Effect of service-learning on knowledge about older people and faculty teaching evaluations in a physical therapy class

Attitudes and Beliefs of Physical Therapists and Physical Therapist Students Toward Working With Older Adults: A Systematic Review

OBJECTIVE

The aim of this study was to systematically review physical therapists' and physical therapist students' attitudes toward working with older adults.

METHODS

CINAHL, EMBASE, ERIC, MEDLINE, Scopus, PsycINFO, and SocIndex databases were searched in duplicate (from inception to March 2023). Studies that assessed knowledge on aging, intention to work with older adults or attitudes toward older adults for physical therapist students and/or clinicians, and that were written in English, Finnish, Spanish, or Swedish were included. Grey literature, qualitative studies, or articles of people with a specific diagnosis (eg, dementia) were excluded. All articles were reviewed by 2 authors independently, and consensus was required for inclusion. Data extraction was completed using a standardized data extraction sheet.

RESULTS

Of 2755 articles screened, 34 met the inclusion criteria. Twenty-five studies recruited only physical therapist students, 6 recruited only physical therapist clinicians, and 3 involved mixed samples of both. Ten intervention studies were included, all of which recruited physical therapist students. Overall, physical therapist students were observed to have predominantly positive attitudes toward older adults, while clinicians had neutral to weak positive attitudes toward older adults. Both physical therapist students and clinicians were observed to have low knowledge on aging and low intentions to work with older adults. Results from intervention studies suggest that education combined with clinical experience with older adults improves attitudes toward older adults.

CONCLUSION

A discrepancy is observed in physical therapists in that although attitudes toward older adults are positive, a lack of knowledge on aging and a disinterest in working with older adults exists. Intervention studies suggest that clinical experience may improve attitudes toward older adults in physical therapist students.

IMPACT

Predominantly positive attitudes toward older adults are reported by physical therapist students, while for clinicians mixed results are observed. Education coupled with clinical experiences appears to be effective interventions to improve attitudes toward older adults, but such research has only been explored in student samples.

A scoping review of ageism towards older adults in cancer care

INTRODUCTION

Ageism towards older adults with cancer may impact treatment decisions, healthcare interactions, and shape health/psychosocial outcomes. The purpose of this review is twofold: (1) To synthesize the literature on ageism towards older adults with cancer in oncology and (2) To identify interventions that address ageism in the healthcare context applicable to oncology.

MATERIALS AND METHODS

We conducted a scoping review following Arksey and O'Malley and Levac methods and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted an exhaustive multi-database search, screening 30,926 titles/abstracts. Following data abstraction, we conducted tabular, narrative, and textual synthesis.

RESULTS

We extracted data on 133 papers. Most (n = 44) were expert opinions, reviews, and letters to editors highlighting the negative impacts of ageism, expressing the need for approaches addressing heterogeneity of older adults, and calling for increased clinical trial inclusion for older adults. Qualitative studies (n = 3) described healthcare professionals' perceived influence of age on treatment recommendations, whereas quantitative studies (n = 32) were inconclusive as to whether age-related bias impacted treatment recommendations/outcomes or survival. Intervention studies (n = 54) targeted ageism in pre/post-licensure healthcare professionals and reported participants' improvement in knowledge and/or attitudes towards older adults. No interventions were found that had been implemented in oncology.

DISCUSSION

Concerns relating to ageism in cancer care are consistently described in the literature. Interventions exist to address ageism; however, none have been developed or tested in oncology settings. Addressing ageism in oncology will require integration of geriatric knowledge/interventions to address conscious and unconscious ageist attitudes impacting care and outcomes. Interventions hold promise if tailored for cancer care settings. 249/250.

