Secondary Logo

Journal Logo

RESEARCH REPORTS: EDUCATION

Moving Toward Excellence in Pediatric Physical Therapy Education

A Scoping Review

Anderson, Deborah K. PT, EdD, MS, PCS; Furze, Jennifer A. PT, DPT, PCS; Moore, James G. PT, PhD, PCS

Author Information
doi: 10.1097/PEP.0000000000000549
  • Free

INTRODUCTION

Pediatric physical therapy is an area of practice that aims to optimize movement for lifelong meaningful participation of all children.1 To achieve this mission, physical therapist (PT) students must develop and apply foundational pediatric physical therapy knowledge in both the didactic and clinical settings. Pediatric physical therapy content is included within professional PT education programs as part of the required preparation of entry-level PT practitioners to be able to work with patients and clients across the lifespan.2,3 In 2017, Jensen et al4 published a comprehensive analysis of professional PT education. This Carnegie-type study investigated elements of excellence and innovation in professional PT education resulting in the development of a 3-pronged conceptual framework: culture of excellence, praxis of learning, and organizational structures.4 In addition to describing commonalities, Jensen et al4 identified significant variability between PT program exemplars in the delivery of professional PT education. In 2011, Schreiber et al5 reported similar variability in curricular and pedagogical practices within the pediatric physical therapy education component of professional PT education programs.

Concerns about variability in pediatric physical therapy education, which potentially could lead to inadequately prepared pediatric PTs, resulted in the convening of 2 pediatric education summits by the APTA Academy of Pediatric Physical Therapy (APPT).6,7 One of 3 research questions identified by consensus, as a priority for the APPT educational research agenda, at the Pediatric Education Summit II held in Denver, Colorado, November 9 to 10, 2016, was, “What is excellence in professional pediatric physical therapy education?”7 The answer to this research question will begin to inform both didactic and clinical educators regarding best practice in pediatric physical therapy education within professional PT programs, which can directly influence the clinical practice of pediatric PTs.7

In 1978, requirements for pediatric-specific curricula became part of the Commission on Accreditation in Physical Therapy Education (CAPTE) standards for professional PT education.8 This modification of the accreditation standards may, in part, have been in response to changes in federal legislation, specifically Public Law 94-142, the Education for All Handicapped Children Act (now the Individuals with Disabilities Education Act [IDEA]), which expanded the role of physical therapy in the school system.9 Between 1990 and 1991, Cherry and Knutson10 surveyed professional PT programs and reported that pediatric physical therapy curricula focused largely on content related to child development, pediatric disorders, and management of pediatric conditions. At that time, pediatric content was delivered within professional PT programs in a variety of ways: stand-alone course, separate unit within another course, or threaded throughout the general physical therapy curriculum.10 Eighty-two percent of responding programs required laboratory experiences in child assessment; however, few offered laboratory experiences in treatment and most experiences were limited to 2 to 4 hours.10 Despite the significant growth in the curricula of professional PT programs, especially with the professions' move to the doctor of physical therapy (DPT) degree, concerns regarding the number of hours, variability of content and instruction, and clinical exposure devoted to pediatric physical therapy education within professional PT programs continued.5

The APPT has published several iterations of guidelines to help inform professional PT education programs on the appropriate content to include within pediatric physical therapy curricula. In 1995, the APPT first published the Section on Pediatrics—Guidelines for Pediatric Content in Professional Physical Therapist Education, which was revised in 2001.11 These guidelines were revised again in 2008 and updated in 2009 to address curricular changes due to the transition to DPT-level education as well as reflect contemporary pediatric physical therapy practice.12 The resulting document, Pediatric Curriculum Content in Professional Physical Therapist Education: A Cross-Reference for Content, Behavioral Objectives, and Professional Resources was recommended as a resource for professional PT programs.12 Despite the availability of these documents, inconsistencies and challenges persisted in teaching pediatric content across educational programs.5

In 2012, the APPT convened its first Education Summit6 to address 6 objectives for the education of entry-level pediatric PTs: (1) recommend optimal pediatric professional PT education practices; (2) recommend strategies for preparation, development, and support of academic faculty adequately prepared to deliver pediatric professional education; (3) summarize traditional, novel, and unique models of delivery of optimal pediatric clinical education experiences; (4) recommend strategies for the preparation, development, and support of clinical instructors in pediatric physical therapy; (5) suggest research projects and funding priorities to support research aimed at identifying optimal educational practices in pediatric professional education; and (6) publish conference proceedings on the basis of workgroups and content identified during the Summit.6 Published outcomes from Summit I included the identification of 5 essential core competencies (ECCs)6 for pediatric physical therapy education and examples of activities to promote the ECCs in both didactic and clinical education.6,13 The ECCs consist of human development, age-appropriate patient/client management, family-centered care for all patient/client and family interactions, health promotion and safety, and legislation, policy, and systems.6

