Applying an Equity Framework to Physical Therapy Education A Case for Culturally Responsive Teaching N Yamaguchi , KA Yamada , R Yamaguchi 1
2
Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA 2
University of North Carolina Greensboro, Office of Research and Engagement, Arlington, VA E-mail: norikoya@pt.usc.edu http://pt.usc.edu
PURPOSE
Figure 1: Equity Framework in Physical Therapy Education Inputs
Improving equity in physical therapy education not only refers to changing what we teach, but also how we teach. With the recognition that our student body will only continue to increase in diversity, adapting teaching methodology and practices is an essential component of equity initiatives. The poster describes specific classroom supports within the equity framework and summarizes its impact on student and faculty engagement and student performance in a first-year clinical laboratory class.
Circle of Influence
Equity Mindsets
DESCRIPTION
An equity framework recognizes the need for structural, instructional, and curricular supports to ensure that each student is thriving, not just surviving, in their program (Yamaguchi et al., 2017). Figure 1 illustrates the equity framework model, where the fundamental goal is to positively impact our profession by broadening full participation and success of linguistically and culturally diverse students in physical therapy. We utilized this framework in a Therapeutic Exercise course of 50 students at University of Southern California’s hybrid DPT program in 2021. Key components for the PT Equity Framework included the following integrated supports: • Structural supports focused on implementing a Plan-Do-Study-Act (PDSA) continuous improvement cycle (Bryk et al., 2015) via brief “Exit Ticket” student surveys administered at the end of each class, which included Likert scale and free response questions. Responses to the surveys provided the instructors with weekly formative feedback from students on their learning, and instructors adapted subsequent lessons plans to meet student learning needs. • Instructional supports focused on utilizing inclusive pedagogical practices consistent with culturally responsive teaching (Hammond, 2015) and principles of Universal Design for Learning (CAST, 2018; Chardin & Novak, 2021) to support students’ learning capacity by optimizing student engagement, including students’ psychological meaningfulness, safety, and availability in the classroom. • Curricular supports focused on designing curricular materials that normalize diversity and increase consideration of contextual factors in patient cases, as recommended by Krishnan et al. (2019). This was achieved via inclusion of non-European names, non-binary gender identities, same-sex spouses, representation of patients across the lifespan and across the ability spectrum, and the patients’ social determinants of health, health attitudes and behaviors, and social history. Specific inputs and outputs/outcomes were prioritized. Key inputs included acquisition of adequate knowledge of equity mindsets and proficiency in utilizing continuous improvement cycles by the hybrid class instructors. Effective PT instructional practices was the primary Instructor Output, and a weekly instructor log was used to record, study, and reflect on instructional practices. Student Performance Outcomes focused on assessments, specifically the practical examinations, which reflect students’ cognitive and academic learning of clinical reasoning and case-based application of therapeutic exercise prescription.
Equity Cycles
Students
Networked Improvement Community
Effective PT Department Practices
(1) Structural Supports Plan-Do-Study-Act (PDSA) Continuous Improvement Cycle
Matthews and colleagues (2021) describe the significant lack of representation by Black, Indigenous, and People of Color (BIPOC) physical therapists in our profession despite statements of support of diversity and inclusion. In USC’s DPT program, approximately one in five students are Black/ Brown (Figure 2). Therapeutic Exercise is a clinical course in which students historically excel, with a 3-year average practical exam score of 95%. Each year, however, a few students require remediation and retesting after the practical exam due to poor performance. Before adopting the equity framework, Black and Brown students were underrepresented in the DPT program but overrepresented in students requiring remediation and retakes of the practical exams. The goal of adopting the equity framework was to improve student outcomes and decrease racial performance gaps. After adopting the equity framework, the overall number of students requiring remediation and retesting did not change. However, the number of Black and Brown students requiring retesting decreased to zero (Figure 3).
