ON A BRUTALLY COLD January morning, Paula Bendry Larsen ’64 was waist high in the swimming pool at the Courage Kenny Rehabilitation Institute in Stillwater. Three students from St. Catherine University’s Doctor of Physical Therapy (DPT) program had their eyes glued on her. This was Larsen’s third round of rehabilitation after a surgical procedure left her paralyzed.
“What do you notice about how she’s walking? What can you see?” asks Meg Erlandson MPT’96, DPT’07, the clinical faculty assigned to work with Sarah Anderson DPT’16, Justine Eggers DPT’16 and Kevin Kosel DPT’16.
A physical therapist and clinical specialist for Allina Health, Erlandson has played an instrumental role in St. Kate’s Integrated Clinical Education (ICE) program since its inception in 2003. This nationally known program exposes DPT students to real world, clinical settings starting in the second week of their first year.
“St. Kate’s students are coming into their first full-time clinical placement [at the end of the first year] more confident,” says Erlandson, “And with some of those initial jitters or unfamiliarity gone, they can really hit the ground running.
Under the ICE model, students travel on a weekly basis to clinical sites in groups of three and work directly with patients under the supervision of a clinical faculty member — a working professional, like Erlandson, at one of St. Kate’s healthcare partners. During that first year, the students will rotate through four areas of specialty: acute, outpatient orthopedic, neurological and subacute.
Back in the pool, Anderson, Eggers and Kosel each take a turn accompanying Larsen in her careful journey across one length and back. This is the students’ exposure to a neurological setting.
“In the pool, we were working on her balance and building up strength in her leg muscles, and learning how those went together so she could eventually walk better on land,” says Anderson.
Larsen had laminectomy surgery to remove a tumor on her spine. The day after surgery, the prognosis was encouraging because she could wiggle her toes. But by day two, she couldn’t move her legs. After a round of acute rehab at Mayo, followed by subacute care at Courage Kenny Rehabilitation Institute in Golden Valley, Larsen was in the homestretch with her outpatient treatment in Stillwater.
“This was the second time we worked with Paula — the first time was on land,” notes Anderson. “It’s really interesting to see the difference of her being in water and her being able to walk without a device to keep her moving forward.” When Anderson enrolled in St. Kate’s DPT program, she wanted to work in pediatrics. But after her experience with Larsen, she’s keeping her options open. “I love this work in the neuro setting as well,” she says. “Paula is so wonderful to work with. She’s so willing to take our questions, which is so great for the learning process.”
Boldly going where few have gone
When St. Kate’s moved from a master’s to doctoral level, it ignited a conversation among faculty leaders about how physical therapy should be taught at the University.
“Did we want to just tweak the curriculum to fit a doctoral standard, or did we want to take the opportunity to reconsider not just what we teach, but how we teach it,” says Deb Sellheim, DPT professor and curriculum director. After a faculty taskforce examined the options, the decision was clear: it was time to move in a bold new direction and adopt a fully integrated approach. ICE, that clinical component for first-year students, would become a key piece of the revamped three-year curriculum.
Unlike traditional DPT programs that provide separate classes in anatomy, neuroscience and kinesiology, St. Kate’s integrated model organizes classes around a practice setting (such as outpatient, acute, rehabilitation) and weaves all those topics together. In the Outpatient I course, for example, students focus primarily on the shoulder and learn its structure (anatomy) as well as how it moves (kinesiology) and how the nerves attached to it are affected (neuroscience).
“They’re also learning how to evaluate a shoulder problem, common shoulder pathologies, basic interventions to treat those pathologies, how to document, patient care in outpatient settings, and the legal and ethical aspects of that setting,” explains Sellheim.
Students see the relevance of their work quickly, especially when all the elements are revisited with each course. “This spiral model allows us to come back and increase the complexity of topics with each course,” says Sellheim. “Research shows, and we’ve found as well, that retention goes up when things are revisited.”
Two recent articles, authored by Sellheim and Mary Weddle, faculty emerita and former clinical education director, in the Journal of Physical Therapy Education spurred interest among other universities. However, few have actually adopted the integrated approach.
“As soon as they discover the commitment required by faculty, the intense collaboration and complicated scheduling, they tend to back away,” says Sellheim.
“A lot of faculty members don’t want to work that closely together.” Under the integrated model, Sellheim and her colleagues don’t have a regular schedule — for instance, they don’t always teach a Monday, Wednesday, Friday class at 9 a.m. Their daily schedules vary according to where students are in the course. And if one aspect in the timeline shifts, the trickle down affects the entire team.
