The recent pandemic and Medicare reimbursement changes significantly affected employment patterns in our profession. In the SNF, when the pandemic started, a significant number of therapists were being furloughed due to the moratorium on admissions. This was aggravated by the shift from PPS to PDPM. During this time, I decided to pursue a graduate degree, an option that is not available to PTA's because they do not have an undergraduate degree.
I was recently invited to participate in a Physical Therapist Assistant (PTA) Education Summit as part of the activities of a task force which was convened “to develop a consensus-driven prioritized agenda of action items intended to help PTA education (and thereby, PT practice) navigate the future.” Inherent in this objective is a discussion in transitioning PTA degree requirements from an associate degree to a bachelor’s degree. This needs assessment will establish the need to design instruction that will suit the needs of PTA clinicians as defined and determined by the profession if this transition in degree requirements proceed.
This online "BS in Physical Therapy Science" degree can be designed to include courses which will fulfill the admission requirements for Doctor of Physical Therapy programs, especially in the new hybrid DPT programs where neither the students nor the faculty reside in the geographic location of the institution. Engaging in a fully online course exposes the potential student to the "rhythm" of distance education. This gives the PTA an additional tool for success, in addition to already possessing the "language of the profession."
Basic science courses (i.e. Anatomy, Physiology, Physics, Chemistry, etc.) can be designed specifically tailored to meet the practice needs of PTA's. This innovative instructional design can potentially facilitate student success if and when the PTA decides to pursue a DPT degree. The degree will be completely online, with clinical practice course instruction delivered while PTA's perform their jobs in their work settings using case-based coursework. The program will be developed by partnering with a continuing education provider with a repository of continuing education videos / webinars presented by expert speakers. These videos will be curated by course instructors for the physical therapy practice content of the program. Existing online general education courses in the college where the program is housed can be used to fulfill the degree requirements for a bachelor's degree.
Marketing this degree offering is easy. The State of Florida Boards of Professional Licenses makes available free-of-charge bulk information on licensed professionals, including the emails and mailing addresses of all licensed PTA's in the state.
The objective of this project is to design instruction for a prototype / course outline / course shell of a sample course which can be used to deliver technical (ie. PTA) content, not general education content (i.e. chemistry, physics, etc.), in a program granting a Bachelor of Science degree for practicing PTA’s. It will involve developing sample instructional materials for a course falling under “PTA Practice in a Skilled Nursing Facility” (refer to image at the end of this document).
NEEDS ASSESSMENT
Comparative Need
In 1969, before development of the first PTA programs, many PT programs were certificate programs. In 1960, the baccalaureate degree was made the minimum educational qualification for a physical therapist. In 2002, the Commission on Accreditation of Physical Therapy Education (CAPTE) only accredited programs which offered a post-baccalaureate degree. In 2015, CAPTE required programs to be at the entry-level Doctor of Physical Therapy (DPT) for accreditation (p. 5). The degree requirement for PT’s has transitioned from a certificate to a bachelor’s degree to a master’s degree to a doctor in physical therapy degree. The degree requirement for PTA’s has remained to be an associate degree.
The Commission on Accreditation of Physical Therapy Education’s (CAPTE’s) Aggregate Program Fact Sheets (p.38) indicate that to receive a PTA degree, a student is accepted to a program which awards an Associate’s degree, and the average credit load is 74.4 credits for the entire program, with 47.9 credits of PTA-specific coursework (technical content). To receive a DPT degree, a student completes a bachelor’s degree, then is accepted to a program which awards a Doctor of Physical Therapy (DPT) degree, with an average credit load of 120.1 credits, with 94.8 credits on average for the professional phase (technical content) of the program.
Expressed and Anticipated Needs
In 2001, a task force appointed by the Board of Directors (BOD) of the American Physical Therapy Association (APTA) (p. 8) decided to recommend that the education level of the PTA “remain at the Associate degree level.” Although they made this recommendation, the task force added that they found gaps in PTA entry level education. These gaps in clinical / practical skills or knowledge in the psychomotor domain / strategic network included manual therapy, outcomes measurement, administration, clinical teaching, clinical problem-solving and judgements, goal setting/designing programs, airway clearance. To maintain licensure, PTA’s are required 24 hours of continuing education per biennium. Despite robust opportunities for continuing education, opportunities for life-long learning, these gaps in knowledge continue to exist.
In 2012, another task force (p. 9) was appointed after a “Feasibility Study for Transitioning to an Entry-level Baccalaureate Physical Therapy Assistant Degree” was conducted. The task force noted changes in the PTA licensure exam administered by the Federation of State Boards of Physical Therapy (FSBPT) which reflected “a higher minimum standard of competence consistent with the health care environment in which PTAs work.”
The 2012 task force included workgroups charged with submitting recommendations to the APTA’s BOD regarding specific issues.
One workgroup (p. 10) was charged “to explore baccalaureate-level educational models for entry-level PTA.” The workgroup “preferred the General Education Model should the baccalaureate degree be adopted because the general education content, traditionally considered foundational content, precedes the PTA-specific content.” They also explored technical education models, but none were selected because “the curricular content for PTA education is clinical in nature as it includes the life sciences, therapeutic techniques, and activities that require ongoing observation and decision-making.”
If baccalaureate programs pursued general education courses to elevate the PTA Program of Study to a bachelor’s level, then the gaps in knowledge identified in the past will continue to remain. This identifies the necessity for including technical (i.e. PTA) content in the curriculum of a transitional bachelor’s degree program. (When the Physical Therapy (PT) profession transitioned to requiring a doctoral degree for graduation, learners who were entering the profession for the first time are referred to as having graduated from an Entry-Level Doctor of Physical Therapy program. Learners who are already licensed, who are practicing and who decide to go back to school are referred to as having completed a Post-Professional Doctor of Physical Therapy degree.)
