Burnout and intent-to-leave in physical therapists: a preliminary analysis of factors under organizational control

A Comparative Analysis of Physical Therapy Anatomical Knowledge and Retention: Human Donor Dissection Versus Virtual Laboratory

INTRODUCTION

Despite a long history of using human donor dissection (HDD) for physical therapy (PT) anatomy education, there are no PT guidelines that require HDD. The purpose of this quantitative causal-comparative study was to determine if Doctor of Physical Therapy students who used HDD had different grades both within anatomy and within courses that require retention and application of anatomical knowledge (kinesiology and a foundational musculoskeletal course) compared with those who used virtual 3-dimensional anatomical software (VAS).

REVIEW OF LITERATURE

Numerous factors affect the decision to use HDD within PT anatomy, and few PT studies have compared the effectiveness of VAS to HDD.

SUBJECTS

All students who took anatomy in an entry-level PT program from 2018 to 2021 (232 total students, 115 who used HDD in 2018-2019 and 117 who used VAS in 2020-2021).

METHODS

Mann-Whitney tests were used to compare anatomy grades (course, written examination, and practical examination) and future grades in kinesiology and a foundational musculoskeletal course for students who used HDD or VAS.

RESULTS

Physical therapy students who used VAS had statistically significant higher anatomy course grades (VAS 93.81% ± 4.99% to HDD 92.20% ± 4.53%) and higher practical examination grades (VAS 97.43% ± 2.91% to HDD 93.55% ± 4.39%) compared with those who used HDD. However, there were no significant differences between groups on written anatomy examinations (VAS 89.42% ± 7.21% to HDD 90.40% ± 4.94%), kinesiology grades (VAS 91.86% ± 4.52% to HDD 92.80% ± 4.27%), or foundational musculoskeletal grades (VAS 89.50% ± 3.89% to HDD 89.77% ± 3.83%).

DISCUSSION AND CONCLUSION

The causal-comparative study design prevents concluding that PT student grade differences were due exclusively to either anatomy laboratory method. It does provide preliminary evidence that the PT anatomy laboratory method did not practically affect anatomy performance or long-term application of anatomy knowledge in future coursework.

"Definitely a Dark Time:" professional and ethical issues in post-acute care physical therapy during the COVID-19 pandemic

BACKGROUND

Disproportionate effects of the SARS-CoV-2 (COVID-19) pandemic on older adults in post-acute care settings created many professional and ethical challenges for patients and healthcare providers.

OBJECTIVE

The purpose of this study was to examine the professional and ethical issues of physical therapists (PTs) and physical therapist assistants (PTAs) in providing facility-based post-acute care in residential settings (skilled nursing facilities, inpatient rehabilitation facilities, and long-term acute care hospitals) during the COVID-19 pandemic.

METHODS

A qualitative descriptive research design was used to explore professional and ethical issues during the COVID-19 pandemic. PTs and PTAs described their experiences during semi-structured interviews conducted virtually. Interview data was analyzed with reflexive thematic analysis.

RESULTS

Thematic analysis produced 4 themes: facility-wide battle against infection and death, doing the best you can to provide care amidst COVID-19 constraints, promoting ethical good and doing the right thing, and a dark intense time.

CONCLUSIONS

Professional and ethical constraints on providing care faced by PTs and PTAs during the COVID-19 pandemic can inform current and future clinical practice. Although some of the challenges faced by PTs and PTAs were unique to COVID-19, many problems represent preexisting systemic and organizational issues that were exacerbated by the pandemic.

Factors Associated With Intent to Leave the Profession for the Allied Health Workforce: A Rapid Review

Shortages of satisfied and well-trained health care professionals are an urgent threat for health systems worldwide. Although numerous studies have focused on retention issues for nurses and physicians, the situation for the allied health workforce remains understudied. We conducted a rapid review of the literature on allied health workers to investigate the main reasons for leaving their profession. 1,305 original research articles were retrieved from databases MEDLINE, CINAHL, PsycInfo, and Epistemonikos, of which 29 were eligible for data extraction. Reviewed studies featured mainly pharmacists, psychologists, dietitians, physical therapists, emergency medical professionals, and occupational therapists. We categorized 17 typical factors of the intent to leave as organizational, psychological, team and management, and job characteristics. The relative importance of each factor was assessed by measuring its prevalence in the selected literature. By revealing common themes across allied health professions, our work suggests actionable insights to improve retention in these vital services.

The first year of private practice - new graduate physiotherapists are highly engaged and satisfied but edging toward burnout

BACKGROUND

A greater understanding of physiotherapists' work-life during their first year of work in private practice, and whether their experiences are mediated by personal traits, may provide valuable information to support their transition and retention.

OBJECTIVES

Describe the first year of practice for graduate physiotherapists in terms of employee engagement, job satisfaction, performance, and burnout, and evaluate the relationship between these measures and personal traits (resilience, grit, mind-set).

DESIGN

One-year longitudinal mixed-methods study.

