Why Some Students Need Our Attention in PT Education

For decades, physical therapy education programs have relied heavily on traditional metrics to predict student success: undergraduate GPA, GRE scores, and prerequisite course performance. While these numbers tell us something important, they don't tell us everything. Recent groundbreaking research from Tufts University & published in the Journal of Physical Therapy Education, reveals that some of the most critical predictors of success in PT school have nothing to do with test scores and everything to do with the lived experiences students bring to our programs.

The Hidden Variables That Matter

The study "Beyond Academics: Holistic Predictors of Success in Physical Therapy Education" examined 63 students in an accelerated, hybrid PT program and found that twenty-six percent of the variance in student academic performance was explained by just two factors: whether students identified as first-generation college students and whether they worked during the program.

Think about that for a moment. More than a quarter of academic success could be predicted not by what students scored on entrance exams, but by their family's educational background and their need to work while studying.

Both first-generation status and work status during the program were inversely related to programmatic success as measured by cumulative GPA after semester 2.

In other words, students who were the first in their families to attend college, and those who needed to work while in school, were more likely to struggle academically despite having met all the traditional admission requirements.

Why This Matters for Physical Therapy

This research challenges us to think more deeply about what we mean by "merit" and "preparedness" in PT education. As the field of physical therapy aims to diversify the workforce, ensuring admissions processes evaluate holistic factors predictive of success is imperative. We know that a diverse healthcare workforce helps address systemic health disparities, but if we're inadvertently creating barriers for students from diverse backgrounds, we're working against our own goals.

The study's findings align with the growing body of research on social determinants of learning (SDOL). A history of educational disadvantage was the only SDOL factor that contributed to early DPT GPA variance (2.6%), and most of the educationally disadvantaged group were first-generation college students.

The Professional Success Factor: Beyond Academic Achievement

While academic performance is important, research increasingly shows that success in physical therapy practice depends heavily on traits that traditional metrics rarely capture: caring, emotional intelligence, grit, resilience, and compassion. These qualities are fundamental to building therapeutic relationships, understanding patient perspectives, and providing patient-centered care that leads to better outcomes.

Studies in healthcare education demonstrate that emotional intelligence is a strong predictor of clinical performance, patient satisfaction, and professional longevity. Physical therapists with higher emotional intelligence scores show better communication skills, more effective patient interactions, and greater job satisfaction throughout their careers. Interestingly, many first-generation students have developed these exact qualities through their life experiences of navigating challenges, supporting family members, and overcoming obstacles that their continuing-generation peers may never have faced.

The ability to show empathy, connect with patients from diverse backgrounds, and maintain compassion under stress often comes from personal experience with adversity. This suggests that some of the students who may struggle academically due to external pressures could actually become the most effective clinicians once those barriers are addressed.

The First-Generation Challenge

First-generation college students face unique challenges that their continuing-generation peers rarely consider:

• Hidden Curriculum: They must navigate unspoken academic and social norms without family guidance
• Financial Pressure: Often working to support themselves and sometimes their families
• Imposter Syndrome: Questioning whether they belong in academic spaces
• Limited Social Capital: Fewer connections to mentors, internships, and professional networks
• Cultural Balancing: Managing expectations from family who may not understand the demands of graduate education

Research beyond PT education shows that first-generation college graduates are less likely to apply and be accepted to medical school, suggesting this is a systemic issue across healthcare education.

What This Means for Educators

As PT educators, we have both an opportunity and an obligation to respond to these findings. The research suggests that students who identify as first-generation college students and those who work during the program may benefit from further supports to improve the likelihood of success.

Here's how we can act on this knowledge:

1. Revamp Our Definition of Readiness

Traditional academic metrics remain important, but they're incomplete. We need admission processes that consider the whole person: their resilience, their motivation, and the unique perspectives they bring from their life experiences.

2. Provide Targeted Support Early

The results of this study may aid in admissions decision-making and, importantly, assist in the early identification of students who need additional academic support. We can't wait until students are struggling to offer help.

3. Address Systemic Barriers

Working during PT school shouldn't be a predictor of academic struggle - it's often a necessity. How can we restructure programs to be more accommodating to students who must work? Can we offer more flexible scheduling, financial aid, or paid assistantships?

From Awareness to Action: Evidence-Based Support Strategies

Knowing that first-generation students and working students face additional challenges is only the first step. The research points us toward evidence-based solutions. Angela Duckworth's groundbreaking work on grit, defined as "perseverance and passion for long-term goals," provides crucial insights (Duckworth et al., 2007). Research specifically in PT education has found that grit was an independent predictor for overall academic success and clinical performance in final-year physical therapist students, with one in five students having low levels of grit and one in four having low levels of resilience (Muldoon et al., 2022).

Importantly, studies in PT programs have found that grit scores may be valuable predictors for program retention criteria, with average grit scores for entering DPT students (3.96) being significantly higher than general population norms for this age group (Akroyd et al., 2016). Students with lower grit scores may benefit from focused retention strategies, thereby increasing graduation rates and student success.

