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This study explored the impact of a curriculum-embedded health coaching program on student professionalism. We compared physical therapy students who participated in a coaching program (n=79) to a control group who did not (n=70). We analyzed differences between the two groups and examined the association of group to achievement of better performance ratings. We found differences between the groups in ratings on the variables that measured safety, communication, professional behavior, and accountability. We also found associations between group and the achievement of a rating of advanced intermediate or better for the same variables. These findings suggest that health coaching programs can promote professionalism and student self-efficacy early in their clinical training. Future research should investigate the program's impact on other relevant areas. J Allied Health 2025; 54(3):e411-e 416.
This study explored the impact of a curriculum-embedded health coaching program on student professionalism. We compared physical therapy students who participated in a coaching program (n=79) to a control group who did not (n=70). We analyzed differences between the two groups and examined the association of group to achievement of better performance ratings. We found differences between the groups in ratings on the variables that measured safety, communication, professional behavior, and accountability. We also found associations between group and the achievement of a rating of advanced intermediate or better for the same variables. These findings suggest that health coaching programs can promote professionalism and student self-efficacy early in their clinical training. Future research should investigate the program's impact on other relevant areas. J Allied Health 2025; 54(3):e411-e 416.
PROFESSIONALISM is a critical indicator of clinical readiness for health professions students. Embedding professionalism into a curriculum and subsequently measuring behavioral outcomes among students can be challenging.(1-3) encompasses variety of definitions based on behaviors, values and attributes. Evidence indicates that teaching methods to facilitate professionalism should be multimodal in nature.(1-3) Experiential learning as a teaching tool to facilitate the development of confidence, clinical reasoning, communication, safety, and accountability is frequently used in health professions.(4-6) Experiential learning provides health professions students opportunities to engage in community-based and service activities.(7,8) Experiential learning in the form of health coaching has been effective in developing components of professionalism such as professional identity, student confidence in skill application, and clinical readiness.(5,9) A health coaching model can be delivered by students using a structured, evidence-based health management program, such as the Arthritis Foundation's Walk with Ease (WWE), embedded within a health professions curriculum.(6)
In an entry-level physical therapy (PT) program, the construct of professionalism can be assessed by the Clinical Performance Instrument 2.0 (CPI).(10) Behaviors measured within the CPI include safety, professional behavior, accountability, communication and cultural competence.(11) Dupre et al.(11) found that the affective domain, including the previously listed behaviors, was predictive of student clinical readiness prior to their first full-time clinical experience. Experiential learning assists in bridging the gap between didactic coursework and clinical practice.(5,12) Researchers report that experiential learning promoted professional attributes in addition to improving application of course material, critical thinking, and self-confidence and accountability.(12,13) Development of self-efficacy through experiential learning contributes to professionalism and improved communication skills.(14) Phillips (5) combined experiential learning with health coaching and found it promoted skill development and confidence in application of those skills. The aim of this study was to examine the impact of a student health coaching program (SCP) on students professionalism as measured by behaviors represented in the CPI 2.0 as students transitioned from the classroom to the clinic.
Methods
Study Design and Participants
This study employed a quasi-experimental design with two naturally formed groups from our pre-physical therapy (Pre-PT) and Doctor of Physical Therapy (DPT) students that each had a different curricular structure. Study participants included all students enrolled in the Pre-PT and DPT programs at the time of this study, the intervention in this study was a new curricular requirement. Group 1, the control group (pre-SCP), was not exposed to the SCP while group 2, the intervention group, was fully engaged in the SCP. During the 20202021 academic year the SCP was integrated into the curriculum for Pre-PT and DPT students (details in Table 1). In each year of the curriculum, the SCP differed in focus for the students: Pre-PT students concentrated on observation, while DPT students focused on delivery of the evidence-based program and mentoring junior students. This study and the use of student derived educational data was approved by the Springfield College Institutional Review Board (#2022223).
Prior to the development of the SCP the DPT cohorts participated in clinical experiences that involved visiting a variety of sites each semester and working with diverse patients. The previous Pre-PT student curriculum incorporated service-learning activities in a hospital setting which was not sustainable during and post Covid-19 lockdown. The SCP provided students the additional opportunity to communicate with and be responsible for a single client over time as they progressed through the evidencebased program.
