Experiential Learning in Pediatric Physical Therapist Education: Challenges and Facilitators : Pediatric Physical Therapy

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RESEARCH REPORTS: EDUCATION

Experiential Learning in Pediatric Physical Therapist Education: Challenges and Facilitators

Wynarczuk, Kimberly D. PT, PhD, MPH; Gagnon, Kendra PT, PhD; Schreiber, Joseph PT, PhD; Rapport, Mary Jane PT, DPT, PhD, FAPTA; Fiss, Alyssa LaForme PT, PhD; Kendall, Eydie PT, PhD

Author Information
Pediatric Physical Therapy 34(1):p 63-71, January 2022. | DOI: 10.1097/PEP.0000000000000849
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INTRODUCTION AND PURPOSE

Experiential learning (EL) has been called an “essential component”1(p356) of doctor of physical therapy (DPT) education.2 Experiential learning in pediatric DPT education is defined as “activities in which students design and implement an experience that engages a child in meaningful activities, including examination, evaluation, intervention, and/or client/caregiver interaction and instruction.”1(p357)

Despite this apparent importance, variability in implementation exists across DPT programs.3 In a recent survey exploring the use of EL with children, pediatric faculty from 80 DPT programs reported that students engaged in a mean of 12.4 hours of EL with children (range: 0-40 hours) and 8.9 hours specifically with children who have participation restrictions (range: 0-38 hours).4 Only 61.7% of the faculty respondents were moderately or extremely satisfied with the quantity of EL with children in their program.4

The range in quantity of EL indicates that certain characteristics facilitate or hinder use of EL in DPT education. Previously, pediatric faculty and students identified barriers to the use of EL with children, including lack of time and resources; lack of support from colleagues and local clinicians; difficulty recruiting families, scheduling, and finding appropriate space; large student cohorts; and student apprehension and disinterest.4,5 These barriers impeded educators' ability to implement the pediatric essential core competencies.2

Before recommendations can be made to universally include or expand EL with children as part of physical therapist education, faculty and program directors need a deeper understanding of challenges and opportunities that influence implementation of pediatric EL. The purpose of this study was to conduct an in-depth investigation of physical therapist educators' experiences and perceptions of challenges to and facilitators of the use of EL with children.

METHODS

Study Design

This was a qualitative study using semistructured interviews with 18 pediatric DPT educators. This study was part of a larger exploratory sequential mixed-methods study, the full methods of which have been published previously.6 Mercer University's Institutional Review Board approved this study, and other researchers' university Institutional Review Boards provided authorization agreements.

Participants

Each participant was a core or adjunct faculty member responsible for teaching pediatric content at an accredited DPT program. Pseudonyms are used in this article (Table 1).