Effective PT Instructional Practices
Student Learning Outcomes
(2) Instructional Supports Pedagogy to Develop Learning Capacity of Students
SUMMARY OF USE
Instructor Outputs
Key Components for the PT Equity Framework
Pedagogy to Build Relational Trust with Students
Cognitive Development
Academic Development
Social Development
Emotional Development
Student Performance Outcomes Access & Opportunity
IMPORTANCE TO MEMBERS
Assessments
(3) Curricular Supports Impact Diverse Patient Case Studies and Curricular Materials
Figure 2: Black and Brown students are under-represented in USC’s hybrid DPT program
Broadening Participation of Culturally and Linguistically Diverse Students in PT
Figure 3: Decrease in exam retakes among Black and Brown students after adopting an equity framework 15
2019
17
83
25
2020
Before the equity framework
75
Percent retakes
1
1
After the equity framework
10
5
REFERENCES
0 2021
16
84
2019
All students % Black/Brown students
% Non‐Black/Brown
Our preliminary results based on the first year of adopting an equity framework suggests that implementing inclusive teaching practices and applying UDL enhanced the effectiveness of PT instruction, which is consistent with similar findings in other STEM fields (Canelas et al., 2017). The structural, instructional, and curricular supports utilized in Therapeutic Exercise produced positive student outcomes for Black and Brown PT students without negative impacts to the overall student body. Based on our initial outcomes, the equity framework holds promise across all course types (basic science, evidence-based practice, clinical, ethics) in decreasing performance gaps and achieving equity goals in DPT education. Future studies will continue to assess the influence of the inputs and outputs/outcomes of this framework, expand upon the current structural, instructional, and curricular supports, and apply this framework in other courses within the hybrid DPT program. We encourage other PT educators and programs to adopt an equity framework for our profession to truly be able to positively impact the participation and success of our increasingly diverse PT student body.
2020
Black/Brown students
2021
Available upon request. Please contact lead author.
Applying an equity framework to physical therapy education: a case for culturally responsive teaching Noriko Yamaguchi, PT, DPT a* Kimiko Yamada, PT, DPT b Ryoko Yamaguchi, PhD c a
University of Southern California, Los Angeles, CA;
b
University of Southern California, Los
Angeles, CA; c University of North Carolina Greensboro, Arlington, VA * Corresponding author: Noriko Yamaguchi. Email: norikoya@pt.usc.edu
Purpose
Improving equity in physical therapy education not only refers to changing what we teach, but also how we teach. With the recognition that our student body will continue to increase in diversity, adapting teaching methodology and practices is an essential component of equity initiatives. The poster describes specific classroom supports within an equity framework and summarizes its impact on student and faculty engagement and student performance in a first-year clinical laboratory class.
Description: Equity Framework in PT Education
An equity framework recognizes the need for structural, instructional, and curricular supports to ensure that each student is thriving, not just surviving, in their program (Yamaguchi et al., 2017). Figure 1 illustrates the equity framework model, where the fundamental goal is to positively impact our profession by broadening full participation and success of linguistically and culturally diverse students in physical therapy. We utilized this framework in a Therapeutic Exercise course with a total enrollment of 50 students at University of Southern California’s hybrid DPT program in 2021. Key components for the PT Equity Framework included the following integrated supports: • Structural supports focused on implementing a Plan-Do-Study-Act (PDSA) continuous improvement cycle (Bryk et al., 2015) via brief “Exit Ticket” student surveys administered at the end of each class, which included Likert scale and free response questions. Responses to the surveys provided the instructors with weekly formative feedback from students on their learning, and instructors adapted subsequent lessons plans to meet student learning needs. • Instructional supports focused on utilizing inclusive pedagogical practices consistent with culturally responsive teaching (Hammond, 2015) and principles of Universal Design for Learning (CAST, 2018; Chardin & Novak, 2021) to support students’ learning capacity
•
by optimizing student engagement, including students’ psychological meaningfulness, safety, and availability in the classroom. Curricular supports focused on designing curricular materials that normalize diversity and increase consideration of contextual factors in patient cases, as recommended by Krishnan et al. (2019). This was achieved via inclusion of non-European names, non-binary gender identities, same-sex spouses, representation of patients across the lifespan and across the ability spectrum, and the patients’ social determinants of health, health attitudes and behaviors, and social history.
