Clinical Reasoning: Survey of Teaching Methods, Integration, and Assessment in Entry-Level Physical Therapist Academic Education.

Background: Although clinical reasoning abilities are important learning outcomes of physical therapist entry-level education, best practice standards have not been established to guide clinical reasoning curricular design and learning assessment. Objective: This research explored how clinical reasoning is currently defined, taught, and assessed in physical therapist entry-level education programs. Design: A descriptive, cross-sectional survey was administered to physical therapist program representatives. Methods: An electronic 24-question survey was distributed to the directors of 207 programs accredited by the Commission on Accreditation in Physical Therapy Education. Descriptive statistical analysis and qualitative content analysis were performed. Post hoc demographic and wave analyses revealed no evidence of nonresponse bias. Results: A response rate of 46.4% (n=96) was achieved. All respondents reported that their programs incorporated clinical reasoning into their curricula. Only 25% of respondents reported a common definition of clinical reasoning in their programs. Most respondents (90.6%) reported that clinical reasoning was explicit in their curricula, and 94.8% indicated that multiple methods of curricular integration were used. Instructor-designed materials were most commonly used to teach clinical reasoning (83.3%). Assessment of clinical reasoning included practical examinations (99%), clinical coursework (94.8%), written examinations (87.5%), and written assignments (83.3%). Curricular integration of clinical reasoning-related self-reflection skills was reported by 91%. Limitations: A large number of incomplete surveys affected the response rate, and the program directors to whom the survey was sent may not have consulted the faculty members who were most knowledgeable about clinical reasoning in their curricula. The survey construction limited some responses and application of the results. Conclusions: Although clinical reasoning was explicitly integrated into program curricula, it was not consistently defined, taught, or assessed within or between the programs surveyed-resulting in significant variability in clinical reasoning education. These findings support the need for the development of best educational practices for clinical reasoning curricula and learning assessment.

Learning Curves Observed in Establishing Targeted Rate of Force Application in Pressure Pain Algometry.

Purpose: To determine whether learning curves can be observed with deliberate practice when the goal is to apply a consistent rate of force at 5 N/second during pressure pain threshold (PPT) testing in healthy volunteers. Methods: In this prospective study, 17 clinician participants completed PPT targeted rate-of-application testing with healthy volunteers using three different feedback paradigms. The resultant performances of ramp rate during 36 trials were plotted on a graph and examined to determine whether learning curves were observed. Results: Clinicians were not consistent in the rate of force applied. None demonstrated a learning curve over the course of 36 trials and three testing paradigms. Conclusion: The results of this study indicate that applying a consistent 5 N/second of force is difficult for practising clinicians. The lack of learning curves observed suggests that educational strategies for clinicians using PPT may need to change.

Objectif : Déterminer si une courbe d'apprentissage se dégage en réponse à un entraînement délibéré visant à appliquer un taux de force constant de 5 newtons par seconde (N/s) lors de tests du seuil de douleur à la pression (PPT pour pressure pain threshold) auprès de participants en santé. Méthodes : Dans cette étude prospective, 17 cliniciens ont réalisé des tests sur des participants en santé au moyen de trois modes de rétroaction. La variation du taux de force observée sur 36 essais a été représentée graphiquement afin de déterminer si une courbe d'apprentissage se dégageait chez les cliniciens. Résultats : Le taux de force appliqué par les cliniciens n'était pas constant. Une courbe d'apprentissage n'a été observée chez aucun d'entre eux au cours des 36 essais, peu importe le mode de rétroaction. Conclusion : Les résultats de cette étude indiquent qu'il est difficile pour les cliniciens praticiens d'appliquer un taux de force constant de 5 N/s. L'absence de courbe d'apprentissage donne à penser qu'il pourrait y avoir lieu de revoir les stratégies de formation des cliniciens appelés à mesurer le seuil de douleur à la pression.

Interdisciplinary group learning in a kinesiology course: a novel approach.

This paper describes an active, collaborative learning project that occurred during a kinesiology course for first-year graduate students in physical (PT) and occupational therapy (OT) that was taught by faculty from both disciplines and designed to promote teamwork and integration of kinesiology concepts. The project required the students to describe and illustrate an assigned functional task, including the involved bony structure, joint mechanics, and muscle actions for joints of the lower extremities. Students from the PT and OT cohorts were intentionally mixed into groups of five students. They were provided with a topic for the assignment and a clear grading rubric. Each group gathered information from a variety of sources to address the topic. The final project was a poster that was presented to the class through an elaborate schedule that required all members of an individual group to present their poster to the group when they arrive at their poster. The presentations were well done and received high marks overall. Student scores were much less critical than faculty scores and included very few comments. The high scores awarded by course faculty indicated the thoroughness of the detail in the posters, as well as the preparedness of the students. An informally determined majority of students commented that being required to present the entire poster required them to comprehend material from the entire course, which we viewed as a positive learning experience.

Integration of cognitive-behavioral therapy with gait training for a 58-year-old male with a fear of falling: a case report.

