Doctor of Physical Therapy students’ clinical reasoning readiness and confidence treating with telehealth: a United States survey
Main Article Content
Abstract
Purpose: Telehealth has an emerging footprint on entry-level physical therapy programs. Students’ readiness for clinical reasoning with virtual versus traditional face-to-face treatment remains unknown. The purpose of this study was to evaluate Doctor of Physical Therapy (DPT) students’ preparedness for clinical experiences with and without telehealth.
Methods: A descriptive and exploratory cross-sectional survey was employed, with a voluntary convenience sample of 211 second- and third-year university DPT students during Fall 2020 clinical experiences. Descriptive and inferential statistics evaluated differences in DPT students’ (1) Physical Therapist Self-Efficacy (PTSE) scale scores, (2) confidence with treating initial and subsequent same-patient visits, and (3) final Clinical Performance Instrument (CPI) clinical reasoning and summative scores during clinical experiences with and without telehealth.
Results: Telehealth availability was 40.3%, with 16.6% of DPT students reporting participation. Most students reported being comfortable (39.3%) or neutral (32.2%) using telehealth. DPT students’ confidence level using telehealth to treat was 74% on initial and 97% on subsequent same-patient visits. Mean PTSE scores were significantly lower during clinical experiences with telehealth (13.1) compared to traditional experiences (15.1) (P <.001) and for integrated (second-year) (14.1) compared to terminal (third-year) clinical experiences (15.5) (P <.001). For traditional experiences, weak positive associations were demonstrated between PTSE and CPI scores. There were no significant differences for CPI scores between telehealth and traditional experiences.
Conclusion: While entry-level DPT programs continue to establish best practice for telehealth education, current trends in academic curriculum seem to prepare students’ clinical reasoning readiness for clinical experiences. The PTSE could be used to identify outlier students requiring additional mentoring during traditional and telehealth clinical experiences.
References
- Babyar SR, Pivko S, Rosen E. Pedagogical tools to develop clinical reasoning: physical therapy students’ perspective. J Allied Health (2010) 39(3): e97–104.
- Higgs J, ed. Clinical reasoning in the health professions. 3rd ed. Amsterdam, the Netherlands: Elsevier; 2011.
- Bandura A. Self-efficacy mechanism in human agency. Am Psychol (1982) 37(2): 122–47. doi: 10.1037/0003-066X.37.2.122
- Aper L, Reniers J, Koole S, et al. Impact of three alternative consultation training formats on self-efficacy and consultation skills of medical self-efficacy of medical students. Med Teach (2012) 34(7): e500–7. doi: 10.3109/0142159X.2012.668627
- Black LL, Christensen N, Furze J, et al. Taking our pulse: clinical reasoning in the classroom and clinic. Paper presented at: combined sections meeting of the American Physical Therapy Association, Indianapolis, IN, 2015.
- Telehealth in physical therapy in light of COVID-19. www.apta.org. Available from: http://www.apta.org/PTinMotion/News/2020/3/16/TelehealthCOVID19 [cited 1 June 2020].
- Fisk M, Livingstone A, Pit SW. Telehealth in the context of COVID-19: changing perspectives in Australia, the United Kingdom, and the United States. J Med Internet Res (2020) 22(6): e19264. doi: 10.2196/19264
- Elvén M, Hochwälder J, Dean E, et al. Predictors of clinical reasoning using the Reasoning 4 Change Instrument with physical therapist students. Phys Ther (2019) 99(8): 964–76. doi: 10.1093/ptj/pzz044
- Postal S. Telehealth considerations today and after the pandemic. APTA (2020) 12: 12–6.
- Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev (1977) 84(2): 191–215. doi: 10.1037/0033-295X.84.2.191
- Sherer M, Maddux JE, Mercandante B, et al. The self-efficacy scale: construction and validation. Psychol Rep (1982) 51: 663–71. doi: 10.2466/pr0.1982.51.2.663
- Musolino GM, Davis CM. Patient practitioner interaction; an experiential manual for developing the art of health care.6th ed. Thorofare, NJ: Slack, Inc.: 2016.
