The Linda Crane Lecture Professionalism & Core Values in Physical Therapy: Lessons Learned From Linda Crane

This lecture was presented at APTA's 2012 Combined Sections Meeting in Chicago, IL.

Linda Crane was a consummate professional. She embodied professionalism and helped to develop the profession of physical therapy (PT), especially the domain of cardiovascular and pulmonary PT. She worked tirelessly to advance the knowledge base of cardiovascular and pulmonary PT and helped others to recognize the importance of cardiovascular and pulmonary PT. Linda was the strongest advocate of cardiovascular and pulmonary PT that I have known. Working alongside Linda with the American Board of Physical Therapy Specialization (ABPTS) process (which she had helped to develop years before), I learned what it meant to be a professional. Before playing a major role in the development of the ABPTS specialization process, Linda almost singlehandedly developed the first entry-level competencies in cardiovascular and pulmonary PT. In reality, Linda was more than a consummate professional. She defined professionalism.

Professionalism defined by Merriam Webster's Collegiate Dictionary (10^th ed) is “the conduct, aims, or qualities that characterize or mark a profession or a professional person” as well as “the following of a profession for gain or livelihood.” A professional is defined by the same dictionary as “of, relating to, or characteristic of a profession.” More specifically, a professional is defined as someone “conforming to the technical or ethical standards of a profession.” And, although probably unnecessary, I would like to define a profession which is among many other choices (by the same dictionary): “a calling requiring specialized knowledge and often long and intensive academic preparation.”

Linda Crane exceeded all of the above behaviors defining professionalism. Linda Crane also exceeded the characteristics defining a professional. However, she not only conformed to the technical and ethical standards of the PT profession, she developed them in the area of cardiovascular and pulmonary PT. Linda Crane was pivotal in identifying and defining the specialized knowledge and academic preparation required of the entry-level PT. Linda Crane demonstrated professionalism, was a true professional, and helped to define the profession of PT.

A review of Table 1, which lists the past 12 Linda Crane lecturers and lecture titles, reveals that these behaviors that Linda characterized so well were recognized by many others. In fact, all past lectures involve some component of professionalism and the superb skills that Linda demonstrated–the Passionate Professional, Integrity, Caring, Clinical Mentoring, Excellence & Artistry, Getting from What is to What Ought to Be, Inspiration, Improving the Health of Society, Quality, the Patient Puzzle, Excellence, and Leading Leaders.¹,²,³,⁴,⁵,⁶,⁷,⁸,⁹,¹⁰,¹¹,¹²

Table 1.

Past Linda Crane Lecturers and Titles of the Lectures

1.	Cohen Meryl. The Passionate Professional. Cardiopulmonary Physical Therapy Journal. 2000;11:74-77.
2.	Ciesla Nancy. Integrity. Cardiopulmonary Physical Therapy Journal 2001;12:50-56.
3.	Irwin Scott. Caring. Cardiopulmonary Physical Therapy Journal. 2002;13:28-33.
4.	Susan Butler-McNamara. Passing the Torch – Clinical Mentoring. Cardiopulmonary Physical Therapy Journal. 2003;14:28-31.
5.	Donna Frownfelter. Excellence and Artistry – Is it a Thing of the Past? Cardiopulmonary Physical Therapy Journal. 2004;15:32-34.
6.	Carol M. Davis. Getting from What is to What Ought to Be? Cardiopulmonary Physical Therapy Journal. 2005;16:24-31.
7.	Martha R. Hinman. Sources of Inspiration. Cardiopulmonary Physical Therapy Journal. 2006;17:84-93.
8.	Robert R. Huhn. Improving the Health of Society, One Individual at a Time. Cardiopulmonary Physical Therapy Journal. 2007;18:21-27.
9.	Ellen Hillegass. The Challenge for the Future: Five Steps to Improve Quality, Incorporate Prevention, Maintain Productivity, and Have Fun! Cardiopulmonary Physical Therapy Journal. 2008;19:54-60.
10.	Mary Massery. The Patient Puzzle: Piecing it Together. Cardiopulmonary Physical Therapy Journal. 2009;20:19-27.
11.	Sherrill H. Hayes. Striving For Excellence. Cardiopulmonary Physical Therapy Journal. 2010;21:22-28.
12.	Venita Lovelace-Chandler. Leading Leaders: A Vision for Our Centennial Years. Cardiopulmonary Physical Therapy Journal. 2011;22:19-28.