Service learning and self-efficacy in exercise science: outcomes of a community fitness training program involving undergraduate Exercise Science students

There is increasing awareness of the importance of civic engagement in higher education. Service-learning activities in undergraduate programs, in particular, have been linked to positive academic outcomes and gains in various forms of self-efficacy. Exercise Science students at our university complete two service-learning courses as part of the curriculum, each of which involves implementing a structured 12-week individualized fitness training program with a community member client. The aim of this study was to investigate the effect of these service-learning experiences on Exercise Science students' self-efficacy for fitness assessment and exercise prescription. Students completed a seven-item self-efficacy questionnaire administered at both the beginning and end of each service-learning course and reflected on their experience using an end-of-course survey. Our results showed significant improvements in self-efficacy from pretest to posttest for each of the two service-learning experiences, with the second experience producing additional gains in self-efficacy over and above the first. Students also reported improved confidence in their fitness assessment and exercise prescription skills in the end-of-course survey. Community members involved in the fitness training program reported a positive experience with students' knowledge of fitness assessment and exercise prescription as well as their own progression to independence in a home exercise program. Our findings highlight the benefits of including a structured service-learning experience in the Exercise Science curriculum.NEW & NOTEWORTHY This study was done to investigate the effect of a structured fitness training experience on Exercise Science students' self-efficacy for fitness assessment and exercise prescription. Our results indicate a significant improvement in self-efficacy from pretest to posttest. Students also reported improved confidence in their fitness assessment and exercise prescription skills. Community members reported a positive experience with students' knowledge of fitness assessment and exercise prescription and their progression to independence in a home exercise program.

Impact of Service-Learning on Physiotherapy Students: Exercise Programs for Patients with Heart Transplantation and Acute Coronary Syndrome—A Randomized Clinical Trial

Introduction. Service-learning (SL) seems to be useful for healthcare students. This study aimed at comparing an SL program versus a traditional approach (TA) on moral sensitivity, ethical competences, knowledge, teaching quality, SL participation and performance, and satisfaction in physiotherapy students. Methods. Randomized clinical trial. A total of 32 physiotherapy students were allocated to an SL group (SLG, n = 16), or to a TA group (TAG, n = 16). Participants had to create an exercise program for patients with heart transplantation and acute coronary syndrome. The SLG performed the program with real patients, whilst the TAG performed a traditional collaborative approach. Moral sensitivity, ethical competences, knowledge and teaching quality were assessed pre- and post-intervention. SL participation and performance and satisfaction of the SLG were assessed post-intervention. Results. After the intervention, the SLG showed higher moral sensitivity, ethical competences, knowledge and reported better teaching quality than the TAG. The SL program was useful, addressed a real need, contributed to learning, helped to solve problems, facilitated better comprehension, increased motivation, and students would like to use SL in other subjects. Conclusions. The SL program had a positive impact on students, encouraging the implementation of similar SL interventions. SL may be considered a teaching–learning methodology of choice in physiotherapy students.

Student-led rehabilitation groups and clinics in entry-level health education: a scoping review

OBJECTIVE

The purpose of this review was to identify, map, and describe the characteristics of student-led physical rehabilitation groups and clinics in entry-level health education.

INTRODUCTION

Student-led groups and clinics for physical rehabilitation are an emergent phenomenon in entry-level health professional education. Data gathered in this scoping review aimed to provide an understanding of the range and scope of student-led groups and clinics within a physical rehabilitation context, and establish the evaluation undertaken to date from a student, service user, and stakeholder perspective. It also aimed to identify other important factors in the design, execution, and feasibility of the concept. Finally, it aimed to identify gaps in the literature that can be addressed by further research.

INCLUSION CRITERIA

This scoping review considered studies and sources that identify student-led methods for carrying out physical rehabilitation for service users in either an exercise group or clinic environment. Students and groups/clinics on entry-level qualifying courses were considered. The review considered primary and secondary research in any paradigm as well as text and opinion articles.

METHODS

The JBI methodology for conducting scoping reviews was employed. The following databases were searched: MEDLINE, CINAHL, AMED, ERIC, Scopus, and SPORTDiscus. Searches were limited from January 1, 1998, to the date of the search (November 1, 2019). Non-English articles were excluded. To supplement the review, searches for gray literature were also undertaken. Data extraction was performed by two reviewers using a pre-determined data extraction form developed by the authors. The results of the review are presented in narrative form and supported by tables and figures.

