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POSITION PAPER

Defining Excellence in Physical Therapist Education: A Comparison of 2 Theoretical Perspectives

Jette, Diane U. PT, DSc, FAPTA; Brechter, Jacklyn H. PT, PhD; Heath, Amy E. PT, DPT, PhD; Tschoepe, Barbara PT, DPT, PhD, FAPTA

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Journal of Physical Therapy Education: September 2020 - Volume 34 - Issue 3 - p 198-205
doi: 10.1097/JTE.0000000000000144
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Abstract

INTRODUCTION

What is quality or excellence in physical therapist education and how does a program achieve it? Defining quality, or excellence in education represents what Rittel and Webber1 labeled a “wicked problem.” Wicked problems cannot be clearly formulated and have a variety of possible solutions depending on how one frames the problem. How a wicked problem is framed and its possible solutions are subject to judgments based on various stakeholders’ ideologies or values. That is, the problem is defined by the solution, and there are multiple possible solutions. Wicked problems are difficult to resolve and, on a large scale, include societal problems such as health care disparities, gun violence, or income inequities. The term, however, can be applied to smaller-scale, socially complex problems. Krause2 used the term in describing the issue of quality in higher education. The classification of higher education quality as a wicked problem is reflected in the related literature. Harvey and Green3 noted that higher education quality is a “relative concept”(p 2/29) and a “value-laden term,”(p 2/29) both characteristics of a wicked problem. Tam4 noted questions related to measurement of quality in higher education that also illustrate the characteristics of a wicked problem, such as who defines the purpose of higher education or who judges the quality of institutions. Srikanthan and Dalrymple5 noted that assessing quality in higher education is challenging because the essential processes involved in learning, a core function of higher education, are too subtle to be measured meaningfully, teaching is necessarily variable, and the stakeholders (or customers) differ depending on what “product” of the university one is considering (e.g., research vs service to community). Thus, the attempts to assess quality in higher education are characterized by tensions about whether to measure inputs, processes, or outcomes; satisfying internal versus external stakeholders; beliefs about the virtues of qualitative versus quantitative data; and views on the value of diversity versus standardization.6

An additional issue is the fact that approaches to measuring the quality of higher education often have been atheoretical, relying on unvalidated, perceived reputation of an institution or program or a collection of vaguely connected data related to structures or processes of education implicitly believed to be related to quality. Such approaches have implicit biases and fail to provide transparent assessments. A theoretical model for defining educational quality can, therefore, be helpful. Generally, a theoretical model provides a logically structured, potential explanation of the nature of a phenomenon, showing probable key explanatory concepts and the linkages among them. In this way, having a theoretical model for investigating a phenomenon such as educational program quality directs what will be measured and explicitly identifies assumptions or biases.

In a search for well-articulated theoretical models defining educational quality, Srikanthan and Dalrymple5 identified 4. One of those models is The Engagement Theory of Program Quality. This theoretical model was developed through a large-scale study by Haworth and Conrad7 designed to address the shortcomings of previously published studies seeking to identify quality indicators in higher education. The researchers identified those shortcomings as a focus largely on inputs such as faculty scholarship quantities, failure to show linkages between program attributes and student outcomes, use of reputational rankings as the (dependent) measure of program quality, use of an atheoretical approach to identifying quality attributes, failure to examine attributes not easily measured such as student interaction, and inclusion of the perspectives of only a limited number of stakeholders.

Haworth and Conrad7 defined quality programs as “those which, from the perspective of diverse stakeholders, contribute to enriching learning experiences for students that positively affect their growth and development.”7(p 15) The authors state that they conducted a multicase study, selecting cases (programs) from various geographical locations around the United States, and across a range of types of institutions, types of graduate programs, and types of program delivery systems. The interviewees were selected from within the programs to represent different stakeholders and other relevant demographic characteristics. To that end, they interviewed 781 people representing 6 stakeholder groups from 47 master's degree programs in 11 different fields of study. Data were analyzed using a constant comparative method. The theoretical model they developed proposed 17 attributes of quality programs within 5 clusters hypothesized to enrich the learning environment. The clusters included diverse and engaged participants, participatory cultures, connected program requirements, interactive teaching and learning, and adequate resources (Figure 1). The Engagement Theory has been studied and validated in subsequent studies of graduate education quality, including master's and doctoral degree programs.8-12

