Department of Physical Therapy, College of Saint Mary, Omaha, Nebraska, USA.
Phys Ther. 2024 Sep 4;104(9). doi: 10.1093/ptj/pzae103.
Patient history assists clinicians in determining the most appropriate tests to identify the symptoms' source and select appropriate interventions. Therefore, a subjective history is an essential component of patient management. When physical therapist practitioners transition into academia, they must understand how the history of the education system may affect learners. Health disparities are related to the lack of workforce diversity and skills in cultural responsiveness, and the education system is critical in addressing the impact of future providers on health disparities. Developing a doctor of physical therapy program to address health disparities requires an analysis of the historical context of the US educational and health care systems, along with traditional components of physical therapist education. This country's education system was built upon a 2-tiered system, where minoritized individuals struggled to overcome barriers imposed by legislation and societal beliefs. Jim Crow laws continued this unequal access to education, and the recent Supreme Court ruling to deny race-based affirmative action continues these inequities. This historical context informed the construction of the College of Saint Mary Doctor of Physical Therapy Program. The program's mission led to using less traditional educational approaches; thus, the pillars of practice took form. The 5 pillars evolved to include social determinants, inclusive faculty and student recruitment and retention practices, equitable grading, culturally responsive pedagogy, and community development. The purpose of this paper is to present a historical overview of the US education system and its influence on physical therapist education. Furthermore, it will illustrate how this historical context inspired the 5 Pillars of Community Practice from College of Saint Mary and discuss the challenges and interventions related to these pillars. There are tremendous disparities in educational outcomes and patient services in the United States. Disparities are most significant in those with historically marginalized identities. If those disparities are to improve, a change is required in the people providing care to patients. The best way to accomplish this is by transforming how future providers are educated.
患者病史有助于临床医生确定最合适的检查，以确定症状的来源，并选择适当的干预措施。因此，主观病史是患者管理的重要组成部分。当物理治疗师从业者过渡到学术界时，他们必须了解教育系统的历史如何影响学习者。健康差距与劳动力多样性和文化响应能力的缺乏有关，教育系统对于解决未来医疗服务提供者对健康差距的影响至关重要。制定解决健康差距的物理治疗博士课程需要分析美国教育和医疗保健系统的历史背景，以及物理治疗师教育的传统组成部分。这个国家的教育系统建立在一个两级制的基础上，少数群体在立法和社会观念强加的障碍面前举步维艰。吉姆·克劳法（Jim Crow laws）继续使这些人无法平等地接受教育，而最近最高法院拒绝基于种族的平权行动的裁决则延续了这些不平等。这一历史背景为圣玛丽学院物理治疗博士课程的构建提供了信息。该课程的使命导致采用了不太传统的教育方法；因此，实践的支柱得以形成。这 5 个支柱演变成包括社会决定因素、包容的教师和学生招聘和保留实践、公平的评分、文化响应教学法和社区发展。本文的目的是介绍美国教育系统的历史概况及其对物理治疗师教育的影响。此外，它将说明这种历史背景如何激发了圣玛丽学院的社区实践 5 大支柱，并讨论与这些支柱相关的挑战和干预措施。在美国，教育成果和患者服务存在巨大差距。在历史上处于边缘地位的人群中，差距最为显著。如果要改善这些差距，就需要改变为患者提供护理的人员。实现这一目标的最佳方法是改变未来医疗服务提供者的教育方式。