The past Linda Crane lecturers provided excellent overviews of each specific topic and the manner by which Linda demonstrated, influenced, or attended to a particular topic. Each of the above topics and the material that was presented by the lecturers reflected on Linda Crane's professionalism. In fact, the primary headings of the American Physical Therapy Associations (APTA) Core Values on Professionalism (shown in Table 2) include many of the above topics and highlight the professionalism of Linda Crane.¹³

Table 2.

The APTA Core Values on Professionalism

1.	Accountability
2.	Altruism
3.	Compassion/Caring
4.	Excellence
5.	Integrity
6.	Professional Duty
7.	Social Responsibility

The major goal of this paper is to highlight the professionalism of Linda Crane to provide examples of the methods that PTs can use to develop their own professionalism. This will be done in 3 separate sections including the influence of “chance encounters” on developing professionalism, a review of the APTA Core Values on Professionalism using the Self-Assessment document, and the measurement of Linda Crane's professionalism using the APTA professionalism assessment tool. The last section will be complemented with personal accounts of individuals who knew and worked alongside Linda Crane. The personal accounts enrich the standardized measures of professionalism developed by the APTA and more fully capture the qualities of professionalism so keenly demonstrated by Linda Crane.

SOCIAL COGNITIVE THEORY AND PROFESSIONALISM – THE INFLUENCE OF CHANCE ENCOUNTERS

Figure 1 presents the primary components of social cognitive theory (SCT) and the influence of social factors in decision-making and the development of certain behaviors. The SCT is a life-course approach to understand human developmental changes based on the model of causation. Rather than using one-sided determinism and unidirectional causation, SCT applies a multidirectional causation involving triadic reciprocal determination.¹⁴ Figure 1 shows the bi-directional influence that each major component of triadic reciprocal causation has on human developmental change. The major components of triadic reciprocal causation include behavior, cognition and other personal factors, and environmental factors. Although each of the above factors are important in human developmental change, each will be of greater or lesser importance at different times throughout one's life.¹⁴

Figure 1.

Social Cognitive Theory.

Furthermore, there appears to be a high degree of interdependence and interrelatedness between the 3 major components of triadic reciprocal causation. The degree of interdependence and interrelatedness appears to be temporally related and the development of a reciprocal effect (defined as one action producing another) takes a certain period of time that differs depending on many factors. Factors that have been found to exert differences in the production of reciprocal effects include age, physical characteristics, gender, social status, and even physical attractiveness.¹⁵

A particular problem when examining the processes associated with triadic reciprocal causation is the finding that each of the 3 factors can be a stimulus, response, or reinforcer depending on when and on which side of the triad the exchange occurs.¹⁴ Increasing levels of positive reciprocity appears to be an important factor to elicit more favorable behavior in children and families as well as professional development.¹⁴,¹⁶ In fact, the manner by which an individual views himself appears to be the result of 4 different processes including (1) direct experience of the effects of his actions, (2) vicarious experience of the effects produced by someone else's actions, (3) judgments made by others, and (4) development of further knowledge from existing knowledge via inference.¹⁴ These 4 processes are likely important for the development of professionalism.¹⁴ In addition to the manner by which an individual views himself, there are several other important SCT components including the influence of chance encounters, freedom of choice, and 5 fundamental human characteristics of decision making [the capability to symbolize, plan alternative strategies (forethought), learn through vicarious experience, self-regulate, and self-reflect (Figure 1)].¹⁴ The effect of chance encounters on decision-making and professional development will be reviewed below.

Chance Encounters and Fortuitous Determinants

Although most developmental models of human behavior support a development process that is determined by age and consequence, such models do not account for the development of fortuitous determinants in the life course. The SCT allows for a more complete understanding of human behavior by including the possible influence of chance encounters throughout the lifespan. For example, people create as well as select environments that are in keeping with their personal characteristics and attributes. Furthermore, Bandura¹⁴ has indicated that such fortuitous experiences often play a prominent role in shaping the course of lives and making decisions.

Bandura¹⁴ has defined chance encounters as an unintended meeting of persons unfamiliar to each other that is associated with a large degree of chance. In fact, an analysis of a group of individuals life histories revealed that people frequently begin one career path, but are redirected on an entirely different path due to a fortuitous experience.¹⁷ Although such experiences are associated with a large degree of chance, a number of determinants exist that are likely to influence the chance encounter and affect the degree of fortuitousness or non-fortuitousness.