Specific inputs and outputs/outcomes were prioritized. Key inputs included acquisition of adequate knowledge of equity mindsets and proficiency in utilizing continuous improvement cycles by the hybrid class instructors. Effective PT instructional practices was the primary Instructor Output, and a weekly instructor log was used to record, study, and reflect on instructional practices. Student Performance Outcomes focused on assessments, specifically the practical examinations, which reflect students’ cognitive and academic learning of clinical reasoning and case-based application of therapeutic exercise prescription. Figure 1: Equity framework in physical therapy education
Summary of Use
Matthews and colleagues (2021) describe the significant lack of representation by Black, Indigenous, and People of Color (BIPOC) physical therapists in our profession despite statements of support of diversity and inclusion. Figure 2: Black and Brown students are underrepresented in In USC’s DPT program, USC's hybrid DPT program approximately one in five students are Black/Brown (Figure 2). Therapeutic Exercise is a clinical course in which students historically excel, with a 3-year average practical exam score of 95%. Each year, however, a few students require remediation and retesting after the practical exam due to poor performance. Before adopting the equity framework, Black and Brown students were underrepresented in the DPT program but overrepresented in students requiring remediation and retakes of the practical exams. The goal of adopting the equity framework was to improve student outcomes and decrease racial performance gaps. Figure 3: Decrease in exam retakes among Black and Brown students after adopting an equity framework in a After adopting the equity Therapeutic Exercise Lab Course framework, the overall number of students requiring remediation and retesting did not change. However, the number of Black and Brown students requiring retesting decreased to zero (Figure 3).
Importance to Members
Our preliminary results based on the first year of adopting an equity framework suggests that implementing inclusive teaching practices and applying UDL enhanced the effectiveness of PT instruction, which is consistent with similar findings in other STEM fields (Canelas et al., 2017). The structural, instructional, and curricular supports utilized in Therapeutic Exercise produced positive student outcomes for Black and Brown PT students without negative impacts to the overall student body. Based on our initial outcomes, the equity framework holds promise across all course types (basic science, evidence-based practice, clinical, ethics) in decreasing performance gaps and achieving equity goals in DPT education. Future studies will continue to assess the influence of the inputs and outputs/outcomes of this framework, expand upon the current structural, instructional, and curricular supports, and apply this framework in other courses within the hybrid DPT program. We encourage other PT educators and programs to adopt an equity framework for our profession to truly be able to positively impact the participation and success of our increasingly diverse PT student body.
References Bryk, A. S., Gomez, L. M., Grunow, A., & LeMahieu, P. G. (2015). Learning to Improve: How America's Schools Can Get Better at Getting Better. Cambridge, MA: Harvard Education Press. Canelas, D. A., Hill, J. L., & Novicki, A. (2017). Cooperative learning in organic chemistry increases student assessment of learning gains in key transferable skills. Chemistry Education Research and Practice, 18(3), 441-456. doi:10.1039/C7RP00014F CAST. (2018). Universal Design for Learning Guidelines (version 2.2). Retrieved from http://udlguidelines.cast.org Chardin, M., & Novak, K. (2021). Equity by Design: Delivering on the Power and Promise of Universal Design for Learning (UDL). Thousand Oaks, CA: Corwin. Hammond, Z. (2015). Culturally Responsive Teaching and the Brain. Thousand Oaks, CA: Corwin. Krishnan, A., Rabinowitz, M., Ziminsky, A., Scott, S. M., & Chretien, K. C. (2019). Addressing race, culture, and structural inequity in medical education: A guide for revising teaching cases. Academic Medicine, 94(4), 550-555. doi:10.1097/ACM.0000000000002589 Matthews, N. D., Rowley, K. M., Dusing, S. C., Krause, L., Yamaguchi, N., & Gordon, J. (2021). Beyond a statement of support: changing the culture of equity, diversity, and inclusion in physical therapy. Physical Therapy, 101(12), pzab202. doi:10.1093/ptj/pzab212 Yamaguchi, R., Avery, L., Cervone, J., Dimartino, L., & Hall, A. C. (2017). Adaptive Implementation: Navigating the School Improvement Landscape. Lanham, MD: Rowman & Littlefield.