Abstract
Residency training is recognized as a valuable form of professional development and pathway to specialization. Currently residency is voluntary for physical therapists, with less than 12% of DPT students choosing to apply upon graduation. Motivations that drive the decision to pursue residency are currently unknown as is the extent of similarity and difference in perspective among various stakeholders.
The purpose of this study was to identify the dominant perspectives on motivations to pursue residency held by various stakeholders.
This study was conducted using Q Methodology, which incorporates aspects of quantitative and qualitative techniques into the examination of human subjectivity.
Program directors, faculty, and current residents from all accredited physical therapy residency programs were invited to complete a forced-choice sorting activity where potential motivations for residency were sorted by perceived level of importance. Principal component analysis was used to identify dominant perspectives, which were interpreted based on emergent themes in the cluster of motivations identified as most important.
Four dominant perspectives were identified: (1) desire to provide better patient care, (2) preparation for specialty practice, (3) fast track to expert practice, and (4) career advancement. These perspectives provided context and utility to 2 broad meta-motivations: improved clinical reasoning and receiving mentoring. Both within- and between-group differences among stakeholders were identified. However, subsets from each role-group population were found to share similar perspectives.
Results from this study may not apply to potential residents in all specialty areas, and the implications of having a particular perspective are unknown.
Identification of the dominant perspective on motivations for pursuing residency may aid in promoting participation, program development, matching residents to programs and mentors, and future research.
Residency training is recognized and promoted by the American Physical Therapy Association (APTA) as a valuable means of meeting professional development expectations and pursuing board certification in a specialty area of practice.1,2 Goal 12 of the APTA Education Strategic Plan 2006–20203 calls for a plan to develop residency programs and establishes specific objectives for providing potential residents with information that explains the rationale for pursuing residency training and helps compare between programs.
In response to the focus placed on residency training by APTA, the number of residency programs and residency-trained physical therapists has experienced exponential growth. According to the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE),4 as of December 2018 there are 3903 residency-trained physical therapists who graduated from one of 264 accredited residency program across the United States. Despite the rapid growth in residency-trained physical therapists over the last 2 decades, only a small percentage of graduates from physical therapist education programs decide to pursue residency training as a pathway for professional development and clinical specialization. Aggregate program data from the Commission on Accreditation in Physical Therapy Education5 identifies 9743 graduates from United States physical therapist education programs for the 2015–2016 academic year. However, ABPTRFE data show only 1161 unique applications for residency training during the 2015–2016 application cycle. Considering that not all residency applicants are new graduates, the actual number of new graduates applying for residency training is somewhat less than 12%.6 The physical therapist profession has not established targets for the proportion of new graduates that should enter residency training. However, the need for quality professional development opportunities that lead to specialization and a reduction in unwarranted practice variance makes higher participation in residency training an attractive solution.2
The reasons for this low percentage of physical therapists choosing to pursue residency training are unclear. No published studies were identified in the physical therapy or medical literature investigating the decision to pursue residency training. Several studies exist in the pharmacy literature suggesting that perceived job availability and a desire to gain specialized knowledge, experience, and confidence positively influenced decisions to pursue residency, and burnout, financial cost, and family obligations were negative influencers.7–13 It is unclear if findings from these studies translate to the physical therapist profession. Anecdotally, student physical therapists report similar perspectives on the desire for knowledge, confidence, and specialization as well as similar concerns for barriers related to cost, time, and effort. An additional factor expressed in the physical therapy community is the relatively low number of residency spots available each year. Data from the 2015–2016 ABPTRFE annual report6 suggest that this may be true in some specialty areas but is not consistently seen across all areas of residency training. For example, 96 and 33 unique applications were received for 32 available pediatric and 12 women’s health positions, respectively. In contrast, there were only 88 unique applications for the 154 available neurology positions and 608 unique applications for the 620 available orthopedic residency positions. At the conclusion of the admissions cycle, there were 117 unfilled residency positions despite a surplus of applicants for some types of residency programs. In the annual report, the ABPTRFE notes:
When reviewing the raw applicant data, it was noted by APTA staff that some residency programs during the 2015–2016 application cycle did not receive a sufficient number of applicants to fill all positions available at that program. At the same time, other residency programs received an exhaustive amount of applications and were not able to accept all qualified applicants as all positions at that program were filled. Reasoning as to why qualified applicants did not apply to programs with unfilled positions has yet to be determined.
Based on the ABPTRFE data, there is both an opportunity to recruit additional applicants and a need to better understand the factors influencing the decision to pursue residency training. Understanding the dominant perspectives regarding the most important motivations driving the decision to pursue residency training may provide useful insights for both those considering residency training as well as those who develop and oversee them.
Purpose
The purpose of this study was to identify the range of perspectives among 3 stakeholder role groups (residency program directors, residency faculty, and current residents) regarding key motivations for pursuing residency training. In addition, between- and within-group similarities and differences in these perspectives were explored.
The specific research questions posed in this study are: (1) What are the collectively held perspectives among residents, faculty, and program directors regarding motivations to pursue residency training? (2) Are their differences in how residents, faculty, and program directors perceive motivations to pursue residency training?
Methods
To answer these questions, we elected to use Q Methodology, which incorporates aspects of both quantitative and qualitative techniques to examine human subjectivity.14 Although novel to the physical therapist literature, Q Methodology has previously been used in other health professions, including occupational therapy, nursing, and pharmacy, to examine attitudes, views, and motivations.15–21 Q Methodology studies identify shared perspectives or attitudes that exist among subgroups of a population regarding a specified topic while also allowing those perspectives and attitudes to be examined and understood in nuanced and holistic ways with considerable qualitative detail.22,23
Q Methodology studies are typified by 2 elements. The first is that data are collected through participant performance of a Q sort, which involves arranging a set of predetermined items related to a specified topic in order of relative importance using a forced-choice grid (Fig. 1). The grid has the same number of slots as the number of items and is arranged in a pattern similar to a normal distribution so that fewer slots are available on each end of the grid and more slots are available towards the center. One end of the grid represents items thought to be of greater importance to the participant with the other end representing items considered of less importance. The resulting distribution of items represents a participant’s perspective on the specified topic as indicated by the placement of each item within the grid.23
Sample Q-sort grid. The Q-sort grid contains the same number of cells as the number of statements in the Q set. Each column in the grid represents a relative level of importance, with the far left side representing less important and the far right representing more important. Each participant completes a grid during the Q-sort activity, which represents their individual perspective. Factor analysis of each participant’s Q-sort produces a factor array representing the weighted average position of each statement for all individuals who share a similar perspective. The sample Q-sort grid above represents the factor array (ie, weighted average position) of resident participants who share the perspective that the most important motivation for pursuing residency training is the desire to improve patient care.
The second element typifying Q Methodology is that once completed, Q sorts are intercorrelated and those intercorrelations are subjected to a by-person factor analysis. In contrast to traditional factor analysis, which identifies how individual statements relate to each other, the by-person factor analysis performed in Q Methodology considers participants’ perspectives as represented by their Q sort and identifies statistically distinct latent factors that represent collectively held perspectives among subgroups of the population. 23
This study used a 2-phase data collection process common in Q Methodology studies followed by the factor analytic and interpretation procedures (Fig. 2).14,23 Phase I involved developing a set of items, called a Q set, that represents discourse surrounding the topic of interest (ie, motivations for residency training). Phase II involved participants using the Q set derived in phase I to perform a Q sort. Each phase will be described separately below followed by a description of the data analytic procedures. An important point to note is that the participants in phase I are not necessarily the same participants in phase II. Although both samples were drawn from the same pool of potential participants (all current residency directors, faculty, and residents at time of the study), participation was anonymous and occurred at 2 separate time points eliminating the ability to identify participation in both phases. All procedures were reviewed by the University of North Florida IRB and determined to be exempt from IRB oversight.
Methodology flow diagram.
Phase I—Developing the Q Set
There is no single recommended procedure for developing a Q set. Instead, use of procedures that are tailored to the specific purposes of each Q study is recommended.23 For the purposes of this study, the discourse regarding motivations for residency training was generated by surveying the entire population of residency directors, faculty, and residents. To recruit for this survey, an email was sent to listed contacts for the 185 accredited residency programs on the ABPTRFE website (https://accreditation.abptrfe.org/#/directory) at the time of the study (February 2016). The email asked contacts to forward the email to the program director (if different from the contact) as well as all current faculty and residents. The email also contained a link to the survey, which asked respondents to provide up to 10 responses to the open-ended question “What do you think motivates DPT students to pursue residency training?”
After all responses were received, 2 of the authors (R.O. and C.J.) reviewed and reduced the number of responses through a constant comparative process, sorting and resorting the responses based on emergent themes that represented motivations for pursuing residency training.24 When multiple responses represented a common motivation, language was developed to provide a comprehensive representation of the identified motivation. Responses that did not directly address the survey prompt were discarded. In Q Methodology this process is termed culling the discourse. The resulting list of motivations for pursuing residency training (the Q set) was then pilot tested for clarity and completeness by asking a convenience sample of residency faculty and recent residency graduates representing geriatrics, neurology, pediatrics, orthopedics, and women’s health residency programs to complete a Q sort. Pilot participants’ Q sorts were not included in the main analyses for this study.