TABLE 1 - Faculty Member Participant Characteristics
Faculty Members, N = 18
Initial physical therapy degree completed, n (%)
Certificate 1 (5.6)
Bachelor's degree 7 (38.9)
Master's degree 5 (27.8)
Clinical doctorate (DPT) 5 (27.8)
Highest educational degree completed, n (%)
Master's degree 2 (11.1)
DPT 10 (55.6)
Academic doctorate (eg, PhD, EdD, DSc) 6 (33.3)
APTA member, n (%)
Yes 18 (100.0)
Board-certified pediatric specialist, n (%)
Yes, current 10 (55.6)
Yes, but I have since let it lapse 1 (5.6)
No, but I am in process of acquiring this certification (awaiting testing and/or examination results) 1 (5.6)
No 6 (33.3)
Current academic position, n (%)
Adjunct faculty member 1 (5.6)
Part-time faculty member 3 (16.7)
Full-time faculty member 14 (77.8)
Years serving in any academic position at any institution/university, mean (range) 11.8 (2-30), y
Level of satisfaction regarding the quantity of EL with children that is required of all students in the DPT program (not including full-time clinical education experiences), n (%)
Extremely satisfied 4 (22.2)
Satisfied to a moderate extent 8 (44.4)
Satisfied to a small extent 5 (27.8)
Not at all satisfied 1 (5.6)
Level of satisfaction regarding the quality of EL with children that is required of all students in the DPT program (not including full-time clinical education experiences), n (%)
Extremely satisfied 10 (55.6)
Satisfied to a moderate extent 5 (27.8)
Satisfied to a small extent 3 (16.7)
Not at all satisfied 0 (0.0)
College or University, N = 18
Setting, n (%)
Urban 8 (44.4)
Suburban 9 (50.0)
Rural 1 (5.6)
Size (based on Carnegie classifications of institutions of higher education), n (%)
Small (≤2999 full-time students) 4 (22.2)
Medium (3000-9999 full-time students) 7 (38.9)
Large (≥10 000 full-time students) 7 (38.9)
Approximate number of students in the next incoming (new) student cohort in the DPT program, mean (SD) 53.4 (19.3)
Curricular format that best represents the inclusion of required pediatric content in the DPT program, n (%)
Pediatric content is included in a specific, or stand-alone, pediatric course 5 (27.8)
Pediatric content is threaded or integrated into multiple courses 4 (22.2)
Most pediatric content is in a specific course, but pediatric content is also included in other courses, assessments, etc, in the curriculum 9 (50.0)
An elective pediatric course is available to students in the DPT program, n (%)
Yes 10 (55.6)
No 8 (44.4)
Hours of EL with children that are required of all students during the didactic portion of the DPT program (not including full-time clinical education), mean (SD, range)
Total hours (including children with and without participation restrictions) 14.4 (14.6; 1-40)
Hours specifically with children with participation restrictions 12.6 (12.4; 2-38)
Students are required to complete a full-time clinical experience in a pediatric-focused clinical setting, n (%)
Yes 1 (5.6)
No 17 (94.4)
Abbreviations: APTA, American Physical Therapy Association; EL, experiential learning.

Interview Guide

Each interview followed a moderator guide with structured open-ended questions and unstructured follow-up questions and probes:

  • What facilitates or helps you and your DPT program provide EL with children for all of your DPT students?
  • What challenges do you experience in providing EL with children?

Procedures

Qualitative methodology procedures are depicted in Figure 1. Prior to data collection, each researcher completed bracketing7 and throughout the research process the research team revisited preexisting assumptions. The DPT educators who had completed an initial questionnaire on the use of EL with children were asked to participate in a follow-up interview.4 Purposive sampling was used to identify educators from programs that used a low quantity (≤5 hours) or a high quantity (≥13.5 hours) of EL with children, with diverse student cohort size, and from different geographic regions. Eighteen educators ultimately participated in an interview: 9 from programs with a high quantity and 9 with a low quantity of EL with children. Each educator participated in 1 semistructured interview, conducted and recorded via Zoom. Each interview lasted 22 to 50 minutes (mean: 35.2 minutes) and was transcribed via an online transcription service.

F1
Fig. 1.:
Qualitative methodology.

Data Analysis

Data from transcribed focus groups were qualitatively analyzed through an exploratory approach using thematic analysis.8 Three researchers organized the transcriptions for analysis. One researcher completed open initial coding for content and developed a codebook including categories, codes, and operational definitions. Transcripts from participants from programs with low and high quantities of EL were coded separately and independent operational definitions were developed for these groups.

All researchers reviewed and discussed the codebook prior to secondary coding. Researchers determined that there was no meaningful difference between responses garnered from the 2 purposive sampling groups; thus, secondary coding proceeded by analyzing all interviews together.

All 6 researchers participated in secondary coding. Each transcript was assigned to 2 researchers and paired researchers were rotated. Researchers independently coded transcripts using the codebook, reviewed transcripts with their coding partners, and arrived at consensus coding. The research team discussed impressions of the transcripts, made revisions to the codebook as needed, established themes, and developed theme maps. Consensus coding was entered into NVivo.

Following qualitative analysis, faculty were randomly selected to participate in member checking. Member checking participants reviewed their interview transcript and the codebook. They then participated in an online focus group or submitted written responses regarding whether the identified themes reflected their experiences and perspectives.

