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This article describes the use of the 10 identified generic abilities and associated behavioral criteria for teaching professional behaviors to physical therapist students in the classroom and during advisory sessions. Also described is a participant-centered problem-solving process for addressing professional behaviors that need improvement. The generic abilities provide the framework for students to self-assess their professional behaviors in the classroom with assistance and feedback from the professor. The generic abilities and the participant-centered problem-solving process provide tools for the student and the academic coordinator of clinical education to collaboratively develop objectives that specifically address the student's professional behaviors. The use of these tools in the classroom and during proactive advising promotes the development of professional behaviors as preparation for the clinical experience.

Key Words: Affective education, Physical therapy education. Professional behaviors.

INTRODUCTION

Today's financial constraints in health care require physical therapy clinicians to be flexible in adapting to an increasingly demanding and fastpaced work environment. The need for physical therapists to communicate effectively with patients, patients' families, and professional and nonprofes sional colleagues is increasing, while the time available to work with patients is decreasing. Physical therapists must demonstrate both good clinical skills and good "people skills." The therapist who has a combination of these skills is equipped for effective patient management and exhibits professional behavior.

The development of good "people skills." such as interpersonal and communication skills, is considered to be in the affective domain of learning. According to Kratliwohl et al,1 the affective domain encompasses qualities that are prerequisites for professional behaviors in students, such as desirable interests, attitudes, values, and character development. Education in the affective domain is often challenging because of its subjective nature. Unlike cognitive and psychomotor skills, which can be evaluated by written examination or practical testing, affective/behavioral skills are difficult to identify, quantify, and assess. Nevertheless, affective/ behavioral skills are recognized as equally important to effective patient management.2

The combination of communication and interpersonal skills provides the foundation for effective teaching-learning skills essential in patient management. Jackson-Wyatt3 described the need for the therapist to assist the patient in making a conscious shift from his or her current frame of reference to one that encompasses an understanding of the new data presented, and she emphasized mat the pace should be set by the patient. She also advocated providing instructions in the format that can be used effectively by the patient. To apply these techniques, students and clinicians must learn the observation skills, questioning style, mental images of motor behavior, and verbal and nonverbal communication patterns that will enable to them to recognize whether patients are understanding the new data presented und to modify their verbal and nonverbal communications accordingly. This ability to self-assess both clinical and affective skills facilitates the development of professional behaviors and is one of the keys to effective patient education and patient management.

Because most beginning physical therapist students are just entering adulthood, the attitudes, interests, values, and character development that underlie their clinical behaviors may not be at the professional level. Novice physical therapists and students may not have acquired the skill of understanding the affective interaction between themselves and the patient from the perspective of the patient; yet, this skill is an essential part of the professional behavior that leads to successful patient education.

Historically, in physical therapy education, the assumption has been that "learning how to act as professionals" will take place automatically along with the incorporation of new cognitive and psychomotor knowledge and skills. However, when students fail to acquire professional behaviors on their own, faculty members may need to help them develop these behaviors.2

When assessing students' professional behaviors, instructors often report dial they rely on a "gut feeling" that students are "on target" or that something is "wrong" in their performance. Because the instructor's "gut feeling" is difficult to quantify, non-professional behavior may be attributed to "personality differences" by both student and instructor and never systematically evaluated and remediated.4 In contrast, students experiencing challenges in the cognitive or psychomotor domains of learning must demonstrate a specific level of competence during periodic evaluations before they can progress in the curriculum.

Noting mat problems in the clinic frequently involve a deficiency in students' professional behaviors and recognizing the need for a systematic approach to physical therapy education and assessment in the affective domain,2 I have devised specific methods for promoting the development and evaluation of professional behaviors prior to and during students' clinical experience. The purpose of this article is to describe these methods, which begin by using the generic abilities identified by May et al,5 and then build on and extend the work of these authors. During their Grst semester, students are introduced to the generic abilities and then periodically self-assess their professional behaviors using the generic abilities; they also receive intervention as needed. The intervention, which I have named "participant-centered problem solving," provides a tool for remediating professional behaviors when inappropriate behaviors have been identified. Objectives addressed by this approach are (1) making students aware of die essential behaviors required for success in the physical therapy profession,5 (2) guiding students in their self-assessment of these professional behaviors, and (3) helping students improve their professional behaviors.

