Welcome back to the Healing Pain Podcast with Gail Jensen, PT, PhD, FAPTA

Contextualizing care is the process of adopting your treatment approach to a patient specific life context. The failure to do so is called a contextual error, which often results in a care plan that is not likely to achieve its intended aim or produce a positive outcome. In this episode, Dr. Joe Tatta discusses how to contextualize care for improved outcomes with Gail Jensen, PT, PhD, FAPTA, Vice Provost for Learning and Assessment, Dean Emerita and Professor of Physical Therapy at Creighton University. She is internationally regarded as a scholarly expert in clinical practice, clinical reasoning, professional ethics, as well as into professional education within and outside of the physical therapy profession. Join in for more powerful information.

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How To Contextualize Care For Improved Outcomes With Gail Jensen, PT, PhD, FAPTA

Welcome to this episode of the show. It’s great to be spending this time with you. In this episode, we are discussing how to contextualize care for improved patient outcomes. Contextualizing care is the process of adopting your treatment approach to a patient-specific life context. The failure to do so is called a contextual error, which often results in a care plan that is not likely to achieve its intended aim or produce a positive outcome.

There is substantial evidence in research that contextual errors are common in everyday practice. They adversely affect patient outcomes. They drive up healthcare costs, and they are widely preventable. Joining us to discuss how to contextualize care and the role that humanities play in the physical therapy profession is Dr. Gail Jensen. Dr. Jensen is Vice Provost for Learning and Assessment, Dean Emerita, and Professor of Physical Therapy at Creighton University.

Dr. Jensen is internationally regarded as a scholarly expert in clinical practice, clinical reasoning, and professional ethics, as well as in professional education within and outside of the physical therapy profession. She has co-authored more than 90 publications in peer review journals and has co-authored thirteen books, including a new addition of Clinical Reasoning in the Health Professions.

She led the research team that completed a national study of excellence and innovation in physical therapist education funded by the American Physical Therapy Association and several APTA components. Dr. Jensen holds a Bachelor’s degree in Education, a Master’s degree in Physical Therapy, and a PhD in Educational Evaluation with a minor in Sociology from Stanford University. In this episode, we discuss the importance of clinical reasoning and the patient context in patient care and healthcare in general. Without further ado, let’s begin and let’s meet Dr. Gail Jensen.

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Gail, thanks for joining the show.

Thanks, Joe. I’m delighted to be with you and share some thoughts on which we both agree with.

It’s an honor to be speaking with you. You’ve been in the physical therapy profession and clinical education for many decades. You’re known as a leader in education in physical therapy and the health sciences in general. The word context is oftentimes thrown around so much. It’s especially thrown around in the world of chronic pain. Oftentimes, you hear things like, “Pain is contextual.” Providers are starting to get an idea of what that really means.

Although when we look at the myriad of chronic health conditions that we see, both physical and mental health conditions, we know that those two things are inseparably interconnected. A lot of the work and the direction we‘re starting to head is how we’re going to bring the clinical side of practice together with the academic world so that we can improve the patient experience and clinical outcomes. How did you become interested in this topic?

It does matters where you go to school. That’s what I would say. I was fortunate to go to an entry-level Master’s degree program at Stanford University. When Stanford Master’s degree program was in operation, those of you may know about Katherine Shepard, she was a huge influence on the curriculum. The commitment that the program had to the integration of the social and behavioral sciences, as well as the physical and biological sciences was foundational in the curriculum. Those were the values that were shared by faculty and promoted in the curriculum.

I had a course in organizational behavior. We certainly had a course in cultural psychosocial elements pushing beyond communication. Setting the stage and putting that in place in what I call the implicit curriculum as part of your professional identity and formation is incredibly powerful and long-lasting. I’ve always seen it like that. My clinical area is musculoskeletal. If you don’t understand the person you’re working with, you’re not going to be very successful.

Your post-graduate training included the biological along with the social and environmental if you will.

That was my entry-level degree. My undergraduate degree was in education, physical education, and health. Instead of getting a second Bachelor’s degree at that time, I got a Master’s degree. It was one of the reasons why I was attracted to being part of the foundational faculty for the first DPT program at Creighton University. It made sense to me to think about preparing therapists at that level in terms of societal needs.

It’s so interesting. What you’re talking about is an evolution of the biopsychosocial model, but you’re starting to contextualize it for physical therapist practice in a way.