RESULTS

This review identified 523 sources of information of which 111 were screened at full-text stage and 48 sources were eligible to be included in the final scoping review. A wide range of student-led groups and clinics that provide physical rehabilitation exist globally. Drivers for the clinics and groups vary; key aims included providing a learning environment for student skill development, serving as clinical placements, and providing a social enterprise. Evaluations focused on student experience, service user experience, and cost-benefit analyses.

CONCLUSIONS

Student-led groups and clinics are at different stages of development and use within entry-level curricula. The objectives and drivers for groups and clinics vary worldwide; therefore, the evolution of groups and clinics has driven a wide range and number of models globally.

Qualitative Analysis of an Inter-Professional, In-Home, Community Geriatric Educational Training Program

This study describes and provides qualitative analysis of an innovative, inter-professional (IP) geriatrics curriculum focused on team-based care with healthy older adults in a home-based community setting. The curriculum consisted of five, four-hour didactic and experiential sessions over one academic year. Dental, medical, occupational therapy, pharmacy, physical therapy, and physician assistant students were placed into teams led by IP faculty from each health professional school. Teams met with a community-dwelling older adult three times. At the program's conclusion, students responded to the reflective question "What is the most important learning experience you expect to take away from the geriatric inter-professional training? A qualitative analysis of student responses revealed four common themes from all five professions aligning with curricular goals: (1) health professional roles/scope of practice, (2) geriatric care and health outcomes, (3) team communication/collaboration, and (4) advocating for one's own profession. As sites for institutional clinical training become scarcer for health professions' trainees, this study offers both a novel, IP, geriatrics curriculum with didactic/experiential learning through community partnerships in a home-based setting and a reflective evaluation.

Social work students' Service Learning experiences with grandfamilies: Contact, comfort, and attitudes

One way to increase student learning about older adults and aging family issues is to engage in community-based field experiences. Results from pre- and post-surveys with 29 Bachelors of Social Work students enrolled in a year-long practicum course to assess their change in the level of contact, comfort, and attitudes with older adults and grandfamilies (i.e., grandparents/kin and the children in their home) are discussed. Students who met with grandfamilies (n = 9) were compared to students who met with older adults in a nursing home (n = 6) and students who met with children from an afterschool program or child treatment facility (n = 9). One-way ANOVA's revealed group differences in contact and quality of contact with grandfamilies. No significant differences were found for contact with older adults or comfort working with older adults and grandfamilies, or for attitudes toward older adults between the three groups. As a result of this project, educators should develop learning opportunities for students to increase their contact and comfort with older adults and aging families.

Service-Learning with College Students toward Health-Care of Older Adults: A Systematic Review

Service-Learning (SL) has become a teaching methodology that promotes social and personal skills while helping groups in need and at risk of social exclusion. This paper is a systematic review of the literature on SL experiences and research on college subjects in the area of health-care promotion in settings for older adults. After an exhaustive search, 43 peer-reviewed publications were classified according to frequency and geographical distribution, sample and duration of the programs, research methodologies, data collection instruments used, and main outcomes investigated. The results indicate that the research methodologies used tended to be qualitative and mixed, while the variety of samples and duration of interventions was very broad. The instruments used were mainly interviews and questionnaires, and the programs were developed specially in the United States of America. The groups receiving most SL were healthy older adults and older adult populations with aging disabilities and illnesses. The articles in the present review highlight that SL can have a positive effect on older adults' health promotion and can enhance their community participation.