The major determinants associated with chance encounters include personal, social, and non-social factors.¹⁴ Personal determinants associated with chance encounters include the entry skills, emotional ties, and values and personal standards of individuals. These determinants can be explained by (1) the attributes one possesses to initiate and sustain acceptance and involvement with another during a chance encounter – the entry skills, (2) some degree of interpersonal attraction – the emotional ties, and (3) the values and standards of another which if similar are likely to have a greater affect on one's behavior – the values and personal standards.

Social determinants associated with chance encounters include milieu rewards, symbolic environment and information management, milieu reach and closedness, and psychological closedness. These determinants can be explained by (1) the rewards provided by a group and an individual's need for such a reward – the milieu rewards, (2) a particular environmental ideology or symbolism (eg, athletic team, medical community, or theatrical troupe) – the symbolic environment and information management, (3) the strength of interpersonal influences on one's life and the openness or closedness of the group – the milieu reach and closedness, and (4) group beliefs and how open or closed the group is to behavior different from the accepted beliefs – the psychological closedness.¹⁴ Social determinants of chance encounters appear to be important for decision making and likely a driving force for professional development.

Nonsocial determinants associated with chance encounters include instances that occur by happenstance or mistake and subsequently lead to a fortuitous or non-fortuitous event. Such events are common in scientific research and often lead to fortuitous results if the researcher is aware of the possible impact and significance.¹⁴

Determining the manner by which the above determinants of chance encounters influence the life course of an individual is complex and cumbersome. However, Bandura¹⁴ suggested that identifying the key events as well as the patterns of direction-setting and factors that have influenced the major facets of life (eg, educational pursuits, occupational choices, and formation of significant partnerships) should provide sufficient data to predict the probability of behavior and alternative directions. Knowledge of specific combinations of personal and social determinants (in particular, milieu rewards) may yield the greatest predictive ability to better understand decision making associated with professionalism and professional development. However, further research in this area is needed.

Chance Encounters Experienced by Linda Crane

Numerous fortuitous chance encounters were experienced by Linda Crane and included her introduction to the field of PT, each new job and PT experience, and her graduate education. Linda received her B.S. in PT at Ithaca College in 1973 where she graduated Magna Cum Laude. She then had the good fortune of working at Cornell Medical Center in New York City where she quickly moved from staff to senior PT because of her superb clinical and managerial skills. Linda remained in this first clinical position until July of 1976 when she moved to Emory University to begin a master's degree in PT and continue her clinical work in the cardiopulmonary service. While at Emory University, Linda met Helen Masin who was also working on her master's degree and the two became quick friends. Helen Masin is currently a faculty member at the University of Miami and is one of many important “chance encounters” in Linda's short, but productive life.

Linda completed her master's degree in one year and moved to Hartford, CT to begin work at Hartford Hospital in January of 1978. Working at Hartford Hospital, Linda experienced another important chance encounter by randomly meeting Sherri Hayes, the current chair of the Department of Physical Therapy at the University of Miami. These two early chance encounters had a major influence on Linda Crane's professional and personal trajectory and were key factors that ultimately brought Linda to the University of Miami in 1988. However, before moving to Miami, Linda also worked at the University of Connecticut as an Associate Professor and spent 4 years in Birmingham, Alabama at the University of Alabama where she directed the pediatric pulmonary center. This latter chance encounter provided Linda opportunities to grow clinically and professionally and helped her to fully develop her examination and management skills of pediatric patients with heart and lung disease. The personal and social chance encounters of working extensively with pediatric patients provided Linda the opportunity to formulate her methods of care for neonatal and pediatric patients that resulted in numerous contributions to the PT literature. In early 1988 Linda returned to the Northeast and worked at the University of New England and Mercy Hospital in Portland, Maine for 3 years before moving to Miami, Florida to work at the University of Miami with several of her former chance encounters.

Linda Crane moved frequently, and often it was due to a personal or social chance encounter that prompted the move which because of subsequent chance encounters prompted another move. Professionally and personally, the chance encounters experienced by Linda Crane became life changing encounters and she took full advantage of them. Linda's personal and professional trajectory consistently included patient care that facilitated her teaching and research agenda. Because of her chance encounters with numerous patients and health care professionals, Linda Crane developed into a superb clinician who consistently demonstrated high levels of professionalism.

