ETSU

ALHE 5500

Spring 2008

Allison Bolt

Thesis Rough Draft

The Effects of the Newly Implemented Doctorate of Physical Therapy entry-level degree on the entry level Physical Therapist Assistant
Abstract

Background and purpose:  The purposes of this study were (1) to examine if the move to the doctorate level for the physical therapist (DPT) would create a gap in educational and treatment skills level between the DPT and the physical therapist assistant (PTA) which is currently awarded at the associates level, and (2) if there was a gap identified, what areas PTA program directors and acute care hospital rehabilitation directors and/or Center Clinical Coordinator of Education (CCCE) think should be adjusted in the didactic or clinical education of the PTA to supplement PTA education.

Subjects:  The subjects were selected based on being the director/manager, preferably of physical therapy departments, or of the rehabilitation departments in hospitals within Tennessee based the Tennessee Hospital Association website listing.  The PTA program directors were obtained from the American Physical Therapy Association and Commission on Physical Therapy Accreditation websites.

Methods:  The subjects were selected based on being the director/manager of the physical therapy or rehabilitation department of hospitals (n=140) within the state of Tennessee based on the Tennessee Hospital Association website listing.  The PTA program directors (7) were obtained from the American Physical Therapy Association and Commission on Accreditation of Physical Therapy Education website listing.  Each subject was sent a written survey that was based on a Likert scale of 1 through 5 with 1 being strongly disagree and 5 being strongly agree.  Survey return rate was 50%.  Nonparametric nominal data was analyzed using Pearson’s chi-square.

Results:  PTA program directors and physical therapy/rehabilitation directors indicated that all 6 curricular content areas should be added or expanded to current curricula as PTA programs adapted to accommodate the need to approximate PTA education level to maintain adequate PTA preparedness to assist the DPT.  The PTA program directors preferred that a large portion of the recommended curriculum to be added or expanded be focused on more in the clinical internship and post graduation setting versus the didactic setting for real life application.

Discussion:  The results of this study indicate that PTA program directors and PT/rehabilitation directors agree that the education of the PTA needs to be expanded in some manner to allow the entry-level PTA to adequately assist the DPT.  However, the program directors felt these added or expanded areas were best served in the clinical rotation or post-graduation setting.

Introduction:

      According to the American Physical Therapy Association Vision 2020 statement, "physical therapy, by 2020, will be provided by physical therapists who are doctors of physical therapy and who may be board-certified specialists."  Based on this vision, physical therapy schools in Tennessee, at least in part, have developed a transitional DPT or an entry level DPT program to help complete this vision.

     Soon after the release of the Vision 2020 statement, the next logical step was to evaluate the profession of the physical therapist assistant as it relates to the Vision 2020 statement.  At the 2008 HoD a motion will be brought forth to the floor that reads "…APTA, in evaluating the future needs of the profession, identify the most efficient and effective method to prepare the physical therapist assistant to support the doctor of physical therapy within the client/patient management model in 2020 with an interim report back to the House of Delegates in 2009 and a completed report in 2010."

     As this evaluative process continues over the stated years of 2008-2010, it is relevant to determine what, if any, are the areas or skills that are lacking in the current PTA education and how to best address any identified deficits.  This study will look at the areas or skills that are lacking in current PTA education as evidenced by survey results from PTA program directors and clinical instructors in the state of Tennessee.

     After examining CAPTE requirements for PTA schools and the currently developing minimum skills criteria for the PTA document, it appears that PTAs working in acute care inpatient settings in Tennessee exhibit a lack of preparedness in the functional mobility skills, patient education, exercise program management, documentation, and overall problem solving/critical thinking.

     The dependent variable will be the preparedness of the physical therapist assistant as it relates to in functional mobility skills, patient education, exercise program management, documentation, and overall problem solving/critical thinking, the independent variables.

     Information will be expressed in parametric Likert scale terms by obtaining and interpreting surveys from rehabilitation directors at acute care hospitals within the state of Tennessee.  The survey will inquire about what it is that may be lacking that could be changed to better address these noted issues (didactic preparation changes, clinical rotation length, location, etc.).

