Impact of a Comprehensive Simulation on Dpt Students' Confidence in Clinical Decision-Making and Clinical Skills
Purpose: Like many other health care professional education programs, physical therapy education utilizes simulation to advance the skills and practice of students.1 The increased use of simulation-based learning has been driven in part by the need for students to encounter complex patient interactions in a low-risk setting. Clinical education does not have these types of learning activities with the frequency and control that a student needs to enable them to become an entry-level clinician. New practitioners are expected to enter the health care workforce ready to manage all of the demands of total patient care. This encompasses safety, efficiency, and effectiveness of clinical practice.2 To help capture this entry-level demand, the faculty at our institution decided to utilize a comprehensive simulation event as students completed their didactic course work, just prior to entering the final clinical experiences. The purpose of this study was to determine how participating in a comprehensive simulation event that consisted of managing patients across settings and life-span would impact physical therapy students’ confidence regarding both their clinical and decision-making skills. Methods/Description: The study utilized a convenience sample of third year Doctor of Physical Therapy students who participated in a comprehensive simulation event. The event focused on four different health care settings—acute care, skilled nursing and rehabilitation, outpatient, and home health, as well as addressing all aspects of the Patient-Client Management Model. The students completed two surveys, before and after the event, to capture a self-assessment of their confidence in clinical and decision-making skills.3,4,5 Quantitative data from these surveys was analyzed using paired-t tests and qualitative data was analyzed for general themes. Results/Outcomes: The Clinical Decision-Making4 survey showed improved student confidence in recognizing physiological and psychological changes in patients in a timely manner (p=0.02288) and distinguishing between clinically important and lower priority impairments (p=0.04781), as determined by a significant decrease in students’ rating of how often they needed advice, support, or intervention from a more experienced physical therapist on the post test. The survey related to confidence in clinical skills demonstrated an overall significant decrease in student confidence(p=0.01223). Several of the skills did not show a significant change, however, the following skills were significant for a decrease in student confidence: strength testing (p=0.00612), postural assessment (p=0.00123), and planning an appropriate intervention plan (p=0.03018). Conclusions/Relevance to the conference theme: Incorporating a comprehensive simulation at the end of the didactic curriculum improves aspects of students’ self-appraised confidence in clinical and decision-making skills and provided an opportunity for student self-reflection and growth based on areas of decreased confidence related to certain clinical skills.