Curriculum Implementation
The SCP evolved from a grant that was awarded to faculty to deliver the Arthritis Foundation's Walk With Ease (WWE) program across the state of Massachusetts.(15) Faculty completed certification to become WWE leaders and then collaborated with Arthritis Foundation staff on a model for the SCP which integrated the already established self-directed WWE program.(16) Faculty identified curriculum goals focused on learning about population health, motivational interviewing, transtheoretical model of behavior change, communication skills and engaging as a professional. These goals and material from WWE were compiled into a student coaching manual (available for public download at https: / /springfield.edu/ sites / default / files /inline-files/ SCPT%20Student%20Health%20 Coaching%20Manual%20V2.pdf) that provided guidance to students to assist their client as they progressed through the program. During the SCP students engaged through the college learning management system (LMS) with required readings, assignments, and forum reflections and postings.
Prior to the establishment of the SCP Group 1 participated in integrated clinical experiences that allowed for a singular encounter with a patient in a local clinic, to deliver interventions, and address their course objectives as outlined in Table 1. The addition of the SCP allowed students in Group 2 to participate across 5 semesters, initially as observers, and ultimately as health coach team leaders. Each semester, through mentorship and learning, students acquired additional roles within their coaching teams. Course assignments were scaffolded through the LMS and required students to integrate more evidence and provided tools for the application of advanced communication and motivational interviewing techniques as they progressed each semester.
The Pre-PT course instruction focused on the development of professional roles, understanding the PT scope of practice and provision of care in a probono от service-learning environment. The DPT1 coursework and expectations provided foundational knowledge about the transtheoretical model of behavior change, population health and evidencebased programs, most specifically WWE, through assigned readings. The students were expected to identify the application of concepts used by their DPT2 team leader through written reflective prompts within the LMS. DPT1 students progressed during the spring semester and with guidance from their DPT2 mentors, applied interview techniques and strategies to promote health behavior change in their participants. The DPT? coursework and expectations aimed to not only provide the foundations noted above, but also incorporate effective communication and leadership skills. Students were challenged to teach their peers and delegate tasks while providing support and ensuring WWE program fidelity as per the student manual.
Recruitment of WWE clients occurred through communication and partnerships with local Senior Centers and Councils on Aging. The SCP design incorporated a virtual weekly meeting for 6 weeks, with a health coaching team and their client, to progress through the self-directed WWE program. Faculty intentionally assigned students to groups that included at least 1 student from each cohort, and then paired them with a WWE client. Individual client preferences were considered by faculty when assigning student groups. Weekly assignments and readings in the LMS aligned with the student health coaching manual so that students had the knowledge base to provide effective health coaching.
Three designated faculty, WWE certified leaders, oversaw the SCP implementation and coursework. One faculty managed the Pre-PT coursework, assignments, and reflections and the other two managed the DPT associated coursework. These faculty were available to triage student and client questions that appeared outside of the scope of WWE, manage client attrition, and reassign health coaching teams due to client attrition as needed. Faculty provided feedback and guidance to students related to both written and verbal communication with clients, peers and faculty. This feedback was more frequent for the DPT2 cohort in their roles as health coaching team leaders.
Measures
Assessment of students toward course objective com pletion occurred through course assignments in the LMS (Table 1). Our measure of professionalism was centered in the CPI. The CPI is a tool used in physical therapy clinical education to measure professionalism through safety, professional behavior, accountability, communica tion and cultural competence. The CPI Version 2.0 was validated in a 2012 study by Roach et al.(10)
Data Analysis
We analyzed CPI data collected at the midterm of the first clinical experience from the 2 groups to evaluate the impact of the SCP on student professional behaviors. The midterm CPI data was selected for evaluation because we were interested in understanding whether students in the SCP group achieved higher professional behavior scores earlier in their clinical experience than the pre-SCP group. We hypothesized that there would be no significant difference in professional behavior scores between the groups. We analyzed CPI data using a Wilcoxon rank-sum test to compare professional behavior scores between the groups and a chi-square statistic to examine the association of group membership with achieving an advanced intermediate or better rating. The Wilcoxon rank-sum and chi-square tests were appropriate due to the non-normal distribution and ordinal nature of the
CPI data. For all the analyses we used Stata SE 18.5 (StataCorp, College Station, TX) software.
Results
The CPI data for students and clinical instructors (CI) across the years (2020-2023) of the study are summarized in Table 2. An analysis of the median, mean, and standard deviation (SD) for each group shows the overall distribution of the CPI scores and identifies potential baseline differences between the groups.
