Examining the Impact of an Integrated Clinical Experience (ICE) on Interpersonal Skills Prior to the First, Full-Time Clinical Internship: Cool as ICE

Abstract

INTRODUCTIONThe development of interpersonal skills is critical for the professional development of physical therapist (PT) students.3'4 Interpersonal skills include both verbal and nonverbal skills necessary for communicating and interacting with patients, both expressively and receptively.4 One method of developing interpersonal skills in physical therapist students is through integrated clinical experiences (ICEs), which is defined as students working with patients for more than 20 hours with faculty serving as clinical instructors (CIs). This method is modeled by physical therapist education programs at Clarke University5 and Nova Southeastern University.6 The American Council of Academic Physical Therapy (ACAPT)7 defines an ICE as clinical education experience that occurs during an academic term in a coordinated fashion concurrent with didactic courses. This terminology was approved after the current study was completed, and is consistent with the operational definition used in the study. The purpose of this study was to examine whether the inclusion of ICEs in PT education curricula helped students develop their interpersonal communication skills prior to entering into their first full-time clinical experience. It was hypothesized that students who participated in an ICE would (1) perceive themselves as more confident to interact with patients as measured by the Interpersonal Communication Questionnaire (ICQ),1 and (2) perform better than students without an ICE, with regards to interpersonal skills during first, full-time clinical internships, as measured by the Medical Communication Behavior System (MCBS).2,8REVIEW OF LITERATURELearning DomainsProfessional physical therapist education consists of 3 major learning domains: cognitive (thinking or knowledge), psychomotor (hands-on skills), and affective (feelings or attitudes).9'10 The skills learned in these domains are essential for practicing PTs who are providing services to patients or clients. Following completion of an initial patient examination, PTs must identify what the patients problems are, the hands-on skills necessary for treatment, and how to interact with the patient to ensure the best outcomes. Interpersonal communication skills are essential professional behaviors expected of the physical therapist.As physical therapist students develop skills in the 3 learning domains, they are evaluated using a variety of assessments. In the academic setting, cognitive and psychomotor skills are traditionally tested using pencil and paper tests, computer-based tests, and practical examinations.11 However, affective skills, such as interpersonal communication and professionalism, are more difficult to formally assess.11 While practical examinations do measure cognitive, psychomotor, and affective skills, these examinations are most frequently conducted in an artificial environment, with classmates or instructors assuming the role of patient and/or caregiver. Familiarity with the person playing the role of the patient may provide a level of comfort during interactions, whereas communicating with and relating to a real patient-with whom students have no previous relationship-may be more difficult.1 Some physical therapist education programs have begun to include simulated patients in curricula to improve communication confidence.1'1215 Simulated patients are professional actors who have been trained to display signs and symptoms of patients with various medical conditions and personalities.1'16'17 However, use of simulated patients can be cost-prohibitive and inadequate for building affective skills, as students are still in a familiar setting during patient interactions.13 Although using simulated patients has been validated in the literature, health care programs must consider both the fiscal impacts and time investments required to implement this pedagogical method.1'14'16'17Clinical Education Learning and AssessmentIn contrast to practical examinations, fulltime clinical internships require students to balance their cognitive, psychomotor, and affective skills while working with patients and being assessed by clinical instructors (CIs). …