Phase II—Q Sort Activity
In phase II, all current residency directors, faculty, and residents affiliated with 185 ABPTRFE-accredited programs at the time of the study were invited to perform a Q sort by using the Q set developed in phase I. To recruit for phase II, a recruitment email was sent to the same list of residency program contacts used in phase I and again requested distribution to all program directors, faculty, and currently enrolled residents. The email contained a link to FlashQ (Hackert and Braehler, 2007), which is an online freeware used for collecting data from electronic Q sorts. Participants completed a Q sort by placing each motivation from the Q set within a forced distribution grid ranging from −5 (less important) to +5 (more important) in response to the prompt “What are the most important motivations for pursuing residency training?” (Fig. 1). Following completion of a Q sort, participants were asked to provide demographic information as well as rationale for selecting their top 3 most important (+5) motivations.
Data Analysis
Quantitative analysis of the submitted Q sorts was performed using the PQMethod 2.35 (Kent State University, Kent, OH) to conduct by-person correlation and factor analytic procedures. Consistent with common practice in Q Methodology, correlations among the Q sorts were determined and then principal component analysis with Varimax rotation was used to identify clusters of similar Q sorts based on intercorrelations among the rating of motivations with each Q sort.22 To identify similarities and differences between role groups, the Q sorts for each role group were analyzed independently.
After factor solutions for each role group were identified, PQMethod generated factor arrays for each resultant factor. Factor arrays are composite Q sorts, and they are calculated through a procedure of weighted averaging. In other words, Q sorts that are higher loads on a factor are given more weight in the averaging process. These factor arrays represent perspectives collectively held by subgroups of respondents who loaded significantly on each factor. Each factor looks just like an individual Q sort and represents the motivations deemed most and least important by respondents loading on the factor. This factor array is displayed in the same form as a Q sort in Figure 1 with the motivations receiving a weighted average of +5 found in the far right column on the grid.
Interpretation of each factor within a role group included a series of procedures to identify the emergent themes represented by the relative rating of motivations. First, the motivations residing in the first 3 columns (+3, +4, or +5) on the more important side of the grid were extracted for each factor. These motivations were considered to be the most important motivations for pursuing residency training as perceived by respondents loading on each factor. Second, each set of most important motivations was scanned for defining motivations, which are motivations with a statistically significant difference in rating (ie, importance) in 1 factor compared with other factors. Third, associated written rationales for placing motivations as most important were retrieved for each factor. In many instances only a small number of rationales were available for review. This small number occurs because respondents only provide rationale for the motivations they place in the +5 column, and during the weighted averaging procedures of the factor analysis an individual’s most important (+5) motivation may not be the same as the most important motivations in the representative factor array. Also, many respondents choose not to provide written rationales. Due to these limitations, the available written rationales are used more as a secondary check for alignment between the interpretation and the concepts expressed in the rationales as opposed to a primary data point for interpretation. In the fourth and final step, the extracted and defining motivations for each factor within a role group were viewed independently and compared with motivations from the other factors within the same role group. Motivations that clearly distinguished between factors were identified as key motivations and used to inform the thematic interpretation. This iterative process was performed for each of the role groups and was repeated until an initial set of themes describing each factor emerged. In Q Methodology, these emergent themes describing a factor are considered a latent perspective. As such, the term perspective will be used in place of factor for the remainder of this paper.
To perform between-group comparisons, perspectives from within each role group were compared with perspectives from the other role groups using the same procedures as the within-group analysis. Perspectives that were consistent across role groups were given a single title to improve clarity. The relative assigned importance (ie, +3, +4, or +5) and the written rationales for key motivations were used to inform the interpretation. To support the credibility of the interpretation, member checking was performed by asking at least 2 members of each role group to review the model Q-sorts for each perspective and provide feedback on the proposed interpretation.25 The phrasing associated with each perspective was refined through this process, and the general constructs represented were affirmed.
Role of the Funding Source
The funding source had no role in the study’s design, conduct, and reporting.
Results
Phase I—The Q Set
A total of 186 individuals responded to the phase I open-ended survey, providing 669 statements related to motivations for residency training. Response rate and demographics were not identified for the phase I survey because Q Methodology emphasizes the representativeness of the resulting discourse and not the representativeness of the sample.23 After culling the discourse, 55 motivations were identified for the Q set. Pilot testing resulted in wording revisions for clarity, but no additional motivations were recommended. The lack of additional recommendations along with respondent comments affirming the completeness of the list of motivations provided support that the 55-item Q set (Fig. 1) was representative of the discourse surrounding motivations for pursuing residency training.
Phase II—The Q Sort
Participants
A total of 97 individuals representing residency directors (n = 21), residency faculty (n = 44), and current residents (n = 32) completed a Q sort. Respondents from each role group were predominately female (62%–70%), and all specialty areas were represented with the exception of acute care. Table 1 provides a full listing of respondents by role group, gender, and specialty area. A response rate was not calculated as the goal of sampling in Q Methodology is to provide representation from a diverse range of perspectives, not necessarily a random or proportionally representative sample. As such, “large numbers of participants are not required to sustain a good Q methodological study.”23 Although representation from each role group differed by specialty area, the diversity achieved within each role group and across the entire sample provides support for the appropriateness of the sample for a Q Methodological study.
Quantitative analysis
The factor analytic procedures resulted in a 3-perspective solution for each role group (Tab. 2). The 3-perspective solution explained between 58% and 68% of the variance in perspectives for each role group with nearly 80% of participants loading (>.40, P < .01) onto 1 of the 3 within-group perspectives (Appendixes 1-3). In other words, the majority of perspectives held by individual participants within each role group were consistent with one of the perspectives identified in the analysis.
Respondent Characteristics by Role
| Role | |||
|---|---|---|---|
| Characteristic | Director n (%) | Faculty n (%) | Resident n (%) |
| Total responses | 21 | 44 | 32 |
| Female | 13 (62) | 31 (70) | 22 (69) |
| Acute care | 0 (0) | 0 (0) | 0 (0) |
| Cardiovascular & Pulmonary | 1 (5) | 1 (2) | 1 (3) |
| Clinical electrophysiology | 0 (0) | 2 (5) | 0 (0) |
| Geriatrics | 0 (0) | 1 (2) | 3 (9) |
| Neurology | 6 (29) | 10 (23) | 2 (6) |
| Orthopedics | 6 (29) | 12 (27) | 14 (44) |
| Pediatrics | 4 (19) | 9 (21) | 4 (13) |
| Sports | 1 (5) | 7 (16) | 6 (19) |
| Women’s health | 0 (0) | 0 (0) | 1 (3) |
| Wound care management | 1 (5) | 0 (0) | 0 (0) |
| Multiple programs | 2 (10) | 2 (5) | 1 (3) |
| Role | |||
|---|---|---|---|
| Characteristic | Director n (%) | Faculty n (%) | Resident n (%) |
| Total responses | 21 | 44 | 32 |
| Female | 13 (62) | 31 (70) | 22 (69) |
| Acute care | 0 (0) | 0 (0) | 0 (0) |
| Cardiovascular & Pulmonary | 1 (5) | 1 (2) | 1 (3) |
| Clinical electrophysiology | 0 (0) | 2 (5) | 0 (0) |
| Geriatrics | 0 (0) | 1 (2) | 3 (9) |
| Neurology | 6 (29) | 10 (23) | 2 (6) |
| Orthopedics | 6 (29) | 12 (27) | 14 (44) |
| Pediatrics | 4 (19) | 9 (21) | 4 (13) |
| Sports | 1 (5) | 7 (16) | 6 (19) |
| Women’s health | 0 (0) | 0 (0) | 1 (3) |
| Wound care management | 1 (5) | 0 (0) | 0 (0) |
| Multiple programs | 2 (10) | 2 (5) | 1 (3) |
Respondent Characteristics by Role
| Role | |||
|---|---|---|---|
| Characteristic | Director n (%) | Faculty n (%) | Resident n (%) |
| Total responses | 21 | 44 | 32 |
| Female | 13 (62) | 31 (70) | 22 (69) |
| Acute care | 0 (0) | 0 (0) | 0 (0) |
| Cardiovascular & Pulmonary | 1 (5) | 1 (2) | 1 (3) |
| Clinical electrophysiology | 0 (0) | 2 (5) | 0 (0) |
| Geriatrics | 0 (0) | 1 (2) | 3 (9) |
| Neurology | 6 (29) | 10 (23) | 2 (6) |
| Orthopedics | 6 (29) | 12 (27) | 14 (44) |
| Pediatrics | 4 (19) | 9 (21) | 4 (13) |
| Sports | 1 (5) | 7 (16) | 6 (19) |