Figure 1.
Figure 1.:
Engagement Theory of Program Quality. (Reprinted by permission of Pearson Education, Inc., New York, New York)7

BACKGROUND AND PURPOSE

In 2012, a task force (BenEx task force) was established by the American Council of Physical Therapy Education (ACAPT) board of directors to develop a definition of excellence in physical therapist education, a tool to assess level of program quality, and a process for DPT programs to benchmark themselves. The authors of this perspective were part of that task force. The process began at the 2011 Educational Leadership Conference where, working in small groups, physical therapist program leaders articulated their beliefs about characteristics necessary for excellence in physical therapist education.13 The task force then used the aggregate data resulting from this group activity to begin conversations about the construct of excellence in physical therapist education.

Task force members next searched for a theoretical model to support their work and to reflect the collective voice of the physical therapist educational leaders. They found the seminal work of Haworth and Conrad7 on the Engagement Theory of Program Quality as well as the studies that built on that work and supported the theory.8-12 The task force then mapped each of the characteristics of program excellence proposed by physical therapist educational leaders in 2011 to the Engagement Theory of Program Quality and found clearly common concepts. This consistency resulted in the decision to adopt the Engagement Theory as the theoretical model by which to further address the task force charge.

Subsequent work of the task force resulted in development and implementation of a measurement tool based on the Engagement Theory of Program Quality: the Physical Therapy Measure of Educational Program Quality (MEPQ). The tool comprised 3 components to assess physical therapist program quality from the perspective of 3 stakeholders: program directors, program faculty, and graduating students. Although part of the MEPQ completed by program directors included items designed to align with accreditation criteria, as well as items related to organizational structure (such as number of faculty, student tuition), the focus was on items assessing aspects of educational excellence implied by the Engagement Theory. The process of developing the tool and data to support its validity and reliability has been reported.13

Soon after the task force began its work and initiated its 2015 beta test of the MEPQ measurement tool, a national study was initiated to identify and describe dimensions and elements of excellence and innovation in physical therapist education programs. This work was widely shared at professional meetings and published in 2017.14,15 The study used a qualitative approach involving a multiple case study design and grounded theory methodology. This design was modeled on that used by the Carnegie Foundation in previous studies of professional education that identified characteristics of program excellence that could serve to frame improvements in the education of those professions they studied.16-20 From their results, the authors developed a theoretical model representing Excellence and Innovation in Physical Therapist Education (Figure 2). The model has 3 key dimensions: culture of excellence, praxis of learning, and organizational structures and resources, 2 of which have 2 or more elements. The dimensions are linked by a focus on learner-centeredness and patient-centeredness, defined as the nexus.

Figure 2.
Figure 2.:
Model of Excellence in Physical Therapist Education. (Reprinted by permission of Oxford University Press)14

The study by Jensen et al14,15 began with criteria for academic site selection that included programs with a breadth of clinical education from entry-level to professional residency, while the work of the ACAPT task force focused on measuring the level of quality of entry-level programs regardless of presence or absence of residencies or fellowships. Despite this difference, there appears to be many similarities in how excellence has been defined through the 2 processes. This paper supports the following positions: 1) There are clearly unifying concepts of program excellence across the Engagement Theory of Program Quality used in the BenEx task force's work and the model for Excellence and Innovation in Physical Therapist Education developed by Jensen et al14,15; and 2) these collective concepts should be used in any further discussion and planning about what comprises excellence in physical therapist education.

As a first step, it seems important to reconcile the differing terms used in the literature. Most of the literature focusing on higher education in general uses the term “quality,” whereas, in the discussion of physical therapist education, the profession has used the term “excellence.” Excellence and quality are often used synonymously, and their distinction is elusive. Consulting a thesaurus, the adjectives excellent and quality are synonyms (https://www.macmillanthesaurus.com/quality#quality__21), whereas WikiDiff distinguishes the nouns: noting that excellence is the state of possessing good qualities to an eminent degree; and quality is a level of excellence (https://wikidiff.com/excellence/quality). In conceptualizing quality in higher education, Harvey and Knight21 proposed that educational quality is exemplified by excellence and associated the concept of quality with words such as distinctive, exceptional, special, and exclusive. In our exploration of how The Engagement Theory of Program Quality fits with the model for Excellence and Innovation in Physical Therapist Education proposed by Jensen et al,14,15 we have considered the terms quality and excellence to be synonymous and have used the term excellence.