Another workgroup (p. 10) was “charged to explore educational models for PTA’s educated at the associate level to transition to a baccalaureate PTA degree” which resulted in the APTA’s BOD to adopt the motion: “That mechanisms to identify and promote best practices in the work and relationships of the Physical Therapist(PT)/Physical Therapist Assistant (PTA) Team in a variety of practice settings be identified and implemented in collaboration with the sections, American Council of Academic Physical Therapy (ACAPT), Commission on Accreditation in Physical Therapy Education (CAPTE), and PTA Caucus.” The motion which came out of this workgroup pointed out two types of content they deemed necessary as important with the transition. It identified the PT-PTA relationship in the clinic as important technical content which should be included in the curriculum. A second idea that can be derived from this motion is the value of teaching the technical content in the context of PT practice in different practice settings.
One of the findings of a PTA Education Trends Task Force (p.18) which developed the cited report found that the depth and breadth of entry-level PTA curricular content have increased as reflected in the CAPTE’s Standards and Required Elements for PTA Program accreditation AND as reflected by the Federation of State Boards of Physical Therapy (FSBPT) Practice Analysis which determines the National Physical Therapy Exam (NPTE) – PTA blueprint which is manifested in the content of the licensure exam.
AVAILABLE DATA
Data on non-pedagogical issues regarding PTA education (p. 19) are derived mostly from research used for presentation in national conferences or as PhD dissertations, therefore mostly unavailable with literature searches.
Druse’s PhD dissertation (p.19) found that out of 2,354 respondents (PT educators, PT’s who supervise PTA’s, and PTA graduates), 49.5% supported elevating entry-level PTA education to a bachelor’s degree, while 34.4% disagreed with the proposition. In a presentation by Jewell, et. al. (p. 21) in a national conference in 2016, among 1,683 PT’s and PTA’s surveyed, 35% recommended PTA’s obtain a 4-year degree, 45% recommended for PTA’s to obtain a 2-year degree and pursue continuing education and advance proficiency, and 20% recommended for PTA’s to obtain a 2-year degree and later pursue coursework to obtain a bachelor’s degree to advance their clinical skills.
LEARNER ASSESSMENT
1. The target audience for this project are licensed, practicing PTA’s from all over the country with an Associate’s degree who are looking to acquire a Bachelor’s degree if the profession transitions from requiring an Associate’s degree to a Bachelor’s degree.
2. When they start to practice after licensure, PTA’s are given autonomy and start managing patients with complex conditions, often not discussed in the classroom. (p. 9)
3. Additional information / profile about the learner can be attained by conducting surveys among different stakeholders which include licensed PTA clinicians, PT clinicians supervising PTA’s, PTA faculty, and PTA Program Directors / Academic Coordinators of Clinical Education.
CONTEXTUAL ANALYSIS
Orienting Context
1. The learner would want to engage in the course to gain new knowledge and skills in the context of their work setting, which makes it more compelling. This will be reflected in their daily practice, which will be recognized by their peers and supervisors.
2. Recognition by their peers and supervisors of the improvement in how they practice will increase perceived utility of the courses / program.
3. After completion of all required courses, the PTA will receive a bachelor’s degree in Physical Therapist Assisting. The curriculum can be designed such that a PTA might want to engage only in the technical content and receive a certificate in Physical Therapist Assisting. Both may, or may not, result in promotion or salary increase.
4. Engagement of the PTA in a transitional program can be credited towards the 24-hours of continuing education required every biennium to maintain licensure.
Instructional Context
The courses will be offered online asynchronously. PT-related courses will be case-based wherein learners will be asked to present case studies on patients they are managing on a daily basis. This will require immediate application of knowledge in all 3 domains – cognitive, affective, and psychomotor.
Transfer Context
Since courses will be organized by clinical practice setting, the learner will be able to immediately apply what they have learned or what they are learning. Each student will complete only one of the groups based on their most current practice setting.
TASK ANALYSIS
Grouping courses by clinical practice setting (i.e. acute care, out-patient, skilled nursing facility, home health) is a unique and novel approach in physical therapist instruction. In traditional PT and PTA programs, courses are grouped according to diagnostic groups (i.e. musculoskeletal, neurologic, integumentary, cardiovascular-pulmonary) and by age groups (i.e. pediatric and geriatric). As already mentioned, this novel approach to course grouping will allow for immediate application of gained knowledge. Treatment techniques and outcome measures used in a specific setting will be thoroughly explored and discussed. This will minimize discussion of extraneous content, which will maintain learner engagement and interest. Within each practice setting, courses can be developed which would address patient management according to diagnostic grouping. Within each course, cognitive knowledge, psychomotor tasks, and interpersonal / interprofessional relationship skills will be integrated. With case-based presentations, an integral discussion will include the collaborative relationship between the PT and the PTA. This relationship was identified by one of the task forces / workgroups as important content.
SOURCES:
1. PTA Education Trends: A Report of the Task Force for the Academy of Physical Therapy Education. (n.d.). Retrieved February 6, 2022, from https://aptaeducation.org/pdfs/PTA%20education%20trends%20task%20force%20report.pdf
2. Standards and Required Elements for Accreditation of Physical Therapist Assistant Education Programs. (n.d.). https://www.capteonline.org/globalassets/capte-docs/capte-pta-standards-required-elements.pdf