RESULTS

The participants acknowledged a variety of challenges to providing EL with children and shared many facilitators and strategies to overcome those challenges. Three themes emerged: (1) stakeholder considerations, (2) pedagogical considerations, and (3) logistical considerations (Figure 2). Overlapping circles of the themes under the topic Facilitators and challenges to EL illustrate the interconnectedness of these themes. Other components of the theme map, Reasons to use EL and Recommendations to other faculty were also discussed during these interviews, the results of which have been disseminated separately.6 Illustrative quotes that represent multiple codes and themes are shown in Table 2. A list of all identified themes and codes, along with accompanying illustrative quotes, is shown in Table 3.

F2
Fig. 2.:
Theme map.
TABLE 2 - Illustrative Quotes That Represent Multiple Codes and Themes Related to Challenges and Facilitators of the Use of Experiential Learning With Children
Challenges and Strategies to Provide Experiential Learning With Children
Illustrative Quote Codes Themes
The first year that I taught these classes, I tried to just get as many volunteers as I could. Reflecting after that first year, I realized that that was not really optimal. I really needed to try to tease out as much from an individual family as I could.... To really be able to prepare the students, have them prepare, have them be able to stand back and critically analyze what's happening, to be able to talk about it.... We had to focus a little more.... I mean, the coordination is very time consuming. And it's time consuming in, not as much in the actual action of contacting families and things like that, that is time consuming. But just keeping it all in your head about who's coming every week. It's sort of like being the scheduler for a clinic, obviously way fewer patients. So that is tough. And, for a lot of the time it's just been me, I'm the only peds person. (Pamela, high quantity of EL) Organization
Scheduling
Students
Logistical considerations

The importance of vested stakeholders and support of experiential learning
[Experiential learning is] something that I believe in. As the primary facilitator of this, and it wouldn't be just me, it's also the other pediatric faculty involved, the adjuncts, et cetera. We all believe in it. So they are the ones reaching out to the families that they work with and the children and they're the ones trying to get them to come to this school on a specific day and whatever time works for them and stuff. They're as vested in this as I am. I think that that's a huge asset and facilitator to providing this type of learning. (Julie, low quantity of EL) Pediatric core faculty
Pediatric adjunct faculty
Families
Children
The importance of vested stakeholders and support of experiential learning
Abbreviation: EL, experiential learning.

