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PHYS THER
Vol. 85, No. 8, August 2005, pp. 766-781
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Research Reports

Association of Importance of the Doctoral Degree With Students' Perceptions and Anticipated Activities Reflecting Professionalism

Marie A Johanson

MA Johanson, PT, PhD, OCS, is Assistant Professor, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Rd, Suite 170, Atlanta, GA 30322 (USA) (majohan{at}emory.edu)


Submitted September 16, 2004; Accepted March 15, 2005


   Abstract
 
Background and Purpose. The American Physical Therapy Association (APTA) has identified the Doctor of Physical Therapy (DPT) degree as 1 of 6 elements necessary to transition the physical therapy profession to a fully professionalized discipline. However, there have been no data to determine whether physical therapist students who place importance on the DPT degree perceive physical therapy to be more professionalized or anticipate participation in activities reflecting professionalism more than those who do not place importance on the DPT degree. Subjects. The subjects were 919 professional physical therapist students. Methods. Faculty members at 34 physical therapist education programs distributed questionnaires to 1,172 professional physical therapist students and returned 919 questionnaires, for a response rate of 78.4%. The data were statistically analyzed using chi-square analysis and logistic regression. Results. There were few differences between students who place importance on the DPT degree (DPT-I students) and those who do not place importance on the DPT degree (DPT-NI students) regarding how professionalized they perceive physical therapy to be relative to other health care professions or regarding their anticipated participation in activities reflecting professionalism. The one potential distinction found when controlling for other variables was that DPT-I students were more likely than DPT-NI students to anticipate becoming faculty members. Discussion and Conclusion. When beginning their professional education, there are few differences between DPT-I and DPT-NI students' perceptions of the professionalization of physical therapy or anticipation of activities reflecting professionalism.

Key Words: Education: physical therapist students • Professional issues


   Introduction
Top
 Abstract
 Introduction
Method
 Results
 Discussion
 Conclusions
 Appendix
 References
 
In 2000, the American Physical Therapy Association's (APTA's) House of Delegates endorsed a vision statement for the physical therapy profession.1 The vision statement indicated that, by 2020, physical therapy would be provided by physical therapists with clinical doctorates. In 2001, APTA released the Strategic Plan for Transitioning to a Doctoring Profession.2 This plan identified 6 elements that are necessary to transition the physical therapy profession to a doctoring profession: the Doctor of Physical Therapy (DPT) degree, evidence-based practice, autonomous practice, direct access, practitioner of choice, and professionalism. Sociologists define a profession in terms of the features that distinguish a profession from other occupations.3–5 Greenwood3 asserted that the defining characteristic of a profession is the presence of a professional culture, which distinguishes the profession's values from those of other occupations.

Professionalization is the process of becoming a profession. Turner and Hodge6 defined professionalization as the degree to which an occupational organization engages in the following activities: (1) development and transmission of substantive theory, (2) development and transmission of practical techniques, (3) regulation of working conditions, (4) regulation of market conditions, (5) identification of practitioners and the recognition of qualifications for practice, (6) promotion of standards of practice, (7) promotion of internal relations between members, and (8) promotion of public recognition. To facilitate the activities that define professionalization, members of a profession establish and nurture a professional association.7,8 Professionalism is the degree to which the members of a profession exhibit the unique attributes of a profession or engage in activities that characterize professionalization. "Professionalized" refers to the extent to which an occupation has undergone professionalization. When sociologists and others attempt to define professions, they often cite medicine as an example of a universally recognized profession or a fully professionalized occupation.3,4,7,9

The APTA has a history of supporting increased professionalization of physical therapists by advocating for all of the activities that Turner and Hodge6 used to define professionalization.10–14 Recently, APTA has begun work on developing an operational definition of professionalism by identifying 7 core values of professionalism in physical therapy: accountability, altruism, compassion/caring, excellence, integrity, professional duty, and social responsibility.2 The APTA lists sample indicators for each core value to eventually permit measurement of the core value indicators in terms of the expected professional behaviors of graduates of physical therapist education programs. Instilling professionalism in students has long been a goal of physical therapist educators, and yet there is little research to document professionalism, or the effect of professional education on the professionalism, of physical therapist students. Physical therapist educators know little of when students develop professional values. Students may graduate from physical therapist programs with the same professional values as when they matriculated into the programs, may develop professional values during their professional education (as a result of the professional curriculum and the influence of faculty and clinical educators), or may exhibit some combination of both.

