Related Information
The following materials are being provided as resources for participants of the March 2009 Clinical Doctorate Design Session. These materials may be helpful in providing background information for the conversations that will take place during the session.
Currently we have materials related to:
Materials related to other Health Professions
Physician Assistants
PA Doctoral Degree Resources
Since the U.S. Army and Baylor University announced in Nov. 2007 the first-ever PA-specific clinical doctorate degree program, ADVANCE for Physician Assistants has been the leading source for information about PA-specific doctorate degrees and their possible impact on the profession.
Value Added: Graduate-Level Education in Physician Assistant
Programs
B
The Physician Assistant Program: Training for a
Medical Career without Medical School.
Surveyed is a pre-physician assistant program by
giving: definition of the career, a historical basis, medical practice
settings, education, advantages, and an evaluation of the student population.
Included is a table which shows the distribution of acceptances into the
physician assistant programs for the medical and clinical phases of training.
(RT)
Physician Assistant Education: An Abbreviated History.
Taking PA Education to the Next Level.
Academic Deress and Clinical Practice Characteristics: The
University of Washington Physician Assistant Program: 1969-2000.
Context: The physician assistant profession has been
moving toward requiring master's degrees for new practitioners, but some argue
this could change the face of the discipline. Purpose: To see if there is an
association between physician assistants' academic degrees and practice in
primary care, in rural areas, and with the medically underserved. Methods:
Surveys were sent to 880 graduates of the first 32 University of Washington
physician assistant classes through 2000. Respondents noted their academic
degree at program entry and the highest degree attained at any time up to the
time of survey. Relationships between practice characteristics and academic
degree levels were tested by unadjusted odds ratios and logistic regression
after controlling for year of graduation and sex. Results: Of the 478
respondents, 54% worked in primary care, about 30% practiced in nonmetropolitan
communities, and 42% reported providing care for the medically underserved.
Respondents with no degree (33% of total at entry, 24% at survey) were
significantly more likely than degree holders to work in primary care and
nonmetropolitan areas. Respondents with no degree at program entry were
significantly more likely, and those with no degree at the time of the survey
were marginally more likely, to self-report work with the medically
underserved. Conclusion: Respondents with no academic degree are significantly
more likely to demonstrate a commitment to primary, rural, and underserved
health care. These findings may inform the national debate about the impact of
required advanced degrees on the practice patterns of nonphysician
providers.
Training Nurse Practitioners and Physician assistants. How
Important is State Financing?
This report identifies issues in state financing of programs to train nurse
practitioners and physician assistants and presents findings of a national
survey of 51 such training programs. An introductory chapter gives the main
arguments for increased use of nonphysician providers of primary health care;
this is followed by a chapter on barriers to the development of such training
programs, including costly tuition and faculty shortages. The third chapter
details the way one state, Virginia, has addressed the issue of training nurse
practitioners. Chapter 4 discusses issues for nurse practitioner education,
including program expansion and budgetary pressures, and offers a comprehensive
definition of the nurse practitioner role. In chapter 5 issues for physician
assistant education are examined, including managing program expansion,
graduate employment, and program budgetary pressures. A definition of the
physician assistant role is included. The sixth chapter briefly describes the
national survey in the context of state support for training programs. The
survey's results are detailed in the seventh chapter. A concluding chapter
notes that state financial support is important to the vast majority of
training programs that receive it and that nurse practitioner programs are
better supported than physician assistant programs. Appendices include the
survey form and a listing of program respondents by state. (DB)
Clinical Doctoral Degrees—Are We
Ready?
Doctoral Degrees for PAs: Questions and
Issues
-
Value Added: Graduate-LevelEducation in Physician Assistant
Programs.
Defining the Future Characteristics of Physician Assistant
Education Proceedings (Alexandria, VA August 16-17, 1996).
This
report summarizes a project that focused on the future of the education of
physician assistants. The panel of expert presenters represented physician
assistant (PA) educators, educators of other health care professionals,
employers of PAs, health care oriented foundations, a health care workforce
expert, and members of the PA profession. The conference outcome indicated the
need for continued examination of the external factors that influence the
education and practice of PAs, as well as the development of strategies to
respond to the rapidly changing health care environment. Papers include: "From
Lexicon to Praxis: Future Characteristics of Physician Assistant Education"
(Eugene Jones); "A Glimpse of the Future" (Albert Simon); "Educator's View"
(Brenda Jasper); "Health Professions: Projections of Supply and Demand" (James
Cawley); "Rural Practice Focus" (Jennifer Krueger); "Health Professions
Foundation View" (Jennifer Ruzek); "Education for a Changing Health Care
System" (Christopher Bork); "PA Employer View" (Brian Trojniak); "Physician's
View" (Norman Kahn); and "PA Employer View" (Kenneth Moritsugu). Lists of the
advisory committee members and panelists are appended. (WD)
Perceptions of US PAs Regarding the Entry-Level Doctoral Degree
in Physician Assistant Education
The Perceptions of Physician Assistants Regarding Doctorate
Level PA Education.
Abstract. Many mid-level health care professions have
implemented the clinical doctorate. The physician assistant (PA)profession has
not implemented doctoral-level education. This cross - sectional study was
designed to determine the perceptions of practicing PAs regarding the Doctorate
of Physician Assistant (DPA). A survey was sent to a randomized sample of
United States PAs that were in the database of the American Academy of
Physician Assistants (AAPA). The results were analyzed using Chi-Square
analysis and descriptive statistics. The response rate for this survey was 23%
(n=1,500). The majority of the respondents were not in favor of the DPA
(55.8%). The study results reveal a group of practicing PAs in the United
States that do not favor the profession moving toward offering a DPA
degree.