Interventions to Reduce Ageism Against Older Adults: A Systematic Review and Meta-Analysis

Background. Research has found a strong link between ageism, in the form of negative stereotypes, prejudice, and discrimination toward older people, and risks to their physical and mental health. Little is known, however, about the effectiveness of strategies to reduce ageism. Objectives. To assess the relative effects of 3 intervention types designed to reduce ageism among youths and adults-education, intergenerational contact, and combined education and intergenerational contact-by conducting a systematic review and meta-analysis. Search Methods. We searched PubMed, PsycINFO, AgeLine, EBSCO, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Global Index Medicus, Database of Abstracts of Reviews of Effects (DARE), Epistemonikos, Cochrane Database of Systematic Reviews, Campbell Collaboration, PROSPERO, GreyLit, and OpenGrey. We identified additional records by hand-searching reference lists of relevant review articles as well as records included in the meta-analysis. Two independent reviewers completed the search and screening process. Selection Criteria. Eligible studies were those that (1) evaluated an intervention designed to reduce ageism, (2) examined at least 1 ageism outcome in relation to older adults, (3) used a design with a comparison group (randomized or nonrandomized), and (4) were published after 1970, when the ageism concept was developed. Data Collection and Analysis. Two independent reviewers extracted study-level data from records using a common data collection spreadsheet. They also assessed study quality by using the Cochrane Risk of Bias Tool, and used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool to assess quality of outcome evidence. Primary outcomes were attitudes toward older people and accuracy of knowledge about aging and older people. Secondary outcomes included comfort with older adults, anxiety about one's own aging, and interest in working in the field of geriatrics or gerontology. We carried out meta-analyses with statistical mixed models. Main Results. We identified 63 eligible studies (1976-2018) with a total sample of 6124 participants. Ageism interventions demonstrated a strongly significant effect on attitudes (differences of standardized mean differences [dD] = 0.33; P < .001), knowledge (dD = 0.42; P < .001), and comfort (dD = 0.50; P < .001), but no significant effect on anxiety (dD = 0.13; P = .33) or working with older adults (dD = -0.09; P = .40). Combined interventions with education and intergenerational contact showed the largest effects on attitudes. We found stronger effects for females and for adolescent and young adult groups. Authors' Conclusions. Interventions are associated with substantial reduction in ageism and should be part of an international strategy to improve perceptions of older people and the aging process. Additional research using more rigorous designs to examine the effects of interventions is strongly recommended. Public Health Implications. Ageism has well-established negative effects on the physical and mental health of older people. Findings suggest that relatively low-cost, feasible strategies involving education and intergenerational contact can serve as the basis of effective interventions to reduce ageism.

A Pediatric Service-Learning Program in Physical Therapy Education

PURPOSE

The purpose of this report was to describe a pediatric service-learning program in entry-level physical therapy (PT) education in Taiwan.

KEY POINTS

To meet the needs of the local community and provide preclinical service-learning experience to PT students with people with physical disability, a service-learning program of a 2-day camp for children with cerebral palsy (CP) was developed in 2012. To date, 356 entry-level PT students have participated in this program, serving 286 children and their families. Important professional attributes, identified by the World Confederation for Physical Therapy guideline, such as altruism, compassion and caring, cultural competence, personal and professional development, professional duty, social responsibility and advocacy, and teamwork, were in the reflective reports of some of the PT students.

CONCLUSIONS

The experiences provided by this pediatric PT service-learning program appear to have the potential to foster the development of professional attributes in entry-level PT students.

Using art in an intergenerational program to improve students' attitudes toward people with dementia

This study explored the effects of participating in an intergenerational service learning program called Opening Mind through Arts (OMA) on college students' attitudes toward people with dementia. In this program, students were paired one-on-one with elders who have dementia to support the elders' creation of visual art projects. They met weekly for one semester. The Dementia Attitude Scale was administered at the beginning and end of the semester to measure changes in students' attitudes. The study included 156 students participating in OMA and assessed if their participation makes a difference in the degree of change in overall attitudes, knowledge, and comfort level toward people with dementia. Results revealed a significant improvement in students' overall attitudes, comfort level, and attitude toward people with dementia. The results highlight the importance of intergenerational service learning in improving college students' overall attitudes and increase their confidence and comfort working with people with dementia.