Currently, professional physical therapist education programs in the United States grant graduates either a master's degree (all professional master's degrees in physical therapy will subsequently be abbreviated as "MPT" in this article) or a doctoral degree (DPT). Although the DPT degree is 1 of the 6 elements that APTA recognizes as essential to transition physical therapists to a greater level of professionalization (practitioners with clinical doctorates), there are few data to determine whether students who place importance on a clinical doctoral degree in physical therapy associate that degree with any of the other elements identified as essential for a doctoring profession by the Strategic Plan for Transitioning to a Doctoring Profession or any of APTA's core values of professionalism.2

Threlkeld et al15 surveyed 51 of 98 recent graduates (response rate=52.0%) from Creighton University, the first university to grant professional DPT degrees. They reported that many of the graduates were working in nontraditional environments for physical therapists, such as research institutes and academia. They related some graduates' comments about the ease with which they established peer relationships with other doctoral-level health care professionals. The authors also readily admitted that, without comparative data, it was difficult to attribute their graduates' success to the DPT curriculum or to the degree itself, versus other factors. Two potentially important uncontrolled factors in that study were the aspirations of the graduates and their perceptions of how professionalized physical therapy is relative to other doctoral-level health care professions when matriculating into the program.

Two surveys investigated differences in the anticipated plans of physical therapist students in MPT versus bachelor's degree programs in 1991 and 1994.16,17 Students in MPT degree programs were more likely than students in bachelor's degree programs to anticipate future involvement in activities that might be considered to reflect professionalism, such as conducting research, publishing articles, and seeking certification as a clinical specialist. However, these surveys were conducted in the students' final year of study, so it is impossible to attribute dissimilarities between students in MPT and bachelor's degree programs to differences in curriculum or degree level. Students in MPT degree programs may have been more likely to anticipate future involvement in activities that might be considered to reflect professionalism when matriculating into physical therapist education programs. Factors such as socioeconomic status (SES) or prior highest degree level attained may have influenced their plans prior to any influence of their physical therapist education program. There is substantial research that documents that SES, student ability factors, sex, race or ethnicity, cost of the institution, and location of the institution all substantially influence high school students' enrollment in college, as well as enrollment in particular types of colleges.18–26 Similarly, there are data that document that SES, student ability factors, previous degree obtained, sex, program characteristics (including cost, location, distance from permanent address, and academic reputation), and marketability of a degree from the institution all affect enrollment in graduate programs, enrollment in particular types of institutions and graduate programs, and academic and career aspirations.27–33

My previously reported findings34 indicate that there are statistically significant differences between students enrolled in MPT and DPT degree programs in factors deemed important during students' selection of a physical therapist education program. Students enrolled in DPT degree programs were more likely than MPT degree program enrollees to report that the degree conferred, availability of the DPT degree, and the curriculum were more important when they selected their program.34 However, it is not known whether the students who indicated that the doctoral degree was important during program selection placed importance on any of the other elements that APTA identifies as those of a doctoring profession or the core values of professionalism in physical therapy.2 If students who seek the DPT degree do not embrace any of the other elements that APTA identifies as those of a doctoring profession or core values of professionalism, it may be less likely that these students will contribute in any substantial manner to greater professionalization of the physical therapist profession. If this is the case, physical therapist educators may consider either selecting students who value the other elements and core values necessary for increased professionalization or producing evidence-based professional socialization components within physical therapist professional education programs and clinical experiences.

Knowledge of students' perceptions of how professionalized physical therapy is and their future plans for activities that might be considered reflective of professionalism when matriculating into programs may provide some initial insight as to whether students' perceptions and anticipated behaviors potentially reflecting professionalism are more related to: (1) selection of students or (2) the professional socialization of students during professional education programs. The purposes of this study were: (1) to determine whether students who place importance on the DPT degree perceive physical therapy as more professionalized relative to other health care professions compared with those who do not and (2) to determine whether students who place importance on the DPT degree are more likely than those who do not to anticipate participation in activities that might be considered to reflect professionalism.


   Method
Top
 Abstract
 Introduction
 Method
Results
 Discussion
 Conclusions
 Appendix
 References
 
Survey Instrument

A mailed questionnaire was used to collect data in this descriptive study of first-year professional ("entry-level") physical therapist students. I developed portions of the questionnaire following some of Sudman and Bradburn's35 principles of questionnaire construction. These basic principles include: (1) asking pertinent nonthreatening questions before potentially threatening questions (eg, undergraduate grade point average [GPA]) as much as possible, (2) asking demographic questions last, or at least not first, because these questions may be perceived as threatening, and (3) matching some questions and response categories to those previously used in surveys of physical therapist students conducted by Warren and Pierson16 and by APTA.17 Using some questions from previous surveys of physical therapist students enabled better comparison of this study's findings with previous data.