Literature review:

A cursory review of the literature found scarce evidence directly addressing the education level or preparedness level of the physical therapist assistant (PTA) in light of the recent change of the entry-level for physical therapists moving to a doctoral level. However, there is some indirect research articles that address issues around the preparedness and skill level of the new PTA graduate.

The 'minimum skills list' for the physical therapy assistant (PTA) is based on survey information and data currently being gathered.  The skills list is constructed of several areas of physical therapy skills and interventions, and is based on the physical therapist plan of care as well as generic abilities and professionalism.

Brudvig & Colbeck (2007) researched the curricular change perceptions of both clinical and academic physical therapists as a result of the move to the doctoral level for the entry-level PT.  The researchers found that both academic and clinical PTs felt radiology, pharmacology, pathology, administration, reimbursement, legal, ethics, managed care, evidence-based practice, differential diagnosis were items that needed to be added or expanded in addition to evaluating  clinical education length and structure.  However, academic PTs did not feel as strongly about certain areas as did clinical PTs.  The authors proposed that that may be due to various causes, some of which include the current curricula being overloaded or potentially academic PTs feeling some of these areas were better addressed in the clinical setting (pg 7).

Martorello (2006) has previously completed a pilot study that addressed “the optimal length of clinical internship experiences for entry-level PT students as perceived by center coordinators” (pg 56).   If the PT student was in their first rotation, eight weeks was seen as optimal.  However, in a PT student’s final clinical experience showed a “bimodal split” between 5-8 weeks and 9-12 weeks.  This information may be used as a parallel scale for evaluating PTA optimal clinical rotation length.

Some research gave information about how other health care professions had transitioned to an entry-level doctorate degree, addressed the inception and progressive role of some type of an assistant as with the physician's assistant.   Catanzaro & Burton (2005) show how the concept of the physicians assistant (PA) in the United States has been and continues to be expressed in the United Kingdom as the profession of a medical care practitioner.  Jones (2007) discussed the education of the PA in the United States.
Plack and coworkers (2006) presented a study where they inquired about "fostering the development of the preferred relationship within a classroom setting" between a PT and a PTA.

This is relevant in that PTs and PTAs need to be aware of and appreciate their perspective roles.  This will help the inquiry into the questionable deficiencies between the DPT and the PT be better visualized and define a starting point.

Methods:

            For this study, a survey was distributed in 2008 to all program directors of PTA programs in the state of Tennessee and all physical therapy or rehabilitation directors in Tennessee that were listed on the website of the American Hospital Association.  The purpose of the first population study was to gain the perspective from the educators of PTAs and the second population study was to gain perspective from the supervisors of PTAs within the acute care setting, i.e. hospital.

            All PTA program directors were surveyed to glean full insight as to the thoughts and ideas of the academic side of PTA education.  All hospital physical therapy or rehabilitation directors were surveyed to gain perspective about the ability of the new PTA graduate to function in the acute care setting.  Surveys were limited to those program directors and physical therapy or rehabilitation directors in the state of Tennessee as a convenience sample.

            With the total number of PTA program directors being (n=7) and the total number of physical therapy/rehabilitation directors being (n=140) allowing over sampling for an anticipated return rate of 50%.  The data collection tool consisted of a written questionnaire.  The survey instrument was developed based on the survey of the Brudvig and colleagues survey tool which was developed from 2 pilot studies.  The first pilot study surveyed random physical therapists from academia and clinical settings in the state of Pennsylvania inquiring about what the thought should be added to the developing DPT curriculum.  The second pilot study targeted 7 academic physical therapy program directors within in Pennsylvania and was based on open-ended interviews.  These survey questions targeted the program directors’ views about a physical therapist as an autonomous practitioner and how this should shape the DPT curriculum. 

This study’s survey was modified from these pilot studies and included 5 sections including demographics, curricular content, curricular perspectives, essential skills, and recommended additions or modifications to curriculum and clinical rotations.  These surveys were mailed directly to the subjects based on addresses list on the CAPTE and the American Hospital Association website listings.  For those that did not return there surveys within 3 weeks, a letter of reminder and a second survey was mailed.   This was repeated again at the subsequent 3 week time period.  This study was approved by the Institutional review Board at East Tennessee State University.

