BACKGROUND AND PURPOSE
Physical therapist (PT) educators who are recruiting students to entry-level PT education programs strive to admit a student body that will fulfill the program and institutional mission, and one that has the capability to manage the rigors of a doctor of physical therapy (DPT) curriculum. Each program is seeking the right student, at the right time, with the right academic background and preparation, while being mindful of the issues students face as they weigh admissions offers. For the students, these issues include program quality, institutional atmosphere, opportunity for personal development as a professional within the context of the program and institution, program costs, and time to degree completion.1-4 A viable route for students who have an excellent high school academic record and who aspire to become a PT is admission through an early assurance program.
Early assurance programs incorporate both an undergraduate and graduate degree into the program of study, and conditionally assure the new high school graduate a spot in professional or graduate study based on the student meeting progression or advancement standards. These programs exist for other graduate professional level degrees, including pharmacy, medicine, and occupational therapy, and offer an alternative and challenging route to the traditional pathway of a graduate professional degree.5
The Commission on Accreditation in Physical Therapy Education (CAPTE) refers to the 33 early assurance programs in its directory of PT education programs as those that “admit students at the freshman level.”6 Within the community of PT education programs, these programs are commonly referred to as the “freshman-entry” or “freshmanadmission” programs. This model of PT education has existed since the beginning of formal training programs for therapists. Of the 13 PT education programs first accredited by the American Medical Association, 3 programs, including Bouvé-Boston School of Physical Education (now the Bouvé College of Health Sciences at Northeastern University), Boston University Sargent College, and Saint Louis University, began by accepting high school students into certificate and later, baccalaureate PT education programs.7 All 3 of these institutions continue to use the early assurance model today.
As the profession transitioned from baccalaureate to the master's degree for entry-level education in the late 1980s and early 1990s, several early assurance programs changed to graduate-entry only. At the end of 2001, all programs were required by CAPTE to confer a postbaccalaureate degree which then transitioned to a clinical doctoral degree by 2015. Based on personal communications (E. Price, written communication, Nov 2015) and a review of CAPTE fact sheets from 1988-2014, we estimate that 90% of the schools that offered the early assurance option for the master's degree have elected to continue this practice with the DPT degree.
In 2012, 32 of the 33 freshman admitting schools identified by CAPTE joined together to establish the Early Assurance BS/DPT Program Consortium (EAC) as one of the first consortia formed in the American Council of Academic Physical Therapy (ACAPT). In the document establishing the consortium, the consortium's purpose statement clarified the need to bring these programs together to address their unique programmatic needs and to document their worth for the higher education community in physical therapy:
“Programs that incorporate an undergraduate course of study leading directly into the DPT degree have unique issues and needs in the areas of admissions, student outcomes, curriculum design and development, faculty workload, and data collection. The purpose of this consortium is to share and collaborate on these issues in an effort to further both institutionally driven and council goals of academic excellence within physical therapy.”
The term “early assurance” was borrowed from the pharmacy profession and adopted by the consortium as the preferred terminology to describe the process of student entry. The American Association of Colleges of Pharmacy5 provides a listing of the 44 (out of 135 total) pharmacy programs that offer 2 types of admission routes for high school students to professional graduate study, the “0-6” and the “early assurance.” Similar to early assurance BS/DPT programs, these alternate routes to the doctor of pharmacy (PharmD) offer students a guaranteed admission as long as the student successfully completes prerequisite coursework and other program-specific contingencies. In pharmacy, the 0-6 schools exclusively admit students directly from high school while the early assurance schools incorporate other routes of admission and encourage options for transfer students. Other doctoring professions that have accredited programs with guaranteed admission prior to the receipt of a bachelor's degree, though not always directly out of high school, include audiology (eg, Southern Illinois University8), medicine (eg, Boston University9), optometry (eg, St. John's University10), podiatry (eg, University of Hartford11), and dentistry (eg, Boston University9). These professions have an array of terms used to describe these programs including joint degree programs (ie, BS/DMD or BS/MD), combined degree programs, and early acceptance programs. Members of the consortium believe that the CAPTE term “freshman-admission” is confusing to the public, including applicants and their families who, on hearing this term, express an expectation that physical therapy coursework would start in the first year of college. Consequently, the preferred terminology and the terminology adopted by ACAPT is “early assurance programs,” referring to those programs that provide a direct route of entry from high school into both a BS and a DPT degree.
