Cooperative education in a physical therapy curriculum.

Cooperative Education in a Physical Therapy Curriculum The purposes of this article are 1) to introduce the goals, objectives, and benefits of cooperative education (also referred to as "co-op") to physical therapy students, faculty, and employers; 2) to present one co-op model as practiced at Northeastern University in Boston, Mass; and 3) to illustrate how a co-op program can benefit a physical therapy curriculum.

Definition of Cooperative

Education

Cooperative education is an educational strategy that involves students in productive work as an integral part of the curriculum. [1] In 1906, Herman Schneider introduced the concept of co-op at the University of Cincinnati. Schneider believed that there are aspects of every profession that cannot be learned in the classroom, but must be learned in the environment in which the profession is practiced. [2] Since that time, the philosophy and practice of co-op have expanded. The National Commission for Cooperative Education reports that more than 900 colleges and universities in the United States have active co-op programs.

According to Wilson, there are three fundamental components of co-op: 1) It is an educational strategy, with goals, learning objectives, and a method of evaluation; 2) it involves students in productive work; and 3) it is an element of the curriculum. [1] To be successful, co-op must be an accepted and recognized component of the curriculum. Co-op periods must be scheduled into the academic calendar to allow students to spend time at the work site. Several calendar models are available including semester, trimester, and quarter systems. Programs may be developed on an alternating or parallel plan. In an alternating plan, students alternate academic periods with periods of time at work. In a parallel plan, students spend part of each day in the classroom and part of each day at work.

In 1975, the federal government commissioned research to evaluate co-op. The study, conducted by Applied Management Sciences of Silver Spring, Md, involved students, graduates, and employers in engineering, architecture, business and management, health care professions, liberal arts, and trade and industry. As summarized by Wilson, results showed that co-op graduates were significantly more satisfied with their careers than were nonco-op graduates. Students enrolled in co-op programs and graduates of co-op programs valued their co-op experience and perceived themselves to be functioning at a higher level of job performance than did their counterparts without co-op. Furthermore, employers of both co-op students and co-op graduates would like to see an increase in the number of students participating in co-op programs (JW Wilson, unpublished manuscript, 1978).

The Northeastern University

Model

One co-op model has been practiced at Northeastern University for 76 years. Northeastern University operates on a quarter system with the academic year divided into four approximately equal quarters. During the freshman year, students attend classes for three quarters, then have the summer off. Beginning in the sophomore year, students are divided into two approximately equal divisions. While one division attends classes, the other division participates in a co-op experience. Students alternate academic quarters with quarters of paid work experience throughout the next four years.

Northeastern University established its five-year physical therapy co-op program in 1972. Currently, the physical therapy education program enrolls 550 students. Students graduate with a Bachelor of Science degree, and they must participate in the co-op program. Prior to graduation, students have the opportunity to complete six quarters of co-op experience, in addition to the 17 weeks of clinical education experience required in every physical therapy curriculum.

A co-op faculty coordinator, who is also a physical therapist, directs the co-op program at Northeastern University. The role of the co-op coordinator includes developing and maintaining appropriate jobs for students, interviewing and counseling students, providing workshops on resume writing and interviewing skills, and maintaining working relationships with both employers and academic faculty. Approximately 200 employers throughout the New England states as well as in Florida, Texas, California, Colorado, Pennsylvania, and Virginia participate in the physical therapy co-op program. Hospitals, rehabilitation centers, private practices, nursing homes, schools, and other specialty areas employ co-op students. THe co-op coordinator refers students to employers for interviews, but the employer makes the ultimate decision as to which student will be hired. In most instances, several students compete for one position. Thus, students begin developing interviewing and job-search skills prior to graduation.

While participating in a co-op experience, students are employees with concomitant rights and responsibilities. Students work under the supervision of registered physical therapists. The employer, in conjunction with the co-op coordinator, develops the co-op job description, which is governed by both state laws regarding the practice of physical therapy and institutional policy. Job descriptions will vary from one facility to another depending on the needs of the employer and the student's experience and academic level. Both the university and the employer provide liability insurance for students working in physical therapy co-op positions.