Although studies exist examining “excellence” in professional education (ie, medicine, nursing, and law),14–16 the first comprehensive analysis of professional PT education was only recently published by Jensen et al.4 Since the early 1990s, several investigators have examined components of pediatric physical therapy education; however, a comprehensive analysis of pediatric physical therapy education within professional PT education does not exist.10,17,18 Excellence in PT education has been conceptualized by experts consisting of 1) visionary leadership that promotes innovative changes and advances in education and practice; 2) education of highly functioning, exemplary graduates using a signature pedagogy; and 3) an interdependence between the academic and clinical worlds with shared learner-centered and patient-centered values.4 At this time, no singular curricular pattern or pedagogical practice has been found to lead to educational excellence.4,10,17 It has been suggested that the curricular pattern may not be an element in defining educational excellence.4

A systematic review was initially proposed to answer the question, “What are the characteristics of exemplary pediatric physical therapy education within a professional PT program?” Due to insufficient published evidence, especially at higher levels, the authors chose to use a scoping review to gain a better understanding of the current evidence to determine “excellence” within the pediatric physical therapy education component of professional PT programs, to identify gaps in evidence, and to address issues that inform practice, such as pediatric educational research.19 Scoping reviews entail systematic selection, collection, and summaries of existing knowledge to identify where there is sufficient evidence to conduct a full synthesis or where insufficient evidence exists and further primary research is necessary.19 Due to the broad nature and purpose of scoping reviews, authors do not typically evaluate the quality of included studies; however, a scoping review does present a critical analysis and interpretation of the available literature.19–21

The purpose of this scoping review was to identify and map the current evidence that underpins excellence in pediatric physical therapy education. Specifically, the objectives of this scoping review were to answer the following questions:

  1. What mechanisms do didactic and clinical faculty use to deliver the pediatric physical therapy education component within professional PT education programs that exemplify excellence in education?
  2. What are the program characteristics, didactic and clinical, of pediatric allied health education within professional allied health programs that exemplify excellence in education?

These objectives will help improve the quality of pediatric physical therapy education within professional PT education to promote best practices in the treatment of children.

METHODS

The protocol used to conduct this review was based on methods developed by The Joanna Briggs Institute.19 This protocol consists of identifying the review objectives and questions, defining the inclusion criteria, implementing a 3-step search strategy (perform limited search to identify keywords, broaden search to include all identified databases, search reference lists of identified articles), extraction (or charting the results), discussion of results, and conclusion/implications.19 To guide the systematic process of the scoping review, the PRISMA22 statement was used to describe the flow of the review process and report results.

Data Sources and Literature Search

Initially, an exploratory search was completed by 1 professional PT student and 2 pediatric physical therapy residents to identify appropriate search terms and search engines for the scoping review. From this exploratory search, the 3 investigators identified the most appropriate databases and search terms.23 Four databases were searched: PubMed, Academic Search Premier, CINAHL complete, and ERIC to capture the largest available evidence to answer our research questions. Inclusion criteria consisted of a time frame from 1990 to 2017. This time frame of 27 years was justified based upon the following critical factors: a period of seminal pediatric literature, evolution of the federal law (IDEA), and the development of the first DPT program. In addition to the time frame, inclusion criteria included full-text articles specifically addressing pediatric physical therapy/medical/allied health education. Studies from outside of the United States were excluded based upon the variability in PT education and the lack of accreditation criteria. One pediatric physical therapy resident conducted the literature search using the following search terms: “professional PT education and pediatrics,” “physical therapy program accreditation standards,” “professional physical therapy education,” “entry-level physical therapy education,” “pediatric physical therapy competencies,” “health professions pediatric curriculum,” “health profession education + pediatric,” “models of physical therapy clinical education AND pediatrics,” “graduate level physical therapy education AND pediatrics,” “professional PT education AND pediatrics,” “clinical education AND physical therapy AND pediatrics,” and “entry level physical therapy education AND pediatrics”. Investigators scanned the references to identify other articles potentially relevant to answering the research questions. These results were then added to review. Concurrent with the initiation of this scoping review, investigators became aware of the upcoming publication of a special series in a professional journal focusing on pediatric physical therapy education. A subsequent conversation with the coeditors of this special edition culminated in access to prepublished relevant articles.

Study Selection

All study designs, including qualitative and quantitative methods as well as expert opinion, were considered using the inclusion and exclusion criteria described earlier. Articles were included if they related to pediatric education and addressed aspects of teaching and learning, curriculum, and pedagogy. Articles were excluded if they only described clinical practice but did not apply this to education. A 6-stage process was implemented to review articles after the exploratory phase (Figure). In the first stage, a pediatric physical therapy resident searched the 4 databases using the search terms developed by the investigators. In the second stage, an investigator independently reviewed the identified titles to determine inclusion in the scoping review. In the third stage, the 3 investigators reviewed the abstracts for eligibility based on the inclusion and exclusion criteria. All investigators, in the fourth stage, retrieved and reviewed all 54 articles. Finally, the investigators accessed the prepublished articles from the pediatric special series in education and evaluated the full-text reference list to determine relevance. The investigators discussed all articles for inclusion in the scoping review until consensus was reached.

Fig
Fig:
Search strategy flowchart.

Data Extraction and Analysis

Extracted data included citation, study design, participants/subjects, methods, outcomes, and recommendations. After the data extraction chart was developed, the investigators piloted these categories to determine consistency in use. Subsequently, sample-completed data extraction tables were provided to the pediatric physical therapy residents and the PT student as a model for completing the remaining article data extraction. Investigators reviewed the final extraction table and made edits as appropriate.

