Beyond the Cognitive Domain: A Therapeutic Exercise Course Redesign Using Fink’s Taxonomy
Purpose: Therapeutic exercise is the most frequently billed intervention in physical therapy practice. Despite its frequent clinical application, effective instructional design for this content remains a challenge.1 While practice pattern variability and patient-centered management highlight the interconnections between the art and science of the physical therapy profession, traditional pedagogical strategies may fail to encourage meaningful learning that transforms future clinicians and translates to patient care.2-3 A contemporary approach requires instructors to adapt course design and facilitate growth beyond the cognitive domain, thereby positioning students with necessary skills to collaborate, communicate, problem-solve, continue to learn and function within the ever-changing needs of society.4 Fink’s taxonomy of significant learning moves the learner beyond foundational knowledge and encourages the functional application of material, connection with previous or concurrent curriculum, and fosters continual reflective awareness in a cyclical and reciprocal pattern.4 The broad skills described by this taxonomy reflect the cognitive, affective, and psychomotor skills necessary to effectively apply therapeutic exercise principles. Recent program assessment data from an entry-level physical therapy doctoral program in Virginia identified students’ challenges with therapeutic exercise application. Graduating students from 2013-2017 reported their ability to prescribe therapeutic exercise as significantly lower compared to other practice domains. On average, 18% of graduating students (between 2013 and 2017) reported they did not feel prepared to prescribe therapeutic exercise. The purposes of this study are to 1) determine the efficacy of an innovative therapeutic exercise course redesign in this program, 2) measure changes in foundational knowledge and significant learning through forward-looking assessment strategies, and 3) use qualitative data to inform future therapeutic exercise course series curricular changes.
Methods/Description: Forty-seven second-year entry-level DPT students enrolled in a lower-quarter therapeutic exercise course participated in this study. A backwards design was used to identify 10 specific learning goals, each informed by one of Fink’s 6 significant learning taxa. Based on Fink’s integrative course design, forward-looking assessments and rich learning activities that reflected each learning goal were carefully planned. Beyond providing a grade, educative assessments were designed to supply students with consistent, formative feedback, and enhance learning. Teaching and learning activities that emphasized active engagement, contextual experience, authentic contexts, peer review, and frequent reflection were also selected. An integration chart ensured the primary components of learning goals, procedures for assessment, and learning activities were complementary, encouraged significant learning, and intentionally variable to support different types of learning and desired skill. Pre- and post-test measures assessed foundational knowledge related to lower-quarter therapeutic exercise principles and application. Adaptations of the 10 specific learning goals, through Likert-style pre- and post-test surveys, captured perceived changes in students’ significant learning. Additionally, qualitative data, extracted from mid-term and final course evaluations, informed adjustments for the latter half of the semester and facilitated changes for future iterations of this course series, respectively.
Results/Outcomes: Despite an emphasis on non-traditional assessment procedures, significant improvement in foundational knowledge of lower-quarter therapeutic exercise application was demonstrated at post-test (p <.001). Significant improvement was noted in all 6 dimensions of Fink’s taxonomy of learning at post-test, including: Foundational Knowledge (p <.0001), Application (p <.0001), Integration (p <.0001), Human Dimension (p <.0001), Caring (p <.005), and Learning How to Learn (p <.0001). Eight of the 10 learning goals were met, as demonstrated by statistically significant improvement in perception of significant learning. Goals that did not improve, within the Human Dimension (p = .28) and Learning How to Learn (p = .71) taxa, informed future learning activities intended to foster evidence-based application and establishing a future learning agenda related to therapeutic exercise. The following themes emerged from course evaluations: the integration of current part-time Integrated Clinical Experiences into the course was effective, consistent reflection allowed opportunities to share experiences and challenged students to be more actively involved in exercise selection, and overall, students were appreciative of the response to previous course feedback and the efforts taken to redesign.
Conclusions/Relevance to the conference theme: The complexity associated with the instruction and application of therapeutic exercise necessitates a course design that moves the student beyond the cognitive domain. Fink’s taxonomy of significant learning encourages the development of technical and non-technical skills that are not found in traditional taxonomies.2-4 A backwards course design that emphasized harmony between learning goals, educative assessment procedures, and learning activities in multiple domains resulted in not only cognitive mastery, but also significant learning across all 6 described taxa. Considering the emergence of biopsychosocial patient-management models, Fink’s taxonomy of significant learning may assist the development of students’ multidimensional skills and represents new curricular opportunities that mirror the evolving needs of our patient population.5