METHOD

As an academic coordinator of clinical education (ACCE), I have used the following approach to teaching, assessing, and remediating professional behaviors in introductory course work and individualized follow-up advisory sessions with students in the professional (entry-level) program at the University of Miami Division of Physical Therapy during the past 5 years.

Using the Generic Abilities to Promote Students' Awareness of Professional Behaviors

The generic abilities, described by May et al5 as professional behaviors essential to success in the profession but not necessarily related to technical skills, were developed through the use of a Delphi study with the physical therapy clinical faculty at the University of Wisconsin in Madison. Several distributions of the study resulted in the identification of 10 essential professional behaviors (Figure 1).

At the University of Miami, the work of May et aM in identifying and describing the generic abilities is used in the classroom to promote the entry-level student's awareness of professional behaviors relevant to the physical therapy profession. To enhance the development of these behaviors throughout their entire course of study, students are familiarized with the generic abilities during a 2-credit course entitled "Foundations in Physical Therapy" that is taught during the first semester of the entrylevel physical therapy curriculum.

The professor initially discusses the generic abilities as part of evidence-based practice in clinical education. Evidence-based practice reflects the fact that treatment received by patients is based on scientific research and evidence to substantiate outcomes.6 The professor then introduces each generic ability and cites examples of students' use of the generic abilities in the clinic (Figure 2).

Class members then form 10 groups of approximately 2 to 6 students, depending on class size. Group members discuss the importance of using all 10 generic abilities in the classroom and clinic and how each can be practiced in the classroom in preparation for the clinical experience. Each group is then assigned one generic ability and is asked to discuss it and prepare to describe it to the class. The group reviews beginning, developing, entry-level, and post-entry-level behavioral criteria for the assigned generic ability1 as described by May and colleagues5,7 (Figure 3). Group members spend additional time discussing, developing, and writing down one behavioral objective that fulfills a beginning- or developing-level behavioral criterion of the assigned generic ability that can be practiced during the rest of the course. The behavioral objective must be measurable, have specific criteria for accomplishment, and have a time frame for completion.

The professor circulates among the groups to answer questions. The professor advises students to pay close attention to their thoughts and feelings as they discuss the assigned generic ability and develop the behavioral objective, and he or she asks them to note any feelings or emotions that arise. The professor reminds the students that an emotional response can indicate an area of challenge.

The following is a typical experience of a group assigned Generic Ability 9-Critical Thinking. The group decides to develop a behavioral objective that fulfills May and colleagues'' beginning-level behavioral criterion "to raise relevant questions." They develop "Each group member will ask one pertinent question during each subsequent class" as their objective. During their discussion, they reflect on their feelings and note that they sometimes feel anxious when asking questions. Noticing the anxiety helps them become aware of what might prevent them from asking questions. In the course of the discussion, they discover that they fear being perceived as unintelligent by the professor.

When the professor circulates to the group, he or she asks guiding questions to assist group members in generating a strategy to address their fear. The professor asks the students whedier they can recall a time when they were not fearful of raising pertinent questions. They respond that they recall several times when they were comfortable raising relevant questions. The professor asks them to identify what skills they used at those times. They reflect and realize that on those occasions they had read all assigned materials prior to class and had discussed confusing items with peers. The professor asks if those strategies might be useful in the current class, and me group members agree on the usefulness of the strategy in the new setting. The students recognize that their "fear" may have been related to their failure to complete the classroom assignments prior to the class and their lack of preparedness for raising relevant questions. Having acknowledged the source of their anxiety as "fear of being perceived as unintelligent," the students come up with a strategy-preparedness-for managing their fear and empowering themselves to ask relevant questions in class. Thus, students draw on their own successful past experience to generate the desired outcome in the current scenario. This group exercise in the classroom introduces students to the participant-center problem-solving process that will be developed further during individual preclinical and clinical advisory sessions.

