Lisa L Black

Up to 85% of health is governed by social determinants such as economic stability. By supporting healthy financial behavior changes to increase economic stability, the Financial Success Program (FSP) is a modality that also addresses the limitations of other health interventions in single mother, low-income households. The novel FSP financial education/coaching intervention has previously been shown to reduce financial strain and perceived effects of financial strain on health, improve relationships, reduce smoking and increase healthcare access. This manuscript reports the financial and economic stability outcomes of the first randomized controlled trial to assess the impact of the FSP financial education/coaching model in 345 single mother low-income households. FSP participants experienced the following positive economic outcomes compared with control participants: significantly greater increases in mean salary and household income; greater increases in savings; larger reductions in the inability to save money; larger reductions in shut off notices and utility balances; greater increases in paying bills on time, reductions in partial payments, late fees, and overdrawn bank accounts; greater increases in effective monthly cashflow management and decreases in counterproductive financial behaviors. FSP significantly built participants' capacity to increase income, emergency savings and retirement savings. The FSP model fosters beneficial financial behaviors while diminishing detrimental financial behaviors, as compared to usual care. By mitigating financial stress, individuals graduating from the FSP increase their capability to plan ahead and think more clearly about financial decisions to improve economic stability, and ultimately overall health.

An evolving conceptualization of clinical reasoning in physical therapy emphasizes the embodied, adaptive, iterative, and collaborative elements of clinical reasoning that personifies physical therapist practice. Contemporary clinical reasoning frameworks have primarily focused on cognitive processes, while overlooking the centrality of movement and the multisensory, collaborative interactions between physical therapists and patients. Recent research highlights the need for a framework that incorporates the bidirectional, sensory-rich exchange integral to clinical reasoning. It is also necessary to create new educational approaches to develop the fundamental skills crucial for embodied clinical reasoning in learners along the professional education continuum. Application of complexity learning theory and Grossman's pedagogies of practice are proposed as the foundation for an education framework that fosters a dynamic, nonlinear, learning approach, promoting exploration and integration of complex clinical reasoning and movement in practice.

Clinical reasoning is a cornerstone of physical therapist education, yet current frameworks often fail to capture its complexity and holistic nature. Traditional approaches primarily emphasize cognitive aspects, overlooking the interconnected and multifaceted components of reasoning. This EduGraphic serves as a valuable tool for both didactic and clinical educators, providing a comprehensive visual representation that makes the depth and breadth of clinical reasoning explicit to learners. It highlights the dynamic interplay between cognitive, sensory, and interpersonal elements, emphasizing the essential role of multisensory communication between the therapist and patient.ABSTRACTClinical reasoning is a cornerstone of physical therapist education, yet current frameworks often fail to capture its complexity and holistic nature. Traditional approaches primarily emphasize cognitive aspects, overlooking the interconnected and multifaceted components of reasoning. This EduGraphic serves as a valuable tool for both didactic and clinical educators, providing a comprehensive visual representation that makes the depth and breadth of clinical reasoning explicit to learners. It highlights the dynamic interplay between cognitive, sensory, and interpersonal elements, emphasizing the essential role of multisensory communication between the therapist and patient.

This Perspective provides a crucial set of actions with corresponding recommendations aimed at propelling the physical therapy profession toward excellence in residency education. The conceptual model includes elements of excellence in the delivery and outcomes of physical therapist residency education and the domain of value experienced by stakeholders impacted by physical therapist residency education. Linked to the conceptual model, the 15 actions, and 28 recommendations draw from (1) the Physical Therapist Residency Excellence and Value (PT-REV) study, (2) the Physical Therapist Education for the 21st Century (PTE-21) study, and (3) research in the learning sciences. This paper proposes a transformative call for decisive and consistent reform directed toward residency programs, residents, sponsoring organizations, and the physical therapy profession. Physical therapist residency education, initiated over 23 years ago, is no longer in its infancy with critical gaps in its maturation that need to be addressed systematically by stakeholders across the profession, thus improving the profession's ability to respond to changing societal needs. This Perspective serves as a call to action and provides specific recommendation for what is needed to promote and achieve excellence in physical therapist residency education to improve the professions' ability to adapt to changing societal needs. Keywords: Adaptive Expertise, Education: Postprofessional, Excellence, Master Adaptive Learning, Organizational Culture, Practice-Based Learning, Professional Formation, Residency, Value, Workforce

Objective. A challenge in health professions is training practitioners to navigate health care complexities, promote health, optimize outcomes, and advance their field. Physical therapist residency education offers a pathway to meet these needs in ways that "entry-level" (professional) education may not. Identifying key aspects of excellence in residency education and understanding its value in developing adaptive expertise will help devise strategies to enhance program, resident, and patient outcomes. The objective of this study was to examine current physical therapist residency education practices to identify and describe examples of excellence and value. Methods. A multi-site, multi-specialty qualitative case series was conducted, examining exemplary physical therapist residency programs and their contextual environments using a social constructivist theoretical lens. Six residency programs operating 20 individual residencies that were considered exemplar were selected for the study to participate in site visits. Qualitative case studies were generated from individual interviews, focus groups, review of artifacts, and field observations. The residencies were diverse in specialty area of practice, setting, and geographic location. Results. A conceptual framework was generated grounded in the domains of excellence and value. These domains were connected by 3 signature indicators: (1) atmosphere of practice-based learning, (2) embodiment of professional formation, and (3) elevated practice. These signature indicators represent the aggregate effects of the interchange between the excellence and value domains which sustain residency education. Conclusion. This study builds upon the work of the Physical Therapist Education for the 21st Century (PTE-21) study and identifies key elements of excellence in residency education, the value of such education, and related outcomes. Findings from this study substantiate the need for a postprofessional phase of physical therapist education founded in practice-based learning encapsulated in residency education. Impact. Results from this study could have compelling and powerful implications on the dialogue and strategic direction in physical therapist residency education. Keywords: Adaptive Expertise, Education: Postprofessional, Excellence, Master Adaptive Learning, Organizational Culture, Practice-Based Learning, Professional Formation, Residency, Value, Workforce