Based on previous research of factors that influence college graduates to pursue graduate education, factors that influence college graduates to choose a particular graduate program, and factors that influence college graduates' academic and career aspirations, items were included on the survey questionnaire that might explain physical therapist students' perceptions of the professionalization of physical therapy relative to other health care professions (question 18 on the survey questionnaire), their anticipated activities reflecting professionalism (question 28 on the survey questionnaire), and the importance they placed on the DPT degree. These items consisted of SES, demographic and student ability variables, and factors that the students deemed important when selecting their physical therapist education program. Items related to students' perception of the professionalization of physical therapy relative to other health care professions were drawn from some of the defining characteristics of a profession, as defined by sociologists and others, because APTA's core values of professionalism had not yet been published. These defining characteristics included autonomy,3,4,6,9,36 prestige,3,4,6,36 and rigor of education.4,6,7 Table 1 presents survey items in relation to APTA's core values of professionalism and the sample indicators of those core values. Questions 5, 10, 13, 14, 16, 17 through 22, and 26 through 31 (Appendix) were used in this study, whereas other questions were used in my previous study.34


View this table:
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[in a new window] 		Table 1. Relationship of Survey Items Related to Students' Plans 10 Years Following Graduation to the Core Values of Professionalism in Physical Therapy2

 
Two faculty members at a private DPT degree program and one faculty member at a public MPT degree program read the survey instrument and provided comments on the clarity of the questions and the content validity. A pilot survey also was conducted of 14 first-year physical therapist students at a private DPT degree program and 10 physical therapist students at a public MPT degree program. Revisions were made to the survey instrument based on the feedback from the faculty and students.

Testing the reliability of data for the entire survey instrument for internal consistency was problematic because coefficients of internal consistency require more than 2 questions for each variable.37 This would have lengthened the survey, thereby likely decreasing the response rate.35

Sample

Accredited physical therapist education programs in the United States were stratified into 4 groups, and a random sample of 10 programs (cluster sampling) was drawn from each of the 4 strata: (1) programs in private institutions that conferred the DPT degree, (2) programs in private institutions that conferred the MPT degree, (3) programs in public institutions that conferred the DPT degree, and (4) programs in public institutions that conferred the MPT degree. The physical therapist education programs were stratified to ensure the representation of students in both public and private programs and both MPT and DPT degree programs.

The objective was to generate a final sample size of 900 students based on an anticipated 66% response rate.16 To do this, 40 participating programs (with an estimated average class size of 36 students based on APTA data of average class size in 2000)38 were selected to target a sample size of 1,364 students (out of an estimated population of 6,336 first-year professional physical therapist students).38,39 A final sample size of 900 students would minimize sampling error to within 3%40(p55) and provide 50 cases for each of 18 predictor variables. Power calculations also were performed. The number of subjects needed for a statistical power of 0.80 was calculated using an effect size of 0.20 for comparison of the association of importance of the DPT degree with the dependent variables reflecting professionalism. Although there is no commonly accepted effect size, Cohen41 suggested that an effect size of 0.20 is between small and medium. The effect size was based on the 17.6% average effect size of differences between students in MPT and bachelor's degree programs on the 5 statistically significant variables examined in a previous study.16 The number of subjects needed to detect an effect size of 0.20 using a chi-square contingency test or Fisher exact test with a power of 0.80 was 309.41 Estimating the sample size needed for a particular power level to detect partial effects of a predictor variable on the dependent variable in multiple logistic regression is imprecise,42 particularly when the predictor variables are categorical, so this calculation was not performed.

Procedure

The directors of selected programs were contacted first by mail to provide a brief description of the purpose of the study. Telephone and e-mail follow-up to the director of each selected program was done within 2 weeks to elicit his or her participation. They were offered descriptive data to be generated by the study on the factors that influenced students to choose their program or to choose programs in their stratum, as well as the students' anticipated plans following graduation. Program directors who did not respond to the second contact were contacted by both telephone and e-mail 2 weeks later, and again, to those not responding to the third contact, 4 weeks later.