- Osório IHS, Gonçalves LM, Pozzobon PM, et al. Effect of an educational intervention in ‘spirituality and health’ on knowledge, attitudes, and skills of students in health-related areas: a controlled randomized trial. Med Teach (2017) 39(10): 1057–64. doi: 10.1080/0142159X.2017.1337878
- van Duijn AJ, Swanick K, Donald EK. Student learning of cervical psychomotor skills via online video instruction versus traditional face-to-face instruction. J Phys Ther Educ (2014) 28(1): 94–102. doi: 10.1097/00001416-201410000-00015
- Venskus DG, Craig JA. Development and validation of a self-efficacy scale for clinical reasoning in physical therapists. J Phys Ther Educ (2017) 31(1): 14–20. doi: 10.1097/00001416-201731010-00005
- Chen G, Gully SM, Eden, D. Validation of a new general self-efficacy scale. Organ Res Methods (2001) 4(1): 62–83. doi: 10.1177/109442810141004
- van Lankveld W, Jones A, Brunnekreef JJ, et al. Assessing physical therapist students’ self-efficacy: measurement properties of the Physiotherapist Self-Efficacy (PSE) questionnaire. BMC Med Educ (2017) 17(1): 250. doi: 10.1186/s12909-017-1094-x
- Jones A, Sheppard L. Self-efficacy and clinical performance: a physiotherapy example. Adv Physiother (2011) 13(2): 79–83. doi: 10.3109/14038196.2011.565072
- Cheragi F. Developing a valid and reliable self-efficacy in clinical performance scale. Int Nurs Rev (2009) 56(2): 214–21. doi: 10.1111/j.1466-7657.2008.00685.x
- English ML, Wurth RO, Ponsler M, et al. Use of the physical therapist clinical performance instrument as a grading tool as reported by academic coordinators of clinical education. J Phys Ther Educ (2004) 18(1): 87–92. doi: 10.1097/00001416-200401000-00012
- Roach KE, Frost JS, Francis NJ, et al. Validation of the revised physical therapist Clinical Performance Instrument (PT CPI): Version 2006. Phys Ther (2012) 92(3): 416–28. doi: 10.2522/ptj.20110129
- Courtright J. The relationship between the physical therapist Clinical Performance Instrument scores and Doctor of Physical Therapy student learning styles. ProQuest LLC: Ann Arbor, MI; 2017.
- Exporting evaluation results-Clinical assessment suite help center. Liaisonedu.com website. Available from: https://help.liaisonedu.com/Clinical_Assessment_Suite_Help_Center/CPI/PT/01_ACCE%2F%2FDCE%2F%2FProgram_Staff/03_Exporting_Evaluation_Results [cited 21 January 2021].
- Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med (2007) 4(10): e297. doi: 10.1371/journal.pmed.0040297
- DeVellis, RF. Scale development: theory and applications. 4th ed. Thousand Oaks, CA: Sage; 2016.
- Aggregate program data-2019 physical therapist education programs fact sheets. Capteonline.org website. Available from: http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Aggregate_Program_Data/AggregateProgramData_PTPrograms.pdf [cited 18 January 2021].
- Fosnacht K, Sarraf S, Howe E, et al. How important are high response rates for college surveys? Rev High Educ (2017) 40(2): 245–65. doi: 10.1353/rhe.2017.0003
- Cohen J. 1988. Statistical power analysis for the behavioral sciences. 2nd ed. New York, NY: Routledge; 1988.
- Lewis J, McAuliffe S, O’Sullivan K, et al. Musculoskeletal physical therapy after COVID-19: time for a new ‘Normal’. J Orthop Sports Phys Ther (2021) 51(1): 5–7. doi: 10.2519/jospt.2021.0102
- Stern DF, Rosenthal R. Clinical Education in physical therapy: the evolution from student to clinical instructor and beyond. Burlington, MA: Jones & Bartlett Learning; 2020.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.