A spokesperson selected by each group describes the assigned generic ability to the class and discusses the behavioral objective developed by the group. The spokesperson asks the class to reflect on whether the objective meets the 3 criteria of a behavioral objective. Class members ask questions that allow the spokesperson to clarify the intent of the group. This exercise demonstrates Generic Ability 5-Use of Constructive Feedback and shows students the importance of feedback in teaching and learning. The exercise helps students recognize whether they are being understood by the patient/learner, if not understood, students gain practice in accepting feedback as constructive and modifying the teaching until understanding is achieved. Thus, the exercise models the teaching-learning process that students will practice with patients in the clinic.

A subsequent session focuses on Generic Ability 2-Interpersonal Skills and Generic Ability 3-Communication Skills. Class members receive instruction in rapport building, as described in the neurolinguisuc psychology (NLP) literature.8 The professor role plays a situation in which a health care practitioner does not have rapport with a patient, and class members identify the verbal and nonverbal behaviors that indicate lack of rapport.

Students then view the film The Doctor,9 based on a true story recounted by Ed Rosenbaum. MD, in A Taste of My Own Medicine.10 The film details the experiences of a physician before and after being diagnosed with a life-threatening illness. It portrays a range of affective behaviors and presents differing perceptions of physicians, medical students, patients, and family members.

Students again form their 10 small groups, and each group is assigned 2 or 3 of the behavioral criteria developed by May and colleagues5,7 related to interpersonal skills or communication skills (Figure 3). Group members are asked to evaluate how the physician portrays those skills and to record their observations as they watch the film. After viewing the film, each group shares its observations with the class. Students arc also asked to note and record behaviors that break rapport and build rapport and to compare the physician's rapport skills before and after diagnosis of his illness. After the film, they discuss the corresponding changes in his perceptions. The professor uses the film as a springboard for discussing the complexity of affective behaviors and how individuals can modify their professional behaviors once they become aware of the impact of their behavior on others. The professor asks students to note that the physician in the film chose to change his behaviors once he became aware of the impact of those behaviors on his patients and their families, his family, and his colleagues.

Using the Generic Abilities for Students' Self-assessment of Professional Behaviors During Course Work

One class session is devoted to students' self-assessment of their professional behaviors. Referring to the beginning- and developing-level behavioral criteria of May and colleagues5,7 (Figure 3), students develop one personal behavioral objective for each generic ability, and they develop 2 strategies for accomplishing each of the 10 objectives by the end of the "Foundations in Physical Therapy" course. Students are given a printed template for recording their objectives and strategies and are provided with written examples of personal objectives and strategies developed by students in previous classes.

The professor asks students to imagine what would indicate professional growth for them in each area, and he or she gives students individual assistance in class. The professor shares selected personal objectives as the students develop them (after attaining their permission). For example, a student with chronic headaches might develop as his or her personal behavioral objective for Generic Ability 10-Stress Management: "Student will seek medical and/or psychological assessment for chronic headaches no later than the end of the second week of classes and implement appropriate follow-up based on evaluative findings by the end of the semester." The student's 2 related strategies might be: "Make an appointment with a university-based neurologist for a physical assessment," and "Make an appointment with a university-based psychologist for a psychological assessment. ' A student who recognizes his or her difficulty with voice volume might write as his or her personal objective for Generic Ability 3-Communication Skills: "I will record my voice on a tape recorder to practice modulation of my voice volume 3 times a week during summer and fall sessions." The student's corresponding strategies might be: "Purchase a tape recorder and audiotapes," and "Allot 10 minutes per day, 3 days a week, for tape recording my voice."

When students have completed their personal objectives and strategies, they work in pairs to determine whether the objectives meet the 3 criteria for a behavioral objective. Students then reform their 10 small groups, and each group shares one objective with the class and receives constructive feedback. Most of the self-assessment is completed during the class, but students may meet with the professor during office hours to gain additional feedback before the project is due at the final class session. The self-assessment is assigned a substantial portion of the "Foundations for Physical Therapy" course grade-20%-to reinforce for students the importance of the topic.