POSITION AND RATIONALE
The intent of our paper is to provide a description and validation of the early assurance approach of admitting and educating students. We believe that the early assurance approach is one that benefits students, institutions, and the profession. We assert that the benefit of early assurance programs to students is in providing them with an economical and efficient admissions and entry route. For the institution, it provides a solid undergraduate base on which to build a graduate program. And for the profession, it ensures diversity in our educational offerings in a manner that meets public interests. In an effort to validate the early assurance model, we used Astin's12 Inputs-Environment-Outputs (I-E-O) framework to describe the students, institutions and programs, and program outcomes, presenting both aggregated data from EAC members and comprehensive data from 1 early assurance program.
Astin12 developed a conceptual model that has been used as a framework for analysis of the impact of institutions of higher education and their programs on student outcomes.13-18 The model incorporates 3 constructs (Figure 1)—inputs, environment, and outputs—and is commonly referred to as the I-E-O model. Inputs describe the individual qualities of the student, environment includes all the experiences to which a student is exposed in the educational program, and outputs are the expected outcomes that occur as a result of the educational program.12 While Astin12 described the I-E-O model and its use to frame experimental studies, the I-E-O model is also a guide for descriptive and exploratory studies.19 The I-E-O model is ideal as a framework for a descriptive analysis of the innovative approach to physical therapy education used by early assurance programs.
In an effort to better understand the nature of the existing early assurance programs, we collected data from a number of sources including CAPTE fact sheets, interviews with program directors who attended the EAC meetings in October 2013 and October 2014, and a web-based survey of program directors delivered in the spring of 2014. The survey was sent to the program directors of the 32 members of the EAC, 21 of whom (65.6%) responded. These same 21 contributed data and qualitative comments at EAC meetings along with 3 additional program directors who did not participate in the 2014 survey. In addition, records and data from the Springfield College Doctor of Physical Therapy program (SCDPT) provide a comprehensive descriptive analysis of 1 institution's methods in managing its early assurance program.
We defined input variables (Figure 1) as those that describe the students in the programs including information about students at admission, and demographic descriptors such as age, race and ethnicity. The environment variables describe the programs and include curricular model, numbers of students in the program, location, nature of the institution (public or private), and Carnegie Classification. Finally, in terms of outputs, we gathered information on the common variables that measure PT student outcomes, including graduation rates, National Physical Therapy Exam (NPTE) pass rates, and employment rates.
Physical Therapy EAC Programs - Inputs
Students who enter early assurance programs apply for admissions during their senior year of high school. There is a common set of admissions application requirements among the early assurance programs that include:
- High school transcript
- Scholastic Aptitude Test (SAT) scores or American College Testing (ACT) scores
- Personal essay
- Physical therapy observation hours
- Letter of recommendation from guidance office and at least 1 teacher
All programs calculate an overall high school GPA and some programs calculate a separate math/science GPA. Minimum standards for admission for early assurance programs participating in the survey are provided in Table 1. Based on the GPA, SAT scores, or ACT scores, the students entering early assurance programs are achieving grades in high school of “B” or better and rank nationally on achievement tests at the sixty-fifth percentile or better. Program directors surveyed stated that the process of admitting students out of high school involved a greater consideration of the students' writing abilities and maturity through a gestalt obtained by reading the personal essays, resumes, and letters of recommendations. Students in the early assurance programs enroll in major courses of study for a BS degree, typically in health science or exercise science. In the years spent completing their undergraduate degree, the students participate fully in student life, including intercollegiate athletics, student governance, theatre and music, and student clubs.
Physical Therapy EAC Programs - Environment
A list of the 33 programs that are identified by CAPTE as having an early assurance option is found in Table 2. The programs are not well distributed across the United States with the preponderance in the Northeast. Of the 33 early assurance programs listed by CAPTE, the majority (31) are at private institutions. In terms of size and Carnegie Classification of Institution there is far more variability, with size ranging from 1,200 to nearly 20,000 students, and a mix of Carnegie Classifications with the modal value (20 institutions) of Master's Colleges and Universities.