While working at the University of Miami, Linda also volunteered at a homeless shelter and worked one day per week at Jackson Memorial Hospital. The numerous patients who had the opportunity to experience a chance encounter with Linda Crane were able to benefit from the compassion and care that Linda consistently provided to others. Furthermore, it was these chance encounters that Linda wrote about in her many publications about optimal PT for neonates with respiratory dysfunction and pulmonary disease,¹⁸ cardiorespiratory management of the high risk neonate,¹⁹ effects of body position changes on transcutaneous carbon dioxide tension in neonates with respiratory distress,²⁰ and PT care for patients with spinal cord injury.²¹ The chance encounters that Linda Crane experienced have touched us all and our patients.

Chance Encounters Experienced by Lawrence Cahalin

Numerous chance encounters were also experienced by Lawrence Cahalin and included his introduction to PT, each new job and PT experience, and graduate education – the very same as those experienced by Linda Crane. My first job was in a relatively small hospital in St. Louis, Missouri where I “by chance” had the opportunity to work closely with a cardiologist to develop phase 1, 2, and 3 cardiac rehabilitation programs. I had hoped to receive a job offer from another larger hospital where I likely would not have had the opportunity to develop the cardiac rehabilitation programs so closely with a cardiologist. Another chance encounter I experienced while working at my first job was to find “by chance” a Cardiopulmonary Physical Therapy Journal (then named the Cardiopulmonary Section Quarterly) lying on the floor of the PT department (I do not think it was purposely thrown on the floor) in which a relay bicycle race of 12 men with heart disease who rode from Los Angeles, California to New York City in 12 days without complication was described. Thinking that I could organize a similar group in St. Louis I called the author of the article–a PT that many of us might remember–Randy Ice. Randy offered me a job during that first phone call and I quickly accepted.

Because of these chance encounters (as well as my educational background, interests, and the environment in which I worked,) I was able to develop professionally–a professional growth that was only beginning. Working with the SCOR PT group had many pluses–monthly SCOR education meetings from 6 to 9 pm on the first Monday of each month, performing independent exercise testing in patients with known or suspected heart disease, and among many other benefits, teaching at the University of Southern California (USC). After helping to teach the cardiovascular and pulmonary content to USC students, I decided that it was time to begin working on my master's degree which I began in the Department of Physical Therapy at USC. “By chance” my randomly assigned academic mentor and advisor was Helen Hislop, PhD, PT.

I had the pleasure of not only taking classes taught by Dr. Hislop, but having her review each and every paper I wrote for all of my courses. As all of you know, Helen was mighty with a pen, and I soon became aware of how well she wielded a “red pen” and the distinct need to improve my writing and vocabulary. After approximately two years of classes and working to improve my writing, Helen called me into her office and said “Larry, you don't belong here at USC.” I was devastated and almost cried. I stated that I had tried to improve my vocabulary and writing and that there appeared to be fewer red marks on each paper I submitted. Helen, smiled at me and said, “Larry, you don't belong here at USC because your educational interests and goals could be better accomplished working with Dr. David Neilson at the University of Iowa.” I smiled, felt a little better about my writing despite the fact that I really did not have fewer red marks on each submitted paper, and moved to Iowa City that fall. Dr. Neilson and the faculty at the University of Iowa provided me with an exceptional education that enabled me to receive a job offer from Massachusetts General Hospital (MGH) in Boston–which I also accepted in one day. The environment at MGH and the chance encounters at MGH helped me to further develop my clinical and research skills and to develop professionally. Although the PT world is relatively small, I believe that chance encounters as well as optimal personal and environmental factors contributed to my professional development and that of Linda Crane.

Combined Chance Encounters Experienced by both Lawrence Cahalin and Linda Crane

Numerous chance encounters experienced by Linda Crane and Lawrence Cahalin have already been presented including our introduction to PT, each new job and PT experience, and graduate education. Several other key combined chance encounters that are important to highlight include the very same initials (L.C.), my new office at the University of Miami was the office used by Linda Crane, and the response I received from my new Chair at the University of Miami regarding my goals for the upcoming year, which simply stated by Sherri Hayes was “extensive and likely humanly impossible.” Linda Crane had apparently received the same response from Dr. Hayes during each of her yearly evaluations.