TABLE 3 - List of All Themes and Codes Regarding Challenges and Facilitators of the Use of Experiential Learning With Children, Accompanied by the Number of Participants Who Made Comments Related to Each Code and an Illustrative Quote
Challenges and Strategies to Provide Experiential Learning With Children
Themes Codes Number of Participants Illustrative Quotes
The importance of vested stakeholders and support of experiential learning Pediatric core faculty 8 Challenge: “... I think resources of myself, since I'm the only one that really works on the peds stuff.” (Kelly, high quantity of EL)
Pediatric adjunct faculty 7 Facilitator: “My background is in acute care pediatrics, cardiac ICU and PICU. So they [pediatric adjunct faculty] offer the early intervention, outpatient, school-based side...So it's actually a really great compliment. All of those students' experiential learning activities would not be possible without those two people.” (Amy, low quantity of EL)
Faculty colleagues 10 Facilitator: “I think having other people on the faculty that also really value that experiential component.” (Pamela, high quantity of EL)
Program director/chairperson 9 Facilitator: “[My] Chair [person] is really open to anything that involves the community.... So he financially supports us to do this if we need financial support.” (Tammy, high quantity of EL)
Upper administrators 2 Facilitator: “I think our Dean, she's really for it because she has a child with special needs, so that helped.” (Michael, low quantity of EL)
Community partners 14 Challenge: “I had reached out to a preschool to see if we could come as PT students and do a group assessment, thinking ‘Who wouldn't love this?’...But no, not everybody thinks the same way. I've been turned down a bunch of times and I think that it's of course appropriate. We're a group of individuals that they're not familiar with. I think what would have been wiser would have been to take the time and knock on their door and go in person versus reaching out via email or phone call.” (Julie, low quantity of EL)
Local physical therapy clinics/therapists 6 Facilitator: “Without community therapists I could not do this.” (Christine, low quantity of EL)
Alumni 4 Facilitator: “We actually advertise to our alumni first...because they experienced this when they were students [and] then they're excited when they have kids to bring them back. We even have some who've driven from two hours away ... because they want to see the program again.” (Christine, low quantity of EL)
Families 8 Facilitator: “Choosing the right families, knowing your audience. Choosing a family that is more open and not terribly concerned.... And giving them the ability to set boundaries and to know that they are the teachers from the community for that day.” (Patricia, high quantity of EL)
Children 4 Challenge: “Oh, there's a myriad of barriers...especially when you're bringing in typical kids, there is no perceived benefit. There is no reason that these people should give two hours of their time and come onto campus.... And there's no reason they should do that other than we have a fantastic community.” (Patricia, high quantity of EL)
Students 3 Challenge and facilitator: “I think getting students involved who are maybe reluctant to get involved, that that is a barrier.... Our students usually take it pretty seriously and are pretty respectful. So that's actually been really good.” (Pamela, high quantity of EL)
Pedagogical considerations Structure of pediatrics course 3 Challenge: “We have a curriculum where the pediatric content is not called out by itself. So there's pluses or minuses in terms of what that looks like.” (Donna, low quantity of EL)
Experiential learning course/thread 1 Facilitator: “We have a specific curricular course that threads through...that is an experiential learning course. And so we have a lot of ... integrated clinical experiences to set the stage...and then it helps support any other extra that we do in our own courses” (Kelly, high quantity of EL)
Flipped classroom 1 Facilitator: “The structure of the course gives us some autonomy to do what we want to do and change things around. The university does give us good autonomy.... It's flipped classroom now that I have all lab time.” (Susan, low quantity of EL)
Logistics Time 7 Challenge: “I think it mostly boils down to practicality.... The amount of time and coordination that it takes to organize families to come in for 70 students...all of those things can probably be the limiting factor above the desire.” (Angela, high quantity of EL)
Scheduling 11 Challenge: “We can't bring [school-aged] kids in during school hours. Parents don't really want to take their kids out of school for that.... The older kids we do have to time with a school break.” (Amy, low quantity of EL)
Recruiting (volunteers/families) 18 Challenge: “I feel like I'm always recruiting. I get a kid into our patient group, they'll come in consistently for a year or two or maybe three, and then they hit school age or they move out of town. It's constant recruiting.” (Michelle, low quantity of EL)
Organization 4 Facilitator: “Maybe organization. I think to make them [experiential learning activities] successful, that's really important.” (Pamela, high quantity of EL)
Student cohort size 9 Challenge: “Big class size.... If we had a smaller class size, I could have a more intimate setting for students to learn with a child...and that also limits if I wanted to send them out to the community.” (Susan, low quantity of EL)
Funding 6 Facilitator: “we're also very fortunate that we have gotten a pretty huge grant from our local pediatric foundation for the last four years that has funded equipment and assessment tools and all of those kinds of things that we can use in that class.” (Melissa, high quantity of EL)
Location 5 Facilitator: “We're very fortunate to have a lot of hospital systems right near us.... So we are very fortunate to have multiple places that we can disperse the students.” (Cynthia, low quantity of EL)
Transportation and travel 5 Facilitator: “Transportation is not an issue...even for students who don't have transportation available to them, other students will figure out how to carpool with them. So that's never been a problem.” (Julie, low quantity of EL)
Parking 4 Challenge: “Parking is a big issue for parents. We have problems with that, with parents coming after students have parked and even[though] we have designated parking, people will move the cones and the people will steal our parking spaces.” (Sandra, high quantity of EL)
Space 6 Challenge: “For years I was doing this solo and felt like at any moment there was going to be a lawsuit because I couldn't be everywhere at once.... So getting that support, making sure people know ahead of time what you're going to need as far as parking and space and cleanliness of the room when we're having kids on the floor, we need to have mats and we need it vacuumed and we need it to look appropriate.” (Patricia, high quantity of EL)
Legal considerations 1 Facilitator: “I haven't really had any safety issues, privacy issues.... We have the family sign a waiver and all of that.” (Pamela, high quantity of EL)
Cancellations 5 Challenge: “Every year we have people cancel out at the last [minute].” (Michael, low quantity of EL)
Abbreviation: EL, experiential learning.