We did a national study of excellence in innovation in PT education. We published a couple of papers in physical therapy. We published a book, Educating Physical Therapists, published by SLACK. It was a Carnegie-like study. We met with Lee Shulman when he was President of the Carnegie Foundation. This was Terry Nordstrom, Laurie Hack, Jan Gwyer, and Elizabeth Mostrom. These were all experienced people.

We had never thought about this. He said, “You’re in a very challenging profession. You’re in a profession of human improvement. Just like teaching, you don’t have complete control over your outcome. We don’t have complete control over students and we don’t have complete control over patients.” He showed us David Khan’s work. David has written for the University of Michigan about how people who work in these caring professions where you don’t have complete control over the outcome are hard and complex work. You really have to understand the people you’re working with. It sounds simple, but it’s not.

It sounds clean when you’re in school, and then you come out of school and you realize that this situation or this context that this patient is in is not so clear cut and dry. What does understanding patient context mean? Let’s start to dig into that a little bit because we mentioned context a while ago. This whole episode is going to revolve around that. What does understanding patient context mean?

We throw words out. The lived experience, what is that? At the heart of it is deep active listening. It’s not just the term. As physical therapists, we have a unique skillset here in that our observational skills are exquisite. They’re good and they’re very much part of reading the patient across all the systems. With context, we use it as a throwaway. We’re like, “Social determinants of health, I know about that. I know it has to do with upstream factors.” We treat it as something like, “I know about it. I need to pay attention to it,” but what does that really mean? That’s the ultimate challenge.

I shared with you this fascinating paper on contextualizing care arguing that understanding the patient context in a meaningful way is an important part of clinical reasoning. It’s understanding where the patient is coming from and what they value. We have a tendency to say, “We’re going to call that motivational interviewing. Here’s the skillset or the tools you need.”

I go back to that deep active listening connected with what we know certainly, how we navigate and ask those meaningful follow-up questions, understanding what kind of support system, and understanding the elements of the ICF model. It’s not everything. If you do the whole ICF model, it takes you an hour. What does it mean to have support? What does it mean to engage in something? It goes back to a high level of expertise that’s needed to do this. I go back to our study of expert practitioners that Laurie Hack, Jan Gwyer, K Shepard and I did. We saw expert clinicians do this well. You’re one of those. I should ask you. Why is it that expert clinicians do this so well? I am asking you that question.

This is my lived experience of being in the profession, working with other professionals, and also hiring and training other professionals. When someone comes to the profession with their own lived experience of a health crisis so to speak, whether that was you tore your ACL in high school and that was a shock to you or your grandparent had a massive stroke, that lived experience has informed the rest of your life, whether you become a healthcare provider or not. What’s encapsulated in that is how you then are able to relate to someone else’s lived experience even if it’s difficult for you at times to relate to someone’s lived experience because it may be far from your current experience.

We’ve used the word lived experience a lot. You said it very pointedly in the beginning that we throw that word around. There’s not just one lived experience. Every person on the planet has their own unique lived experience. There’s curiosity that has to develop there. That’s where you’re bringing this conversation to light for all of us. In some way, the social sciences are embedded in what we do, whether we realize it or not.

They’re not just the integration of the humanities, which is a hot topic in medical education. It’s not just reading a poem or going to a museum, but it is the integration of the story and the narrative. Expert clinicians get the story. They are skillful in asking follow-up probing questions to understand that story. We know novices are rule-governed so they’re going to ask everything. That’s what they’re supposed to do in the examination valuation process. How do we move that along?

I’m fond of the frame document that came out of medical education. I have a table in Cerasoli lecture which will be published in the Journal of PT Education in the winter issue coming up. It’s from the frame document. They make the argument that it’s the integration of the arts and the humanities into the health profession education that’s important. How do we help tie that to things that we have to have or the knowledge that we have to have? It’s the integration of ethical reasoning. They call it perspective-taking. How do you see things from multiple frames of reference? That’s critical if you have any kind of moral or ethical situation versus saying, “This is my view.” How do you see it from other people’s view?

Your point, Joe, was that important critical self-reflection, personal insight, and those non-cognitive parts of who you are important. Clinical reasoning is all about your cognitive part, but it’s also your non-cognitive abilities of how you have that growth mindset and inner drive. Probably the most important is how we see what our professional role is in social justice and advocacy.