Survey of Physician’s Assistant Program in the United
States.
In October 1984 the Association of Physician
Assistant Programs conducted the first national survey to determine the
characteristics of PA programs. The survey collected information on the
administration, faculties and staffs, curricula, students, and graduates of the
programs. Major findings are discussed. (MLW)
The
Doctoral Pipeline in Physician Assistant Education.
The Physician’s Assistant Profession: Results of a 1978
Survey of Graduates.
The major findings of a 1978 national survey of 4,500
physician's assistants are described. Seventy-four percent of the respondents
were working in primary care specialties, and two-thirds were located primarily
in institutions. Physician's assistants were more likely than physicians to be
working in nonurban areas.
A Contextual and Logical Analysis of the Clinical Doctorate for
Health Practitioners: Dilemma, Delusion, or De Facto?
Growth of the number of practice or clinical
doctorates in allied health and nursing is examined from several different
points of view. These perspectives are first discussed contextually and then
organized according to the dilemmas we face, the delusions we need to address,
and the de facto reality we need to acknowledge. The article concludes with an
overview of internal and external review practices and interprofessional
considerations.
A Clinical Doctorate in Emergency Medicine
for Physician Assistants: Postgraduate Education
A Clinical Look at Clinical Doctorates.
Universities complain about clinical doctorates,
arguing that degrees like doctor of pharmacy represent little more than degree
creep and are not equivalent to, say, the Ph.D. or M.D. But few institutions
have done much more than complain, instead coming to rely on the revenues
clinical programs bring them — especially given that many students in those
programs pay tuition over a longer period than do students earning bachelor's
or master's degrees in the same fields. And clinical doctorates have become
increasingly established over time.
A conceptual framework for the study of preservice
professional programs in colleges and universities.
A Report to the Board of Trustees from the Task Force on the
Professional Doctorate.
Sociology
Professions Theory and Physician Acceptance of Physician
Assistants
Workforce
Out of
Order, Out of Time: The State of the Nation’s Health Workforce
Accreditation
Association of Specialized and Professional
Accreditors Statement on Professional Doctorates
General
Credential Creep
The Hyper – Credentialism of the Health
Professions
A Clinical Look at Clinical Doctorates
A Report to the Board of Trustees from the Task Force on the
Professional Doctorate
A Response to ‘A Clinical Look at Clinical
Doctorates’ published in The Chronicle for Higher Education
A Report to the Board of Trustees from the Task
Force on the Professional Doctorate
Materials related to other Health Professions
The Professional Doctorate (Au.D.)
Education Statement Regarding Doctoral Level
Clinical Laboratory Science Professionals
The Doctorate in Clinical Laboratory Science:
Enhanced Quality for Healthcare
The Move Toward the Clinical Doctorate in the Allied Health
Professions
Physical Therapy
The Evolution of the Doctorate of Physical Therapy: Moving
Beyond the Controversy
.
Doctor of Physical therapy (DPT) Degree
Frequently Asked Questions.
FAQs: Transition Doctor of Physical Therapy
(t-DPT) Degree.
Coalitions for consensus: A plan in support of
the “transition” clinical doctoral (T-DPT).
Board of Directors Plan in Support of the Transition Clinical
Doctorate.
The decision to develop a transition DPT program is
fully within the prerogative of institutions of higher education. However, APTA
has chosen to take a supporting role through the development of voluntary
products/resources that have been designed to serve the interests of licensed
physical therapists, postprofessional PT education programs, and the entire
profession. Even though the transition of physical therapy to a doctoring
profession is a long-term process, APTA's Board of Directors enthusiastically
adopted a "Plan in Support of the Postprofessional Clinical Doctorate" in
November 2000 to facilitate the acquisition of the Doctor of Physical Therapy
(DPT) by US-licensed physical therapists. The plan involves four phases:
Doctorate of Physical Therapy: Clinical and
Academic Physical Therapists’ Perceptions of Appropriate Curricular
Changes.
Background and Purpose. The purposes of this study
were (1) to examine what clinical and academic physical therapists (PTs) think
should be added to physical therapist education curricula in order to produce
autonomous professional (entry-level) physical therapist graduates, as physical
therapist education programs make the transition from the entry-level Master of
Physical Therapy (MPT) degree to the entry-level Doctor of Physical Therapy
(DPT) degree, (2) to identify the changes physical therapist educators are
making to curricula in order to meet the goal of producing autonomous
professional physical therapist graduates, as programs transition from the
entry-level MFF degree to the entry-level DPT degree, and (3) to analyze
similarities and discrepancies between what clinical and academic PTs think
should be added to the curriculum and the actual changes educators are
implementing in their curricula as programs make this transition.
The post-professional doctorate of physical therapy: a survey
of practicing physical therapists.