Stakeholder Considerations

Faculty frequently commented that a significant facilitator of the use of EL with children is having vested stakeholders. Stakeholders include pediatric faculty (core and adjunct), colleagues, administrators, community partners, families, and students. As summarized by one participant, “I think we need really strong advocates for pediatric experiential [learning] and pediatric education in DPT programs. Unless you have that, then it's a big barrier” (Karen; low quantity of EL).

The roles, responsibilities, and influence of pediatric faculty were frequently discussed by the participants. Faculty shared that planning, organizing, and executing EL activities require a significant amount of time, which is often not fully acknowledged by colleagues and administrators. Faculty appreciate when others value EL, are supportive, and are welcoming when children and families come to campus. Faculty also discussed that it is easier to sustain long-established EL activities compared with creating new activities. For example:

I think the facilitators are ... [pediatric faculty member] who ran the program who has since retired, I worked with her, I was adjunct for her for a while. And she set it up. She was the one who went to UCP [United Cerebral Palsy] and set up those 3 visits. So I've inherited a gift. (Julie; low quantity of EL)

Establishing new EL activities was a particular challenge for participants who were not full-time faculty, who were in new faculty positions, or who were the only pediatric faculty member in their DPT program. One participant explained the challenge of not being part of curricular discussions, stating, “I'm not a full-time faculty so I'm not in there. I'm not considered really part of the whole team, so I'm not there when they discuss curriculum and so on. So that is a major limitation” (Karen; low quantity of EL). One faculty member who initiated EL within her DPT program saw this as opportunity to “pretty much create the entire pediatric curriculum myself. So I got to create it how I wanted to, and my [Department] Chair was supportive of that” (Pamela; high quantity of EL). Some participants shared that their clinical experience yielded many connections through which they are able to provide EL, including local clinicians with the ability to contribute to and support EL as adjunct faculty.

Faculty rely on ongoing community partnerships with local pediatric clinics, schools, and community-based programs. Relationships with multiple community partners ensure that EL does not become “a burden on one facility or on one site” (Cynthia; low quantity of EL). Building strong partnerships takes time and requires mutual trust and buy-in and is facilitated when it is a priority of the DPT program. As emphasized by one participant:

I think what helps is the development of community relationships... having enough contact with folks in the community that they trust you, they know what your goals are, they know what you hope your outcomes will be, and they therefore are willing to participate at different levels. (Angela; high quantity of EL)

Challenges to providing EL through community partnerships include sites that have tenuous leadership or are not open to having students learn “on the job” (Donna; low quantity of EL). Many participants expressed concern that it is burdensome for local clinicians to host students for EL, especially if they are “swamped with students doing rotations” (Laura; high quantity of EL) or prefer full-time clinical education rather than short-term EL. According to one participant, “All of our clinical sites have shut us down because they don't want those one day, off-the-cuff kind of things. They only want these clinical 8-week or 10, 12-week experiences” (Donna; low quantity of EL).

Faculty also appreciate the dedication of families who participate in EL, support the education of future physical therapists, and feel “vested” in the DPT program (Elizabeth; high quantity of EL). Faculty acknowledge that some families may be unable to participate because of practical reasons such as lack of transportation and schedule constraints. Faculty ensure that EL sessions are worth families' time and that they derive benefit from participating, such as receiving information regarding their child's development or small financial incentives.

Some participants identified challenges when students do not perceive value in EL or are nervous about interacting with children. One faculty member reflected, “Some students are very shy or very reluctant to fail in front of others. They're scared of kids ... that is a barrier” (Pamela; high quantity of EL). Another participant reflected:

I think there is a subset of students that know that they're not going to do pediatrics. No sort of experience is going to change that thought.... But that can be a challenge...identifying that they might not value something that we're trying to get them to do (Cynthia; low quantity of EL).