Sophomore co-op job descriptions may include, for example, transporting patients, applying hot packs and cold packs, monitoring patients in hydrotherapy, performing range-of-motion exercises, supervising ambulation programs, assisting patients with prosthetic and orthotic devices, positioning patients, and changing dressings. In addition, students may be responsible for scheduling appointments, assisting with billing activities, and maintaining cleanliness of the department.

Third- and fourth-year co-op students have more responsibility than second-year co-op students. In addition to the duties described for sophomores, they may assist physical therapists with evaluation procedures, apply modalities, monitor exercise programs, document patients' responses to treatment in the medical record, participate in interdisciplinary patient care meetings, and assist with research projects. In the fifth year, students complete the clinical education component of the curriculum and do not participate in the co-op program.

At the end of each co-op experience, employers evaluate the co-op student's ability to perform assigned tasks as outlined in the job description. In addition, co-op students are evaluated on interpersonal skills, judgment, and dependability. Finally, the employer evaluates the co-op student's major strengths and developmental needs. When co-op students return to campus, they meet with the co-op coordinator to discuss and review their co-op experience and their evaluation. At this time, the co-op coordinator uses the evaluation as a counseling tool to promote the student's professional development. Although co-op students receive no "grade" for their participation in the program, successful completion of each co-op experience is recognized by a notation on the student's academic transcript.

Co-op experience is designed to assist students to develop personally, vocationally, and socially. While participating in the co-op program, students have time to explore and clarify career goals early in their educational experience and to learn what a future job entails by observing and working with physical therapists. They can develop problem-solving skills and learn to integrate theories and to apply knowledge learned in the classroom. Students can become more aware of employer expectations in the work place. As they begin to recognize their strengths and limitations, they may return to campus motivated to expand their knowledge and improve their skills. As students develop interpersonal skills, they become more self-reliant, self-confident, and mature.

Cooperative Education Versus

Clinical Education

The distinction between co-op and clinical education may be confusing to educators, students, and employers. This distinction is extremely important in health care facilities where physical therapy co-op students may be working side by side with physical therapy clinical education students and both report to the same supervisors. Seaverns and Wooldridge cautioned that clinical education must be separate from co-op. Each must be clearly labeled, and responsibility for each must be clearly defined and understood. [3] The co-op coordinator instructs employers and students about the differences and clarifies questions that arise.

Cooperative education experience occurs outside of the formal course of study. While participating in the co-op experience, students are employees of the cooperating facility. Co-op students are paid to perform a service to the organization. Although it is expected that learning will take place during the co-op experience, the student's primary responsibility is to provide service to the employer.

Unlike co-op, clinical education is required by all physical therapy programs as a formal part of the curriculum and is designed to meet the accreditation guidelines of the American Physical Therapy Association. A legal contract exists between the university and the clinical education site. Because the focus of clinical education is learning, the physical therapy supervisor is considered a clinical faculty member. Learning experiences are designed to meet the objectives of the physical therapy curriculum, and students are evaluated based on their ability to meet the objectives.

Need for Change in the Physical

Therapy Curriculum

In a study of the process of formal socialization of schoolteachers, Lortie stated that three basic components are found in the developmental process of all occupations. He identified them as "formal schooling," "mediated entry," and "learning while doing." [4]

Yarbrough applied Lortie's socialization concepts in her study of physical therapy graduates. [5] She described the three stages of socialization of the physical therapist as "formal education," "clinical education," and "the early years of work." Yarbrough concluded that limitations exist in each of these stages, because she found physical therapy graduates unprepared to deal with the reality of hospital culture.

According to Yarbrough, the first stage--formal education--focuses on the acquisition of specialized knowledge. [5] The educational experience in physical therapy often affords few opportunities for interaction with other health care professionals. As a result, students may develop narrow, idealistic perspectives of the health care system. In addition, the physical therapy course work is so extensive that it cannot all be learned and integrated in the time allowed. Limitations are also evident in Yarbrough's second stage--clinical education. Students are frequently assigned the most desirable patients, are sheltered from bureaucratic problems, are excused from administrative responsibilities, and often do not spend enough time in the clinic to encounter a wide range of experience. As a result, during the third stage--the early years of work--new graduates are often frustrated and develop feelings of resentment. [5] Based on these conclusions, Yarbrough made numerous recommendations for changes in the physical therapy curriculum.