Fear of falling is a common concern among adults over age 65, which results in decreased activity levels. Cognitive-behavioral therapy (CBT) uses psychological techniques to redirect negative cognitive, emotional, or behavioral affects for improvement of self-efficacy and reduced fear of falling. The purpose of this case study is to describe the integration of CBT into the physical therapy (PT) management of a middle-aged male with fear of falling and difficulty walking. The single subject was a 58-year-old male with complaints of frequently losing his balance, feeling unstable while walking, and requiring the use of a walker to ambulate. During the initial PT examination his primary impairment was difficulty ambulating in open spaces. Dynamic Gait Index (DGI) was 8/24 and the Modified Falls Efficacy Score (MFES) was 6.36/10. The interventions began with a general lower extremity strengthening program, balance exercises, and gait training. At visit 9, CBT techniques of cognitive restructuring were added. Visualization of correct gait patterns was added to the program during visit 10, which continued until discharge after visit 14. Measurements on the DGI improved to 23/24 and MFES improved to 9.43/10 at discharge. Gait pattern improved with the ability to ambulate indoors without an assistive device and using only a straight cane for community ambulation. The use of CBT is well documented as a group intervention for older adults with fear of falling, but CBT techniques may also be helpful for younger adults with fear of falling.

An investigation of the relationships among academic performance, clinical performance, critical thinking, and success on the physical therapy licensure examination.

BACKGROUND: The purpose of this study was to investigate relationships among clinical education performance, academic performance, critical thinking (CT) skills, and success on the National Physical Therapy Examination (NPTE) of graduates from a post-baccalaureate professional physical therapy program. Results of previous research comparing clinical and academic performance measures have been mixed. Academic performance measures have been linked to CT skills and NPTE performance but identifying factors related to success on the NPTE is unclear. Subjects. Forty-two graduates of one professional physical therapy program participated. The average age at completion of the program was 28.77 years (SD 3.89) with a range of 24-40 years. The sample was primarily female (69%) and White/non-Hispanic (92.9%) with the remaining 7.1% representing Asian/Pacific Islander. METHODS AND MATERIALS: Data for this study collected at the end of the academic program included scores for the California Critical Thinking Skills Test (CCTST), ratings on the Clinical Performance Instrument (CPI), and final Grade Point Average (GPA). The remaining data was self-reported after graduation with each participant providing individual NPTE scores to the researcher. ANALYSIS: Analysis was performed using SPSS 12.0 to calculate a Pearson product moment correlation comparing the scores on the CCTST, CPI, GPA, and NPTE. Logistic regression analysis was used to determine the relationship between the outcome variable of passing the NPTE on the first attempt and scores on the CCTST, CPI and GPA. RESULTS: Two-tailed Pearson product moment correlation found significant relationships between CCTST scores and success on the NPTE (r=0.35; p=0.023) and between GPA and success on the NPTE (r=0.334; p=0.031). Logistic regression analysis results were not significant for any of the variables. CONCLUSION AND CONCLUSION: This research indicates a relationship exists between CCTST, GPA and the NPTE. Expanding the search for meaningful variables to include admission data or other program data might be helpful.

The influence of training on the rating of physical therapist student performance in the clinical setting.

Physical therapist education consists of two distinct elements: the didactic preparation and the clinical education experiences. Clinical instructors at affiliated clinics supervise physical therapist students during clinical education. A clinical instructor can receive additional training through two commonly offered programs: Clinical Performance Instrument (CPI) training, which involves 1 hour of instruction, and Clinical Instructor Education and Credentialing Program (CIECP), which includes 15 contact hours of instruction and assessment. The purpose of this study was to determine if completion of either or both of these training programs affected the rating of the CPI by a clinical instructor. Thirty-four licensed physical therapists participated in the study. They were current clinical instructors or physical therapists who were interested in becoming clinical instructors. The subjects were shown a videotape of a simulated student interacting with a simulated client. The subjects were asked to rate the student's performance using the first five criteria of the CPI. The first five criteria were selected for the study because of their designation as determinants for a successful clinical education experience. Background and demographic data were gathered in addition to the CPI ratings. Four groups of clinical instructors were determined from their previous training, then differences in CPI ratings were analyzed. The groups were CIECP and CPI training, CIECP training only, CPI training only, and no training. A multivariate analysis of variance showed statistical significance between training groups but no statistical significance based on previous use of the CPI. Post hoc tests identified the differences as occurring between the group with CIECP and CPI training compared with the groups with only CPI training or no training when rating the first criterion for safety. Rating the second criterion of responsible behavior was different between the CIECP-only group and the CPI only group. This study indicated that completion of CIECP and CPI training affected rating of the first criterion of the CPI compared with clinical instructors who completed the CPI only. Completion of the CIECP only affected the rating of the second CPI criterion compared with CPI-only training. Previous use of the instrument was not significant in this study. Assessment of student performance in the clinical setting is a complex task and further analysis of the training and use of the CPI is needed.