BACKGROUND
The 2014 update to the 2005 Section on Women's Health (SoWH) of the American Physical Therapy Association (APTA) "Guidelines for Women's Health Content in Professional Physical Therapist Education" (Guideline) is an attempt to assist US physical therapy educational programs in determining what women's health (WH) content should be included in professional (ie, entry-level) programs of study for the physical therapist (PT) student. The creation of the updated document was based on both quantitative and qualitative data from a wide variety of sources. Content input on the new Guideline was driven by research data that were provided by various stakeholders including clinicians, faculty, students, and leadership in both WH and PT education. This document is only a guideline; it does not carry any regulatory weight and is not an official publication of the Commission on Accreditation in Physical Therapy Education (CAPTE), nor the APTA. The SoWH is providing this Guideline to all accredited PT education programs in the United States to assist in curricular planning and implementation in the area of WH. This is an updated version of the "Guidelines for Women's Health Content in Professional Physical Therapist Education," first published in 2005.1 This technical case report provides a description of the process used for updating the 2005 Guideline, with the 2014 Guideline2 as an outcome.
STUDY DESIGN
The task force developed and implemented a survey to all accredited PT education programs in the United States as well as all WH certified PTs. Data were analyzed, prioritized, and organized into an updated 2014 version of the "Guidelines for Women's Health Content in Professional Physical Therapist Education."2
CASE DESCRIPTION
In 2011, the SoWH Board of Directors appointed a task force charged with updating the Guideline originally created in 2005. The task force was made up of academicians and clinicians all of whom had knowledge and experience in the area of WH and comprised individuals with backgrounds in patient care, PT student education, and research. The task force included 4 original members of the task force that created the 2005 Guideline. They provided the new task force with detailed information on the process involved in creating the 2005 Guideline. The 2011 task force held regular conference call meetings during which a specific strategy was planned to gather the most valid data available to use in writing the new Guideline. Detailed information on survey development and analysis is addressed in the Nelson et al article (in this issue). A decision was reached to collect informative data by surveying the academic (CAPTE accredited PT education programs) and clinical (APTA WH Section members) communities. See Table 1 for a summary of the task force timeline.
During the 2012 APTA Combined Sections Meeting, the task force provided an education session: "Professional Program Content Guideline Task Force Update." The purpose of this session was to present the goals of the SOWH task force, to present the preliminary data from the academic survey, and to gather suggestions from the stakeholders in attendance about what WH content should be included in educational program curricula. Roundtable discussions organized by participant roles (faculty, students, or clinicians) were facilitated by task force members to gather information regarding the following issues:
- In the student group: essential content needed for all students; preferred method of content delivery; electives versus required course work; clinical rotation WH expectations.
- In the academic faculty group: essential content needed for all students, teaching tips and strategies, barriers to content delivery, pelvic floor muscle examination competency expectations.
- In the clinicians group: essential content needed for all students, specific skill set, pelvic floor muscle examination competency expectations, optimal types of exposure in academic setting (eg, laboratory, lecture, clinical rotations).
Examples of recommendations from these roundtable discussions included the suggestion that (1) a user-friendly version of the document be provided with a combination of patient-client management model and systems model, (2) levels of knowledge/competency be identified, and (3) methods of delivery of content be outlined. The desire for a "usable" guideline was made clear by all groups. In addition, the reality of combining the patient-client management model with the systems model seemed favorable, as participants felt they often approached curriculum content organization using both models.
OUTCOME: TRANSLATION OF SURVEY RESULTS INTO THE 2014 GUIDELINE
As both academic and clinician survey results were tabulated, the task force met to begin discussion of the most effective format for translating all the information into a format that would be welcoming or understandable to an audience of students, faculty, and clinicians. The process of development of the SoWH guidelines for educational content can be compared with processes for development of clinical practice guidelines. Turner et al3 identified 6 clinical practice guideline development handbooks that had common themes on how to create guidelines. In particular, these authors wrote of the emphasis on facilitating consultation on the draft of guidelines, including peer review utilizing a wide range of experts. The authors noted another key element in the development of user-friendly guidelines to be the importance of creating an organized summary or algorithm. These themes were paramount in the SoWH task force approach to translation of survey and roundtable results into the updated educational guidelines.
The original 2005 Guideline was formatted using "A Normative Model of Physical Therapist Education, Version 2004"4 which was recommended by APTA for consistency with other professional documents at the time. This model describes the disability-related content deemed normative by members of the PT profession to be included within PT education.5 The task force intently deliberated formatting options for the 2014 Guideline once the survey and roundtable data were analyzed and organized. Task force members discussed the merits of several formats, acknowledging that a certain format may be more understandable depending upon who was accessing the information. Three formats were proposed: a systems model, a diagnosis model, and a patient-client management model. There was also agreement that a table of contents would introduce the document to provide clear direction to the user of the guideline.
During subsequent meetings, the task force considered several drafts of a guideline format. A combination of the systems model and the patient-client management model emerged as the most helpful and comprehensive approach for the varied potential users. This also appeared to be the most effective model to capture data from both surveys as to what WH content should be taught in entry-level programs. The group agreed that the ultimate goal would be to incorporate both models, with interactive routes to access more detailed content. The task force concluded that an initial format would list "conditions" organized by systems. The content listed within each condition would be presented in the patient-client management format and also would include a recommendation on level of mastery.
