreger).
Correspondence: Joe Schreiber, PT, PhD, PCS, Chatham University, Woodland Rd, Pittsburgh, PA 15232 (firstname.lastname@example.org).
Grant Support: This work was funded by the Section on Pediatrics of the American Physical Therapy Association.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.pedpt.com).
The status of professional pediatric physical therapy education in the United States was last investigated by Cherry and Knutson1 in 1993. At that time, the authors identified a need to gather information about the pediatric content being taught to physical therapist students, the amount of time devoted to this topic area, and the ways in which pediatric material was organized and delivered within professional curricula.1 In 2008, the Section on Pediatrics (SOP) of APTA created a task force to revisit this issue to provide an updated description of the content and structure of professional pediatric physical therapy education.
Much has changed in the past 18 years in professional physical therapy education. In 1993, respondents to the Cherry and Knutson survey reported that 63% of programs offered a bachelor's degree or certificate, and 37% offered some type of master's degree.1 As of February 2010, 96% of accredited professional physical therapist programs award the doctor of physical therapy degree, and none offers a bachelor's degree.2 In addition to the shift toward doctoral professional education, APTA used a consensus-based process in 2000 to create the normative model of physical therapy professional education.3 This document informs the purpose, scope, and content of professional physical therapy education. The normative model was revised in 2004 and includes 23 professional expectations of graduates who complete education programs and enter practice. The model also includes professional educational outcomes, professional primary content with practice-expectation themes, and examples of terminal behavioral objectives and instructional objectives to be achieved in the classroom and in clinical practice supported by foundational and clinical sciences.3
An additional recent influence on pediatric professional education is the document, published by the SOP, Pediatric Curriculum Content in Professional Physical Therapist Education: A Cross-Reference for Content, Behavioral Objectives, and Professional Sources. The purpose of this document, first published in 2001 and updated in 2009, is to provide a resource for pediatric educators based on contemporary practice.4 The document includes recommendations for key pediatric content areas along with suggested behavioral objectives related to pediatric physical therapy.
In 1993, Cherry and Knutson1 identified a need for the SOP to have updated information available for inquiries regarding the status of pediatric education, to recommend changes, and to establish a baseline for future research.1 In addition, information about pediatric curricula can help educators advocate for inclusion of pediatric content in individual programs. Therefore, it is critical to update the information gathered by Cherry and Knutson1 to address the many changes in professional physical therapy education since that time. The purpose of this project was to survey all professional physical therapy programs to determine the current status of the structure and content of pediatric professional education, to use this information as a foundation to generate recommendations for the SOP, and to suggest potential strategies for implementation of those recommendations.
The SOP created the task force in 2008, with a charge to develop a survey aimed at gathering information about the current status of pediatric professional physical therapy education. The task force designed a 16-item survey (see Appendix, Supplemental Digital Content 1, http://links.lww.com/PPT/A20), which was then reviewed and approved by the SOP board of directors. The project was approved by the Chatham University Institutional Review Board in November 2008 and by the University of Wisconsin–Milwaukee Institutional Review Board in January 2009. At that point all of the professional physical therapy education programs were identified from the APTA Web site, and each task force member was assigned approximately 20 to 25 programs to contact. The task force member reviewed the program Web site for each assigned program and attempted to identify the individual primarily responsible for delivering the pediatric content within that program. Most Web sites include professional credentials and areas of expertise for faculty members, so a pediatric content representative was easily identifiable. For programs in which a content representative could not be found, the program director was identified as the key contact person. Subsequently, the task force member contacted the identified individuals for each program by phone, e-mail, or in person where appropriate, and requested that he or she complete the survey. The surveys were completed either via hard copy or electronically and returned to the task force member, or completed through a telephone interview.
Completed survey data were entered onto a spreadsheet, and individual programs were coded with a numbering system to disconnect the data from specific programs. Variables of perceived adequacy of curriculum, stand-alone pediatrics course(s), presence of didactic pediatric content in other courses, and program requirements for a pediatric clinical experience were coded categorically with 0 = no/none and 1 = yes/some. Furthermore, hours devoted to pediatrics were identified as lecture hours, laboratory hours, contact hours with children, problem-based learning (PBL) hours, and other hours. These variables were then summed to produce a variable for total pediatric hours. Finally, a variable for didactic contact hours (lecture and PBL) and a variable for practical contact hours (laboratory and child contact) were created to examine the extent of required clinically oriented experience within pediatric curricula.