Survey questionnaires and a cover letter were mailed to the faculty facilitator approximately 1 week prior to the matriculation date of the program. An assortment of chewing gum was included for the students who filled out the survey questionnaires, because even nonfinancial incentives were likely to increase the response rate.40 The faculty contacts were requested to distribute the survey questionnaires to students during orientation, or at any point they deemed convenient, during the first 2 weeks of the program in order to: (1) capture students' perceptions regarding the professionalization of physical therapy and anticipation of activities reflecting professionalism before they obtained any substantial portion of their professional education, (2) minimize the amount of time for faculty to influence students regarding the professionalization of physical therapy and faculty expectations for their students' participation in activities that reflect professionalism, and (3) give the faculty contact some flexibility in the timing of the survey administration. Self-addressed large envelopes with prepaid postage were included in the survey packets to allow faculty members to mail the survey questionnaires back in groups. Attached to the return envelopes was a form asking the faculty member to indicate the number of students enrolled in the first-year professional class, because the number of students expected to enroll and the number who actually enrolled may be different. However, no determination of differences between respondents and nonrespondents could be made. The cover letter to the survey advised the potential respondents that any oral or written reports of the study would only contain grouped data and no individual respondents would be identified.

Data Analyses

The students were divided into 2 groups. The first group (DPT-I students) consisted of students who indicated that availability of the DPT was an important or deciding factor during selection of a physical therapist education program (question 17) and ranked "degree conferred" as among the 3 most important factors during selection of a program (question 16). Students who did not meet these criteria were placed in the second group (DPT-NI students). Descriptive data were compiled, using means and standard deviations for continuous data and frequencies and percentages for categorical data. Chi-square analysis was used to test for proportional differences between DPT-I and DPT-NI students who agreed that physical therapist practice is equivalent to other health care professions in terms of independence, prestige, and length or difficulty of education and that they anticipated participating in activities reflecting professionalism. Asymptotic probabilities were obtained for the chi-square values unless fewer than 5 cases were expected in a cell. For the latter case, exact probabilities were obtained for the chi-square values whenever possible, because the chi-square distribution may not closely approximate the actual distribution of cases.43 Logistic regression was used to determine whether the importance students placed on the DPT degree could predict students' contrasts of physical therapy with other professions and students' plans for activities that reflect professionalism (while controlling for numerous other variables). An alpha level of .05 was set for all statistical tests.

The logistic regression models were constructed for 2 sets of dependent variables drawn from 2 different sections of the questionnaire. There were 6 dependent variables that addressed how professionalized the students perceived physical therapy to be relative to other health care professions (question 18) and 10 dependent variables that addressed students' anticipated participation in activities reflecting the APTA's core values of professionalism (question 28). For each of these 16 logistic regression models, there were a total of 17 predictor variables that were entered in 2 steps. All dependent variables were recoded as 1 ("agree") or 0 ("disagree/neutral/do not know") for logistic regression.

Most of the 16 predictor variables entered in the first step of the logistic regression models were those that previous research has shown to predict college graduates' enrollment in graduate school or in particular types of graduate institutions and programs and high school students' enrollment in college and in elite colleges or universities.18–33 The remainder of the 16 predictor variables related to the importance assigned by students to specific program characteristics during their selection of a physical therapist education program (these program characteristics were statistically significant factors of MPT or DPT degree program students' selection of their physical therapist education program established in my previous analysis of the data from this study).34

Variables defined as SES variables were the educational level of students' parents (questions 19 and 20), the parents' occupational prestige scores (questions 21 and 22), and the majority source of financing (recoded as "parents' aid" or "other") for physical therapist education programs (question 10). Occupations were coded using the 1980 Census Occupational Category,44 and the occupational prestige scores assigned to the occupational codes were those established by the National Opinion Research Center (NORC).44 The SES is strongly related to enrollment in college,21,23,25 in graduate programs,27 and in private institutions.22,24

Variables defined as other background characteristics consisted of marital status (recoded as "never married" or "other"), race (recoded as "nonwhite" or "white"), age, and sex (questions 26, 31, 13, and 14, respectively). Factors that affect graduate student enrollment and educational aspirations have been shown to differ by sex27 and age.30 Race or ethnic identity also affect enrollment in students' top 3 choices of a college,25 and race or ethnic identity and sex affect enrollment in selective colleges.19

Variables defined as those related to student ability and the attributes of students' academic institutions (questions 23 and 29) consisted of undergraduate GPA, control of the students' primary undergraduate institution (public or private), and control of the institution in which the students were enrolled in a physical therapist education program (public or private). Student ability factors predict enrollment in graduate programs,27 undergraduate institutions,21,23 private undergraduate institutions,23 and selective undergraduate institutions.18,19,23,25 Undergraduate GPA influences educational aspirations for both graduate and professional programs.29

Variables defined as student program selection factors consisted of the importance of cost, location, and length of the program (all recoded as "unimportant/neutral" or "important/deciding factor") and distance of the program from the students' permanent home address (questions 15a-c and 5). These program characteristics have all been previously shown to affect students' selection of graduate programs27–33 and students' selection of physical therapist education programs.34

The variable entered in the second step was whether or not the student indicated that the DPT degree and the degree conferred were important during program selection (DPT-I students versus DPT-NI students). There were between 290 and 299 cases with complete data on which to predict the dependent variables.