The Engagement Theory of Education Program Quality and Excellence and Innovation in Physical Therapist Education Models

Our case that the Engagement Theory of Education Program Quality and the Excellence and Innovation in Physical Therapist Education model interrelate is organized based on the 5 clusters of the Engagement Theory (Table 1). Using each cluster as a basis of comparison, we have linked the relevant dimensions and elements of the Excellence and Innovation in Physical Therapist Education model and elucidated the similarities.

Table 1. - Comparison of the Engagement Theory of Program Quality and the Excellence and Innovation in Physical Therapist Education Model
CLUSTERS,a ATTRIBUTESb AND ELEMENTSc OF ENGAGEMENT THEORY OF PROGRAM QUALITY7 DIMENSIONS,d ELEMENTSe AND CHARACTERISTICSf OF EXCELLENCE AND INNOVATION IN PHYSICAL THERAPY EDUCATION14
DIVERSE AND ENGAGED PARTICIPANTS
Diverse and engaged faculty and students
 • Hiring to bring in diverse theoretical and applied perspectives as well as a commitment to teaching
 • Admissions policies to enhance diversity with students who match the goals of the program
Engaged leaders
 • Program chairs who champion the program to internal and external audiences
 • Institution and faculty support program leader
CULTURE OF EXCELLENCE
Leadership and vision
 • A culture of shared leadership
 • Leaders attend to internal and external influences
 • Leaders facilitate team-based collaborations
ORGANIZATIONAL AND STRUCTURAL RESOURCES
 • Structure and resources that support the program's needs
PARTICIPATORY CULTURE
Shared program direction
 • Faculty and administrative leaders invite stakeholders to help them develop a shared direction
 • Leaders engage stakeholders in ongoing evaluation of fit between teaching/learning activities and program direction
 • Leaders communicate program direction to all stakeholders
Community of learners
 • Leaders take responsibility for building a learning community
 • Faculty have collegial relationships with students
 • Teaching and learning experiences facilitate co-learning among constituents
Risk-taking environments
 • Environment encourages students to explore new ideas and test their skills
 • Leaders and faculty take risks and encourage students to stretch in new ways
CULTURE OF EXCELLENCE
Shared values and beliefs
 • Community members demonstrate mutual trust and respect and commitment to collaboration
Leadership and vision
 • Leaders attend to internal and external influences
 • Leaders facilitate team-based collaborations
Drive for excellence with high expectations
 • Community members value innovation and embrace risk
Partnerships
 • Community comprises full partnerships between academic and clinical institutions
LEARNER CENTERED AND PATIENT CENTEREDg
 • Faculty focus on learner and learning
PRAXIS OF LEARNING
Practice-based learning
 • Students have early, authentic situated learning experiences
Creating adaptive learners
 • Students are engaged in continuous learning
 • Faculty promote students' ability to struggle with complexity and ambiguity
INTERACTIVE TEACHING AND LEARNING
Critical dialogue
 • Two-way interactive approach to teaching/learning
 • Encourage students to take an inquisitive stance on knowledge and professional practice
Integrative learning: theory with practice, self with subject
 • Investment in real-world and hands-on learning
 • Faculty model integrating knowledge and practice for students
Mentoring
 • Faculty take interest in students' professional goals and tailor courses
 • Occasional one-on-one instruction
 • Faculty provide regular feedback to students on their professional skills development
Cooperative peer learning
 • In and out of class group activities for students
 • Faculty engage in collaborative research and team-teaching, modeling for students
Out-of-class activities
 • Faculty and students develop and sponsor out-of-class activities that are fully supported and an integral part of program
CULTURE OF EXCELLENCE
Shared values and beliefs
 • Community members demonstrate mutual trust and respect and commitment to collaboration
LEARNER CENTERED AND PATIENT CENTERED
 • Faculty focus on learner and learning
PRAXIS OF LEARNING
Practice-based Learning
 • Students have early, authentic situated learning experiences
Creating adaptive learners
 • Students are engaged in continuous learning
 • Students reflection on and learn from experience
 • Faculty promote students' ability to struggle with complexity and ambiguity
 • Faculty engage in mutual inquiry and reciprocal teaching and learning
Professional formation
 • Community members are committed to developing students' sense of responsibility to patients and society
CONNECTED PROGRAM REQUIREMENTS
Planned depth and breadth of course work
 • Periodic meetings of faculty to determine necessary knowledge and skills expected of students to learn
 • Specialized and core course requirements developed to align with expectations
Professional residential learning experiences
 • Residential learning experiences designed with students' goals in mind
 • Faculty maintain ties with employers, alums, community members in service of residential learning experiences
 • Faculty members and site supervisors regularly provide students with feedback during residential learning experiences
Tangible product
 • Culminating activity for students with a product matching program's goals
 • Faculty provide guidance and feedback for the culminating experience
CULTURE OF EXCELLENCE
Partnerships
 • Community comprises full partnerships between academic and clinical institutions
LEARNER CENTERED AND PATIENT CENTERED
 • Faculty focus on learner and learning
PRAXIS OF LEARNING
Practice-based learning
 • Students have early, authentic situated learning experiences
Creating adaptive learners
 • Students seek out and embrace feedback
 • Faculty promote students' ability to struggle with complexity and ambiguity
ADEQUATE RESOURCES
Support for students and faculty
 • Monetary resources for student assistantships/fellowships and travel to professional conferences
 • Non-traditional course formats for working students
 • Career planning and placement assistance for students
 • Monetary resources for faculty salaries, sabbaticals and travel to professional conferences
 • Reward structures for faculty to support involvement in teaching and learning
Support for Basic Infrastructure
 • Departmental leaders and faculty secure requisite equipment and supplies, adequate lab, performance and classroom facilities, and adequate library and technology resources
CULTURE OF EXCELLENCE
Leadership and vision
• Leaders leverage institutional mission to advance goals
ORGANIZATIONAL STRUCTURE AND RESOURCES
 • Structure and resources that support the program's needs
aCluster in UPPER CASE, BOLD FONT. bAttribute in lower case, bold font. cElement in lower case. dDimension in UPPER CASE, BOLD FONT. eElement in lower case, bold font. fCharacteristic in lower case.gThe nexus.