One thing we found in expert clinicians is what we called moral agency. This was a very strong finding. Those master clinicians or expert clinicians regardless of whether they were working in geriatrics, pediatrics, neuro or orthopedics went the extra mile. They didn’t judge. They withheld judgment. They didn’t call the patient a poor historian, worker’s comp case, or “I’m going to discharge. They’re not adherent. They’re not doing what I want them to do.” They saw that as their shared responsibility in trying to manage the complexity of the situation. That is central.

In a lot of ways, it springs together the art of caring for another human with the science of clinical reasoning that we learn in practice. It’s the art of humanities with evidence based on science.

I would say that art is part of the reasoning process. We’re so quick to go to the cognitive way. It’s easier. It’s about dual processing and fast and slow thinking. It’s about cognitive load. Yes, but it’s also about these non-cognitive things. Situational awareness is probably one of the most important elements in your ability to see context. Are you aware? Are you asking questions to make yourself situationally aware of what’s going on with this patient in the world they live in?

There are two things I would like to chime in with this. One, everyone knows that I’ve studied and I’m teaching Acceptance and Commitment Therapy. Within that framework, there are a number of actualizations around perspective-taking. It’s not only your own perspective-taking but being able to take the perspective of others. In our very me–society, oftentimes, that’s a skill that is lacking or missing from someone’s emotional intelligence and awareness so to speak.

Are you asking me how we facilitate that?

What I’m thinking is that there’s a lot of mindfulness that is involved in this type of care.

One of the most thoughtful writers in this area is Ron Epstein. I’m sure you’ve read his work. Ron is an internist and also works in oncology at the University of Rochester. He wrote the book Attending. He also wrote a classic paper called Mindful Practice in 1999 for academic medicine. He talked about how often you see learners that are quite mindless. They’re so focused on the task that they’re not present.

It’s the other thing that we found early on. We did some pilot work before the expert practice study. We looked at what we called master clinicians. We published a couple of papers on that in the pilot work. One of our first observations with master clinicians is they did not allow interruptions. There was nobody coming in saying, “I need the ultrasound.” They were present in every way, shape or form with their patient. They did not allow interruptions. That was in contrast to novices who were a little bit like squirrels.

The question then is whether there are these elements in the master adaptive learner model around what they call the battery power. You mentioned before curiosity. How do we do coaching and mentoring to facilitate curiosity? Do we drive it out of learners? There is a growth mindset and resilience. Certainly, the organization in the healthcare system is not very friendly. It’s somewhat broken. That’s a challenge to all health professionals right now.

That’s an excellent point because oftentimes providers ask me, “How do I start to use pain education? How do I start to use some kind of cognitive techniques?” They’re so focused on being task-oriented. I have to give them the exercise. I have to do this certain technique. What you’re saying is to start to think broader than that. That may be how we start to move toward contextualizing care for people.

One of the experts in our expertise study was Peter Edgelow. I had the honor of observing him in collecting data. Peter passed away a few years ago. He was an exceptional manual therapist who later in his career focused on getting patients’ portfolios where people were sending him patients who were experiencing chronic pain in the San Francisco Bay Area. Peter was an exquisite clinician in how he worked with patients in a very incremental and thoughtful way. He was the one who said again and again, “It’s our shared responsibility here to find ways for these patients to manage their pain and suffering. We can figure it out.” He never gave up. He was incredible.

Intuitively, he probably used many of the strategies that you’re talking about. The challenge for the profession is how is it both-and versus our emphasis. As professionals, we suffer from this. We’re people who like to move or be active. It’s like, “Let’s do the task.” We need more integration. It’s not just that. It’s not just the exercise or the mobilization. It’s more than that.

I have a thought about that. I think about things a lot. With our profession being so focused on physical function, which is important, there are end goals that our patients have. I also wonder if, at times, we need to tend to our expectations of what can happen in let’s say an eight-week clinical encounter that we have based on insurance visits. The patient comes in. They’re approved for physical therapy twice a week for eight weeks. In our mind, we want to get them back to whether it’s walking, running, not using a cane, or whatever the patient’s goal may be.

I do think there are a lot of foundations that have to be built up first with certain patients, certain populations, and certain people that have a lived experience that is a little more distressing for them before we get into the, “We’re now going to strengthen your whole body and work on functional activities.” I think that’s what’s missing.