   Results
Top
 Abstract
 Introduction
 Method
 Results
Discussion
 Conclusions
 Appendix
 References
 
Response Rate

Of the 40 program directors who were solicited to participate in this study, 34 program directors agreed to participate, for a participation rate of 85.0%. Eighteen (53.0%) of the participating programs were in private institutions, and 16 (47.0%) of the programs were in public institutions. Nineteen (56.0%) of the participating programs conferred a doctoral degree, and 15 (44.0%) of the programs conferred a master's degree.

The student response rate to the survey was 78.4%, with 919 of 1,172 enrolled first-year professional physical therapist students completing the survey questionnaires. Four hundred thirty-two (47.0%) of the respondents were enrolled in public programs, and 487 (53.0%) of the respondents were enrolled in private programs. Two hundred seventy-five (29.9%) respondents were enrolled in MPT degree programs, and 644 (70.1%) respondents were enrolled in DPT degree programs.

Bivariate Analyses

The mean ages of the DPT-I and DPT-NI students were 22.9 years (SD=2.5) and 23.0 years (SD=2.6), respectively. Other subject characteristics for both groups are summarized in Table 2. Chi-square analysis showed that there were no differences (P >.05) between the DPT-I and DPT-NI students on 15 of the 17 subject characteristics. There were statistically fewer DPT-I students enrolled in public and private MPT programs than in public and private DPT programs, and fewer DPT-I students were enrolled in 2-year programs than in 3-year programs (Tab. 2). Two-year and 3-year programs were defined as the professional education component of the program lasting less than 21/2 years or more than 21/2 years, respectively.


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[in a new window] 		Table 2. Subject Characteristics of Students Indicating Importance of Doctor of Physical Therapy (DPT) Degree (DPT-I Group) and Students Not Indicating Importance of DPT Degree (DPT-NI Group)a

 
Chi-square analysis demonstrated that larger proportions of DPT-I students than DPT-NI students agreed that their physical therapist education program was comparable in terms of length and difficulty to other nonphysician health care professions (Tab. 3). Chi-square analysis showed no association (P >.05) between DPT-I students and DPT-NI students for any other variable related to students' perceptions of how professionalized the physical therapy profession is relative to other health care professions (Tab. 3).


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[in a new window] 		Table 3. Contrast of Physical Therapy With Other Health Care Professions by Students Indicating Importance of Doctor of Physical Therapy (DPT) Degree (DPT-I Group) and Students Not Indicating Importance of DPT Degree (DPT-NI Group)a

 
Chi-square analysis indicated that larger proportions of DPT-I students than DPT-NI students either feel neutral about conducting some research or anticipate conducting some research 10 years following graduation (Tab. 4). The chi-square analysis also showed that there was no association (P >.05) between DPT-I and DPT-NI students for any other variable related to students' anticipation of involvement in activities reflecting professionalism (Tab. 4).


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[in a new window] 		Table 4. Anticipation of Participation in Activities Reflecting Professionalism by Students Indicating Importance of Doctor of Physical Therapy (DPT) Degree (DPT-I Group) and Students Not Indicating Importance of DPT Degree (DPT-NI Group)a

 
Multivariate Analysis of Students' Contrasts of Physical Therapists With Other Health Care Professionals

Logistic regression showed that the importance students placed on the DPT degree did not predict (P >.05) any of the dependent variables related to how professionalized the students perceived physical therapy to be compared with other health care professions while controlling for the other 16 predictor variables in the models (Tab. 5). These models accounted for 7.6% to 18.3% of the variance in the dependent variables. The beta coefficients (ß) from the logistic regression models are reported as odds ratios (ORs) in Tables 5 and 6. An OR of 1 indicates equal odds, and an OR of greater than 1 or less than 1 indicates differences in odds. For example, in Table 5, an OR of 1.087 means that the odds of DPT-I and DPT-NI students agreeing that physical therapist practice is as prestigious as that of other nonphysician health care professionals are about the same, an OR of 1.449 means that the odds of DPT-I students agreeing that their physical therapist education program is as lengthy and difficult as that of other nonphysician health care professionals is about 1.5 times greater than the odds of DPT-NI students doing so, and an OR of 0.802 means that the odds of DPT-I students agreeing that physical therapist practice is as prestigious as that of physicians is about 0.80 times less than the odds of DPT-NI students doing so.