Table 3 presents the results of the Wilcoxon ranksum analysis used to compare the CPI scores of students who participated in the SCP (Group 2) with those who did not (Group 1) as well as the scores of the CI for the two groups. This analysis revealed statistically significant differences in student professionalism ratings between the two groups. Students in Group 2 (SCP) had higher ratings on four out of the five CPI scores that define professionalism: safety, professional behavior, accountability and communication. Building on the findings of the rank-sum analysis, Table 4 shows the results of the chi-square analysis. This analysis examined the association between student group (preSCP vs. SCP) and achieving a rating of "advanced intermediate" or better on the CPI for both student and CI ratings. Similar to the rank-sum analysis, we found statistically significant associations between group and achievement of a higher rating for the same four professionalism areas (safety, professional behavior, accountability and communication). The chi-square analysis also revealed an association between student group and the CI ratings on communication skills.
Discussion
We found that student groups demonstrated a significant difference in their midterm self-assessment of professional behaviors pre versus post SCP implementation. When students participate in experiential learning activities, they develop more confidence and self-efficacy which contributes to improved performance.(14) Safety, professional behavior, accountability and communication are all examples of professionalism that the SCP required of the students. Student health coach leaders communicated regularly with their team, clients and faculty. They had to organize meetings and be accountable to their student team. The SCP required student physical therapists to present as young professionals and actively listen to safely progress their clients through the program. We attribute the difference between student groups midterm ratings to the improved self-efficacy in the SCP group. This finding which occurred at midterm may also mean that students who participated in the SCP can focus their clinical learning on developing advanced patient care skills, confident in their foundation of professional behaviors established through the SCP.(17,18)
While student groups demonstrated differences, the СТ assessments were only significant in the measure of communication. The CPI data is representative of a variety of clinical settings with variables that influence CI assessments in the areas of safety, professional behavior, and accountability. Differences across setting expectations may have contributed to lower ratings in categories other than communication. We posit that communication skills acquired by students who participated in the SCP were represented consistently across settings and reflected in all CI ratings. It is important to note that these assessments occurred between 2020 and 2023 in the height of the COVID-19 pandemic. There is no way to account for, or assess, the impact this may have had on CI ratings but anecdotally, students expressed higher levels of concern about communication skills during this time period.
The SCP, similar to Phillips et al. and Ickes et al., provided experiential learning in a health coaching model that can be implemented in any health professions program.(5,6) The use of the SCP superimposed on a structured evidence-based health management program can promote professional behaviors without hands on, high-stakes, 1:1 patient interaction. The combination of a standardized intervention with a structured, curriculum-informed student coaching manual, reduces the need for high stakes critical thinking allowing students to focus on the development of professional behavior skills. The use of the coaching manual with its activities and standardized scripts created a framework for students with parameters that they need in early patient interactions. The scaffolded course objectives in each year created the progression, accountability and the leeway to expand the parameters as students moved from year to year in the SCP.
Evidence-based programs such as WWE are delivered in consideration of population health needs. Using an SCP in this population health model shifted the student focus to the construct of professionalism including safety, professional behavior, accountability and communication. Each client interaction required a different level of communication and adaptability from the student team to address the client's needs depending on their readiness to change health behaviors. Students can implement motivational interviewing strategies, build rapport, and monitor client progression throughout a complete program. Students are provided structure through the use of a health coaching manual and guided by designated faculty as needed. This model allows any academic health professions program to provide community outreach through evidence-based programming while facilitating student development of professionalism.
Our model of a SCP can be used to promote the scaffolded development of professionalism from preprofessional to entry-level as demonstrated in the course objectives outlined in Table 1. We believe that knowing the students in each cohort personally and then intentionally matching students in peer mentor groups facilitated the development of individual student skills. Student assignment to teams ensured that there was representation from each cohort with a balance of individual student skills so that opportunities for growth and support existed across the team. The matching process was integral in developing student self-efficacy which may have led to the higher initial mid-term ratings on the CPI in the professionalism categories.
There are a few limitations to this study. First, the potential influence of the COVID-19 pandemic on student and CI CPI assessments. We did not specifically account for the impact of the pandemic on student selfeficacy or Cl impressions of student performance, nor the mental health implications within either group. Next, this study includes only one academic program with a limited sample size impacting generalizability of data. Finally, the assessment of additional groups" experiences over the coming years is limited due to the sunsetting of the CPI 2.0 and the inability to have comparable data moving forward.
Despite these limitations, we concluded that the SCP contributed to the early achievement of benchmarks in safety, professional behavior, accountability and communication skills in our students. The SCP can be effectively integrated into any health professions curriculum to build student skills and self-efficacy in professionalism required for entry-level practice. Student health coaching teams, with faculty oversight and the use of a health coaching manual, have the potential to impact student performance and also facilitate academic-community partnerships and impact population health.
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