Cluster 1: Diverse and Engaged Participants

Diverse and Engaged Participants is one of the 5 clusters of attributes proposed by the Engagement Theory. Haworth and Conrad7 suggested that this is the most important cluster among the 5 proposed by their model. The attributes of this cluster include diverse and engaged faculty and students, and engaged leaders. In their broad view, diversity comprises a mixture of perspectives and experiences and requires institutional hiring and retention policies and student admission policies that attract diverse constituents. Although not specifically mentioned by Jensen et al14 in the description of the elements of their model, hiring practices for faculty and admissions practices for students that promote diversity are reliant on the organizational structures and resources of an institution, aligning with the organizational structures and resources dimension. Furthermore, although not mentioned in the Excellence and Innovation in Physical Therapist Education model, one of the recommendations made by Jensen et al15 in their second paper is for institutions to show leadership in working to improve diversity within the physical therapy profession.

Engagement refers to active interaction between stakeholders in activities that are mutually supportive for teaching and learning. Engaged leaders include those who support the engagement of other stakeholders as well as champion the program internally and externally and encourage leadership roles among faculty and students. Haworth and Conrad7 proposed that programs with more engaged leaders provide students and faculty with more leadership opportunities. They also proposed that having diverse and engaged members in a community leads to students who have deeper knowledge and understanding of professional practice and who inspire each other to commit to their profession. The culture of excellence dimension from the Excellence and Innovation in Physical Therapist Education model, particularly the element of leadership and vision, is coherent with this attribute. That is, both models reflect the notions of shared leadership and leaders having obligations to promote internal and external relationships and collaborations to promote and bring voice to the program. Engagement of leaders, faculty, and other stakeholders is further characterized by substantial investment in student learning through policies and practices that encourage student investment of energy into their learning and personal development. Student-centeredness, part of the nexus of the Excellence and Innovation in Physical Therapist Education model, is reflected in this cluster of the Engagement Model. Student-centered learning environments give students opportunities to engage cognitively, affectively, and behaviorally and have been hypothesized to be associated with learning achievement, well-being, work success, and lifelong learning.22