METHODS

Twenty new graduate physiotherapists completed questionnaires evaluating resilience, grit, and mind-set within 1-week of commencing employment. Engagement and job satisfaction were evaluated at 3, 6 and 12-months, and burnout evaluated at 12-months. Performance data (number of patients seen, revenue) were collected throughout the year. Individual semi-structured interviews were conducted at baseline, 3, 9 and 12-months.

RESULTS

Engagement and satisfaction were high at all time points. At 12-months, burnout was at a medium level. Resilience was positively associated with job satisfaction at 6 (ρ = 0.56, p = .019) and 12-months (ρ = 0.54, p = .027). Engagement (ρ = -0.57, p = .04) and job satisfaction (ρ = -0.56, p = .03) were negatively associated with burnout at 12-months. All participants remained passionate about their work although increasing administrative burden and patient complexity contributed to feelings of burnout.

CONCLUSIONS

Resilience was positively associated with job satisfaction suggesting those with capacity to 'bounce back' were more satisfied and engaged with their job. Although moderate levels of burnout were reported at 12-months, those with higher job satisfaction and employee engagement had lower levels of burnout. Participants proposed practical strategies to help mitigate burnout.

Structural Equation Modeling: Effects of Master Adaptive Learner and Clinical Learning Environment Attributes on Career Satisfaction and Intention to Stay

OBJECTIVE

The objective of this observational study was to test a proposed conceptual model depicting the influence of personal and environmental attributes of clinical learning environments on rehabilitation professionals' career satisfaction and intention to stay with their current organization. The mediating effects of 2 loci of engagement were also assessed.

METHODS

Rehabilitation professionals (physical therapists, occupational therapists, speech-language pathologists, and registered nurses; n = 436) from 4 health care organizations in the Northeast, Southeast, and Midwest regions in the USA completed a battery of questionnaires related to personal attributes (resilience and orientation toward lifelong learning), environmental attributes (innovation support and basic psychological need satisfaction at work), loci of engagement (professional and organizational), career satisfaction, and intention to stay. Data were analyzed using structural equation modeling.

RESULTS

The measurement and structural model fit was acceptable. The greatest total effects on career satisfaction (r = .459) and intention to stay (r = .462) were observed through the influences of basic psychological need satisfaction, professional engagement, and organizational engagement. Orientation toward lifelong learning was negatively associated with career satisfaction (r = -.208) and intention to stay (r = -.154), but this was mitigated by organizational engagement (r = -.060 and - .134, respectively). Small but significant total effects were also observed between innovation support, professional and organizational engagement, and intention to stay (r = .144) and resilience, professional and organizational engagement, and career satisfaction (r = .110).

CONCLUSION

Clinical learning environments that support rehabilitation professionals' basic psychological needs (autonomy, competency, and relatedness) are associated with greater career satisfaction and intention to stay. This association is further enhanced by organizational engagement and innovation support.

IMPACT

Rehabilitation organizations interested in developing and retaining master adaptive learners should create clinical learning environments that reinforce rehabilitation professionals' sense of autonomy, competency, and relatedness, and are supportive on innovative behaviors.

Exploring the workplace and workforce intentions of early career physiotherapists in Australia

BACKGROUND

Previous research has indicated significant concerns regarding attrition of early career physiotherapists in Australia. Despite the importance of retaining skilled and experienced professionals within the profession, the workplace and workforce intentions of early career physiotherapists remain relatively unexplored.

PURPOSE

The aim of this study was to investigate and explore factors influencing the workplace and workforce intentions of early career physiotherapists in Australia.

METHODS

The Turnover Intention Theory was used to guide a whole-of-person qualitative exploration through semi-structured interviews with 14 participants. Transcribed interview data was subjected to reflexive thematic analysis.

RESULTS

Four themes were generated, constructed as questions to represent participants' temporary holding of intentions: 1) What drives me?; 2) Do my expectations align?; 3) Do my values align?; and 4) What does the future hold?

CONCLUSION

Early career physiotherapists' perspectives encompass diverse and varied experiences that reflect an alignment, or in some cases a misalignment, of the expectations, values and resulting practices of becoming and being a physiotherapist. Early career physiotherapists experience a range of challenges within their workplaces, including significant experiences of stress, yet they express an underlying commitment to the wider profession.

Relationships Between Burnout and Resilience: Experiences of Physical Therapists and Occupational Therapists During the COVID-19 Pandemic

OBJECTIVE

Research on burnout among physical therapists and occupational therapists in the context of the coronavirus disease 2019 (COVID-19) pandemic is limited. Resilience may be important for reducing burnout and promoting well-being among rehabilitation specialists, especially during periods of elevated occupational demand and stress. The purpose of this study was to investigate experiences of burnout, COVID-19 pandemic-related distress, and resilience among physical therapists and occupational therapists during the first year of the COVID-19 pandemic.

METHODS

Physical therapists and occupational therapists working in a university-affiliated health system were invited to complete an online survey assessing burnout, COVID-19 pandemic-related distress, state- and trait-like resilience, physical activity, sleep disturbance, and financial concerns. Multiple linear regressions were used to examine variables associated with burnout as well as the contribution of specific aspects of resilience to burnout.

