The (controversial) future of doctoral education in AT education
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1 The (controversial) future of doctoral education in AT education John T. Parsons, PhD, AT Eric L. Sauers, PhD, AT, FNATA ATEC 2013 DISCLOSURES Problem Changes in healthcare Changes in higher education Changes in health professions education A significant need to enhance the sophistication of AT practice through education 1
2 Part 1 Objectives 1. Identify and explain the common components and general goals of doctoral education; 2. Identify and discuss contemporary trends in health professions doctoral education; 3. Identify and discuss the intended outcomes and objectives of various doctoral degrees, with emphasis on difference between research and professional doctorates; ATEC 2013 DOCTORAL EDUCATION OVERVIEW Doctoral Education Purpose What is the purpose of doctoral education? To create a Steward of the Discipline» Colde & Walker. Envisioning the Future of Doctoral Education The Carnegie Foundation for the Advancement of Teaching 2
3 Doctoral Education Need Who needs and who has a doctoral level education?» Commission on the Future of Graduate Education in the United States. The Path Forward: The Future of Graduate Education in the United States Doctoral Taxonomy Doctor s Degree / Scholarship Doctor s Degree Professional Doctor s Degree Other First Professional Degree National Center for Education Statistics. Integrated Postsecondary Education Data System (IPEDS) s Conventional doctoral programs do not meet the needs of students, employers, and society: Poorly prepared Underrepresented Not completing» Colde & Walker. Envisioning the Future of Doctoral Education: Preparing Stewards of the Discipline (The Carnegie Foundation for the Advancement of Teaching) 3
4 ATEC 2013 PROFESSIONAL PRACTICE DOCTORATES IN HEALTHCARE Healthcare s What other health professions have moved to or are moving towards the professional practice doctorate? AuD DO MD DPT DNP OTD PsyD PharmD 4
5 Healthcare s Three types of professional practice doctorates in healthcare: Entry level professional doctorate Transitional professional doctorate Advanced practice professional doctorate Healthcare s Justifications Complexity (safety, quality, outcomes) Curricula Parity Jurisdiction / Scope Pay Autonomy Perceived Negatives Workforce shortage Underrepresentation of minorities Increased education costs Increased employer costs Reimburse service, not degree Patient care delegation Who is a doctor? Degree creep Healthcare s Who are the driving forces behind the development of entry level professional practice doctorates? Health Professions Organizations Academic Institutions Siller and Randolph. A Clinical Look at Clinical s. The Chronicle of Higher Education
6 Health Professions Doctoral Education ATEC 2013 THE HEALTH PROFESSIONS EDUCATION GAP The Education GAP Healthcare practice requires a continuum of learning (Dreyfus model). Novice Advanced Beginner Competent Proficient Expert Leach, Qual Health Care,
7 The Education GAP Knowledge Continuum Professional GAP Enter Into Move Out of Expert Scholar The Education GAP Knowledge Continuum Professional Residency Programs GAP NOVICE PROFICIENT Advanced Clinical? Expert Scholar The Education GAP The vision for the future of US healthcare is highly complex Novice Clinicians Proficient Clinicians PhD scholars? Institute of Medicine. The Learning Health System and it s Innovation Collaboratives
8 The Education GAP Institute of Medicine. The Learning Health System and it s Innovation Collaboratives The Education GAP What is missing because of this gap? Patient oriented research, comparative effectiveness research Translation of research into clinical practice Highly educated clinical experts Health policy expertise Organizational and systems leadership Information technology» Institute of Medicine. Learning What Works: Infrastructure Required for Comparative Effectiveness : Workshop Summary. 2011» National Center for Resources. NCRR Strategic Plan : Translating from Basic Discovery to Improved Patient Care ATEC 2013 THE ADVANCED PRACTICE DOCTORATE 8