ABSTRACT: The purposes of this survey study were to
assess whether practicing physical therapists desire a post-professional
clinical doctorate of physical therapy (DPT) and to explore their expectations
for such a program and future benefits they may expect from acquiring this
degree. A simple random sample of 35% of all Nebraska and Iowa chapter members
of the American Physical Therapy Association was .selected. This random
selection resulted in 173 subjects from Nebraska and 223 subjects from Iowa,
for a total of 396 subjects. The survey instrument consisted of 6 demographic
questions and 21 questions regarding the curriculum content and program
implementation of a postprofessional DPT program, expectations of the DPT
degree, and personal views about the DPT degree. Response frequencies for all
of the survey questions were determined. The data were also examined for
variation in the responses across specific demographic groups based on the type
of physical therapy degree held, the desire to pursue a DPT degree, the number
of years of experience, and the level of exposure to the DPT degree. A total of
280 survey instruments were returned, for a response rate of 71%. One third of
the respondents were interested in obtaining a post-professional DPT degree.
The two most common expectations cited for the DPT degree were enhancement of
professional competence of a physical therapist and assistance in career
advancement. Managed care, business management/administration issues, and
professional communication were identified as desired areas of curriculum
emphasis. There is interest among practicing physical therapists who share
common expectations for developing further professional competence consistent
with current practice demands in obtaining a postprofessional DPT
degree.
The preferred Curricular Model for the Transition Clinical
Doctoral (t-DPT) Program and Learner.
This document is a draft of the model curriculum
entitled The Preferred Curricular Model for the Transition Clinical Doctorate
(DPT)Program and Learner. Content experts in a consensus conference using a
structured decision-making process developed this curriculum.A total of 33
modules were created representing content considered essential for the licensed
physical therapist that may have graduated prior to academic programs awarding
the professional clinical doctorate (DPT). The modules reflect content that has
been augmented orenhanced during the past 5-10 years. All of the modules are
fully congruent with the patient/client management model in the Guide
toPhysical Therapist Practice and the consensus-based educational outcomes and
curricular content for professional education in A Normative Model of Physical
Therapist Professional Education: Version 2000.In the left column (Module) of
the matrix, the specific module (ie, clinical pharmacology, research
methods/design) is identified by nameand number. The number indicates the order
of the sample module within the overall 33 modules. A description of the module
appears in the 2nd column (Module Description). The 3rd column (PrimaryContent)
is intended to provide guidance for faculty in structuring learning objectives
when teaching the module. The far right column (NMV2K Category) provides the
educator and practitioner with a crossreference for the comparable primary
content within the foundational sciences, behavioral sciences, clinical
sciences, and practice expectations (1-19) in A Normative Model of Physical
Therapist Professional Education: Version 2000.
Physical Therapists, Social Workers,
Physician
Assistants.
The Doctor of Physical therapy Degree: A New Curriculum for a
New Degree.
By 2020, all graduates of accredited physical therapy
programs will receive the Doctor of Physical Therapy (DPT) degree. Bachelor
degrees in physical therapy are no longer granted, and over 83% (N = 176
accredited programs) of the entry-level physical therapy education programs
already grant the DPT degree. The purpose of this article is to highlight the
significant curricular changes that have taken place in most physical therapy
education programs as they have transitioned from a masters degree to the level
of the clinical doctoral degree culminating in the DPT. A summary of the key
philosophical elements and practical considerations that drove the development
and implementation of the University of Colorado curriculum as the transition
to the DPT occurred are highlighted. Focusing on the curricular changes in one
accredited entry-level Physical Therapy Program allows for a clearer
understanding of the evolution of physical therapy as a discipline within the
context of healthcare delivery and the provision of PT services in multiple
settings and environments, including school-based physical therapy practice.
Once the DPT level physical therapist has the additional knowledge and skills
necessary for school-based practice, and gains experience in this unique
practice setting, it can be assumed that he/she will demonstrate an advanced
level of clinical decision-making that will be a benefit to the students
receiving PT as a related service and to the rest of the school team.
Initiating Clinical Doctoral Education in Physical Therapy: The
Case of Creighton University.
This article describes the developmental processes
underlying the implementation of the Doctor of Physical Therapy (DPT) program
at Creighton University. Creighton University established the first
professional (entry-level) UPT program in physical therapy. An explanatory case
study was used to frame the analysis of specific decisions and key events. A
case study database was created using documentation, archival records,
interviews with key decision makers, and authors' experiences as participant
observers. Critical factors in the development of this program included
institutional and school leadership, institutional commitment and capacity,
contributions of key educational leaders in ...
The Clinical Doctorate: A Framework for Analysis in Physical
Therapist Education.
This article explores major considerations for
analysis and discussion of the role of the clinical doctorate as the first
professional degree in physical therapist education (DPT). A process for this
analysis is posed based on a conceptual framework developed by Stark, Lowther,
Hagerty, and Orczyk through grounded theory research on professional education.
External influences from society and the profession, institutional and
programmatic influences, and articulation of critical dimensions of
professional competence and professional attitudes as major categories are
discussed in relation to the DPT. A series of questions generated from the
application of the model are put forth for continued discussion and
deliberation concerning the DPT. We conclude that the DPT provides the best
pathway to serve society, the patient, and the profession.
The Future of Physical Therapy Education: APTA’s Education
Strategic Plan.
Physical therapy education has changed dramatically
over the years. When the profession began, physical therapists (PTs) would earn
a bachelor's degree in another closely related field and then obtain a
certificate in physical therapy. As time went on, the profession created and
adopted a physical therapy bachelor's degree as its entry-level degree for the
profession. Later, educational programs adopted the post-baccalaureate degree,
primarily the master's degree, as the highest entry-level degree in the field.
