The Journal of Clinical Education in Physical Therapy

Impact of an integrated clinical experience on Doctor of Physical Therapy students: a qualitative study

2023-08-07T11:06:29+00:00

Purpose: Integrated Clinical Education (ICE) complements didactic material within educational programs, providing an in- person, hands-on experience in coordination with traditional instruction. Different models of ICE are described in the literature, which consists primarily of descriptions and program assessments of these experiences. The purpose of this study was to enhance the literature by applying rigorous methodology to gain a rich understanding of the student’s perspective of the process and impact of ICE on Doctor of Physical Therapy (DPT) students working with older adults, a population not yet rigorously studied.

Methods: A convenience sample of 19 DPT students participated in this study. A descriptive phenomenological approach obtained the perspectives of DPT students engaged in this ICE. Researchers conducted six focus groups using a video chat format following the ICE.

Results: Five themes emerged from the thematic analysis of focus group transcriptions: transformation, circular learning, role of relationships, rollercoaster of emotions, and perceived perks for older adults through the students’ perspective.

Conclusion: Findings are consistent with the literature and support ICE as a complement to didactic learning, especially for those skills that are challenging to teach in the classroom. This study added to the literature by identifying relationship building and circular learning as essential components of ICE. Students also identified and resolved implicit biases previously held about older adults. Further research is warranted to deepen an understanding of these findings, with a mixed-method approach to gather quantitative data to link the ICE process with outcomes.

The clinical education experience of physical therapist students during the COVID-19 pandemic: a phenomenological study

2023-07-21T01:25:58+00:00

Purpose: The purpose of this study was to explore the lived experience of physical therapist (PT) students participating in clinical education (CE) experiences during the COVID-19 pandemic.

Methods: This qualitative study used an interpretive phenomenological analysis to explore the lived experiences of entry-level PT students enrolled in New York (NY) and New Jersey (NJ) PT educational programs in an effort to understand the unique experience of completing full-time CE experiences during the COVID-19 pandemic. Twelve students from accredited programs in New York and New Jersey who participated in a full-time CE experience during the COVID-19 pandemic were interviewed.

Results: Four themes emerged: disruption in their academic education, altered CE experiences, emotional responses to these unanticipated disruptions, and their ability to adapt to these changes.

Conclusion: The COVID-19 pandemic was an exceptionally disruptive experience. However, with support, understanding, and encouragement, students adapted to the disruptions created by this unpredictable clinical environment.

Mentoring the mentor: Developing clinical instructor cross-cultural psychological capital to support culturally/linguistically diverse DPT students

2023-07-19T18:13:32+00:00

Rationale: Cultural and social isolation, microaggressions, and few culturally and linguistically diverse (CLD) mentors contribute to a lack of belonging on clinical education experiences (CEEs) for CLD Doctor of Physical Therapy students. The purpose was to investigate whether a multiple mentor model including a CLD learner, their clinical instructor (CI), and CLD mentor could develop CI cross-cultural psychological capital (CC PsyCap) and mentoring skills to support CLD learners on CEEs.

Methods: Three CLD learners and their CIs were each matched with a CLD mentor. CIs completed online cross-cultural mentor training and met with the CLD student and mentor four times during the 10-week CEE. CIs completed the CC PsyCap survey to measure changes in CI cross-cultural self-efficacy before and after the CEE. Interview data from participants were thematically analyzed.

Results: All CIs demonstrated an increase in CC PsyCap scores over the study period. CIs gained insight into the unique needs of CLD learners, often subjected to bias and discrimination, and developed strategies to proactively support learners. CLD learners faced challenges related to race in the CEE and pressure to assimilate. They valued CLD mentors who role-modeled persistence and success and CIs who celebrated diversity and created a welcoming environment.

Clinical relevance: CIs play an important role in mentoring CLD learners on CEEs. This study highlighted that CI CC PsyCap can be developed through mentoring and coaching from CLD mentors, ultimately increasing support for CLD learners on CEEs.

Longitudinal outcomes of simulation enhanced interprofessional education within a physical therapist education program

2023-07-05T02:16:10+00:00

Purpose: Simulation-enhanced interprofessional education (Sim-IPE) has been shown in cross-sectional studies to be beneficial in improving students’ perceptions of interprofessional teamwork and collaboration. However, there is limited literature regarding the progression of these perceptions over time. Therefore, this study aimed to explore the influence of multiple sim-IPE embedded across a physical therapy education program on student perceptions of collaborative patient care over a 2-year period.