| Women’s health | 0 (0) | 0 (0) | 1 (3) |
| Wound care management | 1 (5) | 0 (0) | 0 (0) |
| Multiple programs | 2 (10) | 2 (5) | 1 (3) |
| Role | |||
|---|---|---|---|
| Characteristic | Director n (%) | Faculty n (%) | Resident n (%) |
| Total responses | 21 | 44 | 32 |
| Female | 13 (62) | 31 (70) | 22 (69) |
| Acute care | 0 (0) | 0 (0) | 0 (0) |
| Cardiovascular & Pulmonary | 1 (5) | 1 (2) | 1 (3) |
| Clinical electrophysiology | 0 (0) | 2 (5) | 0 (0) |
| Geriatrics | 0 (0) | 1 (2) | 3 (9) |
| Neurology | 6 (29) | 10 (23) | 2 (6) |
| Orthopedics | 6 (29) | 12 (27) | 14 (44) |
| Pediatrics | 4 (19) | 9 (21) | 4 (13) |
| Sports | 1 (5) | 7 (16) | 6 (19) |
| Women’s health | 0 (0) | 0 (0) | 1 (3) |
| Wound care management | 1 (5) | 0 (0) | 0 (0) |
| Multiple programs | 2 (10) | 2 (5) | 1 (3) |
Factor Arrays Showing Average Weighted Rating of Motivations by Perspectivea
| Residents | Faculty | Directors | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Q Set Motivations | P1 | P2 | P3 | P1 | P2 | P3 | P1 | P2 | P4 |
| Improved clinical reasoning/critical thinking | +4 | +4 | +5 | +5 | +5 | +5 | +5 | +5 | +5 |
| Receive mentoring | +5 | +4 | +4 | +4 | +5 | +5 | +5 | +5 | +4 |
| Improve diagnostic skills | +3 | +3 | +4 | +4 | +3 | +3 | +4 | … | +5 |
| Improve patient care | +5 | +4 | +3 | +5 | +4 | … | +5 | +3 | … |
| Preparation of board certification exam | +4 | +5 | … | … | +3 | +4 | +3 | +4 | +4 |
| Gain increased knowledge | +4 | … | +3 | +3 | +4 | +3 | +4 | +4 | … |
| Improved ability to treat complex patients | +5 | … | +4 | +4 | +4 | +3 | +4 | … | … |
| Gain expertise | +4 | … | +5 | +5 | … | +3 | … | +5 | +3 |
| Desire for excellence | +3 | … | +3 | … | +3 | +5 | … | +3 | +4 |
| Improve intervention skills | +3 | +5 | +3 | +4 | … | … | +3 | +3 | … |
| Accelerated learning | … | … | +5 | … | … | +4 | +3 | +3 | +3 |
| Passion for a specific clinical population | … | +5 | … | … | +5 | +3 | … | +4 | … |
| Receive feedback | … | … | +4 | +3 | +3 | … | … | +4 | … |
| Professional development | +3 | … | … | +3 | +4 | … | +3 | … | … |
| Be up-to-date with practice knowledge | … | … | +3 | +3 | … | … | +3 | … | +3 |
| Commitment to learning | +3 | … | … | … | … | … | … | +3 | +4 |
| Opportunities for career advancement | … | … | … | … | … | +4 | … | … | +5 |
| Improve examination skills | … | +4 | … | … | … | … | +4 | … | … |
| Characteristics of a specific residency program | … | +3 | … | … | +3 | … | … | … | … |
| Fill in gaps in knowledge/skill from physical therapist school | … | +3 | … | +3 | … | … | … | … | … |
| Gain confidence | … | … | … | … | … | +4 | … | … | … |
| Desire to practice in a specific setting | … | +3 | … | … | … | … | … | … | … |
| Improve employability | … | +3 | … | … | … | … | … | … | … |
| Competitive professional environment | … | … | … | … | … | … | … | … | +3 |
| Gain exposure to new technology | … | … | … | … | … | … | … | … | +3 |
| A sense of pride | … | … | … | … | … | … | … | … | … |
| Beneficial to the physical therapy profession | … | … | … | … | … | … | … | … | … |
| Continued structured learning | … | … | … | … | … | … | … | … | … |
| Delaying transitions from student life to work life | … | … | … | … | … | … | … | … | … |
| Desire to become a mentor | … | … | … | … | … | … | … | … | … |
| Enjoy the challenge | … | … | … | … | … | … | … | … | … |
| Expectations from school faculty/the physical therapist profession | … | … | … | … | … | … | … | … | … |
| Frustrated with current level practice by the physical therapist profession | … | … | … | … | … | … | … | … | … |
| Gain employment at a specific clinic/organization | … | … | … | … | … | … | … | … | … |
| Having a role model who has completed residency training | … | … | … | … | … | … | … | … | … |
| How patients perceive you as a physical therapist | … | … | … | … | … | … | … | … | … |
| Improve communication skills | … | … | … | … | … | … | … | … | … |
| Improve documentation skills | … | … | … | … | … | … | … | … | … |
| Improve efficiency | … | … | … | … | … | … | … | … | … |
| Improve emotional intelligence | … | … | … | … | … | … | … | … | … |
| Improve relationships with other professionals | … | … | … | … | … | … | … | … | … |
| Increased job satisfaction | … | … | … | … | … | … | … | … | … |
| Increased marketability of services as a physical therapist | … | … | … | … | … | … | … | … | … |
| Increased pay | … | … | … | … | … | … | … | … | … |
| Integration into the physical therapist culture | … | … | … | … | … | … | … | … | … |
| Interested in research | … | … | … | … | … | … | … | … | … |
| It is a trend in the profession | … | … | … | … | … | … | … | … | … |
| Leadership development | … | … | … | … | … | … | … | … | … |
| Networking | … | … | … | … | … | … | … | … | … |
| Path to fellowship | … | … | … | … | … | … | … | … | … |
| Personal reputation | … | … | … | … | … | … | … | … | … |
| Preparation for future academic career | … | … | … | … | … | … | … | … | … |
| Teaching experience | … | … | … | … | … | … | … | … | … |
| The timing is good | … | … | … | … | … | … | … | … | … |
| To be around like-minded others | … | … | … | … | … | … | … | … | … |
| Residents | Faculty | Directors | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Q Set Motivations | P1 | P2 | P3 | P1 | P2 | P3 | P1 | P2 | P4 |
| Improved clinical reasoning/critical thinking | +4 | +4 | +5 | +5 | +5 | +5 | +5 | +5 | +5 |
| Receive mentoring | +5 | +4 | +4 | +4 | +5 | +5 | +5 | +5 | +4 |
| Improve diagnostic skills | +3 | +3 | +4 | +4 | +3 | +3 | +4 | … | +5 |
| Improve patient care | +5 | +4 | +3 | +5 | +4 | … | +5 | +3 | … |
| Preparation of board certification exam | +4 | +5 | … | … | +3 | +4 | +3 | +4 | +4 |
| Gain increased knowledge | +4 | … | +3 | +3 | +4 | +3 | +4 | +4 | … |
| Improved ability to treat complex patients | +5 | … | +4 | +4 | +4 | +3 | +4 | … | … |
| Gain expertise | +4 | … | +5 | +5 | … | +3 | … | +5 | +3 |
| Desire for excellence | +3 | … | +3 | … | +3 | +5 | … | +3 | +4 |
| Improve intervention skills | +3 | +5 | +3 | +4 | … | … | +3 | +3 | … |
| Accelerated learning | … | … | +5 | … | … | +4 | +3 | +3 | +3 |
| Passion for a specific clinical population | … | +5 | … | … | +5 | +3 | … | +4 | … |
| Receive feedback | … | … | +4 | +3 | +3 | … | … | +4 | … |
| Professional development | +3 | … | … | +3 | +4 | … | +3 | … | … |
| Be up-to-date with practice knowledge | … | … | +3 | +3 | … | … | +3 | … | +3 |
| Commitment to learning | +3 | … | … | … | … | … | … | +3 | +4 |
| Opportunities for career advancement | … | … | … | … | … | +4 | … | … | +5 |
| Improve examination skills | … | +4 | … | … | … | … | +4 | … | … |
| Characteristics of a specific residency program | … | +3 | … | … | +3 | … | … | … | … |
| Fill in gaps in knowledge/skill from physical therapist school | … | +3 | … | +3 | … | … | … | … | … |
| Gain confidence | … | … | … | … | … | +4 | … | … | … |
| Desire to practice in a specific setting | … | +3 | … | … | … | … | … | … | … |
| Improve employability | … | +3 | … | … | … | … | … | … | … |
| Competitive professional environment | … | … | … | … | … | … | … | … | +3 |
| Gain exposure to new technology | … | … | … | … | … | … | … | … | +3 |
| A sense of pride | … | … | … | … | … | … | … | … | … |
| Beneficial to the physical therapy profession | … | … | … | … | … | … | … | … | … |
| Continued structured learning | … | … | … | … | … | … | … | … | … |
| Delaying transitions from student life to work life | … | … | … | … | … | … | … | … | … |
| Desire to become a mentor | … | … | … | … | … | … | … | … | … |
| Enjoy the challenge | … | … | … | … | … | … | … | … | … |
| Expectations from school faculty/the physical therapist profession | … | … | … | … | … | … | … | … | … |
| Frustrated with current level practice by the physical therapist profession | … | … | … | … | … | … | … | … | … |
| Gain employment at a specific clinic/organization | … | … | … | … | … | … | … | … | … |
| Having a role model who has completed residency training | … | … | … | … | … | … | … | … | … |
| How patients perceive you as a physical therapist | … | … | … | … | … | … | … | … | … |
| Improve communication skills | … | … | … | … | … | … | … | … | … |
| Improve documentation skills | … | … | … | … | … | … | … | … | … |
| Improve efficiency | … | … | … | … | … | … | … | … | … |
| Improve emotional intelligence | … | … | … | … | … | … | … | … | … |
| Improve relationships with other professionals | … | … | … | … | … | … | … | … | … |
| Increased job satisfaction | … | … | … | … | … | … | … | … | … |
| Increased marketability of services as a physical therapist | … | … | … | … | … | … | … | … | … |
| Increased pay | … | … | … | … | … | … | … | … | … |
| Integration into the physical therapist culture | … | … | … | … | … | … | … | … | … |
| Interested in research | … | … | … | … | … | … | … | … | … |
| It is a trend in the profession | … | … | … | … | … | … | … | … | … |
| Leadership development | … | … | … | … | … | … | … | … | … |
| Networking | … | … | … | … | … | … | … | … | … |
| Path to fellowship | … | … | … | … | … | … | … | … | … |
| Personal reputation | … | … | … | … | … | … | … | … | … |
| Preparation for future academic career | … | … | … | … | … | … | … | … | … |
| Teaching experience | … | … | … | … | … | … | … | … | … |
| The timing is good | … | … | … | … | … | … | … | … | … |
| To be around like-minded others | … | … | … | … | … | … | … | … | … |
aP1 = perspective 1 — desire for improved patient care; P2 = perspective 2 — preparation for specialty practice; P3 = perspective 3 — fast track to expert practice; P4 = perspective 4 — career advancement. For clarity, only mean ratings indicating a “more important motivation” (+3, +4, or + 5) are reported; ellipses (…) indicate a mean rating of < +3.