Using the Generic Abilities for Students' Self-assessment of Professional Behaviors During Advisory Sessions With the Academic Coordinator of Clinical Education

At the University of Miami, students are assigned to one ACCE advisor for advising in clinical education during their entire course of study, and they work individually with that advisor on developing their professional behaviors throughout the entrylevel program. In the first advising session, just prior to the student's clinical experience, the ACCE advisor explains to the student that he or she will be required to (1) develop personal behavioral objectives related to each generic ability proactively during the preclinical advisory sessions and throughout the clinical experiences and (2) use and update these personal behavioral objectives as a self-assessment tool to enhance professional behaviors throughout the clinical experiences.

The student discusses his or her personal behavioral objectives with the ACCE advisor in advisory meetings preceding each clinical experience. The ACCE gives the student feedback regarding the objectives during these preclinical advisory meetings and discusses the student's preclinical behavioral objectives again when completing the midterm evaluation during the clinical experience. During the discussion at the midterm evaluation, the student may recognize a need to modify the objectives based on the demands of the specific clinical experience. For example, a student who is in the acute care setting may recognize a need for self-assessment of his or her levels of stress in dealing with patients with acute illness. The student may notice that he or she is having difficulty sleeping at night or experiencing somatic complaints. These behaviors may indicate that the student is experiencing increased stress and may need to seek additional support for adjusting to working with this patient population. The student might seek support from the clinical instructor, the ACCE, or the student counseling service to address these issues. Clinical instructors at the University of Miami Division of Physical Therapy receive training in being supportive to students as part of a clinical instructor training course.

Using Participant-Centered Problem Solving During Advisory Sessions With the Academic Coordinator of Clinical Education to Assess and Remediate Students' Professional Behaviors

When a student identifies a professional behavior that he or she wants to improve or when a problem is noted in a student's professional behavior during the clinical experience, the professor uses the participant-centered problem-solving process in the advisory session to help the student remediate the behavior.

Participant-centered problem solving is an interactive process in which the advisor acknowledges, interprets, and responds to the student's verbal and nonverbal communications regarding the professional behavior under consideration. Two key elements of the process are that it allows the advisor (1) to gain insight into the student's perception of the problematic behavior by noting and responding to the student's verbal and nonverbal communications and (2) to elicit from within the student a solution for remediating the behavior that evolves from the student's own perspective.

The participant-centered problem-solving process incorporates several techniques for clinical education advising that I have adapted from NLP.3,4,8,11-18 (Figure 4). The NLP techniques are developing rapport, matching verbal and nonverbal communication styles, pacing speech and language patterns, calibrating student verbal and nonverbal responses by noting subtle changes that reflect the internal shifts in the student's responses, and coaching the student to achieve the mutually desired outcome.3,4,8,11-18

The advisor begins by establishing verbal and nonverbal rapport. The advisor gains rapport by observing the student's nonverbal and verbal communication patterns and matching the student's posture, language patterns (legato or staccato), tonality (pitch) and tempo (slow, medium, or fast-paced) of speech, and gestural communication. These techniques produce a cooperative communication mode in which the student and the advisor are aware of, and responsive to, one another. This rapport is marked by harmony but does not necessarily indicate agreement." Throughout the problem-solving process, the advisor continues to check for maintenance of rapport and looks for verbal and nonverbal indicators of understanding from the student, making adjustments as needed before proceeding to the next phase.

Once rapport is established, the advisor poses nonjudgmental questions to make it "safe" for the student to explore possible solutions for remediating the problematic behavior. The advisor continues to match the student's verbal style and postural set, which helps him or her gain insight into the student's perspective, such as the student's fear or frustration in dealing with the behavior.

If the advisor notes discomfort in the student at any time, he or she modifies his or her verbal and nonverbal communications to assist the student in accessing a resourceful emotional state. The resourceful state is one in which the student is able to use optimal problem-solving skills in a constructive fashion.11 It is a state of readiness for learning characterized by introspection and reflection. The advisor may not only match the student's nonverbal behavior but also verbally acknowledge it. Verbal acknowledgment of the nonverbal behavior often helps the student articulate his or her feelings, giving the advisor insight into the student's perception. The advisor then verbally acknowledges and validates the student's perception, thereby reestablishing rapport. Bringing the student's nonverbal behavior (such as sitting with rounded shoulders and looking down) to his or her awareness is sometimes the first step in addressing the behavior needing remediation. It can help the student recognize how his or her behavior is perceived by others and provide the stimulus for his or her own creative problem solving.4