Data extraction tables were analyzed to determine clusters20 of common characteristics by which the articles could be grouped into overarching concepts. Disagreement was resolved through investigator discussion.

Level of Evidence

The level of evidence for each article was determined using the hierarchy developed by Melnyk and Fineout-Overholt.24 This hierarchy of evidence encompasses a broad range of evidence from expert opinion to systematic reviews in 7 different categories (Table 1). The Melnyk and Fineout-Overholt24 level of evidence hierarchy expands on the more traditional 5-level hierarchies to include levels that represent qualitative studies. Many studies in this scoping review were qualitative.

TABLE 1
TABLE 1:
Description of Studies

RESULTS

Literature Search

The search yielded 476 articles. After duplicates were removed, 341 articles remained. Articles were excluded with titles that identified content not relevant to pediatrics, medical or health professions education in the United States, yielding a sample of 86 articles. The investigators reviewed the 86 abstracts and excluded 32 that did not meet the criteria. The remaining 54 full-text articles were accessed and reviewed by all investigators. From this full article review, 35 articles were eliminated, leaving 19. Eleven additional articles were accessed for review from reference lists, recent accepted submissions to the Journal of Physical Therapy Education (J Phys Ther Educ) focusing on pediatric PT education, and investigator knowledge. Thirty articles were identified for the final scoping review and analysis (Figure).

According to Melnyk and Fineout-Overholt's24 level of evidence hierarchy, no articles in this scoping review were categorized as systematic reviews or control trials with or without randomization. Six articles were cohort studies (level 4). Fourteen (46.7%) were level 6, single descriptive or qualitative studies.24 Ten articles were expert opinion of an individual or group (level 7) (Table 1).

Characteristics of Studies

Publication dates for the articles are shown in Table 2. The type of studies included in this review was cross-sectional, cohort, case study, or another descriptive method (eg, qualitative or expert opinion). The type of evidence collected was qualitative (n = 6, 20%), quantitative (n = 1, 3.3%), or mixed methods (n =13, 43.3%). One-third (n = 10) of the articles used expert opinion (Tables 1 and 2). Extracted data from the studies are shown in Table 3.

TABLE 2
TABLE 2:
Characteristics of Articles
TABLE 3
TABLE 3:
Extraction Table

Overarching Concepts

Three overarching concepts emerged from the critical analysis of the articles: faculty characteristics, curriculum, and pedagogy (Table 1).

Faculty Characteristics

Three publications addressed the characteristics of faculty responsible for teaching pediatrics in professional PT programs. Cherry and Knutson10 identified that, at the time of their survey, most programs (51%) used full-time faculty to teach pediatric content. However, 38% of programs reported that full-time faculty spent less than 50% of their time teaching pediatrics requiring part-time or adjunct faculty to provide the remaining pediatric content.10 Cherry and Knutson10 expressed concern that this model resulted in a lack of pediatric mentors for students. Stuberg and McEwen17 identified 3 faculty models used by professional PT programs for pediatric physical therapy content: full- or part-time faculty with academic appointments, part-time faculty who were employed by a clinical facility affiliated with the college or university, or part-time faculty who were employed by a clinical facility that was not affiliated with the college or university. These authors17 supported the inclusion of full- or part-time faculty with pediatric expertise to increase the focus of pediatrics in the curriculum and to improve the quality of the students' educational experience. Sixteen years later, faculty characteristics of those responsible for teaching pediatric content appear to have changed. Schreiber et al5 reported that 66% of individuals responsible for teaching pediatric physical therapy content held full-time faculty appointments, with 49% having a PhD, EdD, or ScD. Thirty-eight percent of the respondents were board-certified pediatric clinical specialists through the American Board of Physical Therapy Specialties (ABPTS).5 Many faculty respondents indicated that they would retire within the 15 years following the 2009 data collection.5

Curriculum

Twenty-one articles focused on the pediatric physical therapy curriculum including both didactic and/or clinical education components. Three main constructs emerged from a review of these articles: pediatric curricular model, pediatric educational content, and use of competencies to guide pediatric curricular development.

Curricular Model

Multiple curricular models for delivering pediatric physical therapy content have been described in the literature since the APPT published its first position statement in 1979 suggesting the incorporation of pediatrics into the general curriculum.49 In a survey conducted by Cherry and Knutson,10 the greatest number of respondents indicated that content was being taught as a unit within a broader course. Eighteen years later, a survey by Schreiber et al5 found that 70% of the professional PT programs included at least 1 stand-alone pediatric course. Turner47 and Birkmeier et al26 described the effective use of the stand-alone model in entry-level PT preparation. Sparling and Sekerak44 described an approach to embed content related to family-centered care into sequentially organized courses (not stand-alone pediatric courses) in an entry level PT program versus inserting an additional course into the curriculum. A workgroup of pediatric medical educators suggested that embedding pediatric content regarding end-of-life care across multiple courses would afford greater opportunities for “teachable moments”; however, it would require greater faculty development and academic institutional commitment.41 This scoping review found no published articles supporting one curricular model over another in pursuit of academic excellence.