The data were analyzed using Microsoft Excel and SPSS version 17. Descriptive statistics were generated for the total number of pediatric hours, pediatric didactic hours (lecture and PBL), and pediatric laboratory hours (including all time in contact with children except for clinical education). Student t tests were used to determine whether significant differences in didactic contact hours (lecture and PBL combined) or in practical contact hours (laboratory and child contact hours combined) existed between programs that reported adequate pediatric content and those who reported inadequate content.
A total of 151 surveys (75%) were returned. After the data were coded and added to create the variables of interest, 91 of the 151 responding programs (60.2%) had provided complete data sets. Table 1 presents descriptive data related to the total number of pediatric hours, lecture, laboratory, and child contact hours. Seventy percent of programs reported including at least 1 stand-alone pediatric course, and 70% of respondents reported that the pediatric content within the curriculum was adequate. Eighty-three percent of respondents reported using the curricular content recommendations published by the SOP in developing and delivering the pediatric content in their programs. In the comments section, several respondents reported relying on experience, evidence-based practice, and continuing education seminars such as III STEP as sources of information for curricular content.
Table 2 reports total pediatric hours, broken down by programs that reported pediatric content as either adequate or inadequate. Note that only 91 programs reported this information. Student t tests revealed no significant differences in the total number of pediatric hours between programs that reported adequate versus inadequate pediatric content. However, programs reporting adequate pediatric content also reported significantly more (P = .01) practical contact hours (laboratory and child contact) than programs reporting inadequate content (Table 3).
Respondents were also queried about the individuals primarily responsible for delivering the pediatric content for the program. Sixty-six percent of these individuals have a full-time faculty appointment; 49% have an academic terminal degree such as a PhD, EdD, or ScD; 38% are board-certified clinical specialists; and 26% have a clinical doctorate in physical therapy. Thirty-eight percent of these individuals reported that they will be retiring within the next 10 years and 59% within the next 15 years.
Finally, with regard to pediatric clinical education, most respondents (70%) indicated that the number of pediatric sites was adequate to meet the needs of the program, and 7% of programs have a mandatory pediatric clinical education experience.
Cherry and Knutson1 reported considerable variability in the provision of pediatric professional education in 1993, and the results from this 2009 survey remain consistent with that finding.1 Although the majority of programs reported devoting more than 90 hours to pediatrics, 45% reported less than 90 hours including one program with only 35 total pediatric curricular hours. The current survey also demonstrated a wide range of pediatric lecture and laboratory hours. Mean lecture hours are likely to be affected by programs that use a PBL curriculum. In this survey, 38% of programs reported using a PBL format (range of PBL hours, 2–45) and would therefore be likely to have fewer lecture hours across all content areas than a more traditional curricular model. However, it might be expected that laboratory hours would be less likely to be affected by a PBL format versus a more traditional curricular model, and variability persists in the latter as well.
An additional consideration in pediatric professional education is creating opportunities for students to practice newly learned skills with children. Whereas other aspects of physical therapy practice may lend themselves to practice with adult peers in a traditional laboratory setting, it is suboptimal to practice pediatric skills with adults. Although many programs reported providing hands-on opportunities with children for all students within the professional curriculum, wide variability was reported across professional programs. Notably, a key finding of our survey was that those who perceived their pediatric content to be adequate had significantly more time allotted to practical contact hours (laboratory and child contact) than those who perceived their pediatric content as inadequate. This may be interpreted as a greater valuing of clinically oriented student experiences such as child-contact and laboratory simulations compared with didactic lecture or PBL contact hours.