This Perspective provides a crucial set of actions with corresponding recommendations aimed at propelling the physical therapy profession toward excellence in residency education. The conceptual model includes elements of excellence in the delivery and outcomes of physical therapist residency education and the domain of value experienced by stakeholders impacted by physical therapist residency education. Linked to the conceptual model, the 15 actions, and 28 recommendations draw from (1) the Physical Therapist Residency Excellence and Value (PT-REV) study, (2) the Physical Therapist Education for the 21st Century (PTE-21) study, and (3) research in the learning sciences. This paper proposes a transformative call for decisive and consistent reform directed toward residency programs, residents, sponsoring organizations, and the physical therapy profession. Physical therapist residency education, initiated over 23 years ago, is no longer in its infancy with critical gaps in its maturation that need to be addressed systematically by stakeholders across the profession, thus improving the profession's ability to respond to changing societal needs. This Perspective serves as a call to action and provides specific recommendation for what is needed to promote and achieve excellence in physical therapist residency education to improve the professions' ability to adapt to changing societal needs.

A challenge in health professions is training practitioners to navigate health care complexities, promote health, optimize outcomes, and advance their field. Physical therapist residency education offers a pathway to meet these needs in ways that "entry-level" (professional) education may not. Identifying key aspects of excellence in residency education and understanding its value in developing adaptive expertise will help devise strategies to enhance program, resident, and patient outcomes. The objective of this study was to examine current physical therapist residency education practices to identify and describe examples of excellence and value. A multi-site, multi-specialty qualitative case series was conducted, examining exemplary physical therapist residency programs and their contextual environments using a social constructivist theoretical lens. Six residency programs operating 20 individual residencies that were considered exemplar were selected for the study to participate in site visits. Qualitative case studies were generated from individual interviews, focus groups, review of artifacts, and field observations. The residencies were diverse in specialty area of practice, setting, and geographic location. A conceptual framework was generated grounded in the domains of excellence and value. These domains were connected by 3 signature indicators: (1) atmosphere of practice-based learning, (2) embodiment of professional formation, and (3) elevated practice. These signature indicators represent the aggregate effects of the interchange between the excellence and value domains which sustain residency education. This study builds upon the work of the Physical Therapist Education for the 21st Century (PTE-21) study and identifies key elements of excellence in residency education, the value of such education, and related outcomes. Findings from this study substantiate the need for a postprofessional phase of physical therapist education founded in practice-based learning encapsulated in residency education. Results from this study could have compelling and powerful implications on the dialogue and strategic direction in physical therapist residency education.

Introduction. The definition of excellence in physical therapy (PT) education is evolving, yet the role of postprofessional residency education remains uncertain. Arguments in favor of required residency have emerged through the re-visioning of PT education across the continuum. Yet, little evidence exists whether residency education further develops clinical skills, clinical knowledge, and clinical reasoning abilities. Review of Literature. Previous studies have explored the development of the novice physical therapist in the first 2 years of practice; however, there is little evidence about the outcomes of PT residency education. Thus, this study looked to explore the development of learners through their residency education and to identify the critical elements of the teaching and learning environment in residency education. Subjects. Eleven PT residency programs and 13 residents participated in a qualitative study to explore the learner development through residency. Each residency program consisted of a residency program director, one or more mentors identified by the residency program director, and at least one physical therapist resident. Semistructured interviews were conducted with program participants, and journal entries were collected from residents. Methods. Using a purposeful sample of convenience, an exploratory, multiple-site/specialty area qualitative case study design was conducted. Results. Three emerging themes were identified including growth of self, becoming a member of the community of practice, and facilitation of learning through mentoring. Through the transformative journey of residency education, there are critical elements of the learning environment supporting deep learning within the community of practice. These elements include the provision of opportunities and adequate time and space for learning to occur. Discussion and Conclusion. The intentional design of the community of practice through residency education facilitates the development of the novice clinician to experienced clinician in an accelerated period of time. In addition, residency graduates develop characteristics similar to adaptive learners through planned teaching and learning opportunities. Finally, the structure of residency education mattered to the resident participants such that the learning environment enhanced peer learning and the development of professional relationships.

OBJECTIVEThe purpose of this study was to explore how physical therapists use movement as a component of their clinical reasoning. Additionally, this research explored whether movement as a component of clinical reasoning aligns with the proposed signature pedagogy for physical therapy education, human body as teacher. METHODSThe study utilized qualitative, descriptive methods in a multiple case studies design (each practice setting represented a different case for analysis purposes) with cross-case comparisons. Researchers conducted 8 focus groups across practice settings including acute care, inpatient neurological, outpatient orthopedics and pediatrics. Each focus group had 4-6 participants. Through an iterative, interactive process of coding and discussion among all researchers, a final coding scheme was developed. RESULTSThrough exploration of the research aims, 3 themes emerged from the data. These primary themes are: (1) movement drives clinical reasoning to optimize function; (2) reasoning about movement is multisensory and embodied; and (3) reasoning about movement relies on communication. CONCLUSIONSThis research supports a description of movement as the lens used by physical therapists in clinical reasoning, and the integral role of movement in clinical reasoning and in learning from and through movement of the human body, while learning from clinical reasoning experiences in practice. IMPACTAs the understanding of the ways physical therapists use and learn from movement in clinical reasoning and practice continues to emerge, it is important to continue exploring ways to best make this expanded, embodied conception of clinical reasoning explicit in the education of future generations of physical therapists.