PHYSICAL THERAPY CURRICULA

A course in clinical decision-making (CDM) epitomizes reform-based science instruction.

Most, if not all, courses in the didactic portion of PT programs are siloed, and students need to be given the opportunity to "make sense" of the knowledge provided in these courses. There has to be overt opportunities during the didactic portion for students to manage patients holistically, with knowledge gained from siloed courses contributing to this holistic approach. Clinical instructors, who are not trained teachers and who are not exposed to different forms of pedagogy, are often expected to guide the student through this process. With each student possessing unique learning styles and capacities, there might be tension when the clinical instructor is unable to adapt to a student's uniqueness.

This is the reason why I think students express their opinion that what is taught in the physical therapy classroom is different from how it is practiced in the clinic. There is an insufficient opportunity for sense-making, of putting everything together like how it is done in the clinic.

Robust opportunities for knowledge integration has to be provided in the classroom, and not relegated to the clinical education portion of the program. There is a need for programs to systematically teach inductive clinical decision making to inexperienced, novice students, because this is how experienced clinical instructors practice. The use of simulation has value in a student's education. Not every program has the luxury of utilizing this teaching modality. I suspect that simulation is not meant to replace repetitive teaching and practice of clinical decision-making reflective of holistic patient care. Just like in motor learning, repetition is of primal importance .

Using the C-U-E Framework (Tweed 2009) of Content, Understanding and Environment, my experience informs me that most PT Programs excel in identifying important content, but sometimes fall short in creating an environment for "sense-making" - the holistic management of a patient. This focus on breadth instead of depth might be reflective of the value placed on the results of high-stakes testing. When substandard performance in the licensure exam is a problem, programs look at the content / courses in their curricula. They do not assess how their existing curriculum contributes to deep and meaningful learning. When programs engage in curricular assessment, the result usually involve changes in course sequencing or adding and deleting courses. Programs recognize their strength which is in teaching important (C)ontent. But, they might fail to address potential shortcomings in the curriculum in terms of the (U)nderstanding and (E)nvironment portions of the C-U-E Framework, manifesting in substandard licensure pass rates or high attrition rates.

A substandard pass rate (vis-a-vis CAPTE requirements) might be effectively mitigated by increased efforts in knowledge integration and "sense-making." Efforts in these two domains can be achieved with a well-placed integrated clinical experience (ICE). I am not sure which facilitates student understanding and sense-making better - ICE placed earlier in the program OR ICE placed very close to the full-time clinical experiences. An alternative to ICE would be meaningful service learning activities. This alternative has the potential to provide students with some "a-ha" moments reflective of "sense-making." Service learning activities also provide students the opportunity to develop "soft skills," opportunities which are not available in the classroom.

BREADTH VERSUS DEPTH

Newmann (1988) explored what is important for meaningful and lasting learning - coverage or depth. Although he specifically discusses high school curriculum, physical therapy programs need to reflect on this issue. He inadvertently describes the state of some PT programs when he wrote that students "passively allow teachers and textbooks to pour material into their heads, where they will try to store it for future use in educational exercises. However, the press to "cover" offers little opportunity to develop that material in ways that will help students meet more authentic intellectual challenges." He adds that "to gain rich understanding of a topic, students must master a great deal of information, use that information to answer a variety of questions about the topic, and generate new questions that lead to further inquiry." This last statement reflects the importance of content, but also highlights that understanding and environment are of equal importance.

Programs need to view curriculum in a more holistic manner, and not view it only in the context of content covered.

SENSE-MAKING

Anderson sought to answer the question whether it "makes sense to use inquiry as an organizing theme for science curricula." He highlights the fact that "scientific inquiry refers to the diverse ways in which scientists study the natural world and propose explanations based on the evidence derived from their work." The idea of using inquiry as the basis for discussion and learning will be used in my proposed course / lesson design. It will be used to develop student understanding, consistent with the C-U-E framework, as they progress through a PT program from the didactic portion to the clinical education portion of their programs. A course in CDM will effectively contribute to sense-making.

Again, with reference to my latest accreditation visit, courses were designed with content in mind, but minimal overt opportunities for systematic inquiry to reflect what is required in the "real-world" of clinical practice. Content was delivered in "silos" to reflect specialties and diagnostic groupings, with little opportunity to experience the holistic approach in physical therapist patient management. It failed to provide students consistent, repetitive opportunities for holistically looking at an individual patient with their concomitant primary diagnosis and co-morbidities, with their unique economic and psycho-social capacities and limitations, and all other factors which will significantly influence patient / client physical therapy management. Opportunities for these experiences facilitate deep and meaningful learning, which can potentially translate into success during the licensure exam.

Tweed (2009) discusses sense-making as an important ingredient for understanding, part of the C-U-E Framework. She cited brain research which indicate that in the classroom, instructors have either the learner's attention or have students engaged in making meaning, not at the same time. This provides some clue of how curricula should be structured. In the context of PT education, it makes sense that during their first year, courses are geared towards a discussion of basic sciences or courses designed discussing specific specialties (i.e. neuromuscular PT, orthopedic PT, etc.). But, after that, it is imperative for programs to design courses with sense-making in mind. "Teachers should intentionally help students to understand the connections" between courses and what is expected in the clinic, "between the science learning activity and the intended learning targets. Teachers must make certain that students draw appropriate conclusions and see the purpose" in what they are doing. "Opportunities should also be given for learners to apply learned concepts to new situations and to reflect on the change in their thinking over time (metacognition)." (Northwest Educational Service District 189, 2022)

Tweed, A. (2009). Designing effective science instruction: What works in science classrooms. NSTA Press, NSTA Press, National Science Teachers Association/McREL.

Newmann, F. (1988, January). Can Depth Replace Coverage in the High School Curriculum? Phi Delta Kappan, 345–348.

Using the Elements of Effective Science Instruction to support English Language Learners in Science Classroom. Northwest Educational Service District 189 (2022). Retrieved 16 April 2022, from https://www.nwesd.org/wp-content/uploads/2013/11/sheltering-instruction-is-EESI.pdf