In the early assurance programs at these institutions, students complete the preprofessional phase of their studies with a focus in an undergraduate liberal arts education, along with a minor or minor equivalent. All of the early assurance programs require that students take the standard prerequisite courses for admission in entry-level PT education programs that were developed by ACAPT in 2012 (AC-4-12). Our survey data revealed that the preprofessional phase ranges from 3 to 4 years in length (Table 1). Most early assurance programs are a “3+3” model. In this curricular model, the preprofessional phase is 3 years in length and the student begins the professional phase or DPT degree in their senior year. At the completion of the fourth year, a baccalaureate degree is conferred. The student then continues for 2 postbaccalaureate years to complete the DPT degree. Early assurance programs using a 4+3 model confer a bachelor's degree to their early assurance students and then enter them directly into graduate studies without a second application process. In the preprofessional phase, the majority of programs offer some undergraduate coursework. The credits for these courses range from a single credit to a 3-credit course. Some programs offer a course in each year of the undergraduate program while others only offer a single course. Course content includes medical terminology, student development, introduction to health professions, professional writing, and professional communications.
Most programs do not require a second application process; however, all programs have advancement standards to enter into the DPT phase of study. These standards all incorporate a minimum credits completed requirement, an overall cumulative GPA requirement, and sometimes, a separate math and science GPA requirement (Table 1).
All of the EAC programs through ACAPT have a second and more traditional route of graduate entry into their DPT programs, and most (90%) of the programs use the Physical Therapy Centralized Application Service (PTCAS) to manage graduate-entry students. On average, graduate-entry students account for 35% of the student body in EAC programs. EAC program directors feel that the addition of traditional entry graduate students is an important add-on to the cohort, with postbaccalaureate students providing a new level of life-experience and maturity.
The Springfield College Early Assurance Program Experience - Inputs and Environment
Springfield College has been an early assurance program since it was first accredited as an MS program in 1988. (The program is a 3+3 early assurance program.) In the first 3 years of study, students complete requirements for an interdisciplinary bachelor's degree in health science on the prephysical therapy track. In the final 3 years students enroll in only DPT classes.
During the first 2 years, the focus of study includes general education requirements, as well as DPT prerequisite math and science courses. By the middle of the second year, all students are required to declare a minor course of study, and in the third year, students enroll in 3 courses in the Department of Physical Therapy; 1 on the language and culture of health care, 1 on health research skills, and the third a service-learning course in which students volunteer as mobility aids in a local hospital.
In the service-learning course, students develop a portfolio of evidence showing their readiness to engage in doctoral studies. The portfolio is a graded project that includes reflection papers about student undergraduate service learning experiences, the student's resume, evidence of the completion of undergraduate coursework, a student interpretation of the relevance of the evidence to the student's future DPT studies, and an action plan for successful graduate study. The portfolio project grade includes an interview with a program faculty member. Students must achieve a passing grade of at least a “C” on the portfolio project to obtain a grade sufficient to pass the course and advance into the DPT program.
At the end of the first 3 years of study, students advance into the SCDPT program as long as they have achieved each of the following in their academic studies:
- Cumulative GPA of 3.0 or higher
- GPA of 3.0 or higher in coursework required in the major
- Completion of a 15- to 18-credit minor course of study
- Minimum of 106 credit hours of coursework.
The fourth year of study is the early assurance student's first year of the SCDPT program, which includes 14 credits of 500-level coursework. At Springfield College, 500-level coursework can apply to either an undergraduate or graduate transcript. For the early assurance students, these 14 credits are applied to the undergraduate transcript and the student receives a Bachelor of Science in Health Science at the end of the fourth year. All other courses in the fourth year are 600 level or higher and are applied to the student's graduate transcript. The DPT degree for a student in the early assurance program totals 101 graduate credits. The DPT degree for a student admitted to the SCDPT program for graduate study only totals 115 credits. Both routes of entry into the DPT entail the same course sequence and both have credit totals that exceed CAPTE standards.20
Planned class size for the SCDPT program is 45 students. In each cohort, 80% to 90% of the students enter the program through the early assurance route, with the additional students entering the program through the PTCAS application process as graduate entry. The number of graduate entry students is dependent on the size of the cohort rising to advance from the early assurance route. Coordination of the early assurance program requires that the department work closely with undergraduate and graduate admissions offices, the registrar's office, financial aid office, and the dean of the School of Health Science and Rehabilitation Studies.