No one has given a physical therapist permission to say, “It is okay if you just spend your time holding the space for talking with, counseling, educating, and learning about your patient and their unique history before you dive into the intervention.” The problem with that is it’s uncomfortable for us as physical therapists. It’s uncomfortable because we feel like we have to be doing, as what you’re saying, instead of sometimes, being with the patient is a better way to start to initiate contextualized care.

I have a couple of thoughts on that. First, people are going to say, “Who is going to pay for that?” The second is you do have to be careful of getting into the mental health area. If you don’t have the understanding or skillset, you could get into some dangerous territory. You’ve written about this. It’s the power of touch. We have such a great opportunity. Touch is meaningful. Meaningful touch in therapy communicates a lot. We can’t lose that part of the practice. We have to be careful to make sure we don’t lose that in our education side.

It’s great to have outcome measures. I get that. The therapist is part of the intervention. You can’t separate the therapist from the intervention. It’s not just what exercise you do, to your point. How we handle another person’s body says a lot. It’s in spending time with a patient. It’s in that thoughtful handling that you can learn a lot, and expert therapists do.

I struggle with this with larger class sizes and how we facilitate that kind of development. What I see on the residency side, which has always been quite interesting to me because I’ve been connected to orthopedic residencies for three years, is how therapists come to that because they want to enhance through deliberate practice their manual skills. That has to do with touch, palpation, and all that kind of stuff. I don’t think where they were the ones in PT lab classes that sat there and did things once. That also is frustrating to me. They’re like, “We’ve done it once. Can we move on?” I’m like, “No.” How do we facilitate the importance of deliberate practice in developing our ability as therapists to facilitate movement?

Another reflection you’re making me think back here about our expert practice study is we worked with a couple of consultants. One was Jack Hershey, Laurie Hack’s husband, who did a lot of work in decision analysis. We had two other people from Stanford. One was Lee Shulman and the other was Anna Rickert who was a colleague of mine from graduate school. They looked at our videotapes and said, “This is amazing. How did they know where to put their hands? How did they know how to do this movement?” They were the ones that said, “Movement is a pretty important part of your practice.” We didn’t see it because we were all therapists. They were amazed at what they saw in the video that some were just a simple transfer that we didn’t see ourselves. We can’t lose that.

If you look at anything regarded as a chronic disease, whether it’s on the physical or the mental health side, human movement is essential to that. Even the concept of the movement system, which I know Shirley Sahrmann has pioneered in many ways, I don’t even think we’ve gone as deep and as vigorous as we need to in that area to start to build out the conceptual frameworks. When I say movement system, people think of muscles, joints, and bones, but there are multiple systems that are interconnected with movement. How do we care for movement as well as optimize those other systems so that movement is optimized as well?

We’re talking about context with regard to clinical decisions. I’m wondering if we can give them an idea of a contextual error that might come up in practice. Let’s say a clinician has evaluated a patient but didn’t take context into mind, which maybe led to a less-than-optimal outcome with regard to the patient outcome.

A common error is it comes back to not understanding what support the patient may have or what their sense of ability and self-efficacy is. Do they have the self-confidence to engage in whatever behavior change, exercise, or whatever you’re advising? Do they believe that if they do that, it’ll make a difference in their outcome? The self-efficacy theory has a lot to explain. It’s been used a lot in chronic diseases. The miss is if you don’t understand what happens to the patient in the 23 hours when they leave you. What’s that environment like? What’s their support like? What are their stressors?

Do they live in a neighborhood where they can’t walk? Do they live in a food desert? There are all those kinds of social determinants. What happens is if they’re not successful, then it’s easy for us to judge them. We’ll say, “That’s not my problem. I’m going to discharge.” Whereas the sense of moral agency is saying, “I have some shared responsibility in this.” The system makes it hard for us. It is very challenging. How do you find that the additional support? You’re beginning to see more attention to how important non-health professionals are in making communities healthier. How do we find ways to connect that to patients who don’t have transportation? If we continue to do all of our education in the traditional healthcare system settings, we’re not going to move the needle much on health. We have pretty good evidence of that. We’re not a healthy country, are we?

We’re not. We are a sick country indeed. One of the areas that have interested me with regard to the community is peers, peer trainers, and peer support. Can we educate leaders or pillars of the community to be that bridge or to bridge the gap between what we’re doing in clinical practice versus what’s happening in the home or work setting? Other than one hour, maybe once or twice a week, people are spending many hours on their own. With the contextual nature of what we do and contextualizing patient care, do things like DEI and affirmative practice for LGBT people come into this when you think of it?