The systems model for these clinical guidelines would be based on specific biological "systems" that make up the scope of WH physical therapy practice. The task force examined the systems categorization used in the 2005 Guideline and utilized these systems to some degree adding or modifying them in accordance with the data from the 2011 academic and clinician survey results. The 2014 Guideline focuses, then, on the following systems: cardiovascular and pulmonary; gastrointestinal; immune; integumentary; musculoskeletal; neurologic/chronic pain. These mirror the content covered in the examination portion of the "Guide to Physical Therapist Practice, Version 3.0."6 The patient-client management model seemed an appropriate way to format the specific information within each condition. This model serves as the framework for PT patient management, as noted in the "Guide to Physical Therapist Practice,"6 which, in contrast to the medical model, emphasizes on disease, focuses on managing functional deficits utilizing a process of examination, evaluation, intervention, and outcome assessment. Medical models of disability tend to define disability as a diagnosis directly caused by an individual's disease, trauma, or other health problem.5-10
The task force used data from both surveys to determine that only content that reached 70% or greater responder agreement as being "within the scope of WH practice for entry level" would be included in the Guideline. Content falling outside of that 70% would be catalogued, but not included, in the actual Guideline. During the APTA Combined Sections Meeting in 2013, the task force presented the following platform session: "Women's Health Content in Physical Therapy Professional Programs: A Survey of Academic Faculty." This allowed an initial exposure of the results from the academic survey to an audience comprising faculty, clinicians, and students. In the discussions following the presentation, further suggestions were gathered on formatting the new Guideline and needs of the users.
The systems list with corresponding subcategories went through a series of edits with the intention of eliminating repetition while connecting related topics to each other. Task force members were assigned to smaller working groups, each of which managed 2 of the systems and group members collaborated on the specific content for curricular inclusion. The result of this completed analysis and organization is the final version of the 2014 Guideline. See the Figure for the table of contents to the 2014 Guideline.
The final version of the Guideline was designed so that electronic lists based on the systems model had links to conditions that bridged more than one system. Each system has an overview document of clinical and foundational science content, respectively, for that system. Items specific to WH unlikely to be covered in the general curriculum are bolded. The task force working groups were provided a template so that each condition could be organized using the patient-client management model, with key content knowledge or skill paired with educational objectives that could be incorporated into any course syllabus. Key content areas also included a level of competence expected of an entry-level student. Determination of the competency level was based on responses from both the academic and clinician surveys. The competency descriptors were as follows: (1) Familiarity level, "F," the expectation is that the student gains awareness that this material is part of the scope of practice of a PT practicing in the area of WH; (2) Proficient level, "P," a basic entry-level competency level with the expectation that the student is safe, understands how to apply the material, but will need guidance and practice on clinical internships; and (3) Mastery level, "M," a more advanced level where the student, upon completion of the didactic portion of the PT curriculum, would demonstrate complete cognitive, affective, and psychomotor integration of this material.
Standard templates were also created for the foundational and clinical science documents. The task force felt it important to include medical/pharmacologic management content in the clinical science documents in order to mirror current trends in PT education (Table 2).
A Cardiopulmonary System Foundational Science document example is provided in Table 3 in an abbreviated version. The Foundational Science Condition contains expected skills/abilities along with an accompanying educational objective and mastery-level denotation. A specific illustration from this document notes that each PT student should demonstrate proficiency (P) in knowledge of anatomy of the cardiopulmonary system; however, familiarity (F) is the minimal expectation related to cardiopulmonary pharmacologic knowledge. Clinical science information documents were formatted according to the patient-client management model and provide specific tests, measures, and interventions recommended for the general systems' conditions.
An abbreviated example of a specific cardiopulmonary condition format is provided in Table 4 featuring the medical condition "obstetric-related cardiopulmonary changes." In the "Patient History" section of this example, note that a student should be proficient (P) in knowing triage questions on exercise habits for the pregnant or postpartum patient but need only be familiar (F) with specific changes in obstetric oxygen consumption.
Finally, on the basis of survey data from this project, a list of advance practice topics is provided within the document to assist with postprofessional curricular development.
DISCUSSION
The collaborative process utilized in the updated 2014 Guideline will hopefully benefit a wide range of readers. Women's health content in PT professional education may be delivered by core academic faculty, adjunct faculty, clinicians, guest speakers, or some combination of all of these. Because input from the varied stakeholders involved in WH clinical physical therapy services and academia was obtained, it is expected that the new Guideline will provide evidence-based recommendations for specific curricular content items, learning objectives, as well as suggestions for levels of proficiency. As noted in the introduction to the Guideline, additional information for suggestions on specific teaching strategies and pedagogy is available on the SoWH Web site.
CONCLUSIONS
A systems model and a patient-client management model were used to format the updated 2014 Guideline. The SoWH task force utilized data gleaned from an academic and clinician survey on WH curricular content in entry-level DPT programs to update the 2005 Guideline. The Guideline is published on the SoWH Web site (http://www.womenshealthapta.org) in an interactive format.
ACKNOWLEDGMENTS
The authors thank task force members Kathleen Alcon, PT, MS, QCS, CLT, Andrea Branas, MPT, MSE, CLT, and Ann Dunbar, PT, DPT, MS, WCS, for their contributions to the survey design and creation of the Revised Guidelines. The authors also acknowledge the assistance the task force received from the Section on Women's Health and specifically from the Directors of Education Carrie Schwoerer, PT, OCS, and Darla Cathcart, PT DPT, WCS.
REFERENCES