There is variability in number of contact hours dedicated to pediatric content within professional PT education curricula. Content hours have increased since the early 1990s.5,10 In 1993, Cherry and Knutson10 reported that most programs spent between 11 and 20 hours teaching pediatric content (didactic) and 4 to 8 hours in laboratory activities (assessment and treatment) with children. Pediatric clinical affiliations/internships, when available, were reported for an average of 8 weeks.10 When asked about satisfaction with the amount of time spent on pediatric content, respondents reported different levels of satisfaction depending on content area: child development (63% of respondents satisfied), pediatric disorders (38% of respondents satisfied), and management of pediatric conditions (45% of respondents satisfied).10 Schreiber et al5 in 2009 survey results recounted that the number of hours teaching pediatric content ranged between 35 and 210 hours (mean 99.62); didactic hours between 0 and 170 (mean 44.53), and laboratory hours between 0 and 126 hours (mean 31.8). Seventy percent of survey respondents in the Schreiber et al5 study reported that the number of hours covering pediatric content was adequate. Schreiber et al,5 based upon expert consensus, recommended that 90 hours be devoted to pediatric content within the PT curriculum, including 60 hours for combined problem-based learning and lecture, and 30 hours of laboratory experiences.

Content

Guidelines, standards, and competencies have been published to aid in development of pediatric physical therapy education; however, there is variability in implementation.8,11–13,28,32,50 Pediatric curricular content decisions may have been based on changes in public education legislation (eg, reauthorization of IDEA),9,28,32 health care delivery models (eg, Health Maintenance Organizations and Preferred Provider Organizations),12,43,45 improvements in medical technology (ie, reduced morbidity and mortality rates),29,43–45 transition to the doctorate degree,40 and current terminology (eg, adoption of the International Classification of Functioning, Disability and Health (ICF)).28,32,45

Donahoe-Fillmore31 conducted a survey of accredited physical therapy programs and compared the extent of coverage and perceived importance of pediatric content in the curriculum. Gaps between content coverage and perceived importance were identified in behavior management, cardiopulmonary and orthopedic aspects of pediatric physical therapy, health delivery issues, and application of motor skills to functional training in self-care and work. Hands-on experiences and use of evidence-based resources were also identified as areas in need of improvement. Results should be cautiously interpreted as the response rate for participation was 37%. In 2012, Kenyon et al35 used a mixed-methods approach to examine the perspectives of clinical educators concerning what pediatric content should be included in didactic curricula of entry-level PT education programs. Clinical educators recommended that, in addition to foundational pediatric knowledge, all students should have opportunities to interact with children developing typically and children with disabilities during their entry-level education.35

Guidelines are published that reflect current practice, legislation, and terminology in early intervention (EI),28,33 school-based,32 and neonatal45 settings to guide both entry-level and postprofessional education and practice. Chiarello and Effgen28 recommended changes to existing pediatric content and competencies in EI based on legislative changes (eg, federal mandate for service provision in the natural environment) and terminology changes (eg, adoption of the ICF). Golub-Victor and Dumas33 reported that EI training increased marketability for employment and preparation for EI practice. Effgen et al32 recommended changes to existing pediatric content and competencies in school-based settings due to legislative changes (eg, federal, state, and local mandates on transition, advocacy, embedding intervention into a student's routines) and best practice consensus (eg, wellness, and prevention, adapting environments, methods of service delivery). Sweeney et al45 recommended expansion of neonatal PT practice competencies, including roles, clinical proficiencies, and areas of knowledge. The authors concluded that, although student PTs and generalist PTs are not appropriate in the neonatal setting, recommendations may aid entry-level programs to provide content that better prepares a new graduate for a neonatal precepted practicum, residency, or fellowship training experiences.

Competencies

Several authors further described the use of the 5 ECCs to develop didactic33–35 and clinical13,34,36 content and experiences, and benchmark student performance across the curriculum.34 Using a qualitative research design that included student self-evaluation and reflection, Lardinois et al36 demonstrated how the use of an early, collaborative, integrated clinical experience (ICE) could address key characteristics and professional activities related to the ECC, family-centered care. ICE is a curriculum design model whereby clinical education experiences are purposively organized within a curriculum.51 Moerchen et al37 described a practicum model that consisted of team and problem-based learning to increase students' pediatric experience through repeated ICE activities. The authors suggested that the values that guided development of the practicum model were aligned with the ECCs. Kenyon et al13 demonstrated how the ECCs could be used for organizing and developing general, clinic-specific clinical education objectives, developing and planning individualized student learning experiences, identifying student needs, and showing progression of student learning at beginning, intermediate, and entry levels. Using the Delphi method, Kenyon et al34 developed consensus to describe pediatric-specific knowledge, skills, and abilities that would be expected of PT students prior to pediatric clinical education experience, after a pediatric clinical education experience, and at the end of the DPT program. Consensus was reached on items including basic science and foundations for practice, common pediatric diagnoses/pathologies, examination, interventions/plan of care/documentation, and general skills and abilities. Academic faculty had higher student expectations than clinical instructors at the same points in the curriculum.34