And in 1996, the first professional DPT program graduated its first class of
students.Now that the field has achieved the highest degree-the clinical
doctorate-the question becomes: "Where do we go from here?"
Occupational Therapy
Integrated Health Human Resource Options: The
Impact on Occupational Therapy Professional Practice.
Healthcare systems in many countries have gone
through numerous changes over the last two decades. Funding bodies and
employers have tried to find cost-effective, innovative ways to deliver quality
healthcare including methods to reduce labor expenses. Three approaches to
cost-savings have been proposed for healthcare professionals: multiskilling,
cross-training, and personnel substitution. The advantages and disadvantages
associated with each approach are outlined. Issues related to professional
practice roles are then reviewed and discussed. Implications for occupational
therapy practice are presented and recommendations for the future are
made.
A Descriptive Review of Occupational Therapy
Education.
In an August 2002 Commission on Education (COE)
meeting, COE members decided to design and write a Guide to Occupational
Therapy Education. With the advent and passing of Resolution J- which became
Resolution 670-99 at the 1999 Representative Assembly meeting of the American
Occupational Therapy Association (Accreditation Council for Occupational
Therapy Education [ACOTE], 1999b)-and new degree structures within the
profession (i.e., professional/clinical doctorate), a guide to occupational
therapy education is warranted. This guide, retitled A Descriptive Review of
Occupational Therapy Education, is intended for practitioners, academicians,
and potential occupational therapy ...
Advanced degrees: Are they really necessary?
National status of the entry-level doctorate in Occupational
therapy (OTD).
A multifaceted survey was conducted to identify the
factors that academic occupational therapy (OT) programs were considering in
making decisions as to whether the entry-level clinical doctorate (OTD) is a
viable alternative for their institutions. The survey was sent in the summer of
2004 to program directors of all (150) occupational therapy programs in the
United States. Responses were received from 111 programs (response rate of
74%). Quantitative (demographic) and qualitative (factor identification) data
were compiled and analyzed. Supporting factors for the development of
entry-level OTD programs included (a) coexistence of physical therapy doctorate
program, (b) enhanced preparation of graduates, and (c) improved student
recruitment. Impeding factors included (a) limited resources, (b) philosophical
objections, and (c) lack of demand. In addition, results suggested that overall
there is greater support for the OTD as a post professional degree. The study
provided a historical record of current decision making in occupational therapy
academic programs. In addition, the results of the study suggest a need for the
development of national consensus regarding the place of the OTD in
occupational therapy education.
Is a doctoral education relevant to a practicing OT?
The levels of OT education.
National study of occupational therapy practice.
The possible effects of a change to master's entry level in
Occupational therapy.
American Journal of Occupational
Therapy, 41, 658-666.
One of the most challenging debates facing the
profession of occupational therapy centers on whether or not the standard for
entry level into the field should be upgraded. The occupational therapy
baccalaureate degree has been viewed as too limited in scope and professional
training, and the master's degree has been forwarded as the standard for entry
into the profession. However, upgrading the entry level standard raises several
questions. This study considered 25 areas that would be affected by upgrading
the entry level from the baccalaureate to the master's level in occupational
therapy and in related health professions. A model was developed to provide a
framework for analyzing how a change in entry level will affect the current
status of occupational therapy as a profession. Although the parallel material
is drawn from other health professions, the considerations are similar to the
ones faced by occupational therapy. This comparison is especially important
because a major change in entry level education has far-reaching repercussions
that must be considered before any groundwork is laid for upgrading educational
requirements.
A historical cross-disciplinary perspective on the professional
doctorate in occupational therapy.
Clinical doctorates are emerging in occupational
therapy. By examining the development of clinical doctorates in medicine,
dentistry, psychology, pharmacy, nursing, and physical therapy, implications
can be drawn for the future of occupational therapy education. These histories
offer us a sense of the distinct purpose and curricular structure of the
professional doctorate, its successes and problems, its general sequence of
unfolding, the political dynamics surrounding it, and the potential it holds
for supporting the profession's capacity for service to patients.
A needs assessment for the doctoral-level education in
occupational therapy. Results and discussion.
The relationship between professional productivity andeducational level,
part 2.
Should the clinical doctorate degree be the standard of
entry into the practice of occupational therapy?
Commentary: The need for a clinical doctorate in
occupational therapy (OTD).
Perceptions by Practicing Occupational Therapists of the
Clinical Doctorate in Occupational Therapy.
Despite recent discussions regarding the
implementation of the clinical doctorate in occupational therapy (OTD) as the
entry-level degree for occupational therapy, there is a dearth of published
literature that addresses the issue of the OTD. In this study, recent alumni of
an occupational therapy program from an urban midwestern university were
surveyed to determine their perceptions of the OTD. Most respondents agreed or
strongly agreed that the OTD curriculum should include courses about managed
care and/or insurance regulations, business management/ administration,
effective professional communication, research, and specialization in a
specific area of occupational therapy. Respondents believed that an OTD would
assist in career advancement, obtaining a higher salary, and professional
competence. However, the majority of respondents did not believe that an OTD
would result in enhancement of interprofessional relationships, improved
reimbursement from third-party payers, and enhanced public recognition of the
profession or enhanced ability to practice without a referral. There was not a
strong opinion whether there is an advantage to a clinical doctorate degree,
and only 22% agreed or strongly agreed that they would be interested in
pursuing a post professional OTD. J Allied Health 2007; 36:137-140.