The advisor may proceed with questions that help the student recognize his or her responsibility for developing the desired professional behavior. The advisor may ask for a description of the behavioral outcome that the student desires in the clinical experience. The advisor may continue to pose questions that allow the student to think creatively about the desired outcome and devise alternatives, again matching the student's language patterns, tonality, and tempo to maintain rapport. After the student has arrived at a successful solution, the advisor concludes the session by acknowledging the student's active participation in the problem-solving process.

In the following example, the participant-centered problem-solving process is used in an advisory session to remediate the behavior of a student who has appeared in the clinic several times in unprofessional attire (wrinkled khakis, a collarless shirt, and sandals), thereby violating the clinical dress code. He has failed to comply with the entrylevel behavioral criterion for Generic Ability 7-Professionalism, which states that the therapist "projects a professional image."5,7

The student is asked to come to the office of the ACCE advisor. He seats himself with arms folded across his chest and faces away from the advisor, using body language that demonstrates a lack of rapport. The advisor builds nonverbal rapport by matching the student's body language, folding her arms across the desk and facing slightly away from the student. The advisor waits in this position for the student to look toward her and for his facial muscles to soften, indicating readiness.

When the student does not change his posture or affect after several minutes, the advisor calls attention to his nonverbal behavior by stating, "I notice that your arms are crossed and your jaw is tense, and I'm wondering what that might mean." The student states, "I'm uncomfortable being here, and I'm upset that I have to meet with you." At this point, the advisor matches and paces the student verbally and nonverbally. The advisor states, "I understand that you are feeling uncomfortable here, and I want you to know that my purpose is to assist you in being successful in the clinical experience." She looks for verbal and nonverbal indications of rapport before proceeding.

The advisor cites the concern from the clinic staff that the student's attire is unprofessional. She states, "Your clinical instructor asked me to address professional clinic attire with you before you begin your next clinical experience." The student shifts in his chair and adjusts his position to face the advisor. The advisor then shifts her weight and adjusts her posture to face the student. Noticing that the student's postural shift indicates that he is now attending more closely to the conversation, the advisor asks, "What's the outcome that you want regarding your professional behavior in the clinic?" thereby placing the responsibility for the professional behavior on the student. The student states, "I just want to do a good job, and 1 want to feel comfortable."

The advisor now understands that the student's intention is to do a good job and that, in his perception, the wrinkled khakis, collarless shirt, and sandals indicate his being comfortable. The advisor asks the student to visualize himself working with an elderly patient who always dresses impeccably to attend physical therapy. She states, "Imagine viewing yourself as a student from the perspective of the elderly patient who dresses very nicely." The student is silent for a few seconds and then states. "I guess the patient might wonder why I'm dressed so casually."

The advisor mentions that professionalism has been defined by Pellegrino as "placing the patient's needs ahead of one's own."19 At this point, the student has an "aha" experience. He responds, " I didn't realize that my appearance might he perceived as unprofessional by my patients. Now, I understand that they might interpret my casual appearance as showing a lack of respect for them."

The advisor asks, "How would you see yourself looking in clinic when you are demonstrating professionalism?" This question has an embedded command (seeing oneself looking professional) that helps the student visualize himself in the appropriate professional attire (eg, neat khakis, collared shirt, and closed-toed shoes). By giving the embedded command, the advisor is prompting the student to realize that he already knows how to dress professionally in the clinic. The student comments, "I guess appearance has more of an impact than I thought, especially when I work with elderly patients who dress very nicely themselves. I guess I could prepare my clothes the night before clinic rather than just throwing something on in the morning."

The advisor then questions the student about how he will know that the outcome of dressing professionally has been achieved. She asks, "What will look different if you are demonstrating professional clinical attire?" Again, this question has an embedded command that suggests that the student will look differently than he has in the past. The student responds, "I would see myself dressed professionally by wearing a collared shirt, pressed khakis, and closed-toed shoes."