Pedagogy

Importance of Cognitive, Psychomotor, and Affective Learning

Multiple articles addressed the teaching methods and practices used to deliver pediatric content. Four articles addressed pedagogy from a philosophical or framework perspective.6,13,38,39 Noone38 used a case exemplar to describe the integration of the 3 apprenticeships (cognitive/intellectual, skill/practical, and ethical comportment/behavior), as described by the Carnegie Foundation for the Advancement of teaching, into a specific curricular topic in nursing. The physical therapy ECCs6 and the framework used by Kenyon et al13 for developing pediatric PT student clinical education objectives encompass the 3 apprenticeships and include specific learning activities that reflect cognitive, psychomotor, and affective behaviors. Rapport et al39 recommended that entry-level student exposure to the neonatal intensive care unit be limited to cognitive learning through clinical observation and shadowing of various members of the neonatal intensive care unit interprofessional team due to the specialized requirements for PTs in this area of practice. The 4 articles provide important guidance essential to pediatric physical therapy education.6,13,38,39

Experiential Learning With Children With and Without Special Needs

Eight research articles illustrated teaching and learning practices that underpin excellence in pediatric physical therapy education as measured by successful learning outcomes and positive student feedback. Five of the studies were cohort studies,25,27,30,46,48 2 case studies36,37, and 1 used 6 case exemplars to support recommendations for experiential learning.42 Studies included information from 10 professional PT education programs, 1 professional occupational therapist education program, and 1 professional nursing program. Findings from this research supported pedagogical practices that incorporated experiential learning with children with and without special needs: university-based experiential learning,27,30,37,42,48 ICE,25,36,42,46,48 community-based service learning,42 reflection, and self-directed learning.25,27,36,37,48

University-Based Experiential Learning

University-based experiential learning activities were described as taking place within a didactic course within a laboratory setting. Experiential learning activities were between 1 and 8 hours of student class time and included the use of infant simulators, interactions with children developing typically, and with families and children with a wide range of diagnosis.27,30,37,42,48 These university-based experiential learning activities consisted of observations, development screenings, student performance of examination and interventions, and discussions with children and families regarding goal setting and priorities for intervention. Student outcomes demonstrated improved sensitive communication and confidence working with children and an increased understanding and focus on family-centered care and psychomotor skill development.27,30,37,42,48

Integrated Clinical Education and Service Learning

Experiential learning outside of the classroom consisted of ICE experiences and community-based service learning. ICE experiences and service learning relied on collaborations with community partners.25,36,42,46,48 Within the ICE model, clinical instructors guided the experiential learning activities that included all components of the patient/client management model. Wynarczuk and Pelletier48 reported on teams of 2 to 5 PT students who completed 3 clinic visits for a total of 6 hours. Lardinois et al36 placed teams of 4 PT students with 1 clinical instructor for 3 ICE experiences ranging from 1 to 2 weeks. Tovin et al46 used an ICE model for PT students that took place over 2 semesters for a total of 32 hours. Benson et al25 used a slightly different method of providing ICE experiences to occupational therapy (OT) students. Unlike the PT program experiences that used a variety of clinical partners and settings, Benson et al25 identified a private school that delivered educational services to children and adolescents with a variety of disabilities. Teams of 2 OT students worked with the school OTs to conduct standardized assessments, develop plans of care, and provide interventions. Of the 6 PT program exemplars described by Schreiber et al,42 4 facilitated ICE experiences in natural environments such as preschools. All 6 programs incorporated experiential learning in the form of hands-on or observational experiences at community-based physical therapy clinics.42 All 6 of the PT programs provided their students with the opportunity to participate in service-learning activity such as participation at a camp for children and providing equipment to high school students with developmental disabilities.42 Authors reported a variety of outcomes from experiential learning outside of the classroom based on achievement of course objectives, student and/or clinical instructor feedback, and journaling. Following experiential learning, students demonstrated improved application and manipulation of knowledge, improved clinical reasoning skills, as well as improved child/family interactions and management of the therapeutic environment.25,36,46,48

Reflection and Self-directed Learning

Five of the 8 research articles identified reflection as an important component of student learning either in the form of ongoing journaling during experiential learning experiences or post-experiential learning reflections.25,27,36,37,48 Benson et al,25 through a retrospective analysis of students' reflections, identified a developmental progression in student perspectives. In addition, Chapman and Sellheim27 reported that self-directed learning activities, a supportive learning environment, and well-organized class sessions contributed to second-year PT students' knowledge and confidence.

DISCUSSION

Excellence is predicated on the culture, context, and values of a specific group.52 This scoping review identified and mapped current evidence that provides the foundation for excellence in pediatric physical therapy education as part of professional PT education. Through this scoping review, valuable literature on pediatric physical therapy education published over the past 27 years has been synthesized and analyzed. Expert opinion, case studies, cohort studies, and cross-sectional studies based primarily on survey and qualitative research methods provided the foundation for this scoping review. Despite low level of evidence in these studies, 3 overarching concepts emerged, which warrant further investigation: faculty characteristics, curriculum, and pedagogy. These overarching concepts inform the definition of excellence, as it is perceived currently through the lens of pediatric PT educators, clinicians, and students.

Faculty Characteristics

Cherry and Knutson10 and other PT educators17,43 reported on the need for qualified pediatric physical therapy faculty who have the clinical expertise as well as the educational training to prepare graduates to safely, effectively, and optimally meet the needs of children and their families. Since the initial study of pediatric physical therapy education in 1993,10 a positive shift has occurred in that more pediatric faculty have full-time status and many have terminal academic degrees and ABPTS specialty certification demonstrating advanced knowledge and skills in pediatrics.5 Questions about intrinsic faculty traits or characteristics, such as the ability to engage students at all levels, an exhibited passion or dedication to improving the lives of all children, or innovation and creativity, remain unanswered by this review.

