Addition of a Patient Examination Module to Address Student Preparedness for the First Full-Time Clinical Experience

Abstract

BACKGROUND AND PURPOSEClinical education experiences (CEEs) are a core component and required element of all physical therapist (PT) entry-level education programs,1 affording students the opportunity to be mentored by experienced clinicians as they apply the knowledge and skills gained during the didactic portions of the education program. Readiness to enter and progress through CEEs is a key recommendation identified by the American Council of Academic Physical Therapy (ACAPT).1,2 Our program routinely collects student perceptions about their academic preparation for the CEE. Perceptions are collected during midterm phone calls by our directors of clinical education and through anonymous surveys collected following the first CEE.Historically, students comment they feel least prepared in organizing and executing patient examinations. The authors consulted education literature to develop a 2-week patient examination module. Many educational methods are utilized within the academic setting to help prepare students for CEEs, including the following: skill-based laboratory experiences,3-6 patient case scenario s,3-5,7,8 patient simulations,5,9-13 case-based discussion boards,3 and objective structured clinical examinations.14,15 Literature supports the use of each of these educational methods to develop and assess clinical skills. Limited literature, however, addresses the effect of utilizing these methods on student clinical readiness or performance during the first CEE.The purpose of this paper is to describe our evidence-based 2-week education module focused on patient examination and report outcomes, including themes from student perceptions and student clinical performance using the Physical Therapist Clinical Performance Instrument (PT CPI). The paper also demonstrates the use of outcome-based assessment to inform curricular change. The module was added immediately prior to the first full-time CEE with the goal of enhancing student confidence and preparedness in patient examinations, and ultimately, readiness for the clinic. Reported outcomes include student perspectives on the module and clinical performance, as rated on the PT CPI.METHOD/MODEL DESCRIPTION AND EVALUATIONEducational Theory and Literature Guiding Design of the ModuleEvidence-based clinical practice is a clear professional goal and focus in education. Likewise, student preparation and training should be grounded in evidence-based teaching and learning research. Design and development of the 2-week patient examination module was guided by the established principles of experiential learning16,17 and reflective practice.18-20 Specific components were included based on current literature supporting use of multisource feedback,3,21 adult learning strategies,22,23 and standardized patients (SP) in PT education.24-27Experiential Learning and ReflectionCentral to experiential learning theory is the cyclical process of experience and reflection. Learning as an active process is emphasized with concepts being derived and revised by experiences.16 Kolb's experiential learning model depicts the process of gathering and processing information. The model describes 4 elements that form the basis for making sense of and learning from our concrete experiences. The elements in the model are: engagement in new experiences, reflection on the experiences, interpretation of the experiences to generate new ideas, and application of the ideas to other experiences.17 In cycling through the elements, the learner should be able to solve problems, view problems from a new perspective, and move to a new frame of reference. Reflection, 1 of the 4 elements in Kolb's learning model, is identified as a key process for continued refinement of skills and professional growth.28 Reflection helps to create meaning of our experiences and is important for self-directed growth. Reflection during an experience (reflection-in-action) encourages revisions to actions and decisions throughout an activity. …