Motivations to Pursue Physical Therapy Residency Training: A Q-Methodology Study of Stakeholder Perspectives

2023 Pauline Cerasoli Lecture: It Takes a Village to Raise a Profession

BACKGROUND AND PURPOSE

Personal and profession-related factors affect graduate transition to practice. Social supports and a sense of belonging are recognized as critical factors affecting success. The need for a professional to postprofessional continuum of learning has been identified. Development of a process to effectively move learners through this continuum are affected by conflicts such as economic issues, varied educational and practice philosophies, and capacity demands for clinical sites and instructors. The purpose of this article was to discuss professional formation as an individual experience that needs environmental support. If we look to the intrinsic needs of the individual to develop effective systems, both individuals and the profession will thrive.

POSITION AND RATIONALE

The changing demographics of students and factors affecting health care and education offer compelling reasons to reconsider the pathway for early professional development. Education and practice must collaborate to cocreate the foundation for professional formation. Basic needs such as economic security and social belonging must be met to create optimal conditions for learning and growth.

DISCUSSION AND CONCLUSION

The profession has not adopted an intentional pathway for new graduates to meet foundational practice needs. Some new graduates seek residencies, but residencies are focused on specialization and supply does not meet the demand. Strategies to promote success of early career professionals include a professional to postprofessional curriculum with intentional mentorship, changes in the regulatory environment, and formation of effective partnerships to support education and practice.

Identifying Perspectives on Physical Therapist Residency Program Goals: Hallmarks of Success and Excellence

OBJECTIVE

The purpose of this study was to describe common perspectives important to achieving excellence and success in physical therapist residency education programs.

METHODS

Individuals with direct responsibility for creating and revising physical therapist residency program goals participated in a mixed-methods study using Q-methodology. They sorted 31 goal topics based on the level of importance for achieving excellence and success in physical therapist residency education. By-participant factor analysis identified dominant perspectives, which were interpreted based on emergent themes from the topics identified as the most important. Participants' rationale for selecting goal topics as the most important were extracted from the post-survey.

RESULTS

Seventy-three individuals responded, representing 9 of the 11 clinical residency areas of practice. Three main perspectives emerged: resident behaviors, resident achievements, and program attributes. One shared perspective emerged across all 3 factors that emphasized the residents' ability to become self-regulated, lifelong learners who integrate learning into practice: preparation for future learning.

CONCLUSIONS

Variability in weighting the importance of program goals associated with each perspective may include a program's organization and mission, individual beliefs and experiences related to program leadership, and resource availability. Although respondent emphasis placed importance of some items over others, the findings do not suggest that items ranked lower were unnecessary or unimportant in achieving program excellence. The relative importance of items was weighted differently based on the perspective of program leadership and the individual completing the sorting activity.

IMPACT

The results of this study suggest that physical therapist residency programs should have at least 1 or 2 goals in each of the 3 distinct perspectives, as well as the 1 shared perspective identified in our findings. Some consistency in program goals based on the perspectives identified here may enable further research exploring excellence, value, and outcomes in physical therapist residency education.

Comparisons of Clinical Competency and Job Responsibilities of Physical Therapists With and Without Postprofessional Training

INTRODUCTION

Understanding how educational pathways may influence clinical competence and work responsibilities is important in providing guidance to academic and clinic stakeholders and physical therapists (PTs) on PT career development. The purpose of this paper was to compare perceived clinical competency and job duties between PTs with formal mentored postprofessional clinical education with PTs without formal postprofessional clinical education.

REVIEW OF LITERATURE

The understanding of self-perceived clinical competence of PTs overall in the United States is limited, especially as related to the impact of postprofessional education. Furthermore, there is limited understanding of the career pathways and development of job duties of PTs in the United States.

SUBJECTS

Two thousand three hundred thirty-four PTs in the United States.

METHODS

An online survey was sent to licensed PTs. This survey included items measuring self-perceived clinical competency and questions related to weekly job responsibilities. Participants were categorized as residency trained, fellowship trained, or non-residency/fellowship trained. Frequency analyses and Kruskal-Wallis tests with pairwise post hoc tests were performed comparing the 3 groups.