Cluster 2: Participatory Culture

The participatory culture cluster comprises 3 attributes: shared program direction, a community of learners, and a risk-taking environment. Haworth and Conrad7 noted that programs with a participatory culture are inclusive of all stakeholders who share direction, experience comradery, and are supported to push boundaries. Here, there is a very direct and explicit connection between the 2 theoretical models, focused on shared program values, beliefs and direction. The relationship of the 2 models is evident in descriptions of the role of leaders as communicators and influencers both within and outside their institutions. Although one model uses the words learning community and colearning, the other uses partnerships to describe relationships among stakeholders in students’ education. Furthermore, the Excellence and Innovation in Physical Therapist Education model includes the element of drive for excellence and high expectations as an element of the culture of excellence dimension whose characteristics include risk taking and valuing innovation.

Haworth and Conrad7 proposed that programs with participatory cultures facilitate students' developing their professional identities and direction. Similarly, Jensen et al14 noted that in the programs they studied, there was a commitment to professional formation with an intentional focus on developing students' professional identity and commitment to the profession. Participatory culture also implies, what Jensen et al14 term, learner-centered environments. The community of learners that develops from the formal and informal multilayered interactions of a participatory culture helps students develop confidence and their skills in teamwork, communication, problem-solving, and leadership. These skills are critical components of professional formation for physical therapists. In physical therapy education, the community of learners includes clinical partners who contribute to professional formation through role modeling behaviors and daily interaction in a professional environment. Haworth and Conrad7 noted that often, the informal interactions of participatory cultures allow for students’ spontaneous development of higher levels of understanding of the concepts and problems with which they are presented. In addition, we would argue, they gain new perspectives on professional practice through in-depth discussions or debates outside of the classroom, within the community.

Haworth and Conrad7 proposed that pulling together diverse stakeholders for a common goal and encouraging community interaction can result in deeper learning as students and faculty feel supported enough in their environment to risk debate and discussion to further their goal of educational excellence. This proposition is similar to the Excellence and Innovation in Physical Therapist Education dimension of praxis of learning, in the element of creating adaptive learners. Jensen et al14 noted that an environment that includes a culture of creating adaptive learners promotes students’ ability to struggle with ambiguity and deal with complex issues.

Cluster 3: Interactive Teaching and Learning

The attributes of the interactive teaching and learning cluster include critical dialog, integrative learning, mentoring, cooperative peer learning, and out-of-class activities. Haworth and Conrad7 indicated that these attributes have important consequences for learning. This type of environment helps students to refine critical and holistic thinking skills and contributes to self-assuredness. Students learn in an environment that helps them become adept at translating theoretical and technical knowledge to real-life situations. In addition, students improve teamwork, communication, and interpersonal skills as they collaborate, teach, and learn from each other.

These attributes are reflected in the Excellence and Innovation in Physical Therapist Education nexus of learner-centeredness, and in the praxis of learning dimension, particularly the elements of creating adaptive learners and practice-based learning. Mentoring, cooperative peer learning, and integrated out-of-class activities, attributes of the Engagement Theory, reflect the notion that education should be focused on the learner and learning, including faculty modeling the integration of knowledge and practice, designing learning experiences to facilitate learning, and providing regular feedback to students. The attribute of critical dialog is well reflected in the Excellence and Innovation in Physical Therapist Education model element of creating adaptive learners, in that each identifies the importance of faculty engaging students in interactive learning that requires questioning and probing and continuous learning. There is a common emphasis on the importance of real-world, authentic learning experiences for students.

Cluster 4: Connected Program Requirements

Connected program requirements include the following attributes: planned depth and breadth of course work, residency, and tangible product. Planned coursework implies faculty continuously develop, evaluate, and improve courses that reflect the knowledge, skills, and behaviors that they expect of students. Students are challenged to develop deep learning that improves their ability to practice. These characteristics are inherent in learner-centered environments where the faculty's focus is on learners and their learning. Haworth and Conrad7 described the characteristics of planned depth and breadth of course work in a way that can be linked to the partnership element in the Excellence and Innovation in Physical Therapist Education model. Full partnerships between clinical and academic faculty imply open discussion of common expectations for student learning and learning experiences. Furthermore, the attribute of planned depth and breadth of course work is reflected in the recommendations from Jensen et al15 including the recommendations that all programs participate in residency education and standardization of performance-based outcomes.