Finally, the advisor asks what additional strategies the student might use to project a professional image. She inquires, "What could you do differently to achieve that professional level of dress?" The student responds, "I could practice dressing more professionally outside the clinic as a preparation for coming to clinic. I might ask a friend who always dresses professionally for clinic where he buys his clothes and what preparation is involved."

Next the advisor asks, "What would be the easiest first step you could take to create a professional image in your clinical attire?" The question helps the student recognize that alternate strategies may be needed. The student recognizes that he has no desire to learn to iron, and he responds, "I guess I need to get khakis and a collared shirt that don't need ironing so I can be sure that my clothes always look professional."

At the end of the meeting, the advisor acknowledges the student's active participation in the problem-solving process. She states, "You've done a very good job toward resolving this situation by accepting constructive feedback and generating some alternative strategies, such as buying wrinkle-free khakis and collared shirts." In this example, the participant-centered problem-solving process has empowered the student to modify his professional behavior using strategies elicited from him that evolved out of his own perspective and his appreciation for the perspective of the patient.

OUTCOME

Shepherd and Jensen20 stated that the affective domain deals with student interests, attitudes, appreciation, and values and that these attributes are difficult to teach. The subjective nature of these attributes contributes to the difficulty in teaching and evaluating them. The method/model described above addresses this difficulty by combining 2 elements-(1) self-assessment using the 10 generic abilities identified by May et al5 and (2) the participant-centered problem-solving process-into a framework for recognizing and remediating challenging professional behaviors in students. The combined use of the self-assessment process and the participant-centered problem-solving process empowers students to recognize and resolve most challenging behaviors with the assistance of the advisor.

Although no formal outcome assessment of the method/model has been conducted at the University of Miami, student course evaluations over the past 5 years and one case study4 have been completed. Further study might include a detailed analysis of this course and advisory1 sessions using qualitative approaches such as microethnographic study and sociolingiiistic analysis of the processes. Another option might be a multiple case study design documenting several challenging clinical situations in which the generic abilities and the participant-centered problem-solving process are utilized to remediate challenging behaviors in the clinical setting.

Narrative course evaluations from the past 5 years have demonstrated students' interest in and appreciation of these teaching methods. Students have noted that they consider the highlights of the "Foundations in Physical Therapy" course to be the film The Doctor, the discussion of the generic abilities, group activities related to the generic abilities, active demonstrations of nonverbal communication, and openness during class discussions. Students have often commented that the film demonstrates the impact of the affective behaviors in a powerful way and that the subsequent discussion impresses on them the importance of verbal and nonverbal communications for being effective clinicians.

The method/model for teaching professional behaviors can he applied any time throughout the physical therapy curriculum but is most useful in initial course work. Familiarizing physical therapist students with the generic abilities and the self-assessment process early in the curriculum helps them understand the integral role of the generic abilities in their professional development. Their continued use of the generic abilities for self-assessment in preclinical advisory sessions reinforces their appreciation of this role. Even before students begin their clinical experience, they are aware of the impact that their behavior has on others and recognize that they can modify their behavior to become effective professionals. Students who encounter difficulties with their professional behaviors during subsequent course work are able to utilize their understanding of the generic abilities to address those difficulties with the assistance of their ACCE advisor.

The didactic information necessary for applying this method/model can be incorporated optimally into an introductory class in 9 to 12 hours of class time, depending on the size of the class. A class size of 10 to 60 students is optimal for teaching professional behaviors using this method/model because this number of students allows individual participation within the 10 small groups and engenders discussion. I have used the method/model successfully in classes of up to 100 participants.

A limitation of this method/model is the potential need to educate faculty members regarding the value of the generic abilities for affective education and to guide them in integrating the generic abilities as a curriculum thread. Although some faculty members at our institution initially resisted including the generic abilities in their courses, several have incorporated the beginning- and developinglevel behavioral criteria as part of their course work or practical evaluations.