The undergraduate admissions office provides an initial screen for all high school applicants, but the Department of Physical Therapy admissions committee manages admissions offers to the early assurance physical therapy program. The program has 250 to 300 qualified and complete high school applicants in each admissions cycle. Springfield College participates in The Common Application system for high school applicants. A complete application includes personal data about the student and his or her family, a list of extracurricular activities, high school transcripts, SAT or ACT scores, an essay, and at least 3 recommendations, including 1 from the high school guidance counselor. Springfield College requires supplemental materials in The Common Application, including an essay in which the student provides his or her concept of physical therapy after reading the vision statement for the profession by APTA. A qualified applicant has taken a high school sequence of at least 3 sciences that includes biology, chemistry and physics (if offered), and high school math to at least the precalculus level. The graduate admissions office coordinates with the Department of Physical Therapy admissions committee in consideration of graduate applicants and the PTCAS system. Early assurance students are not entered into the PTCAS system.
Gaining the understanding of the registrar's office and developing a database that could manage both an undergraduate and graduate transcript for students has been crucial to managing the early assurance students' academic program. In each early assurance cohort, 10% to 20% of students do not advance into the PT educational program, either because of a desire to change major, academic difficulties, or personal reasons. These students are still able to complete their baccalaureate degree in health science or transfer into another undergraduate major at the college. The registrar manages the process of degree audits for the early assurance students, both at the moment of receipt of the baccalaureate degree after the fourth year of study and at the moment of receipt of the DPT degree after the sixth year of study.
The financial aid office helps the early assurance program maintain affordability for students. This office has structured aid packages to ensure that students have maximized their federal undergraduate aid opportunities over the span of the first 4 years, and then stretches their institution awards to cover the final 2 years that are graduate-only study.
The SCDPT early assurance program succeeds only through these cross-campus and interdepartmental collaborations, and these collaborations are supported through the dean's office of the School of Health Science and Rehabilitation Studies. This office also supports early assurance programs for students pursuing occupational therapy and physician assistant degrees. The SCDPT program's success has produced 5 classes of students who have become PTs trained at the doctoral level and 22 classes of students who became PTs trained at the master's level.
Physical Therapy EAC Programs - Outputs
CAPTE requires public disclosure of specified outcomes data by all PT education programs. These data are summarized each year in a published “Education Fact Sheet,” available on the CAPTE website.17 The aggregate first-time pass rate on the NPTE, graduation rate, and employment rates are provided in Table 3 and compared to the data from the 21 early assurance programs that responded to the survey. It is important to note that, as information on the variance of the aggregate data is not available, any comparisons between the 2 groups need to be made with some caution. The first-time pass rate and graduation rates are both slightly higher for the early assurance programs, while the employment rate is slightly lower.
The Springfield College Early Assurance Program Experience - Outputs
SCDPT early assurance students have had a 100% ultimate pass rate on the NPTE, a firsttime NPTE pass rate of 96%, and a 100% placement rate into employment within 6 months of passing the NPTE since the inception of its DPT program in 2011. The SCDPT program's graduation rates range from 90% to 96%. Undergraduate outcomes include 30% of the students in the undergraduate program engaging in intercollegiate athletics, 65% of the students engaging in leadership roles and opportunities at the college, and 15% of the students participating in study-abroad and intercultural opportunities. In addition, all students in the undergraduate program meet the college's mission that revolves around the education of students in “spirit, mind, and body for leadership in service to others,” as measured in the college's undergraduate outcomes assessment process.