Audiology
Proposed Academic and performance Standards for
the AuD Degree.
… the work of the AuD National Standards
Council (TANSC) organized by James Jerger in 1994 to develop … wish to earn
the AuD degree, and methods by which appropriate academic credit can be issued
by degree … expected of new AuD students.
The Professional Doctorate (AuD).
Twenty Years Later: The Majority of Audiologists Are
Doctors.
In 1988, only 8
percent of U.S. audiologists held doctoral degrees. Of those, most held PhDs,
most were males, and most worked in university settings. Things have changed.
As of October 2008, Paarlberg reports that more than 6,200 audiologists have
earned their AuD. Additionally, she reports more than 2,200 are currently
enrolled in residential (traditional) AuD programs and another 1,500
audiologists are currently in distant education programs. Further, in the early
1990s, there were approximately 120 programs awarding master’s degrees in
audiology, whereas in 2008, there are about 70 programs offering the
AuD.
Doctor of Audiology Student Issue On Financial Aid and
Licensure.
The Academy of Dispensing Audiologists (ADA) supports
the positions taken by other healthcare doctoring professions: a.)To not
request or expect clinical rotation and externship sites to provide financial
remunerations to students in the form of salaries, health insurance benefits,
retirement plan contributions, paid vacation time, paid sick leave, and any
other form of financial benefits that are associated with “employee”
status. ADA is in favor of residential doctor of audiology (Au.D.) students
receiving traditional financial aid from universities and colleges, the U.S.
Military, and non-profit and philanthropic foundations in the form of loans,
grants, scholarships ,assistantships, fellowships, tuition waivers ,and loan
forgiveness programs throughout their entire four-year program.b.) That any
form of licensure to students is inappropriate. Licensure should remain for
only those who have earned their entry-level degree to practice.c.)That
learning experiences provided to students at clinical rotation and externship
sites are appropriately supervised, and services provided are billed via the
licensed practitioner (or site) who is acting as the preceptor. Students do not
bill for services.
Emerging Models of AuD-PhD Education.
After more than 50 years of evolution, the audiology
profession has made the transition to doctoral-level entry for clinical
practice. Three enrollment models attempt to bridge AuD-to-PhD
education—sequential, simultaneous, and dual-track programs.
AuD Degree: The Doctoring Degree in Audiology.
Chaos or Order? Some Thoughts on the Transition to a
Professional Doctorate in Audiology.
AuD pays off, says salary survey: Median audiology salary rises
to $65,000.
The ASHA Leader, 12(4), 1,23.
Clinical audiologists who hold the AuD and have 25 to
27 years of experience average $20,000 more annually than their counterparts
with master's degrees, according to data collected in ASHA's 2006 audiology
survey.
As AuD Movement Turns 20, a Progress Reports Shows a
Profession Transformed.
With more than 6200 audiologists holding AuD degrees,
more than 2200 students currently attending residential AuD programs, and
another1500-plus practicing audiologists enrolled in distance-education
programs, audiology is looking more and more like a profession of
doctors.
Speech-Language Pathology and Audiology: An Educational
Perspective for the Future.
The report summarizes findings from a 3-year national
self-study of the profession of speech-language pathology and audiology. The
study followed a four-phase timeline; (1) identification of
clinical-educational needs of the communicatively handicapped (traditionally
served speech and language impaired individuals as well as those with other
handicaps); (2) analysis of competencies needed by speech pathologists and
audiologists; (3) analysis of discrepancies in competencies of existing speech,
language, and hearing personnel; and (4) development of recommendations for
preservice and inservice training. Project objectives for each of the four
phases are enumerated and progress or accomplishment in meeting each objective
is described. A summary of recommendations from the self-study touches on 10
issues: undergraduate education, graduate education, professional doctorate,
interface of students with those in other disciplines, preparation of students
to serve in a variety of settings, preparation of speech-language pathologists
and audiologists for a changing society, specialty certification, continuing
education, research, and advanced technology. The bulk of the report is
composed of nine appendixes, including a report of findings from the competency
survey; and papers from a national conference on undergraduate, graduate, and
continuing education.
Nursing
Moving Forward Together: The Practice Doctorate
in Nursing
AACN Position Statement on the Practice Doctorate in Nursing.
Practice-focused doctoral degree programs in nursing are not a recent
development. The first such program, offering the Doctor of Nursing (ND), was
established at Case Western Reserve University in 1979 and offered an
entry-level nursing degree. Since then, several practice-focused doctoral
programs and degree titles have emerged. Over the last several years, an
increased interest in developing a viable alternative to the research-focused
degrees, [Doctor of Philosophy (PhD) and Doctor of Nursing Science (DNS, DNSc,
DSN)] has occurred. Currently, eight clinical or practice doctoral nursing
programs exist or are in the approval stage. In March 2002, the American
Association of Colleges of Nursing (AACN) Board of Directors charged a task
force to examine the current status of clinical or practice doctoral programs,
compare various models, and make recommendations regarding future
development.
The
Essential of Doctoral Education for Advanced Nursing Practice.
Doctoral programs in nursing fall into two principal
types: research-focused and practice focused. Most research-focused programs
grant the Doctor of Philosophy degree (PhD), while a small percentage offers
the Doctor of Nursing Science degree (DNS, DSN, or DNSc). Designed to prepare
nurse scientists and scholars, these programs focus heavily on scientific
content and research methodology; and all require an original research project
and the completion and defense of a dissertation or linked research papers.
