Main Article Content
Purpose: Simulation is a long-established learning and assessment activity in healthcare education. Simulation has been used to provide opportunities for students to experience complex patient interactions in a low-risk setting to prepare students to manage all the demands of total patient care as new practitioners. The purpose of this quasi-experimental, single cohort study, with pre–post quantitative survey analysis including theme frequency, was to determine how participating in a multi-patient simulation consisting of different clinical settings and diagnoses would impact physical therapy students’ confidence in clinical and decision-making skills.
Methods: Thirty-three, entry-level Doctor of Physical Therapy students completed a simulation and debriefing across four different healthcare settings while addressing different aspects of patient management within each of these settings. Students completed two surveys before and after this simulation to measure their self-appraised confidence. Quantitative data from these surveys were analyzed using Wilcoxon tests and the free-response entries from the surveys were analyzed for theme occurrence frequency.
Results: Students’ total clinical skill confidence scores decreased (P = 0.015), specifically in areas of strength testing (P = 0.008), postural assessment (P = 0.002), and planning an appropriate intervention plan (P = 0.033). Students’ total decision-making confidence scores did not significantly change; however, areas of improvement included recognizing physiological and psychological changes in patients in a timely manner (P = 0.025) and distinguishing between clinically important and lower priority impairments (P = 0.048). Occurrence of theme frequencies from free responses revealed a decrease in student confidence related to “flow and organization” as well as “evaluation.”
Conclusion: While incorporating a multi-patient simulation improved some aspects of students’ self-appraised confidence in clinical decision-making skills, there was an unexpected decrease in students’ overall confidence.
Mori B, Carnahan H, Herold J. Use of simulation learning experiences in physical therapy entry-to-practice curricula: a systematic review. Physiother Canada (2015) 67: 194–202. doi: 10.3138/ptc.2014-40E
Sabus C, Macauley K. Simulation in physical therapy education and practice: opportunities and evidence-based instruction to achieve meaningful learning outcomes. J Phys Ther Educ (2017) 30: 3–13. doi: 10.1097/00001416-201630010-00002
Dreifuerst KT. Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. J Nurs Educ (2012) 51: 326–33. doi: 10.3928/01484834-20120409-02
Macauley K. Evaluating changes in clinical decision-making in physical therapy students after participating in simulation. Heal Prof Educ (2018) 4: 278–86. doi: 10.1016/j.hpe.2018.06.001
Shoemaker MJ, Riemersma L, Perkins R. Use of high fidelity human simulation to teach physical therapist decision-making skills for the intensive care setting. Cardiopulm Phys Ther J (2009) 20: 13–18.
Silberman NJ, Litwin B, Panzarella KJ, et al. High fidelity human simulation improves physical therapist student self-efficacy for acute care clinical practice. J Phys Ther Educ (2016) 30: 14–24. doi: 10.1097/00001416-201630010-00003
Ohtake PJ, Lazarus M, Schillo R, et al. Simulation experience enhances physical therapist student confidence in managing a patient in the critical care environment. Phys Ther (2013) 93: 216–28. doi: 10.2522/ptj.20110463
Wright A, Moss P, Dennis DM, et al. The influence of a full-time, immersive simulation-based clinical placement on physiotherapy student confidence during the transition to clinical practice. Adv Simul (2018) 3: 1–10. doi: 10.1186/s41077-018-0062-9
Luedtke-Hoffmann K, Dillon L, Utsey C, et al. Is there a relationship between performance during physical therapist clinical education and scores on the National Physical Therapy Examination (NPTE)? J Phys Ther Educ (2017) 26: 41–9. doi: 10.1097/00001416-201201000-00008
Association APT. Guide to physical therapy practice. 2014. Available from: http://guidetoptpractice.apta.org/ [cited 1 March 2019].
Alexander KM, Olsen J, Seiger C, et al. Student physical therapists’ competence and self-confidence in basic clinical assessment and musculoskeletal differential diagnosis. J Allied Health (2016) 45: 95–100.
Brudvig T, Macauley K. Clinical decision making tool for DPT students. Acad Exch Q (2015) 19: 61–7.
Macauley K, Brudvig T, Barry A, et al. Validation of a self-report clinical decision-making tool using Rasch analysis. J Phys Ther Educ (2018) 32: 248–57. doi: 10.1097/jte.0000000000000019
Sawyer T, Eppich W, Brett-Fleegler M, et al. More than one way to debrief: a critical review of healthcare simulation debriefing methods. Simul Healthc (2016) 11: 209–17. doi: 10.1097/SIH.0000000000000148
Morgan PJ, Cleave-Hogg D. Comparison between medical students’ experience, confidence and competence. Med Educ (2002) 36: 534–9. doi: 10.1046/j.1365-2923.2002.01228.x
Boling B, Hardin-Pierce M. The effect of high-fidelity simulation on knowledge and confidence in critical care training: an integrative review. Nurs Educ Pract (2016) 16: 287–93. doi: 10.1016/j.nepr.2015.10.004
Brudvig TJ, Macauley K, Segal N. Measuring clinical decision-making and clinical skills in DPT students across a curriculum: validating a new survey tool. J Allied Health (2017) 46: 21–5a.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.