Factor Arrays Showing Average Weighted Rating of Motivations by Perspectivea
| Residents | Faculty | Directors | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Q Set Motivations | P1 | P2 | P3 | P1 | P2 | P3 | P1 | P2 | P4 |
| Improved clinical reasoning/critical thinking | +4 | +4 | +5 | +5 | +5 | +5 | +5 | +5 | +5 |
| Receive mentoring | +5 | +4 | +4 | +4 | +5 | +5 | +5 | +5 | +4 |
| Improve diagnostic skills | +3 | +3 | +4 | +4 | +3 | +3 | +4 | … | +5 |
| Improve patient care | +5 | +4 | +3 | +5 | +4 | … | +5 | +3 | … |
| Preparation of board certification exam | +4 | +5 | … | … | +3 | +4 | +3 | +4 | +4 |
| Gain increased knowledge | +4 | … | +3 | +3 | +4 | +3 | +4 | +4 | … |
| Improved ability to treat complex patients | +5 | … | +4 | +4 | +4 | +3 | +4 | … | … |
| Gain expertise | +4 | … | +5 | +5 | … | +3 | … | +5 | +3 |
| Desire for excellence | +3 | … | +3 | … | +3 | +5 | … | +3 | +4 |
| Improve intervention skills | +3 | +5 | +3 | +4 | … | … | +3 | +3 | … |
| Accelerated learning | … | … | +5 | … | … | +4 | +3 | +3 | +3 |
| Passion for a specific clinical population | … | +5 | … | … | +5 | +3 | … | +4 | … |
| Receive feedback | … | … | +4 | +3 | +3 | … | … | +4 | … |
| Professional development | +3 | … | … | +3 | +4 | … | +3 | … | … |
| Be up-to-date with practice knowledge | … | … | +3 | +3 | … | … | +3 | … | +3 |
| Commitment to learning | +3 | … | … | … | … | … | … | +3 | +4 |
| Opportunities for career advancement | … | … | … | … | … | +4 | … | … | +5 |
| Improve examination skills | … | +4 | … | … | … | … | +4 | … | … |
| Characteristics of a specific residency program | … | +3 | … | … | +3 | … | … | … | … |
| Fill in gaps in knowledge/skill from physical therapist school | … | +3 | … | +3 | … | … | … | … | … |
| Gain confidence | … | … | … | … | … | +4 | … | … | … |
| Desire to practice in a specific setting | … | +3 | … | … | … | … | … | … | … |
| Improve employability | … | +3 | … | … | … | … | … | … | … |
| Competitive professional environment | … | … | … | … | … | … | … | … | +3 |
| Gain exposure to new technology | … | … | … | … | … | … | … | … | +3 |
| A sense of pride | … | … | … | … | … | … | … | … | … |
| Beneficial to the physical therapy profession | … | … | … | … | … | … | … | … | … |
| Continued structured learning | … | … | … | … | … | … | … | … | … |
| Delaying transitions from student life to work life | … | … | … | … | … | … | … | … | … |
| Desire to become a mentor | … | … | … | … | … | … | … | … | … |
| Enjoy the challenge | … | … | … | … | … | … | … | … | … |
| Expectations from school faculty/the physical therapist profession | … | … | … | … | … | … | … | … | … |
| Frustrated with current level practice by the physical therapist profession | … | … | … | … | … | … | … | … | … |
| Gain employment at a specific clinic/organization | … | … | … | … | … | … | … | … | … |
| Having a role model who has completed residency training | … | … | … | … | … | … | … | … | … |
| How patients perceive you as a physical therapist | … | … | … | … | … | … | … | … | … |
| Improve communication skills | … | … | … | … | … | … | … | … | … |
| Improve documentation skills | … | … | … | … | … | … | … | … | … |
| Improve efficiency | … | … | … | … | … | … | … | … | … |
| Improve emotional intelligence | … | … | … | … | … | … | … | … | … |
| Improve relationships with other professionals | … | … | … | … | … | … | … | … | … |
| Increased job satisfaction | … | … | … | … | … | … | … | … | … |
| Increased marketability of services as a physical therapist | … | … | … | … | … | … | … | … | … |
| Increased pay | … | … | … | … | … | … | … | … | … |
| Integration into the physical therapist culture | … | … | … | … | … | … | … | … | … |
| Interested in research | … | … | … | … | … | … | … | … | … |
| It is a trend in the profession | … | … | … | … | … | … | … | … | … |
| Leadership development | … | … | … | … | … | … | … | … | … |
| Networking | … | … | … | … | … | … | … | … | … |
| Path to fellowship | … | … | … | … | … | … | … | … | … |
| Personal reputation | … | … | … | … | … | … | … | … | … |
| Preparation for future academic career | … | … | … | … | … | … | … | … | … |
| Teaching experience | … | … | … | … | … | … | … | … | … |
| The timing is good | … | … | … | … | … | … | … | … | … |
| To be around like-minded others | … | … | … | … | … | … | … | … | … |
| Residents | Faculty | Directors | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Q Set Motivations | P1 | P2 | P3 | P1 | P2 | P3 | P1 | P2 | P4 |
| Improved clinical reasoning/critical thinking | +4 | +4 | +5 | +5 | +5 | +5 | +5 | +5 | +5 |
| Receive mentoring | +5 | +4 | +4 | +4 | +5 | +5 | +5 | +5 | +4 |
| Improve diagnostic skills | +3 | +3 | +4 | +4 | +3 | +3 | +4 | … | +5 |
| Improve patient care | +5 | +4 | +3 | +5 | +4 | … | +5 | +3 | … |
| Preparation of board certification exam | +4 | +5 | … | … | +3 | +4 | +3 | +4 | +4 |
| Gain increased knowledge | +4 | … | +3 | +3 | +4 | +3 | +4 | +4 | … |
| Improved ability to treat complex patients | +5 | … | +4 | +4 | +4 | +3 | +4 | … | … |
| Gain expertise | +4 | … | +5 | +5 | … | +3 | … | +5 | +3 |
| Desire for excellence | +3 | … | +3 | … | +3 | +5 | … | +3 | +4 |
| Improve intervention skills | +3 | +5 | +3 | +4 | … | … | +3 | +3 | … |
| Accelerated learning | … | … | +5 | … | … | +4 | +3 | +3 | +3 |
| Passion for a specific clinical population | … | +5 | … | … | +5 | +3 | … | +4 | … |
| Receive feedback | … | … | +4 | +3 | +3 | … | … | +4 | … |
| Professional development | +3 | … | … | +3 | +4 | … | +3 | … | … |
| Be up-to-date with practice knowledge | … | … | +3 | +3 | … | … | +3 | … | +3 |
| Commitment to learning | +3 | … | … | … | … | … | … | +3 | +4 |
| Opportunities for career advancement | … | … | … | … | … | +4 | … | … | +5 |
| Improve examination skills | … | +4 | … | … | … | … | +4 | … | … |
| Characteristics of a specific residency program | … | +3 | … | … | +3 | … | … | … | … |
| Fill in gaps in knowledge/skill from physical therapist school | … | +3 | … | +3 | … | … | … | … | … |
| Gain confidence | … | … | … | … | … | +4 | … | … | … |
| Desire to practice in a specific setting | … | +3 | … | … | … | … | … | … | … |
| Improve employability | … | +3 | … | … | … | … | … | … | … |
| Competitive professional environment | … | … | … | … | … | … | … | … | +3 |
| Gain exposure to new technology | … | … | … | … | … | … | … | … | +3 |
| A sense of pride | … | … | … | … | … | … | … | … | … |
| Beneficial to the physical therapy profession | … | … | … | … | … | … | … | … | … |
| Continued structured learning | … | … | … | … | … | … | … | … | … |
| Delaying transitions from student life to work life | … | … | … | … | … | … | … | … | … |
| Desire to become a mentor | … | … | … | … | … | … | … | … | … |
| Enjoy the challenge | … | … | … | … | … | … | … | … | … |
| Expectations from school faculty/the physical therapist profession | … | … | … | … | … | … | … | … | … |
| Frustrated with current level practice by the physical therapist profession | … | … | … | … | … | … | … | … | … |
| Gain employment at a specific clinic/organization | … | … | … | … | … | … | … | … | … |
| Having a role model who has completed residency training | … | … | … | … | … | … | … | … | … |
| How patients perceive you as a physical therapist | … | … | … | … | … | … | … | … | … |
| Improve communication skills | … | … | … | … | … | … | … | … | … |
| Improve documentation skills | … | … | … | … | … | … | … | … | … |
| Improve efficiency | … | … | … | … | … | … | … | … | … |
| Improve emotional intelligence | … | … | … | … | … | … | … | … | … |
| Improve relationships with other professionals | … | … | … | … | … | … | … | … | … |
| Increased job satisfaction | … | … | … | … | … | … | … | … | … |
| Increased marketability of services as a physical therapist | … | … | … | … | … | … | … | … | … |
| Increased pay | … | … | … | … | … | … | … | … | … |
| Integration into the physical therapist culture | … | … | … | … | … | … | … | … | … |
| Interested in research | … | … | … | … | … | … | … | … | … |
| It is a trend in the profession | … | … | … | … | … | … | … | … | … |
| Leadership development | … | … | … | … | … | … | … | … | … |
| Networking | … | … | … | … | … | … | … | … | … |
| Path to fellowship | … | … | … | … | … | … | … | … | … |
| Personal reputation | … | … | … | … | … | … | … | … | … |
| Preparation for future academic career | … | … | … | … | … | … | … | … | … |
| Teaching experience | … | … | … | … | … | … | … | … | … |
| The timing is good | … | … | … | … | … | … | … | … | … |
| To be around like-minded others | … | … | … | … | … | … | … | … | … |
aP1 = perspective 1 — desire for improved patient care; P2 = perspective 2 — preparation for specialty practice; P3 = perspective 3 — fast track to expert practice; P4 = perspective 4 — career advancement. For clarity, only mean ratings indicating a “more important motivation” (+3, +4, or + 5) are reported; ellipses (…) indicate a mean rating of < +3.