RESULTS

Greater COVID-19 pandemic-related distress was associated with greater emotional exhaustion and depersonalization, whereas state-like resilience at work was associated with lower emotional exhaustion, greater personal accomplishment, and lower depersonalization. Analyses examining the impact of specific components of resilience at work suggested that several components are associated with less burnout, with finding one's calling being particularly relevant for all 3 domains of burnout.

CONCLUSION

Symptoms of burnout were reported by many physical therapists and occupational therapists. COVID-19-related distress and state-like resilience at work, particularly the perception of finding one's calling, emerged as consistently being associated with burnout in the context of the COVID-19 pandemic.

IMPACT

These findings can inform the development of interventions to reduce burnout among physical therapists and occupational therapists amid the continuing COVID-19 pandemic.

Reasons clinical education directors intend to leave their jobs

OBJECTIVES

The goals of this study were to characterize clinical coordinators compared to other Physician Assistant (PA) faculty, and investigate factors associated with intent to leave their position, institution, and academia in the U.S.

METHODS

This was a secondary analysis of data obtained from the 2019 Physician Assistant Education Association (PAEA) Faculty and Directors Survey. We examined bivariate associations with faculty role and conducted multiple logistic regression to identify predictors of intent to leave among clinical directors.

RESULTS

Clinical directors indicated an intention to leave their position more often than other faculty. Factors influencing intent to leave were a lack of satisfaction with professional development and moderate to high levels of burnout. Clinical directors with severe burnout had 27x the odds of intending to leave academia.

CONCLUSIONS

Our results suggest why clinical directors intend to leave and underscore the need for professional development opportunities and faculty mentoring. Faculty-centered work arrangements are needed to reduce burnout among clinical directors.

Views of physiotherapists on factors that play a role in ethical decision-making: an international online survey study

BACKGROUND

There is a lack of knowledge about the ways physiotherapists around the world learn about professional code of ethics and ethical decision-making frameworks. The profession has a gap in the understanding about physiotherapists' views on factors that play a role in ethical decision-making and whether these views differ between World Physiotherapy regions.

METHODS

An online survey study in English was conducted from October 2018 to October 2019. Participants included 559 physiotherapists located in 72 countries. The self-designed survey questionnaire contained 13 items asking about demographic information and means of learning about ethical codes and decision-making frameworks. A further 30 items were presented which included statements underpinned with individual, organisational, situational and societal factors influencing ethical decision-making. Participants were asked to express their level of agreement or disagreement using a 5-point-Likert-scale.

RESULTS

Participants' highest rated responses endorsed that the professional role of physiotherapists is linked to social expectations of ethical behaviour and that ethical decision-making requires more skills than simply following a code of ethics. A recognisable organisational ethical culture was rated as supporting good ethical decisions. Comparing responses by World Physiotherapy regions showed significant differences in factors such as culture, religion, emotions, organisational values, significant others, consequences of professional misconduct and professional obligations. Entry level education was not perceived to provide a solid base for ethical decision-making in every World Physiotherapy region. Participants reported multiple sources for learning about a professional code of ethics and ethical decision-making frameworks. What's more, the number of sources differed between World Physiotherapy regions.

CONCLUSIONS

Multiple factors play a role in physiotherapists' ethical decision-making internationally. Physiotherapists' ethical knowledge is informed by, and acquired from, several learning sources, which differ in both quality and quantity amongst World Physiotherapy regions. Easily accessible knowledge and education about professional codes of ethics and ethical decision-making can foster continuing professional development for physiotherapists. The establishment of constructive ethical cultures in workplaces can improve ethical decision-making, and should acknowledge the influence of individual, organisational, situational and societal factors. The establishment of collaborative learning environments can support knowledge translation which acknowledges practice-based methods of knowing and learning.

Doing things you never imagined: Professional and ethical issues in the U.S. outpatient physical therapy setting during the COVID-19 pandemic

OBJECTIVE

Despite being the most prevalent physical therapy practice setting in the United States, no literature to date has examined the professional and ethical issues faced by outpatient physical therapists during the COVID-19 pandemic. The purpose of this study was to explore professional and ethical issues experienced by outpatient physical therapists in the United States during the COVID-19 pandemic.

DESIGN

An explorative semi-structured interview study using reflexive thematic analysis METHODS: Virtual semi-structured interviews explored physical therapists' experiences during COVID-19 in the OP setting. Data was analyzed using reflexive thematic analysis as described by Braun and Clarke.

RESULTS

Respondents worked predominantly with patients with orthopaedic impairments. Six primary themes and associated subthemes were identified: 1) Disruption of routine professional and personal life. 2) Negative impacts on health and wellbeing (physical, mental, and social). 3) Barriers to relationships, communication, and providing quality care. 4) Telehealth as a safe option to increase access with opportunities and challenges. 5) Discomfort practicing in an environment of misinformation, mistrust, and divisiveness. 6) New & pre-existing ethical issues in the COVID-19 context.

CONCLUSIONS

Results of this study indicate that physical therapists in the outpatient setting wrestled with critical questions regarding outpatient physical therapy practice during the COVID-19 pandemic: the role of touch in professional identity, challenges to the therapeutic alliance, effect of productivity and fiscal expectations and whether outpatient physical therapy is essential during public emergencies.