Probably the most important thing is how we think about equity and how we are able to see everyone as a person. We’re not just treating the human body. We’re treating the human being. If we don’t understand human beings, there’s no way we’re going to help the human body get better. Removing the judgment is important. There is one thing I would say that troubles me. I have students in the first session of our three-semester ethics class, and I have them do a free write of their most recent clinical experience. I’ve done this over the years. I have to say every year, there are more of these free writes from students where they share stories of what I would call disrespect or judgment coming in.

The other thing about students is they’re like the canary in the coal mine. They’re quite sensitive to moral distress because they haven’t been jaded in some way from practice. They will observe pretty critically when someone is saying disparaging things in a staff office, whether it has to do with a patient’s physical size, lack of support or whatever.

Often, students are given an opportunity in clin ed for some of the challenging patients that have a lot going on. It’s symptomatic of the kind of stressors and the brokenness in the healthcare system. I’m not blaming therapists. Ruth Purtilo wrote quite passionately about this. We don’t want complicity. To be complicit is to see something that is wrong and not say anything. That non-action becomes an action. We’re very clear with students to raise questions. You can always raise questions.

Ruth also writes about respect in our book on moral action. Ruth was the first author of that. I forgot the name of the book, but moral action is the first thing. She has a great chapter on respect and how respect is this deeper sense of being and being with. It’s not just a core value we throw around. Core values have to be enacted. They’re not just, “Here’s a list and I can take a survey. I do all these.”

They’re not just cognitive. They’re lived.

The other thing where we get ourselves into a little trouble, and this has been written about, is that when we think of things as behaviors, we see it and we observe it. The deeper concept here is a disposition, which comes from John Dewey. Disposition is where habits come from. It’s the habits of hand, head and heart. A disposition is something that is habitual so that behavior will be consistent. You will see this disposition in a behavior that is predictable. You can count on that learner to do this because they embrace the habit and the disposition. It moves us beyond behaviors to something that is deeper. That’s important.

Do you have any sense of how we’re doing in physical therapy education with these topics?

We’re making progress. We have people interested in the humanities and ethics. We’ve had real leaders for decades like Ruth Purtilo and Dolly Swisher. We’ve had people who have done good work. Sarah Blanton, who is the editor of The Journal of Humanities and Rehabilitation, has been such a great indication of movement in this area.

That’s a fascinating journal. People who have never read that should log on and read it because there are some fascinating articles in there.

It’s open access. Sarah’s an old soul. She is a wonderful neural therapist and is very highly skilled. She has a high level of expertise. Her father was a physician who cared in this area in this way, so she comes from a rich tradition of that. We’re making progress as we get more people on faculties, which includes bringing folks like yourself and connecting with clinicians who do good work in this area so that students can see this. It’s not just about sports medicine or dry needling. There’s a lot more to that.

You said well before that we can’t just treat the body. We have to understand the human. On my show, I talk a lot about chronic pain, but that’s across every physical therapy practice area and specialty.

You said something about the movement system. Go and read Terry Nordstrom’s Developing Habits of the Heart. He’s got a nice piece in there where he talks about what you raised. With the movement system, we can’t just think about it from a traditional systems view. We got to think about the human being.

There are movements of behavior. In many ways, it’s a cognitive behavioral contextualized mode of living.

I like sports but my first attraction to physical therapy was about teaching. What I observed early on while watching physical therapists work is, “They’re teaching. That’s cool.” It’s meaningful teaching. I was like, “This is great stuff. I would like to do that.”

Somehow, we have lobbed that into what’s called patient education, although psychologists use the term psychoeducation, which is a lot more powerful. It’s this idea that there’s some psychology involved in this, but I’m educating you so you understand what you can do and how to empower yourself to cope with whatever health condition you’re dealing with.

The other thing I’m fond of is we’ve had colleagues in our field who have done good work and good writing in this area. Go back and read Carol Davis’ stuff. She wrote a great paper on empathy years ago. Carol is early on. She was at the University of Miami for several years. She’s still emeritus from there. She was out there on the road less traveled in the behavioral sciences, making a case for much of what you’re talking about.