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[in a new window] 		Table 5. Odds Ratios of Students Indicating Importance of Doctor of Physical Therapy (DPT) Degree to Students Not Indicating Importance of DPT Degree Agreeing With Contrast of Physical Therapy and Other Health Care Professions

 

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[in a new window] 		Table 6. Odds Ratios of Students Indicating Importance of Doctor of Physical Therapy (DPT) Degree to Students Not Indicating Importance of DPT Degree Anticipating Involvement in Activities Reflecting Professionalism

 
There were several other predictors in the logistic regression models for several of the dependent variables related to how professionalized students perceive physical therapy to be relative to other health care professions. Nonwhite students had higher odds of agreeing that physical therapist practice is as independent as that of physicians (OR=3.350, 95% confidence interval [CI]=1.588-7.068, P=.002). Students who indicated location and length of the physical therapist education program as important during program selection had higher odds (OR=2.786, 95% CI=1.232-6.300, P=.014 and OR=2.659, 95% CI=1.464-4.830, P=.001, respectively) than those who did not indicate they were important of agreeing that physical therapist practice is as independent as that of a physician. Those who indicated cost as important had lower odds (OR=0.362, 95% CI=0.188-0.699, P=.002) of doing so than those who did not indicate cost as important. Students who indicated that length of the physical therapist education program was important during program selection had higher odds than those who did not indicate that it is important of agreeing that physical therapist practice is as prestigious as that of physicians (OR=1.869, 95% CI=1.122-3.113, P=.016).

Another predictor in the logistic regression models was sex. Female students had higher odds than male students of agreeing that physical therapist practice is as independent as that of other nonphysician health care professionals (OR=1.886, 95% CI=1.002-3.552, P=.049).

Multivariate Analysis of Students' Anticipated Activities Reflecting Professionalism

Logistic regression showed that DPT-I students had higher odds than DPT-NI students of anticipating becoming a faculty member (OR=1.982, 95% CI=1.006-3.906, P=.048). The importance students placed on the DPT degree did not predict (P >.05) any of the other dependent variables related to students' anticipated involvement in activities that reflect professionalism (Tab. 6) in the logistic regression models. These models accounted for 6.9% to 13.3% of the variance in the dependent variables. There were several other predictors in the logistic regression models for some of the dependent variables related to students' anticipated plans reflecting professionalism. A higher educational level of students' fathers increased the odds of students anticipating that they would be conducting research within 10 years of graduation (OR=1.358, 95% CI=1.020-1.807, P=.036), whereas an increase in the students' fathers' occupational prestige score, a higher undergraduate GPA, and being nonwhite decreased the odds of students' anticipation of conducting research (OR=0.971, 95% CI=0.950-0.993, P=.009; OR=0.618, 95% CI=0.405-0.942, P=.025; and OR=0.448, 95% CI=0.205-0.976, P=.043, respectively). Students enrolled in private physical therapist education programs had lower odds than students enrolled in public programs of anticipating practicing as a senior staff physical therapist and mentor to other physical therapists (OR=0.415, 95% CI=0.212-0.812, P=.010), and nonwhite students had greater odds than white students of anticipating becoming a certified clinical specialist (OR=2.902, 95% CI=1.260-6.687, P=.012).


   Discussion
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
Conclusions
 Appendix
 References
 
Subject Characteristics

The over-representation of students in DPT degree programs in the sample resulted from 2 unanticipated factors. First, 4 private MPT degree programs and 1 public MPT degree program converted to DPT degree programs after APTA posted an updated list of accredited programs in February 2002, but before their matriculation dates in the summer term or the fall term of 2002. Second, MPT degree programs in the sample had an average enrollment of 27.3 students, whereas DPT degree programs in the sample had an average enrollment of 38.4 students.

Thus, among respondents with complete data to allow classification into DPT-I and DPT-NI groups, 204 (41.0%) were defined as DPT-I students and 294 (59.0%) were defined as DPT-NI students. The survey instrument instructed respondents to skip the section with most of the program selection factors if they had applied to or been accepted into no more than 1 program (Appendix). Because 48.3% of respondents applied only to one physical therapist education program, there were fewer cases than anticipated for both the bivariate and multivariate analyses.