Curriculum

Schreiber et al5 found that a variety of curricular models exist within pediatric physical therapy curriculum ranging from pediatric content delivered via a stand-alone pediatric course to pediatric content integrated into components of several broader-scope courses. Birkmeier et al26 suggested that it was not a model that informed excellence in pediatric physical therapy education, but rather the pedagogical components of the course structure that resulted in enhanced clinical reasoning and achievement of entry-level practice. Thus, as in PT education where one model has not been found to be superior to another, this appears to also be the case in pediatric physical therapy education.4 Various pediatric educational curricular guidelines and, most recently, the ECCs, have been developed by the APPT to guide pediatric physical therapy education content and inform practice.6,11,12 An increase in the number of hours dedicated to pediatric physical therapy and hands-on laboratory experiences has increased overtime,5 which theoretically should translate to improved learner knowledge and performance. Rapport et al40 and Turner47 also promoted specific curricular elements consistent with Birkmeier et al26 that promoted the development of critical thinking and psychomotor skills though observational analysis, engagement with patients and families, clinical decision-making, and reflective practice. An additional question that remains unanswered in the area of curriculum is the effect, if any, of the explicit versus implicit curriculum.

Pedagogy

The most common approach related to excellence in pedagogy was the opportunity for students to practice “hands-on” skills with children. Since many students do not embark on a full-time pediatric clinical experience, faculty must provide opportunities for simulated experiences in the didactic curriculum. Students' ability to engage with children with and without special needs was discussed in multiple articles as essential in elevating students to the level of independent pediatric PT practitioner. Schreiber et al5 reported a mean of 31.8 hours focused on laboratory activities pertaining to pediatric physical therapy education. However, only 11.7 hours of the 31.8 hours included direct interaction with children.5 Schreiber et al,42 Moerchen et al,37 and Lardinois et al36 provided examples of experiential learning activities that could be incorporated into PT program curricula to enhance student exposure to the physical therapy needs of children and their families. Lardinois et al36 reported that an early, collaborative ICE experience in a pediatric setting can help PT students develop communication, collaboration, and reflection for preparation for terminal clinical experiences. Another area of important future investigation is the use of reflection during the didactic curriculum to improve clinical reasoning skills.

The APPT,12 in the 2009 document regarding pediatric curriculum content in professional PT education, encouraged faculty to use both academic and clinical education curricula to deliver pediatric content. Currently, the majority of PT programs do not require a pediatric clinical education experience for all students, which may be due, in part, to the number of available pediatric clinical education sites as compared with other types of sites.5,53 However, the CAPTE requires all programs to ensure that students gain exposure to patients across the lifespan, including children.3 Thus, programs are meeting this criterion in various ways other than a full-time clinical experience in a “typical” pediatric setting. Kenyon et al53 found that 35% of program respondents reported concerns about the number and variety of pediatric clinical education settings. The majority of pediatric physical therapy clinical education continues to be provided as terminal clinical education experiences further limiting student exposure.53 However, students may gain exposure to pediatric practice through limited or part-time clinical education experiences, especially in rural areas. More work needs to be done to explore the magnitude of the effect of each type of experiential learning in meeting the needs of PT students, taking into consideration the limited resources of time, access to patients/families, and tuition dollars available for these types of experiences.

LIMITATIONS

A limitation of this study was that only articles from health professions education in the United States were included. Additional articles on this topic may be available from health professions educators outside of the United States. A major limitation of this study is the low level of evidence of the included articles. Although an extensive search was completed, it is possible that the databases and search terms that were used did not identify more rigorous studies outside of the field of physical therapy.

CONCLUSIONS

The provision of quality pediatric physical therapy services by new PT graduates continues to be a goal mandated by societal needs and the lifespan requirements of the CAPTE.3 The APPT conducted 2 educational summits in response to this charge: Summit I, which culminated in the development of the ECCs,6 and Summit II resulting in the development of 4 research projects aiming to improve pediatric physical therapy education.7 This scoping review informs practice through description and discussion of faculty characteristics, curriculum, and pedagogy that demonstrates excellence. Specifically, over half of pediatric faculty are full-time, a majority have academic terminal degrees, and over one-fourth have obtained ABPTS board certification in pediatrics. Various guidelines and competencies in pediatric physical therapy education continue to best prepare students for practice.6,11,12 Finally, and perhaps most importantly, pedagogy has significantly evolved over time to include a focus on experiential learning in addition to clinical education experiences to provide students with “hands-on practice.” Despite a renewed interest in educational research and a heightened number of publications over the past few years, the level of evidence reflected in these studies continues to be low and mostly in the form of single institutional case study design. For educational excellence to be attained, it is imperative that educational research, focusing on curriculum and teaching pedagogy across multiple institutions with common assessment tools, be conducted. An in-depth look into the specific faculty characteristics and the interplay between faculty, curriculum, and pedagogy would help us to better understand excellence in pediatric physical therapy education. The results of this scoping review and future research will help to better prepare future PTs to work with children and their families.

