Impact of a multi-patient simulation event on physical therapy student confidence: a quasi-experimental study

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Purpose: Simulation is a long-established learning and assessment activity in healthcare education. Simulation has been used to provide opportunities for students to experience complex patient interactions in a low-risk setting to prepare students to manage all the demands of total patient care as new practitioners. The purpose of this quasi-experimental, single cohort study, with pre–post quantitative survey analysis including theme frequency, was to determine how participating in a multi-patient simulation consisting of different clinical settings and diagnoses would impact physical therapy students’ confidence in clinical and decision-making skills. Methods: Thirty-three, entry-level Doctor of Physical Therapy students completed a simulation and debriefing across four different healthcare settings while addressing different aspects of patient management within each of these settings. Students completed two surveys before and after this simulation to measure their self-appraised confidence. Quantitative data from these surveys were analyzed using Wilcoxon tests and the free-response entries from the surveys were analyzed for theme occurrence frequency. Results: Students’ total clinical skill confidence scores decreased (P = 0.015), specifically in areas of strength testing (P = 0.008), postural assessment (P = 0.002), and planning an appropriate intervention plan (P = 0.033). Students’ total decision-making confidence scores did not significantly change; however, areas of improvement included recognizing physiological and psychological changes in patients in a timely manner (P = 0.025) and distinguishing between clinically important and lower priority impairments (P = 0.048). Occurrence of theme frequencies from free responses revealed a decrease in student confidence related to “flow and organization” as well as “evaluation.” Conclusion: While incorporating a multi-patient simulation improved some aspects of students’ self-appraised confidence in clinical decision-making skills, there was an unexpected decrease in students’ overall confidence.