Faculty members who teach clinical skills, cardiopulmonary physical therapy, and communications classes at the University of Miami Division of Physical Therapy have incorporated the self-assessment process using the generic abilities into their classes or course evaluations. They have reported that introducing the generic abilities at the outset of the curriculum allows students to recognize the importance of the affective domain in clinical practice and its relevance to patient management. In the cardiopulmonary course, students use the generic abilities and associated behavioral criteria to assess the effectiveness of their patient education. Faculty members have reported that the method/model applied in the "Foundations in Physical Therapy" course has helped students recognize that both verbal and nonverbal communications provide vital information as to whether the patient has understood their instructions.

An anecdotal incident demonstrates the value of the method/model. Since the generic abilities were introduced in the "Foundations in Physical Therapy" course 5 years ago, students no longer ask the professor of the communications course why they must take that course. Apparently, students exposed to the method/model in the "Foundations in Physical Therapy" course have realized the importance of both verbal and nonverbal communications in their patient management and are eager to learn more.

To guide students in applying the generic abilities in the clinic, clinical instructors must also be given knowledge of these abilities. At the University of Miami Division of Physical Therapy, the clinical education newsletter distributed to all of its clinical facilities provides information on the generic abilities, and local clinical instructors receive instruction on the generic abilities during in-service training given by the ACCEs.

Remediation of a professional behavior during an advisory session is required for only a few students. In these cases, the participant-centered problem-solving process assists students in accepting responsibility for their behavior and resolving the situation in a constructive manner. Because the process models the use of respectful, collaborative, constructive feedback, students are generally-responsive to working through remediaung challenging behaviors with the advisor in the spirit of mutual respect. They generally do not perceive the process as punitive because it utilizes their own perception to assess the nonprofessional behavior and it draws on their own creative ability to generate alternative strategies for improving it. The process of eliciting the student's perception regarding the nonprofessional behavior is extremely valuable in helping the advisor understand why the student is experiencing difficulties and in providing insight as to how to guide the student in the remediation process. Students reported that the combination of self-assessment of their professional behaviors and participant-centered problem solving during advisory sessions was extremely helpful to them in enhancing these behaviors.4

A main limitation in the use of the participant-centered problem-solving approach is that advisors must learn it and feel comfortable using it. The approach appears to be easily learned and accepted. I have developed and taught the participant-centered problem-solving processes to clinical educators in a full-day interactive workshop format.21 The quantitative evaluation for the workshop showed ratings of "good" or "very good" from all participants (4 or 5 on a scale of 1 to 5). Representative comments were: "I felt this course was well prepared and very interesting. I will work on and use these techniques in the clinic and with clinical instructors and students." "Excellent presentation! I can use these methods immediately, both personally and professionally." "Very informative and added to my professional growth."

I have observed that physical therapists are adept at learning the participant-centered problem-solving approach. Because they are already well trained in observing movement in patients with movement dysfunction, physical therapists are easily able to learn how to interpret the students' non-verbal communication during the problem-solving process.

Having a dual role of ACCE and professor in the curriculum appears to be an asset for incorporating the participant-centered problem-solving process into the curriculum. Because the ACCEs at the University of Miami Division of Physical Therapy have multiple roles as clinical educators, classroom educators, and researchers, they can readily model the integration of the problem-solving process into their classroom teaching for other faculty and clinical instructors.

CONCLUSION

Teaching the generic abilities in introductory course work helps physical therapist students recognize and value professional behaviors early in their studies. The use of the generic abilities for ongoing self-assessment in the classroom and in preclinical and clinical advisory sessions continually develops students' awareness of their professional behaviors and the impact of these behaviors on their patients and colleagues. The use of participant-centered problem solving in advisory sessions assists students in generating strategies for remediating their professional behaviors from their own perspective. It is anticipated that the application of this teaching method/model will enhance students' professional behaviors and enable them to enhance their patient management skills.

ACKNOWLEDGMENT

I thank Laurie Glass Yelle for editing the manuscript.

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Helen L Masin, PT, PhD

Dr Masin is Clinical Associate Professor, Division of Physical Therapy, Department of Orthopaedics and Rehabilitation, University of Miami School of Medicine, 5915 Ponce de Leon, 5th Floor, Coral Cables. FL 33146 (bmasin@miami.edu).

Submitted August 10, 2001, and accepted

November 27, 2001.

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