Value of Cooperative Education

in the Physical Therapy

Curriculum

One of Yarbrough's recommendations is that the curriculum should include more time for interprofessional experiences. [6] The literature in higher education related to professional development confirms this need. In developing a conceptual framework for professional programs, Stark et al recommend increasing communication and cooperation among various professional programs. [6] Mayhew and Ford concur that professional curricula are too compartmentalized, and they recommend changes including increased interdisciplinary study and time to allow for the integration of learning. In addition, they recommend recognition of the value of co-op in the curriculum. [7]

Physical therapy students need time to develop communication skills and to learn to collaborate, consult, and solve problems with other members of the health care team. While participating in the co-op program, students have the opportunity to interact with other physical therapists, physical therapist assistants, and physical therapy aides; nurses; physicians; patients and their families; and other members of the health care team. As paid employees, co-op students are not sheltered from the bureaucratic organization, so they must learn to communicate with staff members on a day-to-day basis. Problems must be dealt with as they arise. Students learn, for example, that different clinical approaches work better with different patients and that treatments must be modified to be effective with various personalities. They can begin to understand that not all therapists do things in exactly the same way. To perform the co-op job effectively, students must learn to consult, collaborate, and solve problems in an interdisciplinary setting. At Northeastern University, co-op experience helps to prepare students for clinical education experience, which occurs later in the curriculum. A second Yarbrough recommendation is that students be given time and opportunity to develop an understanding of the health care system and to be aware of professional issues including job dissatisfaction, turnover, bureaucratic control, and decision making revolving around issues such as ethics and values.

Because co-op provides an opportunity for early identification of career interests, the co-op experience can reduce later job dissatisfaction and turnover. [8] In addition, early interaction with professional physical therapists provides the student with experiences that may enhance the development of professional behaviors. Although all physical therapy students complete clinical education experiences, co-op experience provides additional exposure to a variety of health care environments and a broader view of the health care system. Cooperative education students have the opportunity to observe bureaucratic systems both within and outside of the organization. Students who are involved in billing activities learn the rules and regulations regarding reimbursement for physical therapy services. As students observe ethical dilemmas in "real-life" settings, they become more aware of their own values and begin to understand medical ethics.

Yarbrough also recommended that the curriculum be structured to reduce tension and to allow time for the students to integrate learning. [5] Time spent on co-op away from the classroom setting provides an opportunity to reduce academic stress, allowing students to digest what they have learned in the classroom. In addition, students can integrate theory through work experience by putting into practice knowledge gained in the classroom.

Yarbrough further recommended that the curriculum be structured to support students' growth and self-actualization, [5] an idea supported by Shepard in her writings on curriculum design. [9] According to Shepard, health educators often allow the sciences to dominate the curriculum. She suggests that learning should be a complete experience, responsive to individual needs. Students should have time for personal growth and self-actualization.

Cooperative education can positively affect personal growth. Wilson's study of students in unspecified majors showed that co-op students felt better about themselves, had more self-confidence, and were more independent than nonco-op students. Because they were more aware of the importance of good human relations, co-op students developed good interpersonal skills. They had a heightened sense of responsibility, good work habits, and positive attitudes toward education and learning. [10] Evidence of the positive relationship between co-op and personal growth suggests that the co-op experience in the physical therapy curriculum may assist students in developing self-actualization.

In addition, co-op enriches classroom learning. For example, faculty members can create lively class discussions by calling upon students to bring their co-op experiences into the classroom. Students' experiences may help clarify a point that an instructor is trying to make. If students have worked with a piece of equipment that the university does not own, they can add to the instructor's lecture by sharing their experience with the rest of the class. Often a student will observe something on the job prior to having learned it in the classroom, making the learning process easier for the student and encouraging thoughtful questions. At other times, if a student has difficulty understanding a concept in class, the next co-op experience may help integrate the information. Difficult theories can be more easily understood when students use examples from co-op experience.