The decision to deliberately integrate all parts of the curriculum — from coursework to the ICE program to the PT/PTA relationship (see sidebar) — has paid off for students. In an annual survey conducted since the DPT’s first graduating class in 2006, more than half of employers consistently rank St. Kate’s grads as superior to hires from other programs.
The DPT program at St. Catherine University runs 11 months per year over three years, and a new cohort of 34 students begins each year after Labor Day. Many are drawn to the progressive curriculum.
“I’m a very ‘do-it’ kind of learner,” says Beth McMillan DPT’15. “I like the integrated approach — how everything is pulled together in one class. And the ICE program is a great opportunity to get my hands on patients and try things that we are
just learning in the classroom.”
Back on her feet
Having students around can be empowering for Erlandson’s clients, who, like Larsen, face a long road to recovery despite reaching outpatient status.
“It’s like an unintended gift,” she says. “I’ve had clients tell me that for the first time during their recovery process, they feel like they were giving back. I’m so fortunate to have an employer that recognizes the benefit of providing learning and mentoring opportunities to students. This allows me to open up my schedule one afternoon a week to make this happen.”
Larsen was already game to work with students, but the fact that they were from her alma mater was icing on the cake. “I love that St. Kate’s students are part of this process,” says Larsen. “To see the lights go on for them when it’s real — when they get how important their jobs will be — that’s priceless.”
Six months after she started that last round of rehabilitation, Larsen no longer needed the wheelchair. In June, she walked across the stage at Reunion, and with a cane in hand accepted her 2014 Alumnae Award from St. Kate’s president. “To tell you the truth, had you asked me a year ago, I wouldn’t have believed I’d be walking,” she says. “But through support from family and friends, a lot of hard work and wonderful PTs along the way — so many of them Katies — I did it!”
Today, she’s retired the cane and is driving again. Her formal physical therapy sessions are over. However, Larsen is still working on improving her gait so she can resume tennis and her mission work — her trip to South Africa is already booked.
Online Extra: Leading the Pack
St. Kate’s is one of only a half dozen universities in the nation that offer both PTA (physical therapist assistant) and DPT programs, which provides another way to integrate learning: students from both programs periodically work in the classroom together.
“We've been leading the pack in that regard," says Sellheim. "Our students have a huge advantage by graduating with an increased understanding of physical therapist assistants’ educational background, and how to direct and supervise them."
In fact, this knowledge and skill set is so important, that St. Kate's faculty have presented nationally on the PT/PTA relationship.
The decision to deliberately integrate all aspects of curriculum, from the ICE program to coursework to the PT/PTA relationship, has paid off for students. In an annual survey conducted since the program’s first graduating class in 2006, more than half of employers consistently rank St. Kate’s grads as superior than hires from other programs.
The integrated curriculum and ICE program are also deciding factors for students, like Beth McMillan DPT’15, who choose to attend St. Kate’s.
“I’m a very ‘do-it’ kind of learner,” she says. “I like the integrated approach — how everything is pulled together in one class. And the ICE program is a great opportunity to get my hands on patients and try things that we were just learning in the classroom. It was great prep before my first long internship.”
Part of the student-centered approach to education means not only responding to changes in the healthcare marketplace, but also considering the passions of the students and the heart of St. Kate’s mission — social justice. In their third year, DPT students are required to do a service learning experience at one of three locations.
“We have an international site in the Dominican Republic, a national site in Mississippi, and a local site in the Twin Cities,” says Cort Cieminski, professor and anatomy lab director. “They also have the option of volunteering their services at a Native American diabetic foot clinic in the Powderhorn Park neighborhood in Minneapolis. The pro-bono clinic is entirely student run with a faculty preceptor who supervises.”
Student demand for more of these experiences and earlier in their schooling has ignited discussion by faculty on how to better integrate social justice.
“We’ve always had some element of service learning in the curriculum, but we’re staring to be more deliberate in exploring how we integrate this into professional activities,” says Dutton. “We’re so proud that our students and graduates are strong-minded, ethical leaders who are committed to social justice.”
By the numbers
Since 2008, DPT graduates have secured highly competitive residencies in sports,
pediatrics, orthopedics and geriatrics specialties.
From the 2011–13 cohort:
• 270 applicants for 34 spots
• 96% graduated
• 98% of graduates passed the national licensure exam
• 100% of those licensed secured employment