Haworth and Conrad7 used the term residency to mean any residential learning experience. This would include integrated clinical education experiences and internships in physical therapist education. They noted that residential learning experiences help students develop knowledge, skills, and confidence, as well as professional networks. This attribute is consistent with the element of practice-based learning in the Excellence and Innovation in Physical Therapist Education model.

The tangible product referenced in the Engagement Theory includes a culminating creative performance, writing or directing a play, or completing a thesis or research report. Haworth and Conrad7 found that excellent programs developed the requirements of the tangible products to address “real-world” situations. They noted that a tangible product contributes to excellence by improving students’ analytical skills, increasing their professional independence, encouraging a broader perspective of their profession, and facilitating the transition from student to new professional. To the best of our knowledge, many physical therapist education programs include culminating clinical education experiences and have capstone projects that require some type of synthesis of information and professional writing. Completion of capstone projects or culminating clinical education experiences requires instructors to guide students through complex real-world problems, provide ongoing feedback, and engage students in ongoing self-reflection essential for self-directed learning and long-term professional development. Although not a clear fit with the Excellence and Innovation in Physical Therapist Education model, one could argue that the requirement of a culminating clinical education experience contributes to creating adaptive learners, enhances clinical reasoning, and requires some type of performance-based assessment.14,15

Cluster 5: Adequate Resources

Attributes of the adequate resources cluster include support for faculty, students, and infrastructure. Haworth and Conrad7 indicated that having adequate resources facilitates program and faculty investment in many of the other clusters/attributes, thereby enhancing the overall excellence of the program. Supports include monetary resources and reward structures such as financial aid, graduate assistantships, and travel to professional meetings for students; career development opportunities and sabbaticals for faculty; as well as state-of-the-art laboratories and equipment that support teaching, learning and research. The ability to secure adequate resources is reliant on leadership and vision, one of the dimensions of the Excellence and Innovation in Physical Therapist Education model. Furthermore, Jensen et al14 in describing the dimension of organizational structures and resources noted that their participants had financial autonomy within their institutions. Clearly, having adequate resources is an explicit common concept in both the Engagement Theory and the Excellence and Innovation in Physical Therapist Education model. A combination of control over resources and a method of generating needed revenue provides leaders with the ability to more easily move funds to where they are needed and to provide for the ability to seize opportunities for innovation as they arise.

Model for Excellence in Higher Education

We have illustrated some of the ways that the Excellence and Innovation in Physical Therapist Education model resonates with the Engagement Theory of Program Quality. The Engagement Theory is one of only a handful of theoretical approaches to assessing excellence in higher education. It is a generic model designed to assess graduate programs, whereas the theoretical model proposed by Jensen et al14 is specific to physical therapist education. The models demonstrate considerable correspondence, however, suggesting that excellence in graduate programs in higher education has common roots regardless of type of program. The most salient commonalities of the Engagement Theory of Program Quality and the model for Excellence and Innovation in Physical Therapist Education seem to be the emphases on shared vision, leadership, collaborative relationships/partnerships, adequate resources to support students, faculty and infrastructure, learner-centeredness, and the capacity to transform the people and institutions involved in the educational endeavor.

That being said, there are areas wherein the Excellence and Innovation in Physical Therapist Education model suggests different elements of excellence than the Engagement Theory. The model includes patient-centered as part of the nexus and a signature pedagogy as one of the elements of praxis of learning. These concepts are not explicitly part of the Engagement Theory. These differences are not unexpected, however, given that Haworth and Conrad7 studied a broad range of graduate programs across 11 fields of study. Patient-centeredness was not salient to most of the programs studied. As noted by Jensen et al,14 a signature pedagogy is central to a profession, so would also be unlikely to emerge as a theme from a study across multiple graduate degree granting professions.

In a series of articles from 2001 through 2007, Srikanthan and Dalrymple5,23-26 applied the literature on excellence in higher education7,21,27,28 to set the stage for proposing a generic, holistic model centering on the commonalities among the predominant theories. They based their model on the observation that the common key emphases in all theories were transformation of learners, collaboration across the community, including employers and professional groups, and commitment at all institutional levels. They suggested that the basis of implementation of the proposed holistic model should be a shared vision.26 Interestingly, the common core characteristic of shared vision is reflected in many leadership theories. It may be that the characteristics of excellence reported by Jensen et al14,15 reveal the capacity of the leaders in the programs they studied to transform, influence, and foster a shared vision.