Perspective interpretation
Comparison of the most important motivations from each perspective revealed that 2 motivations (improved clinical reasoning/critical thinking and receive mentoring) were consistently listed in the +4 or +5 position across all perspectives in all role groups (Tab. 2). The ubiquitous presence of these motivations posed a challenge to interpreting between perspective differences. After reviewing respondents’ comments associated with these motivations such as “[Clinical reasoning] is what residency programs are all about” and “the mentoring is the cornerstone of the learning experience in the residency,” the authors concluded that improved clinical reasoning and receiving mentoring were broad, nonspecific motivations instrumental to underlying and more nuanced perspectives on reasons to pursue residency training. Similar to the concept of a meta-theory encompassing a set of different but related theories, improved clinical reasoning and receiving mentoring were considered to be meta-motivations encompassing a set of differentiated but related perspectives on motivations for pursuing residency training (large arrow in Fig. 3). As such, the meta-motivations were extracted from the various perspectives and the interpretation of perspectives continued as previously described.
Dominant perspectives on motivations for pursuing residency training.
The subsequent interpretation process resulted in the emergence of 4 dominant perspectives regarding motivations to pursue residency training: (1) desire to provide better patient care, (2) preparation for specialty practice, (3) fast track to expert practice, and (4) career advancement. The theme for each perspective was based on the relative ratings of key motivations within and between perspectives as well as the relative ratings of the remaining motivations and respondent-provided rationale for the motivations identified as most important (Tab. 3). Perspectives 1 and 2 were present across all role groups, whereas perspective 3 was only present among residents and faculty and perspective 4 was only present among directors. Further description and rationale for each perspective is provided below.
Perspective 1—Desire to provide better patient care
A subset of participants from each role group shared a common perspective expressing a general desire to provide better patient care as the most important motivation for pursuing residency training. This perspective was represented by the key motivations “to improve patient care” and “improved ability to treat complex patients” being placed in a position of higher importance both within the perspective and compared with the placement of these motivations in other perspectives (Tab. 2).
Respondents with this perspective appear to view the meta-motivations of improved clinical reasoning and receiving mentoring during residency training as instrumental to gaining the knowledge and expertise necessary to provide the highest level of care possible to even the most complex patients. The respondent-provided rationales for placing such a high level of importance on “to improve patient care” and “improved ability to treat complex patients” were used to support this interpretation. Example rationales are provided in Table 3.
Perspective 2—Preparation for specialty practice
A separate subset of participants from each role group shared a common perspective expressing a desire to prepare for specialty practice as the most important motivation for pursuing residency training. This perspective was represented by the key motivations “preparation for Board-certification exam” or “passion for a specific population” being placed in a position of higher importance both within the perspective and compared with the placement of these motivations in other perspectives (Tab. 2).
Respondents with this perspective appear to view the meta-motivations of improved clinical reasoning and receiving mentoring during residency training as instrumental to the ability to either become a specialist or work with a specific patient population. The respondent-provided rationales for placing such a high level of importance on “preparation for board certification exam” or “passion for a specific population” were used to support this interpretation. Example rationales are provided in Table 3.
Perspective 3—Fast track to expert practice
A third subset from the resident and faculty role groups shared a common perspective expressing the desire for a fast track to expert practice as the most important motivation for pursuing residency training. This perspective was represented by the key motivation “accelerated learning” being placed in a position of higher importance both within the perspective and compared with the placement of this motivation in other perspectives (Tab. 2).
Respondents with this perspective appear to view the meta-motivations of clinical reasoning and receiving mentoring during residency training as instrumental to accelerating the professional development process. Resident respondents with this perspective placed greater emphasis on a fast track to expertise and knowledge currency while faculty respondents emphasized a fast track to excellence, confidence, and career opportunities. None of the respondents selecting accelerated learning as a most important motivation provided a rationale for this decision. Although the subgroups of residents and faculty rated the importance of “gain expertise” and “desire for excellence” slightly differently, the respondent-provided rationales for these items suggest respondents viewed these motivations as being closely related (Tab. 3).
Perspective 4—Career advancement
Only a subset of participants from the program director role group held a perspective expressing career advancement the most important motivation for pursuing residency training. This perspective was represented by the key motivations “opportunities for career advancement” and “competitive professional environment” being placed in a position of higher importance both within the perspective and compared with the placement of these motivations in other perspectives (Tab. 2).
Respondents with this perspective appear to view the meta-motivations of clinical reasoning and receiving mentoring during residency training as instrumental to gaining skills, expertise, and credentials that will provide a competitive edge in terms of career advancement. Only 1 respondent-provided rationale was received for “opportunities for career advancement” (Tab. 3).
Dominant Perspectives, Associated Distinguishing Motivations, and Example Respondent Rationales
| Perspective | Key Motivations | Example Respondent-Provided Rationale for Selecting Key Motivation as Most Important |
|---|---|---|
| 1 — Desire to provide better patient care | Improve patient care | If what we do does not improve the life of our patients then why bother doing it? –Director |
| Improved ability to treat complex patients | This was the main reason I did a residency. I was not happy with my overall patient outcomes and wanted to give my patients better care. –Resident | |
| 2 — Preparation for specialty practice | Preparation for board certification exam | Taking the NCS exam is the most tangible goal for most of the residents. Our program is structured to prepare residents to sit for the examination. –Director |
| Passion for a specific clinical population | The patient population I enjoy working with the most are athletes and I feel that going through a sports residency will help me only treat athletes. –Resident | |
| 3 — Fast track to expert practice | Accelerated learning | No rationale provided |
| Gain expertise | I believe it is important to strive to for expertise—a residency provides the ability to receive mentorship and further education to begin a path towards excellence. Perhaps most importantly, the residency provides a foundation of habits and characteristics to progress towards excellence. –Resident | |
| Desire for excellence | Being a physical therapist that can function at a high level as an expert to improve patient skills –Faculty | |
| 4 — Career advancement | Opportunities for career advancement | Residency training in a specialty is impressive on a resume –Director |
| Competitive professional environment | No rationale provided |
| Perspective | Key Motivations | Example Respondent-Provided Rationale for Selecting Key Motivation as Most Important |
|---|---|---|
| 1 — Desire to provide better patient care | Improve patient care | If what we do does not improve the life of our patients then why bother doing it? –Director |
| Improved ability to treat complex patients | This was the main reason I did a residency. I was not happy with my overall patient outcomes and wanted to give my patients better care. –Resident | |
| 2 — Preparation for specialty practice | Preparation for board certification exam | Taking the NCS exam is the most tangible goal for most of the residents. Our program is structured to prepare residents to sit for the examination. –Director |
| Passion for a specific clinical population | The patient population I enjoy working with the most are athletes and I feel that going through a sports residency will help me only treat athletes. –Resident | |
| 3 — Fast track to expert practice | Accelerated learning | No rationale provided |
| Gain expertise | I believe it is important to strive to for expertise—a residency provides the ability to receive mentorship and further education to begin a path towards excellence. Perhaps most importantly, the residency provides a foundation of habits and characteristics to progress towards excellence. –Resident | |
| Desire for excellence | Being a physical therapist that can function at a high level as an expert to improve patient skills –Faculty | |
| 4 — Career advancement | Opportunities for career advancement | Residency training in a specialty is impressive on a resume –Director |
| Competitive professional environment | No rationale provided |
Dominant Perspectives, Associated Distinguishing Motivations, and Example Respondent Rationales
| Perspective | Key Motivations | Example Respondent-Provided Rationale for Selecting Key Motivation as Most Important |
|---|---|---|
| 1 — Desire to provide better patient care | Improve patient care | If what we do does not improve the life of our patients then why bother doing it? –Director |
| Improved ability to treat complex patients | This was the main reason I did a residency. I was not happy with my overall patient outcomes and wanted to give my patients better care. –Resident | |
| 2 — Preparation for specialty practice | Preparation for board certification exam | Taking the NCS exam is the most tangible goal for most of the residents. Our program is structured to prepare residents to sit for the examination. –Director |
| Passion for a specific clinical population | The patient population I enjoy working with the most are athletes and I feel that going through a sports residency will help me only treat athletes. –Resident | |
| 3 — Fast track to expert practice | Accelerated learning | No rationale provided |
| Gain expertise | I believe it is important to strive to for expertise—a residency provides the ability to receive mentorship and further education to begin a path towards excellence. Perhaps most importantly, the residency provides a foundation of habits and characteristics to progress towards excellence. –Resident | |
| Desire for excellence | Being a physical therapist that can function at a high level as an expert to improve patient skills –Faculty | |
| 4 — Career advancement | Opportunities for career advancement | Residency training in a specialty is impressive on a resume –Director |
| Competitive professional environment | No rationale provided |
| Perspective | Key Motivations | Example Respondent-Provided Rationale for Selecting Key Motivation as Most Important |
|---|---|---|
| 1 — Desire to provide better patient care | Improve patient care | If what we do does not improve the life of our patients then why bother doing it? –Director |
| Improved ability to treat complex patients | This was the main reason I did a residency. I was not happy with my overall patient outcomes and wanted to give my patients better care. –Resident | |
| 2 — Preparation for specialty practice | Preparation for board certification exam | Taking the NCS exam is the most tangible goal for most of the residents. Our program is structured to prepare residents to sit for the examination. –Director |
| Passion for a specific clinical population | The patient population I enjoy working with the most are athletes and I feel that going through a sports residency will help me only treat athletes. –Resident | |
| 3 — Fast track to expert practice | Accelerated learning | No rationale provided |
| Gain expertise | I believe it is important to strive to for expertise—a residency provides the ability to receive mentorship and further education to begin a path towards excellence. Perhaps most importantly, the residency provides a foundation of habits and characteristics to progress towards excellence. –Resident | |
| Desire for excellence | Being a physical therapist that can function at a high level as an expert to improve patient skills –Faculty | |
| 4 — Career advancement | Opportunities for career advancement | Residency training in a specialty is impressive on a resume –Director |
| Competitive professional environment | No rationale provided |
Discussion
To our knowledge, this is the first study to explore the existence of physical therapists’ shared perspectives regarding motivations to pursue residency training. By using Q Methodology, we were able to develop a robust and widely agreed-on list of important motivations (the Q set) and systematically identify collectively held perspectives related to the relative importance of these motivations as viewed by subgroups of stakeholders. Our finding of 2 broad meta-motivations that encompass 4 distinct perspectives provides both context and utility to the current discussion surrounding clinical reasoning and mentoring in residency training. Understanding that the instrumentality of these meta-motivations differs among subgroups of residency directors, faculty, and residents may inform efforts towards communicating the value of residency training, program development, forming effective mentoring relationships, and evaluating residency outcomes.
