A Comparison of 2 Case Delivery Methods: Virtual and Live

Abstract

Background and Purpose. Time, safety issues, and patient availability often limit the amount of hours that professional physical therapist students are able to spend in the clinical setting. Therefore, there is a need to develop educational approaches that afford students the opportunity to engage in meaningful practice with realistic patient scenarios in order to develop clinical-reasoning skills. The authors propose patient experiences delivered through technology.Methods. A sequential, mixed-methods design was used to study 2 methods of delivery (large group discussion [LGD] and patient simulation [VP]) on clinical reasoning, knowledge acquisition, transfer of knowledge, and students' perception of their learning. Students were randomly assigned to either LGD or VP groups to complete 6 patient cases related to course material.Results. There were no significant differences between groups for clinical reasoning as measured by the Health Science Reasoning Test (HSRT); however, there were within-group differences for the simulation group only. Additionally, qualitative data revealed differences between groups in clinical reasoning and level of engagement.Discussion and Conclusion. There were no significant differences between the 2 delivery methods; however, the simulation group did score higher on all objective measures. The VP offers students the benefit of working independently and reduces faculty group facilitation time. Thus, patient experiences holds promise as a tool to teach clinical reasoning as well as knowledge acquisition and transfer of knowledge skills.BACKGROUND AND PURPOSEPhysical therapist programs require students to practice their clinical-reasoning skills in a clinical setting. Literature indicates clinicalreasoning skills develop through substantial exposure to and reflection on real patient cases.13 However, time, patient safety issues, and patient availability often limit the amount of time that students are able to spend in the clinical setting. Therefore, there is a need to develop educational approaches that engage students in meaningful practice with realistic patient scenarios in order to promote the development of clinical-reasoning skills. Computer technology may provide an alternative case delivery method to increase student exposure to realistic patient scenarios.Computer-simulated or virtual patients are being used in health professional programs to teach history taking, examination, and diagnosis skills, exposing students to realistic patients in a safe environment.4'11 Medical students use a web-based simulation program, DxR Clinician,® to complete a history, perform an examination, diagnose, and design a treatment program. To the authors' knowledge, there are no studies reporting the use of this technology in physical therapy. As the medical version of DxR Clinician was not appropriate for physical therapist students, 2 of the authors (KH, JED) worked with DxR Development Group to modify its existing patient simulation program. A description of the development process and initial testing of the simulation has been published.12As is true with any instructive methodology, design of educational technology should be grounded in sound pedagogy and based on accepted-learning theory. Constructivism and active learning provide a theoretical framework for the use of patients. The constructivist theory, for example, suggests that effective learners must develop their own depiction of information and advocate that this is best achieved through realistic situational contexts and multiple experiences.13 Realistic situational contexts and multiple experiences are consistent with what we know about the development of clinical-reasoning skills, in that clinical-reasoning skills develop over time with substantial experience with realistic patients.2Active-learning strategies advocate the engagement of students in the learning process by requiring meaningful and self-reflective learning. …