Value of Cooperative Education

to Physical Therapy

Employers

Employers can also benefit from co-op. A 1974 study conducted y the Arthur D. Little Company, Incorporated, demonstrated that there are four major classes of benefits to co-op employers: 1) good source of a para-professional work force, 2) increased release time for professional staff, 3) improvement in the personnel selection process, and 4) improved relationships with colleges leading to an increase in effective college recruitment. [11]

Wilson and Brown showed that co-op students (majors not specified) have a favorable effect on the motivation and enthusiasm of permanent employees. Because students alternate work and school, they do not have time to become bored with the job. Co-op students usually have a great deal of enthusiasm and are anxious to learn all that they can. Thus, they can provide new ideas and different viewpoints, which may cause both staff and supervisors to consider decisions in a new light. [12]

Comparing engineering graduates from co-op and traditional (nonco-op) programs, Yencso demonstrated that co-op graduates are highly motivated and more mature at graduation than nonco-op graduates. In addition, co-op graduates are immediately productive and show a one- to two-year "experience lead" over nonco-op graduates. [13]

Brown, studying the influence of co-op on the first job held following graduation, compared business and engineering graduates in a high technology company who had participated in co-op programs with graduates who had completed traditional (nonco-op) programs. Although most graduates had completed some form of undergraduate employment, co-op graduates had clearer career goals and were more confident of their career choice than their counterparts without co-op experience. In addition, co-op graduates had more realistic job expectations. [8]

Because of the shortage of both physical therapists and physical therapist assistants, many physical therapy departments are understaffed. Because co-op students assist therapists in completing routine treatments, professional staff have more time to perform other necessary functions including evaluation of patients, research, and administrative tasks. Because many students accept positions with former co-op employers following graduation, employing co-op students assists in recruitment of new professional staff.

Reports from physical therapy employers and graduates indicate support for the co-op program. Clinical faculty members observe that, as a result of co-op experience, students are well prepared for clinical education. Students are already comfortable interacting with patients, physicians, and staff members, and they are ready to work on developing higher-level skills. Employers indicate that physical therapy co-op graduates adjust rapidly to new facilities and are immediately able to assume a full caseload.

Limitations of Cooperative

Education

Addition of co-op periods to the curriculum does increase the amount of time needed to obtain a degree. Two factors, however, offset the increase in time spent in school. First, as Yarbrough recommends, [5] co-op students graduate with more patient care experience than students from traditional physical therapy education programs. The additional time in the clinic during co-op periods provides the student more time for interprofessional experiences, for the integration of learning, and for the development of self-actualization. Second, money earned during co-op can assist students in paying tuition and other college expenses.

Some scheduling problems can occur. Because two groups of students are alternating co-op with course work, courses must be scheduled at least twice a year to allow all students to progress in the curriculum. Faculty members, therefore, must teach the same course for two consecutive quarters. Because three academic quarters comprise an academic year and the summer quarter is additional, however, physical therapy faculty members have approximately the same work load as their colleagues teaching in semester or trimester systems.

Scheduling co-op periods into the curriculum results in an interruption of academic studies. Some faculty members fear that when students return to school from their co-op experience, they may have forgotten the theoretical knowledge gained during the previous academic period. Wilson and Lyons, however, refuted this argument with a study of 165 liberal arts, business, and engineering faculty members who taught in co-op programs. When faculty members were asked whether students returning from their co-op experience required an undue amount of time to review material, only 6% of the respondents "clearly agreed" whereas 68% "clearly disagreed" and an additional 7% "tended to disagree." [14]

Finally, although many undergraduates enjoy changing roles from student to employee, others find the transition difficult. Although it is not easy, for example, to maintain a ful-time job and continue to take an active role in athletics and other college activities, students who are committed to doing so are capable of balancing co-op and college activities effectively. Successful physical therapy co-op graduates at Northeastern University have included members of the varsity hockey, track, and swim teams. Overall, physical therapy co-op graduates and employers seem to agree that the advantages of co-op far outweigh the disadvantages.