Methods: A sample of convenience of students in an entry-level Doctor of Physical Therapy program (n = 94) was utilized. Students were placed in one of three groups with students completing either three sim-IPE experiences across the first 2 years of the program (n = 57), one simulation at the beginning of the program (n = 17), or one experience prior to their second full-time clinical experience (n = 20). The Interprofessional Socialization and Values Scale-21 (ISVS-21) was used to assess student perceptions of interprofessional collaboration. Scores across the program were analyzed using a Friedman analysis with a post hoc Wilcoxon matched pairs test. To assess the influence of maturation on student perceptions, performance on the ISVS-21 for students completing three experiences was compared with students completing one sim-IPE experience within the program.

Results: Overall, scores on the ISVS-21 demonstrated a statistically significant improvement across the three simulations occurring within the program (P < 0.001). Furthermore, students completing three sim-IPE experiences demonstrated statistically significantly higher scores on the ISVS-21 compared to students completing just one experience, regardless of the placement of the experience within the program.

Conclusion: Multiple sim-IPE performed across a professional education program may be an effective learning strategy to influence perceptions of interprofessional collaboration. Further research is needed to determine the number and placement of simulations for optimal preparation for interprofessional practice.

Comparison of Flex vs. residential clinical education program outcomes: physical therapy students’ self-efficacy, confidence, and clinical competence

2022-10-25T17:55:29+00:00

Purpose: Alternative flexible (Flex) path Doctor of Physical Therapy (DPT) programs may have an emerging footprint. The differences between Flex and traditional residential DPT program clinical experience outcomes remain unknown. The purpose of this study was to evaluate Flex and residential DPT students’ clinical reasoning self-efficacy, confidence with treating, and Clinical Performance Instrument (CPI) clinical reasoning and summative scores during clinical experiences.

Methods: A descriptive and exploratory cross-sectional survey was used with a voluntary convenience sample of 211 university DPT students during Fall 2020 full-time clinical experiences. Descriptive and inferential statistics evaluated differences in Flex and residential DPT program students’ (1) Physical Therapist Self-Efficacy (PTSE) scale scores, (2) confidence with treating initial and subsequent same-patient visits, and (3) final CPI clinical reasoning and summative scores during clinical experiences.

Results: Mean PTSE scores were significantly lower for Flex (x̄ = 14.2) compared to residential DPT students (x̄ = 15.2) (P < 0.05). No significant student differences were found in (1) Flex (x̄ = 2.1) and residential (x̄ = 2.2) confidence with treating at the initial visit (P = 0.59), (2) Flex (x̄ = 2.8) and residential (x̄ = 3.0) confidence with treating subsequent same-patient visits (P = 0.15), and (3) Flex (x̄ = 15.8) and residential (x̄ = 16.5) CPI clinical reasoning (P = 0.17), and (4) Flex (x̄ = 16.1) and residential (x̄ = 16.7) CPI summative scores (P = 0.21).

Conclusion: Clinical reasoning self-efficacy among Flex DPT students was lower, but there was no difference in CPI clinical reasoning or summative results between Flex and residential DPT students. In the university investigated, the Flex distance learning DPT program curriculum appeared effective in preparing students’ clinical reasoning readiness for the available full-time clinical experiences. We recommend academic institutions consider expanding Flex entry-level DPT program availability options because the outcomes were comparable. Additional flex entry programs may help address the underrepresentation of nontraditional students in entry-level DPT programs and societal demands for physical therapy services.

Initial validation of a script concordance test to measure the development of clinical reasoning among physical therapy residents

2022-12-06T14:56:04+00:00

Rationale: Clinical reasoning (CR) skills of physical therapy (PT) residents may be limited by a lack of clinical experience, and the complexity of neurologic and elderly patients requires individualized approaches for prescribing walking assistive devices (ADs). Script concordance tests (SCTs), which are case-based assessments that present information that the test taker must examine before answering, can measure the growth in CR. The purpose was to validate a SCT designed to measure CR growth in residents for walking AD prescription.

Methods: Using a prospective cohort design, a panel of 20 experienced practicing clinicians reviewed the test content and provided the correct answers. Neurologic and geriatric residencies were identified from the American Board of Physical Therapy Residencies and Fellowships database. Residency directors were informed of the study, and 27 of them provided access to their residents. Residents gave assent in month 1 and were followed through month 6. The SCT and instructions were emailed at both time points. In total, 27 month-1 tests and 20 month-6 tests were returned. Fleiss kappa was used to evaluate the consistency of the clinician panel’s and the residents’ responses at both time periods. Mean scores for the panel and the residents at months 1 and 6 were calculated. Testing for differences between the clinician panel and the residents at months 1 and 6 was assessed using a Mann-Whitney U test, and testing for differences between the residents at the same time points was assessed using a Wilcoxon signed rank test.