A variety of descriptive statistics was used to quantify and summarize information.  Chi-square tests were used to determine statistical differences in distributions.

Discussion:

            Both PTA program directors and physical therapy/rehabilitation directors agree that fundamental skills of functional mobility skills, patient education, exercise program management, documentation, and overall problem solving/critical thinking can be improved upon.  Both agree that documentation is among the weakest of these areas, but both feel this area will improve with experience.  Physical therapy/rehabilitation directors feel that problem solving and critical thinking skills is an area needing improvement, but again feel this will improve with hands-on experience.  Mobility skills, as it relates to acute care patients, are another area in which supervisors of student PTAs need improvement.  It was thought that the unavailability of “real life” practice prior to clinicals could be a major factor contributing to this identified deficit

            It was however no congruent on how to best address these identified areas needing improvement.  Program directors in general feel they are already covering massive amounts of material in minimal amounts of time and do not see how they could possibly add more to the current curriculum.  In general, the only way they saw to achieve covering the massive amounts of material in more depth is to move the current associates level degree awarded to the PTA to a bachelor.  This in itself would create an additional set of issues to address that is beyond the scope of this study.  They state they feel these things could be better addressed in the clinical setting.  On the other hand, physical therapy/rehabilitation program managers feel these issues must be addressed more directly in the didactic curriculum to be able to be adequately carried over into the limited amount of clinical practicum of most PTA programs.

Conclusion:

It is clear that both PTA program directors and physical therapy/rehabilitation directors feel that all areas of functional mobility skills, patient education, exercise program management, documentation, and overall problem solving/critical thinking are areas that newly graduated PTAs are lacking in.  The physical therapy/rehabilitation program directors felt more strongly about select areas being deficient.  Both agreed that these identified areas could be worked on more in the clinical setting, but physical therapy/rehabilitation program directors felt that these issues must first be addressed in the didactic portion of the student PTAs education.  It was alluded to that extending the current associates level into a bachelors level degree could potentially aid in addressing all of these issues, but further studies are needed to explore this issue.

References

Brudvig, T. J., & Colbeck, C. L. (2007). The doctorate of physical therapy: clinical and academic physical therapists’ perception of appropriate curricular changes.  Journal of Physical Therapy Education, 21(1), 3-13.

Catanzaro, R., Burton, J. (June 2005).  From physician assistant to medical care practitioner.  Work based learning in primary care, 3(2), 115-118.

Chambers, A., Cochrane, A., Duffy, A., Harrison, L., Ingman, E., Stewart, H. & Selfe, J.  (June, 2005).  Development of a foundation degree in health and social care.  International Journal of Therapy & Rehabilitation, 12(6), 243-248.

Graham Center one-pager (October 1, 2005). Physician assistant and nurse practitioner workforce trends.  American Family Physician, 72(7): 1176.

Jones, P. E. (2007).  Physician assistant education in the United States.  Academic Medicine

Martorello, L. ( Spring, 2006).  The optimal length of clinical internship experiences for entry-level physical therapist students as perceived by center coordinators of clinical education: a pilot study.  Journal of Physical Therapy Education, 20(1), 56-58.

Mitchell, R. E. (2004).  Evaluating the clinical preparation of the physician assistant versus nurse practitioner students and the characteristics of their preceptors.  Internet Journal of Academic Physician Assistants, 4(1), January 1. http://web.ebscohost.com.ezproxy.etsu.edu:2048/ehost/detail?vid=3&hid=109&sid=feb19f26-703e-485a-894d-6b3985553747%40sessionmgr103

Plack, M. M., Williams, S., Miller, D. Malik, F, Sniffen, J., McKenna, R & Gilner, G. (Spring, 2006).  Collaboration between physical therapists and physical therapist assistants: fostering the development of the preferred relationship within the classroom setting.  Journal of Physical Therapy Education, 20(1), 3-13.

Priestley, J.& Selfe, J. (2003).  The foundation degree: an education framework for rehabilitation assistants.  International Journal of Therapy & Rehabilitation, 10(11), 504-510.

Siler, W. L., & Randolph, D. S. (July 21, 2006).  Degree Creep.  Chronicle of Higher Education, 52(46), B12.