Value of the Residency Motivation Q Set
A primary aim of this study was to identify the range of perspectives on motivations for pursuing residency training held by members of each stakeholder role group. Respondents’ affirmation of the comprehensiveness of the Q set, combined with 80% of participants loading onto a perspective, provides support for achieving this aim. As such, the Q set resulting from this study has potential value as a tool for further exploring individual or group perspectives on motivations for pursuing residency training. Several potential examples are provided in the following discussion with the intent to stimulate thought and discussion. The current study supports the existence of the various perspectives but does not provide evidence of a particular effect based on which perspective is held.
One example of using the Q set for self-reflection is to create cards with the various motivations and perform a Q sort using the same force-choice grid used in this study. While this exercise lacks the factor analytics performed in the study, individuals can qualitatively interpret their Q sort to potentially gain insights about their perspective on the relative importance of these motivations. Individuals considering residency training may use this information when exploring various residency programs and deciding which programs to apply to or attend. Another example may be for program faculty to perform this activity as a faculty development exercise to better understand how their perspectives influence the program design, resident selection, and mentoring experiences.
Researchers may use the Q set in future studies to confirm the presence of the identified perspectives in additional samples or explore the perspectives of additional populations such as student physical therapists and physical therapy academic faculty not involved in residency training. Future research is also needed to explore the influence of various perspectives on residency outcomes and, if positive effects are seen, how to positively influence desirable perspectives.
Context and Utility of the Meta-Motivations and Dominant Perspectives
This study was specifically designed to identify collectively held perspectives as well as differences in perspectives among stakeholder role groups. The results from this study suggest consensus on the importance of mentoring and clinical reasoning across role groups but show that between- and within-group differences in perspectives exist regarding the locus of this importance. Identification of these differing perspectives within the meta-motivations may add context to current discussions regarding mentoring and clinical reasoning in residency training. Several potential practical applications are provided to stimulate thought and discussion regarding the possible utility of these findings. However, evidence for the effect of these examples is lacking.
Mentoring as a meta-motivation
The importance of mentoring, especially in the initial transition into professional practice, is well recognized within the physical therapy profession.26–29 To address this need, the ABPTRFE has established a minimum of 150 hours of mentoring and developed a resource manual aimed toward improving the quality of mentoring experienced during residency training.30,31 Although mentoring may occur in a variety of forms outside of a residency program, it is not surprising that the structure and guarantee of substantial mentoring is considered one of the most important motivations for pursuing residency training. However, agreement that mentoring is important for new professionals does not identify what the focus of that mentoring should be and, more importantly, if the goals of the mentee and mentor are aligned. The results from our study indicate that current residents viewed the decision to pursue residency training as being motivated by 1 of 3 perspectives: (1) to generally provide better care for their patients, (2) to prepare for specialty practice, or (3) to be on a fast track to expert practice. These perspectives are also held by subgroups of residency faculty who may provide mentoring to residents. One example of an exercise might be for mentors and residents to become aware of their own perspective, identify that of the other, and openly discuss similarities and differences.
One opportunity for this discussion may be during the recruitment and application process. While the impact of matched vs unmatched perspectives is unknown, an understanding of how each party views the instrumentality of mentoring may help inform program and applicant selection decisions. Knowledge of the dominant perspectives identified in this study may help residents, directors, and faculty ask more specific questions or inform interpretation of answers during interviews or on applications. For example, a faculty member may ask a potential resident, “What goal do you expect the mentoring you receive in residency training to help you achieve?” Conversely, a potential resident may ask a faculty member, “How will the mentoring I receive in this residency program prepare me for practice as an orthopedic clinical specialist?”
Another potential opportunity for discussing perspectives is when a resident interacts with multiple mentors or when a mentor has interactions with multiple residents. When differences in perspective are present, discussing how to construct a mentoring relationships that is both respectful of differences and effective at meeting agreed-on goals and objectives may help strengthen the mentoring relationship and achieve greater learning outcomes. Future research is needed to understand the influence of matched and mismatched perspectives on residency outcomes.
Clinical reasoning as a meta-motivation
Similar to the desire for mentoring, a desire to improve clinical reasoning was consistently rated as one of the most important motivations for pursuing residency training across all perspectives. This combination of meta-motivations to receive mentoring and improve clinical reasoning is consistent with literature on developing expertise. Higgs et al32 point out that learners develop expertise by reflection on experience, which requires clinical reasoning/meta-cognitive skills that are connected to the development of clinical knowledge. The mentoring that occurs during residency training is expected to help residents gain knowledge and learn to reflect on their clinical experiences, thus enhancing clinical reasoning skills. Despite being recognized as an important focus across the physical therapy education continuum and being identified as 1 of 7 domains of residency training, there is considerable inconsistency in the definition and instruction of clinical reasoning.33–37 Given this inconsistency, respondents to this study may have assigned different but personally important meaning to the term. Some respondents may view clinical reasoning from a more cognitive perspective, expecting to gain knowledge and efficiency of thinking. Others may have a more humanistic view of clinical reasoning, expecting to gain an appreciation for the context and complexities of patients’ experiences. In either case, the lack of clarity about what clinical reasoning is and how it should be taught makes our finding both interesting and difficult to interpret. What is clear is that clinical reasoning is viewed as a highly important aspect of high-quality patient care, specialty practice, development of expertise, and career advancement. Further research is needed to understand how various factors such as mentors’ perspectives or clinical specialty influence one’s view on clinical reasoning and if differing views influences learning, patient, or residency outcomes.
Strengths and Limitations
A strength of Q Methodology is the ability to draw meaningful conclusions from a relatively small sample size given that the sample represents the diversity present in a population.23 While this study included an adequate number of responses from members within each role group, and there was representation from all but 1 specialty area, the majority of responses (n = 81, 84%) came from only 4 specialties (neurology, orthopedics, pediatrics, and sports). Furthermore, some of the specialty areas did not have representation from all role groups, and the anonymous nature of the study prohibits the ability to identify how many unique residency programs are represented in the responses. These limitations should be considered before generalizing the results of this study to all specialty areas. Future studies confirming the presence of the identified dominant perspectives in underrepresented populations are needed.
It is also important to note that identification of 4 dominant perspectives in this study does not preclude the existence of additional perspectives or suggest that some individuals may hold a perspective that is congruous with more than one of the dominant perspectives. This is supported by the factor loadings (Appendixes 1-3), which show that in the 20% of respondents who failed to load on just a single perspective, some respondent had relatively low loading values for all perspectives and some had a relatively high loading value on more than 1 perspective. However, the high percentage of respondents loading on a single perspective (80%) and the large amount of variance explained by the identified perspectives (58%–68%) supports the validity and generalizability of the findings.
As with any study design that includes an aspect of qualitative interpretation, the potential for the authors’ personal perspectives to influence the interpretation of the findings must be considered. Use of the factor analytic procedures associated with Q Methodology to quantitatively identify the presence of 3 perspectives within each role group helped to address this concern. Furthermore, pilot testing and member checking was performed to help guard against an undue influence from researcher bias when developing the Q set and interpreting the perspectives.
Conclusion
This study identified the existence of 4 dominant perspectives about what motivates physical therapists to pursue residency training: (1) desire to improve patient care, (2) preparation for specialty practice, (3) fast track to expert practice, and (4) career advancement. The desire to receive mentoring and improve clinical reasoning are consistently viewed as meta-motivations, which are instrumental to realizing the more specific motivations expressed by the 4 dominant perspectives. Results from this study may be used by potential residents and residency faculty to better understand their own perspectives on motivations for residency training and to inform residency-related application, selection, and program design decision. Future research is needed to understand how various perspectives influence mentoring, clinical reasoning, and residency outcomes.