Pedagogical Considerations

Participants identified pedagogical considerations that influence the use of EL. Faculty who teach pediatrics as a unit within a lifespan-based course viewed curricular structure as a challenge. One faculty member from a program that has multiple overlapping student cohorts enrolled in any given year and thus offers a pediatrics course multiple times each year shared that the frequency with which they use EL puts a significant demand on families. Faculty from programs that have a course dedicated to EL or use integrated clinical experiences with varied populations and settings perceive that type of curricular structure as a facilitator, as EL is a foundational element of the curriculum and is not merely adjunctive to one course. Faculty perceive that using a flipped classroom approach facilitates the use of EL. For example:

We don't do any lecture anymore in lab or any lecture in face-to-face time. They get it all online and they come to me simply for labs. We actually have a lot more time to process, to have kids in front of us because I don't lecture at all. (Susan; low quantity of EL)

Logistical Considerations

Participants discussed logistical considerations that impact the use of EL, including time, scheduling, and recruitment; organization, coordination, and communication; student cohort size; funding; and location, parking, and classroom space. Time, scheduling, and recruitment were viewed as the largest challenges to the use of EL. Faculty spend significant time on logistics (setup, organization, recruitment) and nurturing community and family partnerships. One participant stated:

I would say for every lab it's probably 20 hours of preparation.... Between the invite, the set-up, the performance, and the thank you...I think people don't really recognize and don't appreciate faculty time to do this.... It's kind of overwhelming. (Sandra; high quantity of EL)

Student time is also a challenge. Many faculty discussed that they block out more time than is actually used for EL to ensure that students have adequate time and flexibility. One participant shared:

I think the challenges are sometimes the time that it takes within the curriculum to do these things. For example, those 2 visits...are between one and one and a half hours each...we block four hours [in the students' schedule] each of those 2 days for the students to be able to participate.... So that has drawn some attention within our faculty about how much time that blocks off in their schedule. (Angela; high quantity of EL)

One participant shared that scheduling EL activities was “one of my least favorite things to do” (Susan; low quantity of EL). Faculty were challenged by trying to coordinate clinician, family, and student availability. Faculty also coordinate scheduling with colleagues, which becomes even more complex with interprofessional EL activities. Participants shared that facilitators include being flexible with program scheduling, scheduling pediatrics courses for the same time across professional programs (eg, occupational therapy and speech-language pathology), and using split laboratories whereby some students participate in EL while some complete other learning experiences.

Recruiting family participants and “access to children is one of the biggest [challenges]” (Laura; high quantity of EL). Faculty must consider whether they have enough families, whether participating children have a temperament that will likely result in a positive experience for students, and whether they will be able to adapt their plans if families cancel. Participating faculty recruit families via word of mouth, social media, university listservs, community partners, friends, family, and alumni.

Faculty emphasized the importance of organization, coordination, and communication. Specific challenges included communication with laboratory assistants and pediatric clinicians; recruitment of pediatric sites; and organization of parking, space, and equipment during on-campus EL. One participant shared, “We always have that panic moment, we're 4 weeks before and we're still 2 kids down and then all of a sudden we're 4 kids over. The coordination of it is a challenge” (Melissa; high quantity of EL). Another reflected:

When I began bringing children in, this was brand new and no one had done it before. I would valet park them while I told the students, “Don't touch anybody. I'm going to go valet park and come back on my scooter.” And then I would buy gift bags for everyone that attended and send out thank you notes. It's not easy to bring in 12 kids multiple times during a quarter and to coordinate all of that. (Patricia; high quantity of EL)

Some faculty with large student cohorts viewed cohort size as a barrier to the use of EL, while some were able to advocate for additional support. Faculty with large student cohorts also experienced challenges with student clearances needed for community settings. For example:

This past semester we had 80 students, so “prohibitive” is not even remotely close. But then at some point they [EL sites] wanted fingerprinting, immunization proof, all of that.... We were doing that, but you can only imagine how intensive [it was] for a 2 hour visit. It was just ridiculous. (Julie; low quantity of EL).

Faculty also reported that it was difficult to recruit enough families to maintain small student teams, but large teams make children and parents uncomfortable, change the dynamic of interactions, and decrease hands-on opportunities. Participants also remarked that they need to balance the number of student teams so that they can supervise teams and ensure child safety.