Conclusions

Research on co-op in other majors and experience at Northeastern University with physical therapy co-op employers and graduates suggest that co-op benefits students, graduates, and employers. Although co-op research to date has focused on other majors, it is likely that physical therapy students, graduates, and employers would enjoy similar benefits. Research specific to physical therapy, however, is needed before sweeping curriculum changes can be recommended. Future research must address the following questions:

1. Are physical therapy co-op graduates more satisfied with their careers than nonco-op graduates?

2. Do physical therapy co-op graduates stay in the field longer than nonco-op graduates?

3. Do physical therapy co-op graduates have higher levels of self-actualization than nonco-op graduates?

Theorists and educators agree that professional curricula are too highly structured and compartmentalized. There is a need for more interprofessional experience and a greater understanding of the role of other health care professionals. Cooperative education addresses these issues. In addition, the co-op experience allows the student time to integrate theory and practice and to develop personally, professionally, and socially. As physical therapy educators work toward developing a curriculum to educate professional physical therapists of the future, they might consider co-op as a positive adjunct to the physical therapy curriculum.

References

[1] Wilson JW: Conceiving cooperative education. In Wilson JW (ed): Developing and Expanding Cooperative Education: New Directions for Experiential Learning. San Francisco, CA, Jossey-Bass Inc, Publishers, 1978, pp 1-4

[2] Schneider H, referred to in Barbeau JE: Second to None. Boston, MA, Custom Book Program of Northeastern University, 1985

[3] Seaverns CF Jr, Wooldridge RL: Coordinators and placement. In Knowles AS, et al (eds): Handbook of Cooperative Education. San Francisco, CA, Jossey-Bass Inc, Publishers, 1971, pp 269-284

[4] Lortie DC: Schoolteacher: A Sociological Study. Chicago, IL., University of Chicago Press, 1977, p 57

[5] Yarbrough P: An Ethnography of Physical Therapy Practice: A source for Curriculum Development. Doctoral Dissertation. Atlanta, GA, Georgia State University, 1980

[6] Stark J, Lowther M, Haggerty B, et al: A conceptual framework for the study of preservice professional programs in colleges and universities. Journal of Higher Education 57:231-258, 1986

[7] Mayhew LB, Ford PJ: Reform in Graduate and Professional Education. San Francisco, CA, Jossey-Bass Inc, Publishers, 1974

[8] Brown S: The Impact of Cooperative Education on First Job After College. Boston, MA, Cooperative Education Research Center, 1984

[9] Shepard KF: Considerations for curriculum design. Phys Ther 57:1389-1393, 1977

[10] Wilson JW: What students gain from coopertive education. In Ryder KG, Wilson JW (eds): Cooperative Education in a New Era. San Francisco, CA, Jossey-Bass Inc, Publishers, 1987, pp 269-284

[11] Documented Employer Benefits from Cooperative Education. Boston, MA, Arthur D Little Co, Inc, 1974

[12] Wilson JW, Brown S: A Benefit-Cost Model for Employer Participation in Cooperative Education. Boston, MA, Cooperative Education Research Center, 1985

[13] Yencso WR: A Comparative Analysis of Engineering Graduates from Cooperative and Regular Programs. Doctoral Dissertation. Flint, MI, University of Michigan, 1970

[14] Wilson JW, Lyons EH: Work Study College Programs. New York, N Y, Harper & Row, Publishers Inc. 1961

(*1) A Noonan, MEd, PT, is Assistant Professor and Coordinator of Cooperative Education Northeastern University, PO Box 746, Boston, MA 02117. Address correspondence to 30 Glover Dr, Stoughton MA 02072 (USA).

This article was adapted from a platform presentation at the Combined Sections Meeting of the American Physical Therapy Association, Washington, DC, February 11-14, 1988.

This article was submitted September 6, 1988; was with the author for revision for two weeks; and was accepted December 21, 1988.