The convergence of 2 models of educational excellence demonstrated by our analysis suggests a solid theoretical foundation for addressing the wicked problem of defining and achieving excellence in physical therapist education from the perspective of different stakeholders. We come back, however, to one of the major challenges of a wicked problem—determining why, what, and how quality metrics should be assessed.

The history of the work of the BenEx task force using The Engagement Theory of Program Quality in developing the MEPQ is a cautionary tale. In a stepwise, developmental fashion, the task force created a computer-based assessment tool with Likert-scaled items based on the Engagement Theory of Program Quality for completion by physical therapist program administrators, faculty and students.13 The tool also integrated characteristics of excellence identified by physical therapist program leaders in 2011. It was tested and psychometrically analyzed, resulting in support for its validity in assessing the qualities outlined in the theory.13 The measurement tool, however, was relatively long and required getting participation of busy faculty and students. In addition, at the beginning of the implementation process, there were logistical issues that created barriers for some participants. The Physical Therapy MEPQ tool was beta tested and then fully implemented for 3 academic cycles. Despite efforts at getting input and communicating with stakeholder groups, not all community members agreed with the definition of excellence engendered in The Engagement Theory and the related MEPQ assessment tool. At this time, further implementation is on hold. This issue highlights the very nature of wicked problems: They have innumerable solutions that can only be characterized as better or worse, often based on the viewpoint of some stakeholders, and there is no ultimate test of the fit of a chosen solution.1

The physical therapist education community does not have a culture of agreement on collective participation in standardized, routine processes; therefore, implementation of any system that defines and measures excellence will require a significant cultural shift. Such a shift takes time, effort, and persistence. As members of the BenEx task force, our perception is that the process and decisions related to defining and measuring excellence were inconsistently supported by the changing leadership of ACAPT to the extent necessary to encourage constituent participation and routinize the process. Any large-scale, new, and innovative practice that is rolled out to multiple constituents needs time to develop efficiencies, respond to feedback, and adjust processes to suit various needs and circumstances. In the case of the MEPQ, most of this work was done by a volunteer task force. The scale of the change that programs were asked to adopt in collecting data was such that the time allowed for its full and effective implementation was insufficient to create the required cultural shift.

To further address this wicked problem in a way that meets the expectations of our professional community, we must create a cultural shift that embraces shared assessment. The effort requires the full backing of leadership and sufficient resources. Our recommendations include: 1) build on the substantial work that has been done both within and outside of the profession and use existing empirical data and theoretical models as a basis for defining excellence in physical therapist education programs; 2) seek and reconfirm a commitment by all stakeholders to participate in standardized processes for measuring excellence; 3) require participation in routine, standardized assessment of excellence as an expectation of being a member of ACAPT; 4) invest resources in large-scale assessment activities including data collection, storage and analysis technology, personnel, and communication; 5) collaborate with all stakeholders such as the Commission on Accreditation in Physical Therapy Education and the Federation of the State Boards of Physical Therapy to integrate relevant data; and 6) educate constituents on the of value of data-driven decision-making and ways that data can be useful for program benchmarking, quality improvement, strategic planning and accreditation self-study.

CONCLUSIONS

This perspective has examined previously published work defining excellence in higher education in general, as well as physical therapist education, specifically. The theoretical models from 2 studies related to excellence in physical therapist education, one a generic model for excellence13 and one specific to physical therapist education,14,15 were compared and commonalities highlighted. There is clear convergence of major constructs across the 2 models, suggesting the foundation for defining excellence and assessing quality in physical therapist education programs. We have outlined the steps we believe are required to move these efforts forward. The process will take leadership, shared vision, commitment, and collaboration of the entire physical therapist education community to transform our culture and ensure a fruitful outcome.

Contributing Participants and other BenEx Task Force members

Peter Altenberger, PT, PhD, Gary Chleboun, PT, PhD, Denise Schilling, PT, PhD, and Kimberly Topp, PT, PhD, FAAA.

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Keywords:

Physical therapist education; Defining excellence; Engagement Theory

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