Results: Demographics of the clinical panel and residents are presented. Internal consistency was moderate, and chance agreement was fair in both groups. Mean test scores were 34.8 (4.3), 34.5 (4.1), and 36.3 (3.9) points for the panel, and residents at months 1 and 6, respectively. Concordance of choices on the SCT between the clinician panel and residents was similar at month 1 and grew more concordant by month 6.

Conclusion: The SCT did not differentiate between the practicing clinicians’ and residents’ CR skills to prescribe ADs. Further research comparing the CR of PT residents to PT clinicians in early practice should be undertaken since the residents’ responses were consistent with the practicing clinicians. The unique test construction or the clinician panel, whose members were not required to be board certified, may have introduced error.

A model for remote remediation to address communication deficits identified during clinical placement

2022-12-01T01:01:53+00:00

Clinical case problem: Effective communication is vital for the successful transmission of information and has been attributed to better patient outcomes, patient satisfaction, and patient safety. Deficits in soft skills, such as communication, can be challenging to address due to a lack of standardized remediation strategies. This case report describes a student identified for inadequate communication skills during an intermediate clinical experience. To prepare the student for future clinical experiences, the faculty developed a comprehensive remote remediation plan.

Case description: A four-step remote communication remediation plan was developed and implemented utilizing optimal-fidelity patient simulations. As the remediation occurred during a global pandemic limiting in-person contact, the scenarios were based on telehealth encounters and included faculty debriefing. A challenging communication component was embedded within each simulation. Outcomes including a communication survey to assess verbal and nonverbal skills, student self-reflection, and clinical performance assessment post-remediation demonstrating the transfer of newly acquired skills were used to evaluate the effectiveness of the intervention.

Implications: The remote remediation was effective. Careful planning ensured that all deficiencies were targeted using multiple teaching modalities. This remediation plan may be adapted to target other soft skill development and implemented for formative or remedial training, based on learning objectives and student needs.

Outcome measures in clinical education research

2023-11-28T11:39:40+00:00

The Journal of Clinical Education in Physical Therapy (JCEPT) is an open-access journal that disseminates peer-reviewed quantitative and qualitative scholarship to increase the quality evidence available related to clinical education in physical therapy. Since 2021, the number of article downloads has increased by more than 10-fold, with annual increases exceeding 200%. Open-access allows JCEPT readers free access to both read online and download full-text articles. Last year, one article was viewed over 900 times while another was downloaded nearly 1,200 times. The Directory of Open Access Journals (DOAJ) began indexing JCEPT last year and now accounts for 14% of our referral sources. Next year, we expect to obtain indexing in PubMed Central (PMC), which will further increase the discoverability of JCEPT articles.

The nature of clinical education raises various challenges to research, with one being how to assess outcomes. Articles published this year in JCEPT reflect the thoughtful application of different approaches to outcome measures. Some questions were assessed with quantitative measures while others used qualitative research methods. Self-efficacy was measured in two different articles exploring the domains of cross-cultural psychological capital and clinical competence. Clinical reasoning was assessed using the physical therapy Clinical Performance Instrument in one article and script concordance tests in another. A more recently established outcome such as inter-professional socialization was assessed with a quantitative scale while emotional and educational adaptability themes were explored with qualitative methods. In past volumes, a SNAPPS model (summarize, narrow, analyse, probe, plan, select) of clinical mentoring was used to help students process initial evaluation findings and longitudinal narrative analyses were used to assess the development of resident clinical reasoning skills.

Outcome measures assessing the effectiveness of clinical education are essential.¹ Efforts may start with the thoughtful choice of psychometrically supported quantitative measures as well as rigorous description of qualitative measures.² However, recent JCEPT articles suggest many factors can influence the quality of a clinician,¹ including their educational curriculum, pre- clinical training, the clinical environment of their patient exposures, the individual characteristics and stresses of students and their clinical instructors, as well as environmental forces such as the COVID pandemic. Translating the effectiveness of clinical education to improved clinical care and patient outcomes remains a challenge for future researchers.

JCEPT publishes scholarly work affecting any aspect of clinical education in physical therapy addressing academic or clinical faculty, entry-level students or residents, curricula or teaching and learning methods. In addition to original research, systematic reviews, and innovative teaching methods, this year JCEPT published our first ‘clinical education case report’ describing remediation methods during clinical training and related outcomes. We look forward to publishing more papers and developing the evidence underpinning physical therapy clinical education.