Practice-focused doctoral programs are designed to prepare experts in
specialized advanced nursing practice. They focus heavily on practice that is
innovative and evidence-based, reflecting the application of credible research
findings. The two types of doctoral programs differ in their goals and the
competencies of their graduates.
Current Strengths and limitations of doctoral education in
nursing: are we prepared for the future?
The number of doctoral programs in nursing has
increased significantly over the past 20 years. This growth has been driven in
part by the pressing need to supply faculty to teach in undergraduate and
graduate programs in nursing. Yet, enrollment in and graduation from these
programs has remained fairly constant even as the number of programs has grown.
During this 20-year period, there have been numerous conferences, workshops,
and meetings devoted to the topic of doctoral education with a constant thread
running through them calling for the need to maintain quality--quality
students, quality faculty, quality research, and quality course work and
requirements--in them. Faculty teaching in these programs have given
considerable thought to ways of assuring quality in the program of study so as
to ensure the graduate's ability to function as a teacher and researcher. Yet,
despite these efforts, still less than 50 per cent of nursing faculty possess
the doctorate, faculty are experiencing difficulty in fulfilling the tripartite
mission of colleges and universities, and extramural funding for research is
very unevenly distributed across programs and, in total, is inadequate to build
the science. This article examines the strengths and weaknesses of doctoral
programs in nursing at the start of the new millennium in which the challenges
in higher education are forecasted to become more focused and intense, using
accepted benchmarks of quality for students, faculty, and curricula.
The Doctor of Nursing Practice Degree: Lessons from the History
of the Professional Doctorate in Other Health Disciplines.
Despite the American Association of Colleges of
Nursing’s adoption of the Doctor of Nursing Practice (DNP) degree as the
appropriate level of education for advanced practice, a number of controversies
have persisted, including questions of timing, academic support,
grandfathering, diffusion of nursing research, and economics. This article
discusses the path to the professional doctorate in optometry, osteopathy,
public health, pharmacy, physical therapy, audiology, chiropractic, and
naturopathy. It reveals similar struggles to professionalism and the consensus
drawn from doctoral development in these fields. It concludes with lessons for
a path forward for the DNP.
The Clinical Doctorate—Asset or Albatross?
In recent years, there has been increasing dialogue
about the development and expansion of doctoral degrees options for advanced
practice nurses. However, a consensus has not yet been reached on these issues.
Those who are interested in pursuing additional education have expressed a
desire that there be a doctoral degree with a clinical rather than research
focus since the majority of nurse practitioners, including those in pediatrics,
work in clinical settings. A recent article by Fitzpatrick (2003) suggested
that the clinical doctorate would be an important degree for faculty whose
interests lie in teaching clinical skills and professional development but not
in participating in research. Certainly, there are benefits to this type of
degree, but there are also potential pitfalls for the profession at large.
While the majority of those who are in favor of this degree say that it will
not become the standard for entry into the profession, it is conceivable that
this may eventually become a requirement at some point in time. Two groups have
been investigating this issue. The American Association of Colleges of Nursing
(AACN) currently has a task force addressing this issue.
The Practice Doctorate: Innovation or Disruption?
Advanced practice nurses, particularly nurse
practitioners, have been described as a disruptive innovation. The American
Association of Colleges of Nursing (AACN) has proposed that by 2015 all
advanced practice nurses be prepared with a Doctor of Nursing Practice (DNP).
This article uses critical reflection on published literature to examine the
potential difficulties that mandating such a change may present to potential
students, practicing advanced practice nurses, colleges of nursing, and
doctoral education in general. After considering the pressures in the nursing
profession to prepare nurse faculty and reviewing the success of current models
of education for advanced practice, we explore in depth the unintended
consequences of the AACN recommendation. Implications for academic nursing,
curriculum, advanced practice nurses, doctoral education, titling and
licensure, economic issues, and the lack of evaluation research are addressed.
We recommend abandoning the 2015 deadline for implementation of advanced
practice nurse preparation with the DNP.
National Agenda for Advanced Practice Nursing: the practice
doctorate.
The purpose of this article was to provide the
background and rationale for the practice doctorate in nursing. The American
Association of Colleges of Nursing's Position Statement on the Practice
Doctorate in Nursing, approved in October 2004, will be discussed. Outlined are
some of the changes that will be needed in education, regulation, and advanced
practice. Common questions and concerns that advanced practice nurses have,
including titling, salary, and transitioning to the doctor of nursing practice
degree, will be addressed.
Guest Editorial The Clinical Doctorate: Whoa or Go?
The recent movement toward the development of a
clinical doctorate—the Doctor of Nursing degree, or DNP— as a requirement
for advanced practice nurses and an alternative to the PhD has raised
considerable discussion and debate about the purposes and aims of master’s
and doctoral education in nursing. This guest editorial provides two different
perspectives: one advising caution in adding another degree to the “alphabet
soup” of nursing credentials and perhaps drawing attention away from the need
for nursing research, and one stressing the importance of seizing the
opportunity to demonstrate nurses’ strengths and responsibilities and to more
readily translate nursing research findings to practice.
Clinical Doctorate: Meeting the public need?
Formative and Summative Evaluation of a Practice Doctorate
Program.