I believe it also important to note that both Linda and I had the opportunity to develop professionally through the Cardiovascular and Pulmonary Section–our section of preference. In the Cardiovascular and Pulmonary Section, we had the opportunity to learn and work in an environment with other like-minded professionals. Linda and I were strong advocates of specialization in physical therapy and we both worked to fully develop specialization during its infancy. In fact, it was during this time that I met Linda and began to understand her many strengths. Linda and I worked on our terminal graduate degrees late in our lives after we gained optimal clinical experience and knowledge to propel our research agendas. Linda frequently spoke about Maine, how she loved the Northeast, and wondered why I never spent much time in her beloved state of Maine. I vividly remember photos of Maine that preceded each and every presentation given by Linda and I now fully realize why Linda loved Maine. The environment in which Linda lived gave her meaning, purpose, an opportunity to relax, and so much more. The environment in which Linda Crane lived combined with her chance encounters and personal factors facilitated her personal and professional behaviors. Linda Crane is a perfect example of SCT in action and I now spend as much time as possible in Linda's beloved state of Maine, relaxing.

PROFESSIONALISM IN PHYSICAL THERAPY

Professionalism in PT has been a topic of interest for many years.²² As early as 1964, professionalism was at the forefront of the PT profession. Dr. Jacquelin Perry published in the Physical Therapy Journal a manuscript entitled “Professionalism in Physical Therapy” in which she highlighted several professional issues that remain relevant today.²² In particular are the methods used to teach and measure professionalism in the classroom and clinic. Teaching and measuring professionalism is not limited to PT. Numerous papers similar to that published many years earlier by Dr. Perry were published at the advent of the new millennium regarding the need to address professionalism in medicine and other health related fields.²³,²⁴,²⁵,²⁶,²⁷,²⁸ For a variety of reasons, professional behavior was recognized to be in need of further assessment and educating future health care providers about professional behavior became a new objective for many health care professions.²³,²⁴,²⁵,²⁶,²⁷,²⁸

In 2001, Cary and Ness²⁹ wrote about the “Erosion of Professional Behaviors in Physical Therapist Students” that was addressed the following year by MacDonald et al³⁰ in an article entitled “Consensus on Methods to Foster Physical Therapy Professional Behaviors.” Several years earlier, Hayward et al³¹ provided a qualitative review of PT students’ affective behaviors as well as specific attitudes and motivations. Although we are beginning to better understand professionalism in PT, the level of understanding is likely no better than that described in 1964 by Dr. Perry.²² Professionalism, therefore, continues to be an important issue in PT–both in the classroom and clinic.

Work by May et al in the mid-1990's³² and again in 2010³³ has examined professional behavior in PT education. Figure 2 presents the 1995 Generic Abilities and 2009 Generic Abilities (which have now been described as Professional Behaviors) as well as rank order of importance in 1995 and 2009 by May et al.

Figure 2.

A comparison of professional behaviors between 1995 and 2009.

The rank order of importance of professional behaviors appears to have changed considerably from 1995 to 2009.³²,³³ In 1995, several of the Generic Abilities of May et al (Critical Thinking, Communication, Problem Solving, Responsibility, Stress Management, and Professionalism) had lower ranking of importance compared to 2009 with Critical Thinking changing the most from a rank of 9 in 1995 to a rank of 1 in 2009. Problem Solving moved from a rank of 6 in 1995 to a rank of 3 in 2009 while Responsibility moved from a rank of 8 in 1995 to a rank of 5 in 2009. Interestingly, Professionalism moved minimally from a rank of 7 in 1995 to a rank of 6 in 2009. Similarly, the ranking of Communication and Stress Management in 2009 was only one level higher than in 1995. Conversely, Commitment to Learning had the greatest change in ranking by moving from a rank of 1 in 1995 to a rank of 10 in 2009.³²,³³ The above changes in professional behaviors are important in PT, however, the methods by which the data were obtained and analyzed showing the change in professional behaviors from 1995 to 2009 were not described in adequate detail to replicate the study nor could the results of the study be found in a peer reviewed journal.³³ Thus, further research on professionalism and the current domains of professional behaviors that are most in need of attention in PT practice and education is warranted.