9 Advanced A Model: The Doctor of Nursing (DNP) Designed to prepare experts in specialized advanced nursing practice Focus on practice that is innovative and evidencebased, reflecting the application of credible research findings American Association of Colleges of Nursing. The Essentials of Doctoral Education for Advanced Nursing Advanced Intended outcomes include: Advanced competencies for increasingly complex clinical, faculty and leadership roles; Enhanced knowledge to improve patient outcomes; Enhanced leadership skills; Advanced educational credential Increased supply of faculty for clinical instruction» American Association of Colleges of Nursing. Position Statement on the in Nursing Advanced 9
10 Advanced Knowledge Continuum Professional Residency Programs GAP NOVICE PROFICIENT Advanced Clinical Expert Scholar Advanced Knowledge Continuum Professional Residency Programs NOVICE PROFICIENT Advanced Clinical Expert Scholar Advanced Knowledge Continuum Professional Residency Programs Advanced NOVICE PROFICIENT Advanced Clinical EXPERT Expert Clinical Leadership Expert Scholar 10
11 Part 1 Conclusions A convincing case can be made that the professional doctorate has a clearly defined place in the hierarchy of US higher education Particularly in the health care professions there is an obvious need to create capacity to educate practitioners and those who will primarily be educating practitioners Higher Learning Commission. Report of the Task Force on the Professional Part 1 Conclusions The PhD is the degree of the professional scholar, The advanced professional practice doctorate is the degree of the scholarly professional» United Kingdom Council on Graduate Education. Professional Awards in the UK ATEC 2013 END OF PART 1 11
12 Part 2 Objectives 1. Identify and discuss potential advantages and disadvantages of practice doctorates in AT; 2. Propose and explain a taxonomy and common terminology for doctoral education in AT; 3. Propose a set of model program outcomes & curricular offerings for post-professional practice doctoral degrees in AT. Advanced Advanced Clinical Knowledge and Patient-centered care Interprofessional collaboration EBP Quality Informatics Policy Professionalism AT 12
13 ATEC 2013 AT DEGREE LANDSCAPE Historic Current Residencies Professional: Baccalaureate Post- Professional Master s PP Competencies Specialty Certification Advanced Discipline Boundary Emerging: ELM Residencies Professional: Baccalaureate Post- Professional Master s Specialty Certification Advanced Discipline Boundary 13
14 Manspeaker & Van Lunen, 2011 Emerging: ELM Residencies Professional: Baccalaureate Master s Post- Professional Master s Specialty Certification Advanced Discipline Boundary ATEC 2013 DEGREE OPTIONS 14
15 Option 1: Master s Degree Residencies Professional: Master s Post- Professional Master s Specialty Certification Advanced Discipline Boundary Curricular Content 1 13 Outcomes Course Yes No NA 5 9 EBP Course Curricular Size Relevance 15
16 Option 2: s Residencies Professional: Master s Specialty Certification Advanced Discipline Boundary 13 Degree Programs Kinesiology: 6 ExSS: 1 Human Movement / Performance: 2 Rehab Sciences: 1 Education: 1 Interdisciplinary: 2 AT Body of Evidence 88% Level 3 evidence 11% POEM 19% use Patients 75% controlled / descriptive laboratory study Parsons, Snyder, et al, JAT Suppl,
17 Option 3: Entry-Level Residencies Professional: Professional: Master s Specialty Certification Advanced 17
18 Source: Fact Sheet Physical Therapist Education Programs, CAPTE Autonomous Not a professional goal Not consistent with: Current practice complexity Regulatory environment ATEC 2013 OPTION 4: ADVANCED PRACTICE DOCTORATE IN AT 18
19 Option 4: Advance Residencies Professional: Master s Advanced Specialty Certification Advanced Discipline Boundary Faculty Clinical Education Coordinators Clinical Preceptors Industry Leaders Liaisons Scholarly professionals Clinically-oriented scholars Enrollment 19
20 General Observations DAT Key to Vision Quest Require Future Directions implementation Facilitated by move to ELM Bridge clinician faculty gap Concerns 1. Structural inflexibility 2. Resource intensive 3. Qualified faculty 4. Expense 5. Industry / employer reaction 6. Production capacity 7. Specialization Part 2: Conclusions Advanced practice gap Legitimate & recognized Avoids difficulties of EL doctorate Will require profession-wide support, coordination, and monitoring 20
21 ATEC 2013 QUESTIONS? 21
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