INTRODUCTION

1. CASE REPORT: PROFESSIONAL DEVELOPMENT OF A NOVICE PHYSICAL THERAPIST Susan Cunningham, PT; Mary Knab, PT, DPT Faulkner Hospital and MGH Institute of Health Professions, Boston, MA INTRODUCTION REFLECTIVE PRACTICE COMMUNICATION AND TEAMWORK DISCUSSION In examining LB’s case it becomes apparent that her professional development was strikingly consistent with the current teaching and learning research in the health professions. Formal and informal mentoring can provide the support needed to develop as a clinician, but alone is not enough. Participation with the team, fostering immersion in the professional culture, nurtures professional identity development. With reflection emerging as the basis for critical thinking, self assessment, and lifelong learning, encouragement of reflective practice should also be part of the practice in which the novice is immersed. Facilitated by a schedule and culture on the inpatient service that provided for ready access to the team and her mentors/supervisors, LB thrived. • Novice will have a wide variety of experiences with communication issues, including problems in this domain, and should gain skill as confidence increases. • Communication breakdowns can significantly impact patient care, with novice needing support and ability to reflect-in-, -on-, and -for-action. • Active participation in the interdisciplinary team is essential to professional identity development. • Drawing on personal experience, an exploration of one novice PT’s journey through her first year of practice, and current education literature, the goal of this project was to identify critical elements in the development of reflective practitioners who are lifelong learners. • We attempt to answer the following questions: • What are the needs of the novice clinician as he or she transitions from student to health care professional? • Can we identify best practices to facilitate novice professional development and how do we optimize them? • What are some of the obstacles or barriers, and how might we minimize them? WHY FOCUS ON REFLECTION? • Facilitating reflection can be a means of fostering the development of clinical reasoning skills. • REFLECTION- • -in-action • -on-action • -for-action • Guiding reflection can help the novice clinician learn to ask and answer questions such as: • What occurred in that encounter that resulted in the experience I just had with my patient? • What will I do differently next time? • How can my practice improve? • Competence and confidence • Realization of sound clinical decision making can lead to increased confidence in one’s ability to practice competently. To optimize learning and development, the novice must be actively engaged in the practice community. METHODS This case analysis is based on qualitative data consisting of LB’s personal recollection of and reflections on her first year of clinical practice, as reported to the author in two semi-structured interviews and numerous lunchtime conversations. Analyzed for major themes, these data validate the findings of a comprehensive literature review exploring novice to expert development, teaching and learning best practices, reflection and reflective practice, and the role of communities of practice. PROFESSIONAL RELEVANCE As this case illustrates, reflection, engagement with the team, and immersion in the professional culture are critical to the novice clinician’s learning and development. Conscious attention to formal and informal mentoring, inclusion in team process, and focused reflection and self-assessment can, thus, set the stage for a career of lifelong learning and development. By engaging our novice practitioners in this way, we can facilitate the assimilation of the values and beliefs of the profession. Reflection is necessary to learn from one’s own practice and to think critically. PROFESSIONAL SOCIALIZATION RESULTS: MAJOR THEMES • Analysis of the case data, when integrated with the literature, reveals four themes which, while discussed separately here, contain overlap and are not mutually exclusive. They are: • Reflection / Reflective Practice • Communication and Teamwork • Professional Socialization • The importance of the professional culture can be seen in this novice clinician’s experience where she experienced… • SUCCESS on the inpatient service, having had mentoring that included: • Encouragement and support • Ongoing evaluative feedback • Access to supervisors and peers, • Participation as full fledged member of the inpatient team • FAILURE on outpatient service, having had: • Inadequate access to mentors and peers • Lack of necessary professional engagement and interaction within the outpatient culture • Elements necessary for development of reflective practice: • Intellectually and emotionally supportive environment • Authentic context • Support for differences in learning styles • Mentoring • Peer discussions • Freedom for expression of opinions • Mann, et al, 2007. SELECTED REFERENCES Atkinson, H. L., & Nixon-Cave, K. (2011). A tool for clinical reasoning and reflection using the international classification of functioning, disability and health (ICF) framework and patient management model. Physical Therapy Journal of the American Physical Therapy Association, 91(3), 416. Black, L. L., Jensen, G. M., Mostrom, E., Perkins, J., Ritzline, P. D., Hayward, L., et al. (2010). The first year of practice: An investigation of the professional learning and development of promising novice physical therapists. Physical Therapy Journal of the American Physical Therapy Association, 90(12), 1758. Mann, K., Gordon, J., & MacLeod, A. (2007). Reflection and reflective practice in health professions education: A systematic review. Advances in Health Science Educ Theory Pract 14(4) 595. Plack, M. M. (2006). The development of communication skills, interpersonal skills, and a professional identity within a community of practice. Journal of Physical Therapy Education, 20(1), 37.

3. ABSTRACT BACKGROUND The physical therapy profession is evolving, influenced by a changing healthcare environment and societal needs. PT education programs are changing to keep pace, many moving to the DPT level and revising curricula. How we teach, and students learn, has become an area of focused study where evidence-based best practice is being applied. However, the learning needs of novice physical therapists and best strategies for facilitating their continued development, have been less well investigated, despite growing evidence regarding how critical the first year of practice is to professional identity development. CASE DESCRIPTION The subject, LB, is a novice PT in her first job at the Boston teaching hospital where she completed her final clinical experience. This poster’s first author observed, listened to, and helped mentor LB through her first year of practice. Additional data was gathered via interview and discussion. Major findings included challenges and professional growth. LB was unsuccessful in a split in- and out-patient schedule, despite her desire to continue developing in both areas. Her schedule afforded only minimal contact with outpatient peers which, along with missing outpatient meetings and communications, increased her stress. Her outpatient practice did not evolve as desired. Conversely, she was able to become a fully participating member of the inpatient team and thrived in that environment. OUTCOMES Many of LB’s experiences reflect themes found in the literature including: need for support, encouragement, and ongoing evaluative feedback; role of assimilation into the professional culture in the development of professional identity; and role of reflection in fostering lifelong learning. DISCUSSION In examining LB’s case it becomes apparent that her professional development was strikingly consistent with the current teaching and learning research in the health professions. Formal and informal mentoring can provide the support needed to develop. Participation in the professional culture nurtures professional identity development. With reflection emerging as the basis for critical thinking, self assessment, and lifelong learning, encouragement of reflective practice should be part of the professional culture in which the novice is immersed. PROFESSIONAL RELEVANCE As the case of L.B. illustrates, by assisting our novice practitioners to reflect on and learn from their own experiences, we can encourage the assimilation of the values and beliefs necessary for professional practice.