In 2003, Jette and Portney³⁴ reported on the construct validity of the Generic Abilities in PT by having 182 students (using the classes of 2000-2004) attending two Boston PT programs [both with 3 year professional master's degree programs that were transitioning from professional master's degree (MSPT) to professional doctoral degree (DPT) programs] rate how frequently they performed 152 behaviors via questionnaire. Factor analysis was employed and attempts were made to develop 10 factors to be in keeping with the original study by May et al.³² However, only 7 factors emerged from the analysis and included professionalism, critical thinking, professional development, communication management, personal balance, interpersonal skills, and working relationships. Professionalism explained the greatest amount of the variance (34%) with all other factors accounting for very little of the variance. Critical thinking and professional development accounted for 5% and 3.2% of the variance, respectively, with all remaining factors accounting for ≤ 3% of the variance. The total variance explained with the 7 factors was 52%.³⁴ Also of note, was the finding that there was no significant difference in factor scores across the levels of student clinical education experiences for 3 of the 7 factors (professionalism, interpersonal skills, and working relationships), but that significant differences in factor scores across the levels of student clinical education experiences for the remaining factors (critical thinking, professional development, communication management, and personal balance) were observed.³⁴ The above findings are important and emphasize the importance of developing optimal professional behaviors in PT and examining best methods to develop optimal professional behavior in PT–especially as it relates to the classroom and clinical needs of today's DPT student. Further research to better understand the professional behavior of the DPT student and entry-level clinician is needed.

A recent study by Tischenko-Osorno et al³⁵ examined professional socialization in PT education with a focus on the transition from the classroom to clinical practice. The 3 primary purposes of this mixed-methods study that were most relevant to the development of professionalism in PT were to (1) examine the role of academic and clinical faculty as well as the role of other students on the development of DPT student professional behaviors, (2) describe the sources and differences of knowledge and application of concepts related to DPT student professional behaviors, and (3) examine how professional behaviors are taught (explicitly or implicitly), modeled, and assessed by academic and clinical faculty.³⁵

The emerging themes included the findings that professional behaviors and knowledge acquisition related to professional behaviors does develop over time. Furthermore, professional behaviors within the affective domain are critical in PT and are frequently modeled by faculty and other student's behaviors as well as professional appearance. Finally, professional behaviors appear to be taught from an implicit to explicit manner.³⁵ The categories and codes for several professional behaviors that emerged from the data support the role of academic and clinical faculty as well as other students in facilitating professional behaviors and professionalism in today's DPT student.³⁵ Further research is needed to better understand specific methods by which academic and clinical faculty and students can foster and further develop professionalism in PT.

Because of many of the above issues and concerns, a consensus-based conference was convened in 2002 by the APTA Education Department where 18 individuals with expertise in PT practice, education, and research were assembled to accomplish two goals including the development of (1) a comprehensive consensus-based document on professionalism in PT that could be integrated into the APTA's Normative Model of Physical Therapist Professional Education and (2) outcome strategies for the promotion and implementation of the consensus-based content within PT education.¹³ These two goals were very much in keeping with the earlier (2000) APTA House of Delegates adoption of Vision 2020 in which 6 key elements formed the strategic plan for transitioning to a Doctoring Profession. One of the 6 key elements forming the strategic plan of Vision 2020 was professionalism. In 2003, the APTA Board of Directors reviewed and approved the consensus-based document on professionalism in PT entitled “Professionalism in Physical Therapy: Core Values” that was adopted as a core document on professionalism in PT practice, education, and research.¹³

The consensus-based document consists of 7 separate areas in which a PT or PT student can assess his or her level of professionalism (using a Likert scale of 1-5) pertaining to the 7 core values of professionalism (Figure 3). Under each of the 7 core values of professionalism are several examples of the core value, defined as sample indicators. The sample indicators enable specific behaviors associated with each core value to be further defined and measured.¹³

Figure 3.

The American Physical Therapy Association Professionalism in physical therapy core values.

The instructions accompanying the document indicate that the Likert scale for each sample indicator under each of the 7 core values be completed based on the frequency that the assessor demonstrates the behavior associated with each sample indicator. The respective Likert scores of 1-5 are defined as never, rarely, occasionally, frequently, and always demonstrates the behavior associated with each sample indicator. Thus, each defined core value has a series of sample indicators (or behaviors) to further define the core value and allow the PT to measure the frequency that they perform the sample behavior.¹³ As shown in Figure 3, the number of sample indicators for the core values of accountability, altruism, compassion/caring, excellence, integrity, professional duty, and social responsibility are 10, 5, 11, 11, 12, 7, and 12, respectively. The greatest number of points possible within the core values (if a 5 was chosen because the assessor always demonstrates the behavior) of accountability, altruism, compassion/caring, excellence, integrity, professional duty, and social responsibility are 50, 25, 55, 55, 60, 35, and 60, respectively, yielding the highest total number of points possible of 340 (Figure 3).¹³

The APTA Professionalism in PT Core Values document provides an in-depth assessment of professional behavior and a useful metric to gauge professional development. These core values have been incorporated into several APTA documents and have been incorporated into some PT educational programs. Further examination of the APTA Professionalism in PT Core Values is needed in PT education and clinical practice.