Only 10 programs reported that pediatric clinical education placements are required, and some professional students are graduating with few pediatric laboratory hours or little contact with children. One school reported only 3 pediatric laboratory hours. Cherry and Knutson1 reported similar findings, with the majority of programs in 1993 providing less than 4 hours of assessment and treatment of children.1
As a response to the initial survey by Cherry and Knutson,1 and in an effort to address the need for more consistency in the provision of pediatric professional content, the SOP created Guidelines for Pediatric Content in Professional Physical Therapist Education in 2001. Subsequently in 2009, this document was revised and titled Pediatric Curriculum Content in Professional Physical Therapist Education: A Cross-Reference for Content, Behavioral Objectives, and Professional Sources.4 A challenge for individuals responsible for delivering professional pediatric content is determining how best to ensure that graduates are able to achieve the numerous suggested objectives in this document, a challenge that would appear to be extremely difficult for programs reporting low numbers of hours for lecture, laboratory, and/or contact with children. In the revised document, published in 2009 and available from the SOP,* faculty are encouraged to use methods such as prerequisite course work, the academic curriculum, and the clinical education curriculum as ways to deliver the pediatric content. A consideration for the section and for future curricular content guide revisions may be the inclusion of more explicit suggestions for content delivery. For example, specific recommendations for numbers of hours necessary to fulfill the listed objectives and perhaps a recommended number of contact hours with children would be of some benefit. As noted earlier, only 7% of programs require a pediatric clinical education placement. Therefore, it is not possible for all students to meet the pediatric objectives in the clinical education curriculum. Guidance regarding where and how objectives might optimally be achieved for all professional students would be extremely helpful.
Another area of consideration is the development and support of pediatric faculty. Although the percentage of full-time faculty teaching pediatric content has increased, this may, in part, be explained with an increase in students attending physical therapy programs. Furthermore, 34% of programs report that the individual primarily responsible for pediatric content does not have a full-time faculty appointment. In addition, almost 60% of respondents reported that the individual responsible for delivering pediatric content is likely to retire within the next 15 years, with 38% of those individuals likely to retire within the next 10 years. Although data are not available for other practice areas, this clearly represents a concern for pediatric physical therapy practice in general. The SOP should strive to create opportunities for practitioners to successfully transition into academic positions and to advocate for full-time faculty appointments for these individuals. In instances in which full-time appointments are not available, all pediatric courses should have a core faculty member identified as a liaison to ensure that the course follows the framework and structure of the rest of the professional curriculum.
ADDITIONAL CONSIDERATIONS AND RECOMMENDATIONS
The variability and lack of consensus among professional programs regarding the necessary elements of a quality professional education in pediatric physical therapy is concerning. The authors recommend that the SOP support a study that asks clinicians and academic educators to evaluate the Pediatric Curriculum Content in Professional Physical Therapist Education: A Cross-Reference for Content, Behavioral Objectives, and Professional Sources document and identify gaps between academic preparation and clinical practice. The SOP might also consider supporting a consensus conference that pairs academic and clinical educators, similar to the III STEP format, with the goal of building agreement regarding the knowledge and skills necessary for an entry-level practitioner.
As noted earlier, it would be beneficial to generate recommendations for the number of pediatric curricular hours, including the optimal number of laboratory hours and contact hours with children. Based on the combined experiences of the authors, it is recommended that at least 90 hours be devoted to pediatrics, including 60 for a combination of PBL and lecture hours. The remaining 30 hours should be a combination of laboratory hours and hands-on interaction with children. In the comments section of the survey, some programs described creative use of service learning hours and other nontraditional experiences to gain experience interacting with children. These included Special Olympics, hippotherapy programs, and respite care.
Finally, the survey revealed that academic educators rely on the core content guidelines, personal experience, continuing education, and evidence-based practice to guide decisions about what to teach. Clearly the SOP must continue to support the development of practice guidelines and the publication of systematic reviews to aid faculty in providing information to students that is based on research evidence.
In 1993, Cherry and Knutson1 asked, “What is being taught to entry-level physical therapy students to prepare them to treat pediatric clients? How much time is spent teaching it? How is it organized within the overall curriculum?” Their work provided answers to those questions in 1993. The results of this study provide some answers to these critical questions in 2011. The information gathered provides pediatric educators support in developing and updating the pediatric physical therapy curriculum in their individual programs. The SOP may also use these data to better support professional education and research that investigates questions about the most effective strategies for effective delivery of professional pediatric physical therapy content.
© 2011 Lippincott Williams & Wilkins, Inc.