Early assurance program directors feel that an important outcome of the early assurance programs is the opportunity for the program to directly influence student development in the preprofessional years. Several of the early assurance programs, including the SCDPT early assurance program, have courses in the preprofessional years of the curriculum that focus on personal and professional student development. These courses often incorporate exposure to PT practice and to the variety of settings and populations available to PTs. Students are encouraged to complete self-inventories and identify personal strengths and weaknesses that could influence their practice as a clinician. Through such a course or sequence of courses, students are prepared for entry into the professional phase of the program, and gain an understanding of the program's demand and the students' eventual selected career path. Faculty members in these preprofessional development courses have the opportunity to help students understand the integration of their liberal arts and professional education. This typical and representative quote from a student portfolio developed in the SCDPT preprofessional courses provides evidence of the value:
I think one concept that was stressed this year is that we are all working towards a common goal of becoming physical therapists. Throughout school, we are trained to be the best through GPAs and class rank, transforming school from a learning experience into a competition amongst peers. I think this semester has helped us to work together, helping each other to succeed and learn the information necessary to treat our patients in the future. In years to come, we will be each other's resources, friends, and colleagues. Now, instead of trying to be better than each other, we must strive to reach our personal best.
I have certainly learned to study and be very diligent. School always used to come easy to me and I never had to really try until now. This semester has truly been a growing experience through managing my stress (which there was plenty of) and time (which there never seemed to be enough of), prioritizing, learning how to interact with patients, peers, and other professionals, and simply conducting myself as a professional who will have a career in physical therapy.
Another outcome that is an advantage of the early assurance model is college cost control. According to the most recent published data from CAPTE, the median total program cost (tuition and fees) for public instate institutions is $48,515, and for private institutions, it is $92,277.21 For students in traditional postbaccalaureate graduate-entry programs, this cost comes on top of a 4-year undergraduate degree. For early assurance students, especially those in 3+3 programs, there is the potential of decreasing the cost of the tuition and fees for 1 year while accelerating the opportunity to become a wage earner. Given the high debt load of graduates of PT educational programs, this year of savings and additional year of earnings can make a significant difference in the debt owed to lenders. The SCDPT early assurance program was designed in conjunction with the financial aid office to ensure that aid options for these students are maximized.
This early assurance option allows students with an early but strong career focus on physical therapy the opportunity to develop their interest through interaction with physical therapy faculty during their early college years, and allows them to attend an institution where they are assured a seat in the PT education program—as long as they meet the eligibility standards. Since students are not competing with classmates for a seat in the program, the early assurance model fosters a collaborative learning atmosphere among students rather than an atmosphere where peer students may be viewed as competitors. Preprofessional students also have the opportunity to explore physical therapy-related service events in their preprofessional years, when curricula may be more flexible to allow for service trips nationally or internationally. In the SCDPT early assurance program, academic advising from the freshman year through the final year of the DPT program is coordinated in the Department of Physical Therapy. Students in the program have the same academic advisor for 6 years, and that advisor truly knows the student's needs and can guide the student's academic and professional trajectory.
Over the past decade, the integration of interprofessional education in PT education has been a curriculum priority. Based on the recommendations of organizations—including the Institute of Medicine, the Pew Health Professions Commission, and the Interprofessional Education Collaborative22—interprofessional education initiatives are present in all health professions education. The reality of patient-centered care and health care workers functioning in teams obligates all professions to understand the training and scope of practice of other health professions. Another advantage of early assurance programs is the potential to introduce interprofessional education in the preprofessional years, allowing earlier interaction with and greater exposure to other prehealth profession students and to enhance understanding of the criticality of interprofessional collaboration and practice.
At the institutional level, we believe that students who graduate from early assurance programs become a solid alumni base. Program directors surveyed reported that the cohorts in early assurance programs completing the baccalaureate degree at the DPT institution are more involved as alumni, providing services postgraduation that range from mentorship for current DPT students to donations that fund development and program activities. At Springfield College, students in the early assurance program tend to ally themselves with their undergraduate or baccalaureate graduation year. Alumni from the program return to campus with their bachelor's degree compatriots from all other majors, and the development office reports that giving is more highly associated with undergraduate class year than with graduate year or program completion.