Students' Perceptions of the Professionalization of Physical Therapy Relative to Other Health Care Professions

Overall, DPT-I students exhibited very few differences from DPT-NI students when contrasting physical therapy with other health care professions. Medicine is the most universally recognized health care profession3,4,7,9 and received the highest occupational prestige score (86) on NORC's General Social Survey (GSS).44 The NORC's occupational prestige score for physical therapists was 61. The examples of nonphysician health care professions provided on the survey instrument (question 18) were clinical psychologists, podiatrists, and chiropractors (chiropractors are not specifically listed on the GSS and therefore fall under the nonspecific "Health Diagnosing Practitioner" category), whose occupational prestige scores were 69, 65, and 50, respectively. Thus, regardless of the importance placed by physical therapist students on the DPT degree, these students tended to rate the prestige level of the physical therapy profession similar to the public's rating—approximately that of other doctoral-level nonphysician health care professions, but below that of physicians.

Fewer than one third of both the DPT-I students and the DPT-NI students agreed that physical therapist practice was as independent as that of physicians and that physical therapist education was as lengthy and difficult as that of physicians. Autonomy and rigor of training, 2 of the attributes sociologists use to characterize professionalism,3,4,6,7,9,36 were identified by physical therapists as deficient when contrasting physical therapy with medicine.7,45 Interestingly, students who indicated the importance of the program's location and length during selection of their physical therapist education program were more likely to equate the independence of physical therapist practice to that of physicians, whereas those who indicated the importance of cost were less likely to do so. The direction of length (shorter or longer) was not specified on the survey instrument. Although speculative, it is possible that students valued something about their program's location and associated that with more independent practice, such as location of the program in a state with direct access.

More DPT-I students than DPT-NI students equated the length and difficulty of physical therapist education to that of other nonphysician health care professions (Tab. 3), although not to a statistically significant degree when controlling for other variables. Because more DPT-I students than DPT-NI students in this sample were enrolled in 3-year professional programs, this may account for the difference in perception between DPT-I and DPT-NI students regarding length and difficulty of physical therapist professional education.

Students' Anticipation of Activities Reflecting Professionalism

There were also few differences between DPT-I students and DPT-NI students regarding their anticipated participation in some of the activities that might be considered to reflect professionalism. The bivariate analysis revealed that a greater proportion of DPT-I students than DPT-NI students plan to conduct some research, but this association lost significance when controlling for other variables in the multivariate analysis. Socioeconomic status, demographic variables, and academic variables were more predictive of students' anticipation of participation in research than the importance placed on the DPT degree. It is possible that SES, demographic factors, and academic factors contribute to the importance students place on the DPT degree and that there is no further predictive gain to importance of the DPT degree after accounting for these other variables.

In the multivariate analysis, the odds of DPT-I students anticipating becoming faculty members was nearly twice that of DPT-NI students (Tab. 6). These data need to be interpreted with caution, however, because the lower boundary of the 95% CI of the OR drops to 1 (Tab. 6). About the same percentages of DPT-I and DPT-NI students anticipated pursuing additional graduate degrees following professional physical therapist education (23.5% and 20.8%, respectively). However, among respondents planning to pursue an additional degree, fewer DPT-I students than DPT-NI students identified the PhD degree as the degree they planned to pursue (18.5% and 37.0%, respectively). Based on these data, it is unlikely that DPT-I students anticipated obtaining advanced research degrees prior to becoming a faculty member. If being a DPT-I student is more predicative of plans to become a faculty member, it is possible that DPT-I students see the doctoral degree as a terminal degree that will meet the requirements for future faculty positions.

The odds of DPT-I students anticipating involvement in the 6 activities reflecting professionalism are greater than 1 for only 4 of the 6 activities compared with the DPT-NI students (Tab. 6). Moreover, the lower boundaries of the 95% CIs of the ORs drop below 1 for all except the statistically significant variable (becoming a faculty member). It appears that the responsibility of instilling the value of any of these activities that might be considered reflective of professionalism in all physical therapist students, regardless of the importance they place on the DPT degree, remains upon the faculty of physical therapist education programs and the students' clinical instructors. Physical therapist students who place importance on the DPT degree do not yet equate the DPT degree with at least some of the sample indicators of professionalism indicative of a doctoring profession.2

Current Study Findings Related to Previous Research

Because the profession of physical therapy has a history of increasing the depth and breadth of education to match increasing practice responsibilities, the anticipation of professional activities of DPT-I students versus DPT-NI students can be contrasted with 2 previous studies of students in MPT degree programs versus physical therapist students in bachelor's degree programs.16,17 Such contrasts are problematic for several reasons. In both studies, the researchers surveyed students in the final year of their physical therapist education programs; thus, differences between students based on degree level could have occurred as a result of the different curricula. However, differences between students based on degree level may have been due to differences between students before they matriculated into the programs. Both previous studies also used only bivariate statistics, and the conclusions in both studies may be misleading, because the bivariate analyses did not control for any other variables that may have accounted for the results obtained. In addition, wording differences between questionnaires may reduce the validity of comparisons. Finally, both previous studies compared students in different types of programs and not different perceptions of the importance of the degree level.