Author Contributions
Concept/idea/research design: R. Osborne, C. Janson, G.M. Jensen
Writing: R. Osborne, C. Janson, G.M. Jensen
Data collection: R. Osborne
Data analysis: R. Osborne, C. Janson, G.M. Jensen
Project management: R. Osborne
Consultation (including review of manuscript before submitting): L. Black
Disclosures and Presentations
The authors completed the ICMJE Form for Disclosure of Potential Conflicts of Interest and reported no conflicts of interest.
This study was presented as a platform at the APTA’s Combined Sections Meeting, February 21–24, 2018, New Orleans, Louisiana.
References
Factor Loading by Director Respondent
| Factors | |||
|---|---|---|---|
| Director | 1 | 2 | 3 |
| 6 | 0.574a | ||
| 9 | 0.635a | ||
| 11 | 0.637a | ||
| 12 | 0.693a | ||
| 13 | 0.721a | ||
| 15 | 0.695a | ||
| 18 | 0.631a | ||
| 20 | 0.732a | ||
| 21 | 0.763a | ||
| 2 | 0.803a | ||
| 3 | 0.693a | ||
| 4 | 0.636a | ||
| 5 | 0.743a | ||
| 7 | 0.738a | ||
| 17 | 0.637a | ||
| 8 | 0.752a | ||
| 19 | 0.626a | ||
| 1 | 0.511 | 0.354 | 0.596 |
| 10 | 0.620 | 0.518 | 0.356 |
| 14 | 0.433 | 0.457 | 0.423 |
| 16 | 0.559 | 0.617 | 0.263 |
| Variance explained, % | 0.290 | 0.250 | 0.140 |
| Cumulative % | 0.290 | 0.540 | 0.680 |
| Factors | |||
|---|---|---|---|
| Director | 1 | 2 | 3 |
| 6 | 0.574a | ||
| 9 | 0.635a | ||
| 11 | 0.637a | ||
| 12 | 0.693a | ||
| 13 | 0.721a | ||
| 15 | 0.695a | ||
| 18 | 0.631a | ||
| 20 | 0.732a | ||
| 21 | 0.763a | ||
| 2 | 0.803a | ||
| 3 | 0.693a | ||
| 4 | 0.636a | ||
| 5 | 0.743a | ||
| 7 | 0.738a | ||
| 17 | 0.637a | ||
| 8 | 0.752a | ||
| 19 | 0.626a | ||
| 1 | 0.511 | 0.354 | 0.596 |
| 10 | 0.620 | 0.518 | 0.356 |
| 14 | 0.433 | 0.457 | 0.423 |
| 16 | 0.559 | 0.617 | 0.263 |
| Variance explained, % | 0.290 | 0.250 | 0.140 |
| Cumulative % | 0.290 | 0.540 | 0.680 |
a P < .01.
Factor Loading by Director Respondent
| Factors | |||
|---|---|---|---|
| Director | 1 | 2 | 3 |
| 6 | 0.574a | ||
| 9 | 0.635a | ||
| 11 | 0.637a | ||
| 12 | 0.693a | ||
| 13 | 0.721a | ||
| 15 | 0.695a | ||
| 18 | 0.631a | ||
| 20 | 0.732a | ||
| 21 | 0.763a | ||
| 2 | 0.803a | ||
| 3 | 0.693a | ||
| 4 | 0.636a | ||
| 5 | 0.743a | ||
| 7 | 0.738a | ||
| 17 | 0.637a | ||
| 8 | 0.752a | ||
| 19 | 0.626a | ||
| 1 | 0.511 | 0.354 | 0.596 |
| 10 | 0.620 | 0.518 | 0.356 |
| 14 | 0.433 | 0.457 | 0.423 |
| 16 | 0.559 | 0.617 | 0.263 |
| Variance explained, % | 0.290 | 0.250 | 0.140 |
| Cumulative % | 0.290 | 0.540 | 0.680 |
| Factors | |||
|---|---|---|---|
| Director | 1 | 2 | 3 |
| 6 | 0.574a | ||
| 9 | 0.635a | ||
| 11 | 0.637a | ||
| 12 | 0.693a | ||
| 13 | 0.721a | ||
| 15 | 0.695a | ||
| 18 | 0.631a | ||
| 20 | 0.732a | ||
| 21 | 0.763a | ||
| 2 | 0.803a | ||
| 3 | 0.693a | ||
| 4 | 0.636a | ||
| 5 | 0.743a | ||
| 7 | 0.738a | ||
| 17 | 0.637a | ||
| 8 | 0.752a | ||
| 19 | 0.626a | ||
| 1 | 0.511 | 0.354 | 0.596 |
| 10 | 0.620 | 0.518 | 0.356 |
| 14 | 0.433 | 0.457 | 0.423 |
| 16 | 0.559 | 0.617 | 0.263 |
| Variance explained, % | 0.290 | 0.250 | 0.140 |
| Cumulative % | 0.290 | 0.540 | 0.680 |
a P < .01.
Factor Loading by Faculty Respondent
| Factors | |||
|---|---|---|---|
| Faculty | 1 | 2 | 3 |
| 3 | 0.610a | ||
| 12 | 0.591a | ||
| 14 | 0.688a | ||
| 17 | 0.646a | ||
| 19 | 0.588a | ||
| 20 | 0.527a | ||
| 22 | 0.556a | ||
| 23 | 0.618a | ||
| 24 | 0.645a | ||
| 25 | 0.528a | ||
| 30 | 0.542a | ||
| 31 | 0.650a | ||
| 35 | 0.651a | ||
| 40 | 0.745a | ||
| 42 | 0.605a | ||
| 1 | 0.561a | ||
| 2 | 0.410a | ||
| 4 | 0.620a | ||
| 15 | 0.626a | ||
| 39 | 0.443a | ||
| 43 | 0.546a | ||
| 5 | 0.654a | ||
| 6 | 0.647a | ||
| 7 | 0.604a | ||
| 8 | 0.816a | ||
| 11 | 0.737a | ||
| 13 | 0.529a | ||
| 16 | 0.574a | ||
| 28 | 0.579a | ||
| 29 | 0.585a | ||
| 32 | 0.615a | ||
| 36 | 0.717a | ||
| 38 | 0.589a | ||
| 41 | 0.540a | ||
| 9 | 0.327 | 0.482 | 0.505 |
| 10 | 0.582 | 0.356 | 0.464 |
| 18 | 0.343 | 0.434 | 0.461 |
| 21 | 0.433 | 0.178 | 0.409 |
| 26 | 0.418 | 0.304 | 0.413 |
| 27 | 0.302 | 0.502 | 0.531 |
| 33 | 0.486 | 0.310 | 0.545 |
| 34 | 0.444 | 0.565 | 0.395 |
| 37 | 0.408 | 0.417 | 0.440 |
| 44 | 0.546 | 0.585 | 0.271 |
| Variance explained, % | 0.230 | 0.140 | 0.210 |
| Cumulative % | 0.230 | 0.370 | 0.580 |
| Factors | |||
|---|---|---|---|
| Faculty | 1 | 2 | 3 |
| 3 | 0.610a | ||
| 12 | 0.591a | ||
| 14 | 0.688a | ||
| 17 | 0.646a | ||
| 19 | 0.588a | ||
| 20 | 0.527a | ||
| 22 | 0.556a | ||
| 23 | 0.618a | ||
| 24 | 0.645a | ||
| 25 | 0.528a | ||
| 30 | 0.542a | ||
| 31 | 0.650a | ||
| 35 | 0.651a | ||
| 40 | 0.745a | ||
| 42 | 0.605a | ||
| 1 | 0.561a | ||
| 2 | 0.410a | ||
| 4 | 0.620a | ||
| 15 | 0.626a | ||
| 39 | 0.443a | ||
| 43 | 0.546a | ||
| 5 | 0.654a | ||
| 6 | 0.647a | ||
| 7 | 0.604a | ||
| 8 | 0.816a | ||
| 11 | 0.737a | ||
| 13 | 0.529a | ||
| 16 | 0.574a | ||
| 28 | 0.579a | ||
| 29 | 0.585a | ||
| 32 | 0.615a | ||
| 36 | 0.717a | ||
| 38 | 0.589a | ||
| 41 | 0.540a | ||
| 9 | 0.327 | 0.482 | 0.505 |
| 10 | 0.582 | 0.356 | 0.464 |
| 18 | 0.343 | 0.434 | 0.461 |
| 21 | 0.433 | 0.178 | 0.409 |
| 26 | 0.418 | 0.304 | 0.413 |
| 27 | 0.302 | 0.502 | 0.531 |
| 33 | 0.486 | 0.310 | 0.545 |
| 34 | 0.444 | 0.565 | 0.395 |
| 37 | 0.408 | 0.417 | 0.440 |
| 44 | 0.546 | 0.585 | 0.271 |
| Variance explained, % | 0.230 | 0.140 | 0.210 |
| Cumulative % | 0.230 | 0.370 | 0.580 |
a P < .01.