A few participants commented that lack of funding is a barrier to EL. The participants use funding to purchase appreciation gifts for participating families and to procure equipment for EL sessions. One faculty member shared:

I have minimal [financial] support to help pay some of the lab instructors, but not near enough. I don't get financial support to present any kind of thank you or acknowledgement to the families or the instructors or the community liaisons. So I usually just do that myself. (Elizabeth; high quantity of EL)

The participants were also concerned with location, parking, and classroom space logistics for on-campus EL. Faculty from urban universities perceive their location as a facilitator because they are in close proximity to many families but perceive parking as a challenge. Although multiple participants commented that students did not mind driving to off-campus EL, one participant expressed concern that her EL activities are often 45 minutes away from campus. On-campus EL requires considerable space, which must be safe and welcoming. Many faculty use multiple rooms to accommodate students and families but that requires more faculty to provide adequate supervision. One participant shared:

We have five different lab groups and we have five different treatment spaces in the building.... I'm running up and down trying to make sure I can at least check in with several of the groups. And the kids don't always like to stay where they are. So we're in the hallways and the stairwells and outside on the lawn and curbs on the edge of the parking lot. (Melissa; high quantity of EL)

DISCUSSION

Although expert consensus strongly supports the use of experiential leaning with children1,2,3,9 and emerging research identifies positive student outcomes from EL,10–14 there is wide disparity in the number of hours of EL used in DPT programs.1,3,4 This disparity may exist because of challenges and facilitators to EL faced by individual programs. The findings of this study provide evidence not only of what those challenges and facilitators are but also of how they are perceived and managed by pediatric physical therapy faculty.

Based on the themes that emerged from this research, faculty who are considering developing EL activities should thoughtfully consider facilitators and challenges they may encounter:

  • Who may serve as vested stakeholders and advocates of EL?
  • Will pedagogical considerations facilitate the use of EL, such as schedule flexibility, use of integrated clinical experiences, and use of a flipped classroom approach?
  • What logistical affordances are in place, such as sufficient time and assistance for planning EL, as well as sufficient funding, parking, and classroom space?

Faculty may benefit from recommendations from experienced faculty and tools to help develop EL opportunities. Faculty members' frequent comments regarding students who do not value EL with children are concerning because it indicates that faculty feel the need to “sell” students on the importance of learning to be a physical therapist who can work with a variety of patients. This approach to “selling” students on the importance of learning to work with children may not be universal to other aspects of physical therapy education. The finding that faculty appreciated and acknowledged the dedication of families to participate in EL is positive, as it indicates that families are not passive participants in such experiences. Family and community partners may serve as consultants and collaborative partners to ensure that activities meet the objectives and needs of all stakeholders.

The DPT program directors should likewise consider how they may support and advocate for the meaningful use of EL. Program directors should also consider programmatic changes that may support the use of EL. For example, they should identify and discuss budgetary implications of EL, such as funding needed to hire faculty to properly supervise and facilitate learning activities, to cover expenses, and to provide stipends for families. Program directors should also consider the investment of time needed to develop, organize, and carry out EL. Faculty may benefit from administrative assistance, reduced teaching loads, and considerations of the extent to which an investment in EL may affect time spent on other academic commitments.

Limitations and Future Research

This study is limited in that it provided a look into the experiences of a select sample of faculty who use at least some EL with children in their DPT program. Although participants included faculty who use a low quantity and a high quantity of EL, the challenges experienced by faculty who do not use EL may differ from challenges identified in this study. In addition, as participants had indicated a willingness to participate in an interview, there may be selection bias whereby these participants may be more engaged in the use of EL. Therefore, their experiences and perspectives may not be representative of other faculty, especially of faculty who do not use EL. This study was also completed pre-COVID when EL was not restricted to limitations attributed to the virus and public health precautions.

Additional research is needed to describe how EL is implemented and structured and how faculty leverage facilitators in spite of challenges. Future research should also explore the effect of EL on student learning outcomes and should investigate the experiences and perceptions of families who participate in EL.

Experiential learning with children has been advocated as an important component of entry-level DPT education. Recognizing challenges and facilitators of the implementation of EL is an important first step in making additional recommendations to academic programs. Themes of the importance of vested stakeholders and support of EL, pedagogical considerations, and logistical considerations identified in this study highlight the complexity of EL and the need for future work in this area.

ACKNOWLEDGMENTS

The authors thank the pediatric faculty members who participated in the interviews and member-checking process for this research.

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Keywords:

curriculum; experiential learning; pediatrics; physical therapist entry-level education; qualitative research

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