ACKNOWLEDGMENTS

The authors thank pediatric physical therapy residents, Jennifer O'Loughlin PT, DPT, Board Certified Pediatric Clinical Specialist, Creighton University; Nicole Greenberg PT, DPT, Board Certified Pediatric Clinical Specialist, University of Miami; and Midwestern University physical therapist student Rima Lintakas for the invaluable assistance with this project.

REFERENCES

1. Furze J. Message From the Chair. Alexandria, VA: Academy of Pediatric Physical Therapy; 2017. Academy of Pediatric Physical Therapy, Academic & Clinical Educators Special Interest Group Newsletter 2.
2. Practice Committee, Academy of Pediatric Physical Therapy, American Physical Therapy Association. The ABCs of Pediatric Physical Therapy. https://www.pediatricapta.org/consumer-patient-information/resources.cfm. Accessed November 12, 2017.
3. Commission on Accreditation in Physical Therapy Education. Standards and Required Elements for Accreditation of Physical Therapist Education Programs. http://www.capteonline.org/uploadedTherFiles/CAPTEorg/About_CAPTE/Resources/AccreditationHandbook/CAPTE_PTStandardsEvidence.pdf. Published March 2016. Accessed May 11, 2017.
4. Jensen GM, Nordstrom T, Mostrom E, Hack LM, Gwyer J. National study of excellence and innovation in physical therapist education: part 1-design, method, and results. Phys Ther. 2017;97(9):857–874.
5. Schreiber J, Goodgold S, Moerchen VA, Remec N, Aaron C, Kreger A. A description of professional pediatric physical therapy education. Pediatr Phys Ther. 2011;23(2):201–204.
6. Rapport MJ, Furze J, Martin K, et al Essential competencies in entry-level pediatric physical therapy education. Pediatr Phys Ther. 2014;26(1):7–18.
7. Lundeen H, Moerchen V, Dannemiller L, Fiss A, Catalino T. What we have done and where we are going: Education Summit II and the journey toward excellence in pediatric physical therapy education. Paper presented at: APTA Academy of Pediatric Physical Therapy Annual Conference, November 2017, Cincinnati, OH.
8. APTA. Standards of Accreditation for Physical Therapy Education Programs. Alexandria, VA: APTA; 1978; B–6.
9. McEwen IR, ed. Providing Physical Therapy Services: Under Parts B & C of the Individual's with Disabilities Education Act (IDEA). Alexandria, VA: Section on Pediatrics; 2009:77–87, 107–114.
10. Cherry DB, Knutson LM. Curriculum structure and content in pediatric physical therapy: results of a survey of entry-level physical therapy programs. Pediatr Phys Ther. 1993;5(3):109–116.
11. American Physical Therapy Association Section on Pediatrics. Guidelines for Pediatric Content in Professional Physical Therapist Education. Alexandria, VA: APTA; 1995, 2001.
12. American Physical Therapy Association Section on Pediatrics. Pediatric Curriculum Content in Professional Physical Therapist Education: A Cross Reference for Content, Behavioral Objectives and Professional Sources. Alexandria, VA: APTA; 2008, 2009.
13. Kenyon LK, Birkmeier M, Anderson DK, Martin K. Innovation in pediatric clinical education: application of the essential competencies. Pediatr Phys Ther. 2015;27(2):178–186
14. Flexner A. Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. http://archive.carnegiefoundation.org/pdfs/elibrary/Carnegie_Flexner_Report.pdf. Accessed November 28, 2016.
15. Foster C, Dahill L, Golemon L, Tolentino BW. Educating Clergy: Teaching Practices and Pastoral Imagination. San Francisco, CA: Jossey-Bass; 2006.
16. Sullivan W, Colby A, Wegner JW, Bond L, Shulman L. Educating Lawyers: Preparation for the Profession of Law. San Francisco, CA: Jossey-Bass; 2007.
17. Stuberg W, McEwen I. Faculty and clinical education models of entry-level preparation in pediatric physical therapy. Pediatr Phys Ther. 1993;5(3):123–127.
18. Gandy JS. Survey of academic programs: exploring issues related to pediatric clinical education. Pediatr Phys Ther. 1993;5(3):128–134.
19. Peters MDJ, Godfrey CM, McInerney P, Soares CB, Khalil H, Parker D. Methodology for JBI Scoping Reviews. Adelaide, Australia: The Joanna Briggs Institute; 2015.
20. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Imp Sci. 2010;5(69):1–9.
21. Tricco AC, Lillie E, Zarin W, et al A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Meth. 2016;16:15. doi:10.1186/s12874-016-0116-4.
22. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–269, W64.
23. Jones ML. Application of systematic review methods to qualitative research: practical issues. Jour Adv Nurs. 2004;48(3):271–278.
24. Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice. Philadelphia, PA: Lippincott, Williams & Wilkins; 2011.
25. Benson J, Provident I, Szucs K. An experiential learning lab embedded in a didactic course: outcomes from a pediatric intervention course. Occup Ther Health Care. 2013;27(1):46–57.
26. Birkmeier M, Plack M, Wentzell E, Maring JR. A course of its own: a stand-alone pediatric course designed to meet the essential core competencies and program goals. J Phys Ther Educ. 2017;31(2):97–107.