Practice doctorate programs are developing rapidly to
meet the American Association of Colleges of Nursing recommendation that
advanced practice nurses will be prepared with a Doctor of Nursing Practice by
2015. Evaluation of nursing doctoral programs has focused almost exclusively on
research doctorate programs. The authors examine formative evaluations from
students enrolled in a practice doctorate program and summative evaluations
provided by students at the time of and 1 year following graduation.
Suggestions for nurse educators and administrators are presented.
Addressing Challenges in Nursing Education Through a Clinical
Instructions Model Based on a Hybrid, Inquiry-Based Learning Framework.
This article describes an innovative hybrid,
inquiry-based learning clinical instruction model used in accelerated
baccalaureate nursing programs at three university nursing schools in the
Washington DC metropolitan area. The authors describe student and faculty roles
and offer examples of grading criteria. Nurse faculty and students from the
three schools of nursing regard the clinical instruction model as a valuable
teaching-learning approach that strengthens the relationship between theory and
practice, prepares students to think critically and act effectively, and grooms
students and faculty for a lifetime of learning in a changing world.
Doctor of Nursing Practice.
In 2005, The National Academy of Sciences Report
stated, The need for doctorally prepared practitioners and clinical faculty
would be met if nursing could develop a new nonresearch clinical doctorate,
similar to the MD and Pharm D in Medicine and Pharmacy, respectively.
Credential Inflation and The Professional Doctorate in
California Higher Education.
The article argues that the time has come to change
California's 1960 Master Plan for higher education by permitting the California
State University (CSU) to award the doctorate in selected professional
programs. The article also addresses the inadequacies of the joint doctorate as
the means to remedy degree or credential creep; the CSU's focus on securing
permission to grant the Ed.D. rather than other professional doctoral degrees;
and the dominant role played in the State by the CSU relative to the UC in
master's level education. Subsequently, the article considers why degree and
credential creep occurs and explanations for the changes going on in physical
therapy and audiology; and it explores other fields where degree changes are in
flux. (Contains 6 notes.)
The Case Against the DNP; History, timing, substance, and
marginalization.
Doctor of Nursing Practice (DNP) or not? The answer
is not! Within the historical context of our discipline, a doctorate degree
should stand for advancing and translating knowledge. Clinical practice is the
core of this knowledge. Separating the practice and research missions could
undermine our ability to be equal partners in universities, as well as diminish
our effectiveness in establishing the evidence for quality and safe health
care.
A Marketing Clinical Doctorate Programs.
Over the past decade, clinical doctorate programs in
health disciplines have proliferated amid both support and controversy among
educators, professional organizations, practitioners, administrators, and
third-party payers. Supporters argue that the explosion of new knowledge and
increasing sophistication of technology have created a need for advanced
practice models to enhance patient care and safety and to reduce costs. Critics
argue that necessary technological advances can be incorporated into existing
programs and believe that clinical doctorates will increase health care costs,
not reduce them. Despite the controversy, many health disciplines have advanced
the clinical doctorate (the most recent is the doctor of nursing practice in
2004), with some professions mandating the doctorate as the entry-level degree
(i.e., psychology, pharmacy, audiology, and so on). One aspect of the
introduction of clinical doctoral degrees has been largely overlooked, and that
is the marketing aspect. Because of marketing considerations, some clinical
doctorates have been more successfully implemented and accepted than others.
Marketing is composed of variables commonly known as "the four P's of
marketing": product, price, promotion, and place. This report explores these
four P's within the context of clinical doctorates in the health
disciplines.
Moving Forward Together: The Practice Doctorate in Nursing.
Doctor: for physicians only?
A colleague of mine is a graduate nursing student,
very excited about practicing as an advanced practice nurse in the near future.
She told the physician she has worked with for many years that she was in
graduate school to become a nurse practitioner. My colleague was stunned by the
physician's response, which was "Why are you doing that, you still won't be a
doctor?" Perhaps you are thinking that this an isolated response by a physician
who does not have an appreciation for the role of the advanced practice nurse
or for the doctorally prepared nurse.
A contextual and logical analysis of the clinical doctorate for
health practitioners: dilemma, delusion, or de facto?
Growth of the number of practice or clinical
doctorates in allied health and nursing is examined from several different
points of view. These perspectives are first discussed contextually and then
organized according to the dilemmas we face, the delusions we need to address,
and the de facto reality we need to acknowledge. The article concludes with an
overview of internal and external review practices and interprofessional
considerations
Is the burden worth the benefit of the doctorate of nursing for
NP’s? Doctor of Nursing Practice: the time is now.
I recently enrolled in Doctor of Nursing (DNP)
program at the University of Arizona. During orientation, I learned that the
amount of healthcare information doubles every 5 years. That fact gave me pause
as it should anyone. We practice in a scholarly environment that is moving at a
mind-numbing speed. The increasing complexity of healthcare demands the best
possible preparation for licensed independent providers. Accordingly, the
American Association of Colleges of Nursing (AACN) has proposed that the DNP be
the terminal clinical degree offered in nursing (for the full report, see
http://www.aacn. nche.edu/DNP/pdf/DNP.pdf). It is expected to be the
requirement for entry into practice for nurse practitioners by 2015. The DNP is
a clinical practice degree; it is neither a replacement nor a substitution for
the PhD in nursing, which emphasizes development of nurse researchers. The
focus of the DNP is to create expert nurse clinicians.
Developing A Nursing Doctorate for the 21st Century.