Gerontology and youth-focused service learning: the relation between service recipient age and student responses

Service learning is a pedagogical technique that integrates traditional coursework with activities outside the classroom that meet the needs of the community. Gerontology-focused service learning has been incorporated into many courses that cover aging content and is believed to be beneficial to the learning process. Other research has demonstrated that service learning in general has benefits, regardless of the age of the service recipient. It is unclear whether benefits associated with gerontology-focused service learning are unique to experiences with older adults or are a product of the general benefits associated with this pedagogy. This study examined student responses to gerontology-focused service learning compared to youth-focused service learning. The results revealed that students working with older adults reported more negative expectations related to the assignment, more positive experiences interacting with the service recipients, and more reports of learning benefits attributed to service learning.

Training socially responsive health care graduates: is service learning an effective educational approach?

BACKGROUND

Health care educators strive to train graduates who are socially responsive and can act as "change agents" for communities they serve. Service learning (SL) is increasingly being used to teach the social aspects of health care and develop students' social responsiveness. However, the effectiveness of SL as an educational intervention has not been established.

AIM

To assess the evidence for the effectiveness of SL.

METHOD

Seven electronic databases were searched up to 2012 and included all articles on SL for pre-professional health care students. Hand searching was also conducted.

RESULTS

A total of 1485 articles were identified, 53 fulfilled the search and quality appraisal criteria and were reviewed across six domains of potential SL effects: (i) personal and interpersonal development; (ii) understanding and applying knowledge; (iii) engagement, curiosity and reflective practice; (iv) critical thinking; (v) perspective transformation and (vi) citizenship.

CONCLUSION

While SL experiences appear highly valued by educators and students the effectiveness of SL remains unclear. SL is different from other forms of experiential learning because it explicitly aims to establish reciprocity between all partners and increase students' social responsiveness. Impact studies based on the interpretative paradigm, aligned with the principles of social accountability and including all stakeholder perspectives are necessary.

Using service-learning to integrate death education into counselor preparation

Service-learning can be a meaningful and effective tool for integrating death education into counselor preparation. The authors describe the design, implementation, reflection process, and evaluation of a service-learning based support program for grieving families and offer suggestions for death educators interested in service-learning as pedagogy. Their evaluation indicated that students who took a graduate-level group counseling course with a service-learning component exhibited lower distress in death-related clinical situations than students who took the course without the service component. Service-learning is closely aligned with death education aims and can be used to enhance counselor preparation program curricular alignment with relevant accreditation standards.

Service-learning-based instruction enhances students' perceptions of their abilities to engage in evidence-based practice

ABSTRACT Education leaders in occupational therapy (OT) propose that active learning is one means to developing critical thinking skills essential for successful integration of knowledge into evidence-based practice. This study examines the impact of one type of active learning, service-learning, on students' perceptions of their knowledge, skills, and confidence in their abilities to provide OT services to adults with neurological conditions. Change in OT students' (n == 43) perceptions before and after engagement in service-learning were assessed using quantitative and qualitative data in a triangulation mixed-methods design. Results support previous studies indicating that service-learning can influence positive gains in student knowledge and confidence.

Balancing structure and choice in intergenerational service-learning

Intergenerational service-learning has become an important component of many educational gerontology programs. The model at the University of North Carolina Charlotte incorporates multiple elements of student choice within a very structured service-learning experience. A review of the literature reveals some discussion of the value of choice, but very little utilization of choice within a structured intergenerational service-learning model. Qualitative analysis of data from 210 student reflection papers reveals the experience of having choices in structured undergraduate service-learning. These findings support the utilization of choice within structure as a best practice in intergenerational service-learning.

Intergenerational service-learning: a review of recent literature and directions for the future

This review examines recent studies that have addressed outcomes of intergenerational service-learning courses in gerontology. The history of service-learning pedagogy in higher education and its place in today's colleges is also reviewed. Particular attention is given to evaluations of stakeholders: students, older adult participants, agencies and staff, faculty, community residents, colleges, and the community itself. The need for adopting research designs that permit clear conclusions and for utilizing assessments that have psychometrically sound foundations is important in future studies to permit unambiguous comparisons from study to study. The value of the pedagogy for students in particular has been documented over a number of years. Equally important is today's need to assess the impact of the pedagogy on the community.