Factor Loading by Faculty Respondent
| Factors | |||
|---|---|---|---|
| Faculty | 1 | 2 | 3 |
| 3 | 0.610a | ||
| 12 | 0.591a | ||
| 14 | 0.688a | ||
| 17 | 0.646a | ||
| 19 | 0.588a | ||
| 20 | 0.527a | ||
| 22 | 0.556a | ||
| 23 | 0.618a | ||
| 24 | 0.645a | ||
| 25 | 0.528a | ||
| 30 | 0.542a | ||
| 31 | 0.650a | ||
| 35 | 0.651a | ||
| 40 | 0.745a | ||
| 42 | 0.605a | ||
| 1 | 0.561a | ||
| 2 | 0.410a | ||
| 4 | 0.620a | ||
| 15 | 0.626a | ||
| 39 | 0.443a | ||
| 43 | 0.546a | ||
| 5 | 0.654a | ||
| 6 | 0.647a | ||
| 7 | 0.604a | ||
| 8 | 0.816a | ||
| 11 | 0.737a | ||
| 13 | 0.529a | ||
| 16 | 0.574a | ||
| 28 | 0.579a | ||
| 29 | 0.585a | ||
| 32 | 0.615a | ||
| 36 | 0.717a | ||
| 38 | 0.589a | ||
| 41 | 0.540a | ||
| 9 | 0.327 | 0.482 | 0.505 |
| 10 | 0.582 | 0.356 | 0.464 |
| 18 | 0.343 | 0.434 | 0.461 |
| 21 | 0.433 | 0.178 | 0.409 |
| 26 | 0.418 | 0.304 | 0.413 |
| 27 | 0.302 | 0.502 | 0.531 |
| 33 | 0.486 | 0.310 | 0.545 |
| 34 | 0.444 | 0.565 | 0.395 |
| 37 | 0.408 | 0.417 | 0.440 |
| 44 | 0.546 | 0.585 | 0.271 |
| Variance explained, % | 0.230 | 0.140 | 0.210 |
| Cumulative % | 0.230 | 0.370 | 0.580 |
| Factors | |||
|---|---|---|---|
| Faculty | 1 | 2 | 3 |
| 3 | 0.610a | ||
| 12 | 0.591a | ||
| 14 | 0.688a | ||
| 17 | 0.646a | ||
| 19 | 0.588a | ||
| 20 | 0.527a | ||
| 22 | 0.556a | ||
| 23 | 0.618a | ||
| 24 | 0.645a | ||
| 25 | 0.528a | ||
| 30 | 0.542a | ||
| 31 | 0.650a | ||
| 35 | 0.651a | ||
| 40 | 0.745a | ||
| 42 | 0.605a | ||
| 1 | 0.561a | ||
| 2 | 0.410a | ||
| 4 | 0.620a | ||
| 15 | 0.626a | ||
| 39 | 0.443a | ||
| 43 | 0.546a | ||
| 5 | 0.654a | ||
| 6 | 0.647a | ||
| 7 | 0.604a | ||
| 8 | 0.816a | ||
| 11 | 0.737a | ||
| 13 | 0.529a | ||
| 16 | 0.574a | ||
| 28 | 0.579a | ||
| 29 | 0.585a | ||
| 32 | 0.615a | ||
| 36 | 0.717a | ||
| 38 | 0.589a | ||
| 41 | 0.540a | ||
| 9 | 0.327 | 0.482 | 0.505 |
| 10 | 0.582 | 0.356 | 0.464 |
| 18 | 0.343 | 0.434 | 0.461 |
| 21 | 0.433 | 0.178 | 0.409 |
| 26 | 0.418 | 0.304 | 0.413 |
| 27 | 0.302 | 0.502 | 0.531 |
| 33 | 0.486 | 0.310 | 0.545 |
| 34 | 0.444 | 0.565 | 0.395 |
| 37 | 0.408 | 0.417 | 0.440 |
| 44 | 0.546 | 0.585 | 0.271 |
| Variance explained, % | 0.230 | 0.140 | 0.210 |
| Cumulative % | 0.230 | 0.370 | 0.580 |
a P < .01.
Factor Loading by Resident Respondent
| Factors | |||
|---|---|---|---|
| Resident | 1 | 2 | 3 |
| 1 | 0.652a | ||
| 2 | 0.742a | ||
| 3 | 0.742a | ||
| 4 | 0.718a | ||
| 5 | 0.645a | ||
| 8 | 0.419a | ||
| 10 | 0.671a | ||
| 13 | 0.626a | ||
| 16 | 0.622a | ||
| 19 | 0.608a | ||
| 20 | 0.588a | ||
| 22 | 0.683a | ||
| 25 | 0.562a | ||
| 31 | 0.652a | ||
| 7 | 0.690a | ||
| 12 | 0.652a | ||
| 14 | 0.681a | ||
| 15 | 0.731a | ||
| 17 | 0.650a | ||
| 24 | 0.629a | ||
| 32 | 0.736a | ||
| 9 | 0.712a | ||
| 21 | 0.694a | ||
| 26 | 0.631a | ||
| 28 | 0.524a | ||
| 6 | 0.319 | 0.227 | 0.381 |
| 11 | 0.260 | 0.503 | 0.447 |
| 18 | 0.435 | 0.360 | 0.550 |
| 23 | 0.525 | 0.405 | 0.501 |
| 27 | 0.475 | 0.301 | 0.493 |
| 29 | 0.508 | 0.407 | 0.493 |
| 30 | 0.603 | 0.342 | 0.536 |
| Variance explained, % | 0.260 | 0.200 | 0.170 |
| Cumulative % | 0.260 | 0.460 | 0.630 |
| Factors | |||
|---|---|---|---|
| Resident | 1 | 2 | 3 |
| 1 | 0.652a | ||
| 2 | 0.742a | ||
| 3 | 0.742a | ||
| 4 | 0.718a | ||
| 5 | 0.645a | ||
| 8 | 0.419a | ||
| 10 | 0.671a | ||
| 13 | 0.626a | ||
| 16 | 0.622a | ||
| 19 | 0.608a | ||
| 20 | 0.588a | ||
| 22 | 0.683a | ||
| 25 | 0.562a | ||
| 31 | 0.652a | ||
| 7 | 0.690a | ||
| 12 | 0.652a | ||
| 14 | 0.681a | ||
| 15 | 0.731a | ||
| 17 | 0.650a | ||
| 24 | 0.629a | ||
| 32 | 0.736a | ||
| 9 | 0.712a | ||
| 21 | 0.694a | ||
| 26 | 0.631a | ||
| 28 | 0.524a | ||
| 6 | 0.319 | 0.227 | 0.381 |
| 11 | 0.260 | 0.503 | 0.447 |
| 18 | 0.435 | 0.360 | 0.550 |
| 23 | 0.525 | 0.405 | 0.501 |
| 27 | 0.475 | 0.301 | 0.493 |
| 29 | 0.508 | 0.407 | 0.493 |
| 30 | 0.603 | 0.342 | 0.536 |
| Variance explained, % | 0.260 | 0.200 | 0.170 |
| Cumulative % | 0.260 | 0.460 | 0.630 |
a P < .01.
Factor Loading by Resident Respondent
| Factors | |||
|---|---|---|---|
| Resident | 1 | 2 | 3 |
| 1 | 0.652a | ||
| 2 | 0.742a | ||
| 3 | 0.742a | ||
| 4 | 0.718a | ||
| 5 | 0.645a | ||
| 8 | 0.419a | ||
| 10 | 0.671a | ||
| 13 | 0.626a | ||
| 16 | 0.622a | ||
| 19 | 0.608a | ||
| 20 | 0.588a | ||
| 22 | 0.683a | ||
| 25 | 0.562a | ||
| 31 | 0.652a | ||
| 7 | 0.690a | ||
| 12 | 0.652a | ||
| 14 | 0.681a | ||
| 15 | 0.731a | ||
| 17 | 0.650a | ||
| 24 | 0.629a | ||
| 32 | 0.736a | ||
| 9 | 0.712a | ||
| 21 | 0.694a | ||
| 26 | 0.631a | ||
| 28 | 0.524a | ||
| 6 | 0.319 | 0.227 | 0.381 |
| 11 | 0.260 | 0.503 | 0.447 |
| 18 | 0.435 | 0.360 | 0.550 |
| 23 | 0.525 | 0.405 | 0.501 |
| 27 | 0.475 | 0.301 | 0.493 |
| 29 | 0.508 | 0.407 | 0.493 |
| 30 | 0.603 | 0.342 | 0.536 |
| Variance explained, % | 0.260 | 0.200 | 0.170 |
| Cumulative % | 0.260 | 0.460 | 0.630 |
| Factors | |||
|---|---|---|---|
| Resident | 1 | 2 | 3 |
| 1 | 0.652a | ||
| 2 | 0.742a | ||
| 3 | 0.742a | ||
| 4 | 0.718a | ||
| 5 | 0.645a | ||
| 8 | 0.419a | ||
| 10 | 0.671a | ||
| 13 | 0.626a | ||
| 16 | 0.622a | ||
| 19 | 0.608a | ||
| 20 | 0.588a | ||
| 22 | 0.683a | ||
| 25 | 0.562a | ||
| 31 | 0.652a | ||
| 7 | 0.690a | ||
| 12 | 0.652a | ||
| 14 | 0.681a | ||
| 15 | 0.731a | ||
| 17 | 0.650a | ||
| 24 | 0.629a | ||
| 32 | 0.736a | ||
| 9 | 0.712a | ||
| 21 | 0.694a | ||
| 26 | 0.631a | ||
| 28 | 0.524a | ||
| 6 | 0.319 | 0.227 | 0.381 |
| 11 | 0.260 | 0.503 | 0.447 |
| 18 | 0.435 | 0.360 | 0.550 |
| 23 | 0.525 | 0.405 | 0.501 |
| 27 | 0.475 | 0.301 | 0.493 |
| 29 | 0.508 | 0.407 | 0.493 |
| 30 | 0.603 | 0.342 | 0.536 |
| Variance explained, % | 0.260 | 0.200 | 0.170 |
| Cumulative % | 0.260 | 0.460 | 0.630 |
a P < .01.
Comments