Psychosocial and behavioral aspects are in CAPTA requirements, so this shouldn’t be new. You’re well-versed in the education side of this. Should we start to look at this as a separate class where we can bring together certain topics and concepts, or should it be something that we weave through different parts of the program? You know what happens. When topics like this first come up, people say, “We’ll have a 1 hour or a 90-minute lecture on humanity.”

I’ll give you an answer on both sides. Do you integrate it in a way so that it’s everywhere, yet it’s nowhere? Every explicit decision you make about curriculum has a strong implicit message. When you mark a course, that sends a message to students, if that’s the way your curriculum is organized. I will say that I’m involved in our medical school in the Department of Medical Humanities. I’m part of small groups in both ethics and humanities.

Those modules or those experiences are integrated into the systems knowledge during the first two years of medical school. When they do a unit on neuro, we have ethics and humanities cases and discussions that are focused on that. That’s quite powerful. It’s pretty effective. We’re studying it. Nicole Piemonte heads this up. Nicole did a great talk a couple of years ago at our ELC meeting. She’s got a great paper in the Journal of Humanities and Rehabilitation. In that case, it works well.

The other thing is role modeling. You can’t underestimate how much role-modeling the students pick up from the faculty. It’s both-and. We have a three-semester course in ethics in all of our health professions programs because it’s part of our Jesuit Catholic identity. It’s built-in, which is good, but we still integrate it. That’s been the argument about clinical reasoning. With Jennifer Furze in the group, we published a point of view on physical therapy. Is clinical reasoning a core competency or is it integrated? There are two schools of thought on that.

I agree with you on the intentionality of things. When there’s a course labeled manual therapy, then people reflect back and say, “I took a manual therapy course. I learned about manual therapy and I got a certain grade. Now, I can position myself in a manual therapy course for continuing education and learn more,” versus when things are dispersed throughout the curriculum.

This is why things like Pain Education and Cognitive Behavioral Therapy had to be thought out and considered. If you bury them within the curriculum, it’s not everyone, but some students might not feel like they have enough confidence or confidence in a certain area to then use it in practice or to reflect back on it when they start to practice.

My observation has been that it is too much like, “We have a course in pain science.”What is that? It’s too focused on the science aspect and the mechanism. Why don’t we have a course on chronic disease or population health? These things are all connected.

When you look at integrative approaches to healthcare these days, they’re talking about bringing the humanities in with the arts, as well as the science. Gail, this has been great speaking with you. I’m sure people are going to want to reach out to you, learn more about your work, and maybe ask you some questions. How can people find you?

They can send me an email at [email protected]. I’m very good at email. I don’t tweet. I’m not on Facebook, but I’m good at email. I love to hear from colleagues. We’re all colleagues. I’m just like all the other physical therapists. I care deeply about physical therapy. It’s been a great profession for me. That’s my identity. I’m fond of sending all sorts of VIP referrals to our faculty practice because I use my observational skills.

We appreciate your dedication to the profession. You can reach out to Gail via her email. If you can’t find her email, you can go to Creighton University and search for Dr. Gail Jensen. She’ll come up and you can reach out to her. Thank you for joining us and helping us build out the importance of patient contacts and why that matters. It has been great being here with you. We’ll see you in the next episode.

Important Links

• Dr. Gail Jensen
• Creighton University
• Clinical Reasoning in the Health Professions
• Educating Physical Therapists
• Attending
• Mindful Practice
• The Journal of Humanities and Rehabilitation
• Developing Habits of the Heart
• [email protected]
• https://www.ScienceDirect.com/science/article/pii/S0738399121004158

About Dr. Gail Jensen

Dr. Jensen is Vice Provost for Learning and Assessment, Dean Emerita, and Professor of Physical Therapy at Creighton University. She is known nationally and internationally for scholarly contributions in expert practice, clinical reasoning, professional ethics, and interprofessional education. Dr. Jensen is author or coauthor of more than 90 publications in peer-reviewed journals and has coauthored 13 books, including the fourth edition of Clinical Reasoning in the Health Professions (Higgs, Jensen, Loftus, Christensen), Educating Physical Therapists, and in 2020, Clinical Reasoning and Decision Making in Physical Therapy. She serves on a number of editorial boards and most recently became an associate editor for The Clinical Teacher. Dr. Jensen received her PhD in educational evaluation with a minor in sociology from Stanford University. She holds a master’s degree in physical therapy from Stanford University and a bachelor’s degree in education from the University of Minnesota.