27. Chapman DD, Sellheim DO. Assessment of teaching and learning activities in pediatric physical therapy: factors influencing knowledge development and confidence. J Phys Ther Educ. 2017;31(2):108–118.
28. Chiarello L, Effgen SK. Updated competencies for physical therapists working in early intervention. Pediatr Phys Ther. 2006:18;148–158.
29. Cochrane CG, Farley BG, Wilhelm IJ. Preparation of physical therapists to work with handicapped infants and their families: current status and training needs. Phys ther. 1990;70(6):372–380.
30. Darcy-Mahoney AE, Hancock LE, Iorianni-Cimbak A, Curley MA. Using high-fidelity simulation to bridge clinical and classroom learning in undergraduate pediatric nursing. Nurse Educ Today. 2013;33(6):648–654.
31. Donahoe-Fillmore BK. PediatricCurriculum ContentinEntry-Level Physical Therapist Education [doctoral dissertation]. Cincinnati, OH: Union Institute and University; 2002.
32. Effgen SK, Chiarello L, Milbourne SA. Updated competencies for physical therapists working in schools. Pediatr Phys Ther. 2007;19:266–274.
33. Golub-Victor AC, Dumas H. PT graduates' perceptions of a higher education early intervention training program on employment and practice. Pediatr Phys Ther. 2015;27(2):152–159.
34. Kenyon LK, Dole RL, Kelly SP. Perspectives of academic faculty and clinical instructors on entry-level DPT preparation for pediatric physical therapist practice. Phys Ther. 2013;93(12):1661–1672.
35. Kenyon LK, Tovin MM, Hellman M. Clinical instructors' perspectives: what should we be teaching in pediatrics? Pediatr Phys Ther. 2012;24(2):183–191.
36. Lardinois KL, Gosselin D, McCarty D, Ollendick K, Covington K. A collaborative model of integrated clinical education in physical therapist education: application to the pediatric essential core competency of family-centered care. J Phys Ther Educ. 2017;31(2):131–136.
37. Moerchen VA, Dietrich M, Dietrich A. Description and outcomes of a practicum model for experiential learning in pediatrics. J Phys Ther Educ. 2017;31(3):130–140.
38. Noone J. Teaching to the three apprenticeships: designing learning activities for professional practice in an undergraduate curriculum. J Nurs Educ. 2009;48(8):468–471.
39. Rapport MJ, Sweeney JK, Dannemiller L, Heriza CB. Student experiences in the neonatal intensive care unit: addendum to neonatal physical therapy competencies and clinical training models. Pediatr Phys Ther. 2010;22:439–440.
40. Rapport MJK, Stelzner D, Rodriguez J. The doctor of physical therapy degree: a new curriculum for a new degree. Phys Disabil Educ Relat Serv. 2007;26(1):63–76.
41. Sahler OJ, Frager G, Levetown M, Cohn FG, Lipson MA. Medical education about end- of-life care in the pediatric setting: principles, challenges, and opportunities. Pediatr. 2000;105(3, pt 1):575–584.
42. Schreiber J, Moerchen VA, Rapport MJ, et al Experiential learning with children: an essential component of professional physical therapy education. Pediatr Phys Ther. 2015;27(4):356–367.
43. Spake EF. Reflections and visions: the state of pediatric curricula. Pediatr Phys Ther. 1994;6(3):128–132.
44. Sparling JW, Sekerak DK. Embedding the family perspective in a physical therapy curriculum. Pediatr Phys Ther. 1992;4(3):116–122.
45. Sweeney JK, Heriza CB, Blanchard Y. Neonatal physical therapy. Part I: clinical competencies and neonatal intensive care unit clinical training models. Pediatr Phys Ther. 2009;21(4):296–307.
46. Tovin MM, Fernandez AF, Smith K. Pediatric integrated clinical experiences: enhancing learning through a series of clinical exposures. J Phys Ther Educ. 2017;31(2):137–149.
47. Turner D. A model for entry-level pediatric physical therapy education. Pediatr Phys Ther. 1993;5:117–122.
48. Wynarczuk KD, Pelletier ES. Use of academic-community partnerships in teaching pediatric physical therapy. J Phys Ther Educ. 2017;31(2):150–157.
49. Section on Pediatrics, American Physical Therapy Association. Pediatrics in basic physical therapy professional education. Totline. 1979;5(2):4–5.
50. APTA. A Normative Model of Physical Therapist Education. Alexandria, VA: APTA; 2004.
51. American Council of Academic Physical Therapy. Physical Therapist Clinical Education Glossary. http://www.apta.org/ACAPT/Glossary/. Published 2017.
52. Green H. Redefining excellence for today's world. https://www.forbes.com/sites/work-in-progress/2012/03/06/redefining-excellence-for-todays-world/#1616456e347f. Accessed December 12, 2017.
53. Kenyon L, Anderson DK, Frost JG. A survey of pediatric clinical education in DPT professional education. J Phys Ther Educ. 2017;31(3):105–113.
Keywords:

excellence in education; pediatric physical therapy; physical therapist education; scoping review

Copyright © 2019 Academy of Pediatric Physical Therapy of the American Physical Therapy Association