Nursing in the next century will reflect changes in
the health care system, and although the profession has made great strides in
preparing nurse researchers, the current system has a serious gap that must be
addressed; that of preparing clinical leaders. The article describes the need
for a practice-focused doctoral curriculum that will produce a new type of
senior clinician or expert practitioner to fill this gap. The envisioned
graduates will be skilled in clinical decision making and information
processing and will effect changes at both the micro- and macro-levels of the
system. There is a clear future need to expand the number of primary care
providers. The faculty required for their education must be doctorally prepared
nurses who are themselves clinically proficient. The research and practice
doctorates should be differentiated by faculty, the program of studies,
resources, and placement/expectation of graduates. The article includes a model
curriculum plan.
The Doctor of Nursing Practice Degree and research: Are
we making an epistemological mistake?.
There has been much discussion in the literature
about whether a Doctor of Nursing Practice (DNP) curricula should prepare
students to be principle investigators of research of whether this skill should
be left to other doctorally prepared nurses. Currently, nurse practitioners
have to rely on medical research to support their practice due to a lack of
research and researchers. Consequently, these practitioners run the risk of
adopting practice values of medicine rather then those unique to this
specialty. Despite this risk, several national organizations have recommended
that DNP programs not prepare graduates to be principle investigators.
Epistemologically, this decision poses several levels of concern, including
failure to analyze the adequacy of our current approach to research, the mixed
messages presented in the position of statements of these national
organizations, and the effects of the looming doctoral faculty shortage. These
issues, among others, are explored in this article.
Social Work
Employment opportunities in social work
education: a study of jobs for doctoral graduates.
Guidelines for Quality in Social WorkDoctoral Programs
(Revised).
Is There a PhD in Your Future?
The number of Ph.D. graduates in social work has
remained fairly constant over the past 10 years, while the number of social
work programs has grown steadily. In 1992-1993, 229 students were awarded the
doctoral degree by Schools of Social Work responding to a Council on Social
Work Education (CSWE) survey reported on in Statistics on Social Work Education
in the United States: 1993. But according to a recent report, approximately 400
social work faculty openings are advertised per year
A
Deepening Doctoral Crisis.
Opportunities for PhDs abound, but why is there a growing shortage of them? Is
the DSW an alternative for students seeking doctoral degrees?
Social Work Doctoral Education Program: A Consumer’s
Eye-View.
A study of doctoral programs in social work is
reported. Required courses, credit hours required, specializations, and
admissions criteria are examined using descriptive materials usually
distributed to prospective applicants and incoming doctoral students. The study
found a lack of uniformity in the essentials for a doctorate in the
profession.
One school’s experience in reconceptualizing part time
doctoral education in social work.
THERE HAS BEEN A SIGNIFICANT GROWTH in the number of
doctoral programs in social work in the United States over the past 2 decades
and in the number of students enrolled in such programs. In 1977, there were 35
doctoral programs in social work, which enrolled a total of 866 students
(Wittman, 1979). The growth in the number of doctoral programs continued over
the next 2 decades, such that by 1999, there were 62 doctoral programs in
social work which enrolled a total of 1,953 students (Lennon, 2001). Thus,
during this 2-decade period (1977-1999) the number of students in social work
enrolled in doctoral programs increased by 126%. However, the percentage of
graduates increased by only 50%, growing from 178 graduates in 1977 to 267
graduates in 1999.
Reinventing Social Work Accreditation.
Accreditation under the Council on Social Work
Education (CSWE) has contributed to the professional decline of social work.
The lack of scholarship of the Board of Directors of CSWE compromises its
decision making. The quality of the professional literature suffers from the
weak scholarship of editors and referees. The caliber of deans and directors of
social work educational programs is low with respect to their scholarship as
well. Graduate students are ill-prepared to commence studies in social work.
The substitution of ideology for academic rigor makes social work education
vulnerable to its critics. Proposed revisions in Accreditation Standards
indicate that CSWE is unlikely to undertake the necessary steps to reform
social work education; therefore, schools of social work should be free to
obtain accreditation independent of CSWE. (Contains 3 tables.)
Social work education responds to the shortage of persons with
both a doctorate and a professional social work degree.
THERE IS A RECOGNIZED SHORTAGE of persons who have
both a doctorate and a professional degree (BSW or MSW) from a program
accredited by the Council on Social Work Education (CSWE). One of the sources
of evidence for this assertion is the finding that 72% of the respondents in a
survey conducted by the authors--deans and directors of CSWE-accredited
baccalaureate and master's social work education programs--agreed there is an
insufficient number of candidates with both a doctoral degree and a
professional degree available for teaching vacancies in social work education
programs.
Social – organizational characteristics of work and
publication productivity among academic scientists in doctoral-granting
departments.
Scientific work takes place in organizations that may
either facilitate or inhibit performance and within a larger, social community
of science that may limit, constrain, or stimulate the development of ideas and
actions (Blau, 1973; Fox, 2001; Long & McGinnis, 1981; Pelz & Andrews,
1976). Scientific work is conducted within organizational practices and
policies; it relies upon the cooperation of others; it requires human and
material resources. Thus, performance becomes tied to scientists' work groups,
practices, and climates (Fox, 1983, 1991, 1992a; Lambright & Teich, 1981).
Consequently, in order to understand scientific productivity, we need to assess
explicitly how social-organizational characteristics of work groups, practices,
and climates are associated with performance, particularly for scientists
within higher education.