Health professionals' attitudes toward older people and older patients: a systematic review

Attitudes toward older people and older patients among healthcare professionals are of concern throughout the world, but there are no recent systematic reviews which have examined and compared the attitudes across the various healthcare professionals who provide healthcare to older people. A comprehensive literature search (2000-2011) was undertaken on electronic databases (CINAHL, MEDLINE, EMBASE, British Nursing Index, PsycINFO, Chinese Biomedical database, China Medical Academic Conference and China Academic Journal) using a combination of terms. We identified 2179 articles indexed with these terms. Initial screening was undertaken by two researchers and then checked by a third researcher. In total, the reviewers selected 117 articles which, on the basis of their abstracts, appeared to meet the criteria for inclusion. We obtained the full texts and two reviewers assessed each full text paper to further examine whether it met all the criteria. The final review identified 51 studies. Publications over the last 10 years show that attitudes towards older people and older patients range from neutral to positive among healthcare professionals and highlight the need for well-designed studies of both qualified and student healthcare professionals recruiting random samples across multiple sites and utilizing validated instruments consistently to permit comparison over time and across countries.

Using service-learning to teach mental health and research skills

ABSTRACT This paper describes how an occupational therapy program used service-learning to integrate the learning objectives for mental health and research curriculum content. The service-learning program assisted participants diagnosed with mental illness to achieve success in higher education and/or related goals and served as a clinical program within a research curriculum for entry-level graduate occupational therapy students. The occupational therapy students served as mentors for the participants. The purpose of the program for the occupational therapy students was to teach research skills, clinical skills, and increase comfort in working with the mental health population. Seventy-eight occupational therapy students participated in the program over four academic years. A case example of a student/participant mentoring relationship is provided. Results indicated that the occupational therapy students gained comfort with the population and competence in their clinical and research skills.

Helping hands for healthy living: a collaborative service learning project with occupational and physical therapy students

The purpose of this article is to describe the development of a unique interdisciplinary service-learning course and to evaluate the impact of this experience on allied health students' professional development. One hundred and twenty-seven students from occupational and physical therapy programs served medically uninsured individuals (n = 170) at a community health clinic through provision of direct patient care services, depression screens, and a health promotion program. Surveys and personal reflections were used to measure the outcome of the course. The results indicated that student cognitive skills, ability to work with diverse populations, social responsibility, beliefs and opinions about service learning, and appreciation of each other's discipline were enhanced by their participation in the class.

Physiotherapy students' attitudes towards and knowledge of older people

The purpose of this study was to determine whether students' attitudes towards and knowledge of older people changed throughout the physiotherapy undergraduate program. Students' demographic information and attitudes towards and knowledge of older people were gathered via repeated question-responses over three points of time during the 4-year program. Validated instruments--the Geriatric Attitudinal Scale (GAS) and the Facts on Ageing Quiz 1 (FAQ1)--were used to measure participants' attitudes and knowledge of older people. The FAQ1 yielded two variables: knowledge as percentage of FAQ1 correct responses, and ignorance as percentage of FAQ1 Don't Know responses. The instruments were administered in Year 2 prior to the students' first clinical (Time 1), immediately after their first clinical (Time 2), and Year 4 just prior to completion of the program (Time 3). Changes over time were analysed using paired t-tests with significance set at p < 0.05. Participants initially demonstrated positive attitudes towards older people with a mean of 73.8% GAS positive responses with no significant change over time (p = 0.56). Initial knowledge about older people was poor with a mean of 43.6% FAQ1 correct responses which increased significantly over time to 51.7% (p = 0.0001). This improvement in knowledge was accompanied by a decrease in ignorance over the study period (p = 0.0001). While attitudes toward older people were positive and knowledge improved over time, the level of knowledge attained was below expectation for beginning practitioners. This finding has implications for the education and training of physiotherapy students.