Measurement of Linda Crane's Professionalism

The measurement of Linda Crane's professionalism was performed using a convenience sample of faculty at the University of Miami. The 6 faculty members who completed the APTA Professionalism Assessment were likely biased since they either worked alongside or were students of Linda Crane. The mean scores that Linda received for each of the 7 Core Values are shown in Figure 4. Recall that the highest total score possible if an individual scored the highest possible number of points for each item (5 points) is 340. Linda Crane was awarded a total score of 333/340 points. The below sections will review the scores that Linda was awarded in each of the 7 core values and will be accompanied by personal accounts relevant to the core values and specific sample indicators of each core value.

Figure 4.

Applying the APTA Professionalism in physical therapy core values to Linda Crane.

Accountability

Linda Crane received a near perfect score (48/50 points) in this domain of professionalism. The personal account addressing the accountability of Linda Crane and focusing on several specific sample indicators (assuming responsibility for learning and change, communicating accurately to others, seeking continuous improvement in quality of care, and educating students in a manner that facilitates the pursuit of learning) is provided by Lawrence Cahalin. As previously described, Linda made major contributions to the development of the cardiopulmonary entry level skills for PT educational programs and spearheaded the development of specific competencies in 1983 and 1984. Her work catapulted the cardiovascular and pulmonary domain of PT as a major area of PT education and practice. Linda also had an innate ability to teach and do so with a variety of props. Linda was accustomed to use a Slinky to discuss ventilation and perfusion of the lungs that exemplified her ability to communicate and teach a complex issue both accurately and effectively and to educate students in a manner that facilitated a superior understanding of material and the pursuit of additional knowledge.

Altruism

Linda Crane received another near perfect score (24/25 points) in the domain of altruism. The personal account addressing the altruism of Linda Crane and focusing on several specific sample indicators (providing pro-bono services, PT to underserved and underrepresented populations, services beyond expected standards of practice, and care/professional responsibility prior to personal needs) was provided by Sherri Hayes, PhD, PT, Chair of the Department of Physical Therapy, University of Miami. Dr. Hayes stated, “Linda and many of the PTs from Jackson Memorial Hospital volunteered at Camillus House, a homeless shelter in downtown Miami. When doing Linda's annual review, she still had as one of her goals for the coming year to volunteer at Camillus House when she was about to begin an extensive and lengthy series of chemo- and radiation-therapy. Somehow Linda forgot to think that it may not be such a good idea to volunteer at Camillus House with a compromised immune system. This behavior was typical of Linda.”

Compassion/Caring

Linda Crane received a perfect score (55/55 points) under the professionalism domain of compassion/caring. The personal accounts addressing the compassion and caring of Linda Crane and focusing on two specific sample indicators (being an advocate for patient's/client's needs and demonstrating respect for others and considers others as unique and of value) were provided by Helen Masin, PhD, PT, Associate Professor and Robert Gailey, PhD, PT, Professor, Department of Physical Therapy, University of Miami. Dr. Masin stated, “Linda worked tirelessly for the pediatric patients in the NICU and developed PT interventions that were widely utilized.” Dr. Gailey stated, “The thing that I remember most about Linda is that many faculty members at the University of Miami had young children and babies and the special effect Linda had on children and babies–especially if a child or baby was agitated. Linda had a natural way of calming children and babies and she did so while wearing a grin from ear to ear. In the same way that Linda calmed babies, she also calmed students and other faculty. Linda was the person you would and could go to for a problem. She was the type of person that you could talk to and open up–she really cared and she always hit the mark. You felt good when you left her office–she brought a nice calm to people–that was Linda Crane.”