This suggests that the qualities we need to foster in PT students (resilience, persistence, adaptability) are exactly the qualities that many first-generation students have already developed through their life experiences. David Yeager's research on resilience and mindsets provides a framework for understanding how these qualities can be nurtured. His work demonstrates that when students believe that personal characteristics can be developed (rather than being fixed), they show enhanced resilience in the face of academic and social challenges (Yeager & Dweck, 2012).

Real-World Application: Dr. Jodi Miller's Success Story

Theory becomes powerful when it translates into practice. Dr. Jodi Miller, DPT, has been operating a mentoring service specifically designed to support DPT students in an accelerated, hybrid PT program, providing a concrete example of how targeted interventions can work.

Her results provide valuable insights: 89% retention after the first year, with students leaving for various reasons including personal choice, lack of engagement with support services, and academic challenges.

When corrected for factors not related to engagement with tutoring, that number is more like 91% after the first year, which represents a significant improvement from before she got involved.

Dr. Miller's success demonstrates what happens when we move beyond awareness to action. By providing targeted academic support that addresses the specific challenges faced by students from diverse backgrounds, she has created a model that other programs can follow.

Her work exemplifies the kind of "academic scaffolding" that helps students navigate not just the content, but the hidden curriculum of graduate education.

The challenge isn't their capacity for success; it's removing the structural barriers that make success unnecessarily difficult.

The Path Forward

Expanded use of holistic review admissions practices may help decision makers value the strengths first-generation college graduates and other underrepresented applicants bring to healthcare education and the healthcare workforce. The same is true for physical therapy education.

We need:

• Mentorship programs that connect first-generation students with faculty and alumni, and people like Dr. Miller and her team.
• Financial support that reduces the need to work during school
• Academic scaffolding that helps students navigate the hidden curriculum (as demonstrated by Dr. Miller's success)
• Community building that helps students feel they belong
• Grit and resilience interventions that build on research by Duckworth and Yeager to enhance student persistence

Beyond Serving Students

The impact of our educational choices extends far beyond our students. When we support first-generation students more effectively, we're not just improving their individual outcomes. We're investing in more diverse, empathetic, and culturally competent healthcare providers who will better serve their communities.

The patients these students will eventually treat, the communities they'll serve, and the profession as a whole all benefit when we move beyond traditional metrics to embrace a more holistic understanding of student potential and success.

Conclusion

The research is clear: academic success in PT education isn't just about entrance exam scores. It's about recognizing and supporting the diverse pathways students take to reach our programs. By paying attention to factors like first-generation status and work requirements, we can create more equitable and effective educational environments.

Dr. Jodi Miller's remarkable 91% retention rate proves that when we provide targeted, evidence-based support, we can dramatically improve outcomes for all students, particularly those who might otherwise struggle despite their potential and determination.

As the field of physical therapy aims to diversify the workforce, ensuring admissions processes evaluate holistic factors predictive of success is imperative. The question isn't whether we can afford to make these changes. It's whether we can afford not to.

The students who need extra support today will be the clinicians who serve underrepresented communities tomorrow. Supporting them isn't just good education. It's good for the future of healthcare.

What strategies has your program implemented to support first-generation students?

What barriers have you identified that still need addressing?

How can you include programs like Dr. Miller's in your institution?

References

Akroyd, D., Caison, A., & Adams, R. D. (2016). Is grit a key factor in DPT program retention and success? Academy of Education Research Presentations. American Physical Therapy Association.

Duckworth, A. L., Peterson, C., Matthews, M. D., & Kelly, D. R. (2007). Grit: Perseverance and passion for long-term goals. Journal of Personality and Social Psychology, 92(6), 1087-1101. https://doi.org/10.1037/0022-3514.92.6.1087 (opens in a new tab)

Duckworth, A. L., & Gross, J. J. (2014). Self-control and grit: Related but separable determinants of success. Current Directions in Psychological Science, 23(5), 319-325. https://doi.org/10.1177/0963721414541462 (opens in a new tab)

Muldoon, K., Biesty, L., & Smith, V. (2022). Grit, resilience, mindset, and academic success in physical therapist students: A cross-sectional, multicenter study. Physical Therapy, 102(7), 1-11. https://doi.org/10.1093/ptj/pzac051 (opens in a new tab)

Wooten, L., Casertano, L., Mulligan, E. P., Wilkinson, T., Gisselman, A. S., Burgemeister, M., & Dao, K. D. (2025). Beyond academics: Holistic predictors of success in physical therapy education. Journal of Physical Therapy Education, 39(2). https://doi.org/10.1097/JTE.0000000000000408 (opens in a new tab)

Yeager, D. S., & Dweck, C. S. (2012). Mindsets that promote resilience: When students believe that personal characteristics can be developed. Educational Psychologist, 47(4), 302-314. https://doi.org/10.1080/00461520.2012.722805 (opens in a new tab)