Astin's12 I-E-O model for higher education assessment has framed this presentation of the early assurance model of education for physical therapy. We have provided both aggregated data from EAC programs as well as the specific experiences of 1 program to demonstrate that while early assurance programs may have different inputs and be structured in different environments, the outputs are similar to all other accredited programs in the United States.
In his 2011 Cerasoli Lecture, Dr James Gordon criticized the diversity of program types and lengths in physical therapy as a threat to academic excellence in physical therapy.23 He also encouraged the profession to emulate professional education in dentistry, medicine, and pharmacy. In his list of professions to emulate, Dr Gordon included a set of professions that all recognize the potential to recruit and train academically gifted students through an early assurance pathway. A close read of Dr Gordon's lecture shows it to be critical of options like early assurance programs while simultaneously calling on our profession to act in a manner consistent with professions that recognize the benefits of alternate routes of admission. We believe that the diversity of program types, including early assurance programs, may be an asset to physical therapy education.
There is limited evidence to support a singular path as the best route to admission to a DPT program or any doctoring health professional program. Two studies conducted on students who followed an early assurance path in pharmacy at a single academic pharmacy program indicated that the early assurance students' academic performance, as measured by grade point average (GPA), was lower than those who had a 4-year BS degree, yet these students were equal in their attainment of leadership and professional development positions.24,25 Different from early assurance BS/DPT programs in which students enter the professional program after 3 or 4 years of undergraduate studies, the PharmD students in the studies by Renzi et al24,25 completed only 2 years of college prior to entering the professional program. We note the contrast between the 2 professions because completing only 2 years of college results in younger students with fewer credits and courses completed. Physical therapy early assurance programs, with a transition after 3 to 4 years of college, advance students with more credits, more academic achievement, and who are closer to obtaining a BS degree.
Physical therapy has no literature that examines the early assurance model beyond our paper. Though not a study about early assurance programs, Fell et al22 recently published a study that examined the impact of the preadmission baccalaureate degree on NPTE performance. These authors found that having an undergraduate degree was not a predictor for first-attempt pass rate for the NPTE. In a model predicting NPTE scale scores, having a bachelor's degree in hand prior to entering a physical therapy program contributed only 1% of the score variance.26 This study is implicitly related to and is supportive of 1 element of many early assurance programs, when students often enter the professional program without a completed baccalaureate degree.
Beyond a call to accept early assurance programs as a valid alternative for prospective students entering physical therapy, we want to use this paper to call for further study and data collection. Our efforts using the I-E-O model to validate the early assurance route were limited by the lack of a longitudinal database on educational programs, structures, and outcomes in our profession. We feel such a database would be a substantial benefit to educational research.
Early assurance programs are different from traditional graduate entry programs as they identify students for DPT study directly out of high school, then provide a seamless combined bachelor's and DPT degree. Early assurance is not the appropriate route for every student, nor is it the appropriate program for every academic institution. The outputs or outcomes as measured by NPTE exam pass rates, employment rates, and graduation rates of the early assurance programs are comparable to those of traditional graduate entry programs. Early assurance programs offer an effective alternative that can meet the needs of the profession and the students entering into it.
In a time with intense public focus on the costs of higher education,27-29 early assurance programs may provide students and their families with the opportunity to successfully complete a DPT at tuition-reduced costs, and allow for a quicker transition into the workforce. This is especially true for students seeking an undergraduate education at a private institution where most early assurance programs reside.
In terms of academic performance, Renzi et al25 and McCall et al30 both reported that students who had completed a bachelor's degree before entering pharmacy school performed better in terms of pharmacy school GPA. CAPTE provides only GPA data for students at entry into the DPT program; thus, we could not complete a similar analysis comparing early assurance students' academic performance during the DPT program. There are no data published comparing any other outcomes data for early assurance students in the other professions that use this model.