Nonetheless, when contrasted with data from 1991,16,17 the data from physical therapist students in 2002 revealed a conflicting trend regarding students' anticipation of involvement in activities reflecting professionalism. More physical therapist students in 2002 than in 1991 anticipated conducting research and becoming board-certified clinical specialists, but fewer students anticipated becoming members of APTA. Although 96.3% of students in 1991 anticipated APTA membership,16 only 81.3% of the students in this sample planned to be active APTA members 3 years following graduation and 85.9% of the students planned to be active APTA members 10 years following graduation. This potential decline in numbers of students anticipating active membership in APTA is disturbing. However, it also may serve as an assessment tool for faculty and others. If more than 81.3% of graduates in 2004 and 2005 join APTA, it may indicate a positive effect of the faculty, curricula, and clinical educators.

Limitations

A significant limitation of this study is that the ultimate choice of program in which the students enrolled is likely to influence the students' responses to questions related to the importance of the DPT degree. Students enrolled in MPT degree programs may not be willing to indicate importance of the DPT degree because such an indication would contradict their decision regarding choice of program. Moreover, the variety of formats of physical therapist education programs and the rapid change of the degree conferred by programs may have confounded this problem further. The total amount of variance explained by the logistic regression models varied from approximately 7.0% to 18.0%. Thus, many factors may explain the dependent variables not included in the models, and the degree to which the dependent variables truly reflect professionalism is questionable.

Although the power for chi-square statistical tests was adequate, the power for the logistic regression tests was likely low. There was no determination of any differences between student respondents and student nonrespondents. Were there any substantial differences, the results of the study may not represent the general population of physical therapist students. Of even potentially greater importance is that the majority of students who had applied to, or been accepted into, no more than one program did not fill out the portion of the survey questionnaire that included the variables related to the criteria for DPT-I and DPT-NI students. Therefore, the sample used in this study was reduced by approximately two thirds from the entire sample of respondents. If students who had applied to, or been accepted into, no more than one program responded much differently to the questions related to comparison of physical therapy with other health care professions or future plans, then the results of this study could have been substantially different. Finally, the test-retest reliability and validity of students' responses on the questionnaire were not assessed.

Recommendations

This study investigated whether physical therapist students who place importance on the DPT degree value other elements that might be considered inherent to professionalism. This study focused on the attributes and activities associated with the professions from definitions derived mainly from sociological literature. Much further study is needed to determine how applicants to physical therapist education programs and physical therapist students' professionalism can best be measured.

Because the importance students placed on the DPT degree explained no more than 18.0% of the variance in the variables that might be considered reflective of professionalism, further study, both qualitative and quantitative, is important to identify other factors predictive of professionalism not included in this study. The associations between students who place importance on the DPT degree and the value of other elements inherent to professionalism were examined prior to the impact of their professional curriculum. It would be illuminating to survey students both at the beginning and at the end of their professional education to study the effect of the physical therapist educational curriculum on students' professional values, such as anticipation of APTA membership. As APTA's core value indicators are further refined and consistency of measurement is established, if there are any discrepancies between APTA's core values of professionalism and those of graduates of physical therapist education programs, then future investigations on the effect of timing and approach to professional socialization within physical therapist curricula and within clinical education on physical therapist graduates' professional values and on the reliability and validity of data for methods to identify students' professional values during the admissions process will be critical to facilitate APTA's goal of physical therapy becoming a doctoring profession.


   Conclusions
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
 Conclusions
Appendix
 References
 
The importance placed on the DPT degree during program selection by physical therapist students just beginning their professional education had little predictive effect on how professionalized students perceived physical therapy compared with other health care professions or on their anticipation of participation in activities that might be considered to reflect professionalism. Therefore, physical therapist educators must determine whether, and to what degree, the professional socialization of students during their professional education programs affects students' professional values.


   Appendix
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
 Conclusions
 Appendix
References
 


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[in a new window] 		Appendix. Survey Instrumenta

 


   Footnotes
 
Georgia State University's Institutional Review Board for the Protection of Human Subjects approved the study.

This work, in part, was given as a platform presentation at the Combined Sections Meeting of the American Physical Therapy Association; February 23-27, 2005; New Orleans, La.


   References
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
 Conclusions
 Appendix
 References
 

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