Excellence

Linda Crane received a near perfect score (54/55 points) in the domain of excellence. The personal account addressing the excellence of Linda Crane and focusing on several specific sample indicators (demonstrating investment in the profession of PT, participating in integrative and collaborative practice to promote high quality health and educational outcomes, and contributing to the development and shaping of excellence in all professional roles) was provided by Neva Kirk-Sanchez, PhD, PT, Associate Professor, Department of Physical Therapy, University of Miami. Dr. Kirk-Sanchez stated, “I was a PT student at the University of Miami and Linda Crane was my cardiopulmonary professor. Linda was one of my favorite teachers–her class was wonderful. When I started teaching I tried to emulate the methods Linda used to teach in class–especially her enthusiasm for her topic and PT in general.”

Integrity

Linda Crane received another near perfect score (57/60 points) in the domain of integrity as it pertains to professionalism. The personal account addressing the integrity of Linda Crane and focusing on the specific sample indicator of acting on the basis of professional values even when the results of the behavior may place oneself at risk was provided by Helen Masin, PhD, PT, Associate Professor, Department of PT, University of Miami. Dr. Masin stated “Linda always made cardiopulmonary PT a priority in all of the higher education settings she worked which at times was difficult to manage in a PT curriculum with limited hours and other faculty interested in prioritizing their area of specialization.”

Professional Duty

Linda Crane received a perfect score (35/35) in the domain of professional duty. The personal account addressing the professional duty of Linda Crane and focusing on the specific sample indicator of taking pride in one's profession has been provided by Dr. Linda Crane, PhD, PT, Associate Professor, Department of PT, University of Miami. Linda was more than proud to be a PT – it was her life.

Social Responsibility

Linda Crane received another perfect score (60/60) in the domain of social responsibility. The personal accounts addressing the social responsibility demonstrated by Linda Crane and focusing on several specific sample indicators (advocating for the health and wellness needs of society including access to health care and PT services; providing leadership in the community, promoting social policy that effect function, health, and wellness needs of patients/clients; and advocating for changes in laws, regulations, standards, and guidelines that affect PT service provision) was provided by Lynn Cameon-Neifel, MHM, PT, Chief PT, Jackson Memorial Hospital, Miami, Florida and by Carol Davis, PhD, PT, Professor Emeritus, Department of PT, University of Miami. Lynn Cameon-Neifeld stated, “Linda loved to teach. She would go with our staff to the floors and stress the importance of the cardiopulmonary system. Linda modeled so many of the core values.” Dr. Davis stated, “Linda embodied all of the core values, but the one that really stands out to me is social responsibility and two specific sample indicators (promoting social policy that effect function, health, and wellness needs of patients/clients; and advocating for changes in laws, regulations, standards, and guidelines that affect PT service provision). It may be hard to believe, but in the 1970's the APTA did not have prevention nor social responsibilities on their radar – the master's degree and accreditation were issues of concern. Nonetheless, throughout the 1970's Linda would go to the APTA House of Delegates and present a bill that the APTA investigate methods for PTs to be more involved to help people stop smoking since this was the major killer of men at the time. Unfortunately, Linda was all but booed in her efforts. However, every year Linda would return to the APTA House of Delegates and state with utmost confidence that PT has a social responsibility as both individuals and as a professional association to prevent lung disease by supporting smoking cessation and investigating methods for PTs to become more involved in such efforts. The APTA House of Delegates never supported the bill that Linda presented, but she was persistent and returned for many years in hope that a new House would support the bill. Linda never gave up and she did not care what others thought. She kept knocking on the door of social responsibility with a goal to have the APTA support the role of the PT in the prevention of lung disease and smoking cessation. Linda was a very dear friend and a wonderful role model for all of us in PT.”

SUMMARY

The professional behaviors demonstrated by Linda Crane were exemplary as documented in the above personal accounts and objective measures of professionalism using the APTA Professionalism in PT Core Values Self-Assessment. Our professional development should likely include many facets of those so keenly portrayed by Linda Crane. It is likely that Linda's professionalism was strongly facilitated by becoming a member of the APTA and the Cardiovascular and Pulmonary Section. She found a professional association and section in which she could comfortably and easily share her ideas. She found a section in which she could contribute by serving in a variety of manners (ie, development of entry-level competencies, specialization, research, and education). Linda strongly believed that the professional development of each and every PT is critical to the profession of PT. Following the above examples of Linda Crane, optimizing one's “chance encounters,” and choosing an environment in which to grow (and relax) will likely facilitate one's professional development in PT. The APTA Professionalism in PT Core Values Self Assessment provides us with a tool to measure our own level of professionalism. Please examine your level of professionalism using this tool and contribute to the profession of PT by becoming a professional in whom Linda Crane would be proud.