We also note the small movement in higher education towards accelerated baccalaureate degrees.31-33 For advocates of this movement, the early assurance program is a natural choice when the program follows the 3+3 model. Early assurance programs provide a viable option for the well-educated consumer who has an affirmed interest in the profession of physical therapy. Three-year bachelor's degree programs are not unusual. The 3-year concept is embedded in the European Union's “Bologna Process” in which the intent was for students to complete baccalaureate degrees in 3 years followed by master's or doctoral studies.32 The 3-year concept has been emulated in the United States at a number of institutions and has strong proponents in education.31,33 Programs that have adopted the 3-year concept cite lower opportunity costs, reduced tuition costs, better planning and utilization of high school, predictable structured degree programs in college, and an expedited path to graduate school.34
Early Assurance Programs - Limitations
Though we have presented the inputs, environment, and outputs that we believe are advantages and demonstrate the efficacy of early assurance programs, the model poses some limitations for educators and for the achievement of educational outcomes. In the postbaccalaureate model of entry, PT students often complete their undergraduate degree at 1 institution and then seek their DPT postbaccalaureate education at a different institution. However, in the early assurance model, students stay at the same institution for their undergraduate and graduate education. Early assurance program directors report that this circumstance requires intentional efforts by the faculty to assist students in making the transition from the preprofessional to the professional phase of the program. Unless this is done, students may see the first year of the professional phase as “more of the same” rather than a distinctively different phase of their education. Programs use a White Coat Ceremony or some type of formal orientation and advancement ceremony at the start of the professional phase as a natural demarcation for the professional curriculum and to enhance awareness of professional obligations and the change in academic programming at the graduate level. Furthermore, as described previously, program directors use the addition of traditional entry graduate students to alter cohort dynamics.
A second challenge related to the early assurance model is the overlap of the first year of the professional phase with the students' senior year of college. This presents unique issues as students may be completing athletic, music, or other extramural activities during their first year in DPT professional education. These students need to be appropriately counseled about the challenge of this potential conflict of commitment, and may require mentoring and tutoring support. From personal experience with several students in this circumstance, we can say with confidence that it can, and has been done successfully by students, and has taught valuable lessons in time management and prioritization.
A third challenge is potential premature selection of a career. Students in most early assurance programs commit to the PT career pathway at 17 or 18 years of age, and there is the risk that students may not have carefully weighed other career options. Once students have completed 1 to 2 years in the preprofessional curriculum, they are less likely to change their major given the time and cost that has been invested. One strategy employed by several early assurance programs is to have a course or series of student development courses in the preprofessional program. This course (or courses) provides students with the opportunity to develop a strong understanding of a career as a PT and to do selfreflection and assessment in deciding if this is the right career to choose. Many universities offering early assurance also allow for easy transfer out of the program and timely completion of a baccalaureate degree should the students decide physical therapy is not the profession for them.
An unusual challenge faced by programs that offer the early assurance model, and often identified in interviews with the early assurance program directors, is the labeling of these programs as “freshman-entry.” That label creates confusion among potential students and families in at least 2 ways. First, as described earlier in this paper, early assurance does not result in an automatic admission to the professional program. Second, and equally important, some parents do not recognize that PT education is at the clinical doctorate level from the term “freshmanentry,” and think of the program as physical therapy at the baccalaureate level. For these reasons, programs that offer this model of PT education prefer the term “early assurance.” We believe that all of physical therapy education should adopt this terminology. Clarifying that students are not enrolled in the “physical therapy” major as undergraduates at Springfield College has revolved around changing the name of the undergraduate major to Health Science, working with the registrar on the dual transcript issue, and working with faculty and athletic coaches across campus. While students and faculty in these programs face unique challenges, there are numerous creative options employed to ensure students are confident in their career path, have ample opportunity for interprofessional interactions, engage with physical therapy faculty early in their academic career, and have the opportunity to mature and develop professional behaviors.
It is our position that the early assurance model of PT education is a viable and successful pathway of professional education. High school students with strong academic qualifications and clearly articulated career aspirations for physical therapy are excellent candidates for these programs. There is a long history of these programs which, when combined with the positive outcomes data, show evidence of success of this model. Students in early assurance programs are confident in their career path, have ample opportunity for interprofessional interactions, engage with physical therapy faculty early in their academic career, and develop professional behaviors as they mature and enter the profession. Beyond support for early assurance programs, we advocate the development of a longitudinal database on educational programs, structures, and outcomes for physical therapy education. This database would support our profession's educational research agenda and could promote innovative educational approaches that meet the needs of the profession and society.
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