RESULTS

Residency-trained (P < .007) and fellowship-trained (P < .001) groups demonstrated elements of higher self-perceived clinical competency compared with the non-residency-/fellowship-trained group. Both the residency- and fellowship-trained groups spent less time with patient care and more time with other responsibilities (e.g., teaching, mentoring, and research) (P < .02) during an average workweek. Fellowship-trained PTs (P < .001) spent more time with administrative duties compared with the non-residency-/fellowship-trained group.

DISCUSSION AND CONCLUSION

Results from this paper demonstrate that residency- and fellowship-trained PTs have elements of higher self-perceived clinical competency and spend more of their job duties outside of direct patient care compared with PTs who were not residency or fellowship trained. These results may help guide PTs, academic institutions, and employers in planning and achieving specific career paths.

Attributes, Attitudes, and Motivations of Personnel Involved with Sports Physical Therapy Residency Training

BACKGROUND

Post-professional residency training in sports physical therapy has undergone rapid growth since its inception over 20 years ago with 58 programs currently accredited.

PURPOSE

The purpose of this survey was to describe and contrast the demographics, motivations, and selection influences from the perspective of both potential training applicants and program faculty.

STUDY DESIGN

Cross-sectional descriptive survey.

METHODS

156 physical therapists identified as stakeholders in sports residency and fellowship training were invited to participate in a 115-item survey. Descriptive measures of central tendencies to describe the data and Mann Whitney Rank Sum tests were used to detect differences between the perspectives of applicants and faculty.

RESULTS

50 program faculty and 57 applicants responded to the survey for a 69% response rate. Motivations for post-professional training categorized as extremely important were largely intrinsic behavioral modifiers centering on improved knowledge, skills, and outcomes while satisfying a passion for sports specialty training and enhancing job opportunities in the field. 7 of the 10 highest rated application motivations were rated as significantly more important by applicants than faculty members (p<0.05). The two most highly rated influences for choosing to apply to a specific residency site were the perception for subsequent job opportunities and perceived relationship and qualifications with the residency director and staff. The importance of job opportunities in sports PT was rated much higher by the applicant than the faculty (p=0.003).

CONCLUSIONS

While the motivations for residency training may be slightly different between groups the importance of information acquisition and methods for residency selection criteria seem more congruent. Residency faculty may underestimate the importance of some of the most important motivations that prompt interest in residency training. Recognition of these factors may alter the presentation and content design of residency curriculums.

A scoping review of Q-methodology in healthcare research

BACKGROUND

Q-methodology is an approach to studying complex issues of human 'subjectivity'. Although this approach was developed in the early twentieth century, the value of Q-methodology in healthcare was not recognised until relatively recently. The aim of this review was to scope the empirical healthcare literature to examine the extent to which Q-methodology has been utilised in healthcare over time, including how it has been used and for what purposes.

METHODS

A search of three electronic databases (Scopus, EBSCO-CINAHL Complete, Medline) was conducted. No date restriction was applied. A title and abstract review, followed by a full-text review, was conducted by a team of five reviewers. Included articles were English-language, peer-reviewed journal articles that used Q-methodology (both Q-sorting and inverted factor analysis) in healthcare settings. The following data items were extracted into a purpose-designed Excel spreadsheet: study details (e.g., setting, country, year), reasons for using Q-methodology, healthcare topic area, participants (type and number), materials (e.g., ranking anchors and Q-set), methods (e.g., development of the Q-set, analysis), study results, and study implications. Data synthesis was descriptive in nature and involved frequency counting, open coding and the organisation by data items.

RESULTS

Of the 2,302 articles identified by the search, 289 studies were included in this review. We found evidence of increased use of Q-methodology in healthcare, particularly over the last 5 years. However, this research remains diffuse, spread across a large number of journals and topic areas. In a number of studies, we identified limitations in the reporting of methods, such as insufficient information on how authors derived their Q-set, what types of analyses they performed, and the amount of variance explained.

CONCLUSIONS

Although Q-methodology is increasingly being adopted in healthcare research, it still appears to be relatively novel. This review highlight commonalities in how the method has been used, areas of application, and the potential value of the approach. To facilitate reporting of Q-methodological studies, we present a checklist of details that should be included for publication.