Integration of a New Clinical Practice Guideline into Entry Level Physical Therapist Education
Purpose: In 2018, a clinical practice guideline (CPG) outlining new recommendations for a core set of outcome measures (OM) for with adults with neurologic conditions undergoing neurologic rehabilitation was published through the Academy of Neurologic Physical Therapy. According to the American Physical Therapy Association’s CPG manual, an essential component of knowledge translation requires inclusion of CPG content into entry level program curricula. The Commission on Accreditation in Physical Therapy Education mandates that entry-level education is consistent with contemporary guidelines. The purpose of this project was to create and implement a systematic process for the integration of the new CPG: A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation into an entry level DPT program’s curriculum. Student learning objectives related to this process were: 1) explain development and use of the CPG 2) administer and score each OM 3) apply principles and concepts from CPG to the patient management continuum during an experiential learning activity. Methods/Description: The CPG was incorporated into a course focused on rehabilitation for adults with neurologic conditions. Students were introduced to the CPG through required reading and traditional lecture. A lab experience provided an opportunity to practice administration of each OM in small groups. Over the course of the semester, students were required to apply the principles and concepts from the CPG in additional lab experiences that involved direct interactions with adults with neurological conditions who served as lab volunteers. Both formative and summative assessment procedures were utilized to determine students’ achievement of learning objectives. Data related to students’ confidence in using the CPG was measured at multiple points in time (pre-instruction, post-lab activity and after work with the volunteers) through a faculty developed survey. The survey used a 5 point Likert scale to measure confidence (1 = not confident, 5 = extremely confident). Open ended questions were added to surveys completed after work with the volunteers to gain further insight into the students’ clinical reasoning skills related to the application of the CPG into clinical practice. Results/Outcomes: A preliminary review suggests that learning objective 2 was achieved and that students were confident in use of the CPG after the initial instruction. The addition of the experiential learning activity may not have advanced student’s confidence with the administration, scoring, and interpretation of the results. Anecdotal evidence obtained through direct interaction with the students during experiential learning component indicated that the students’ understanding of the role of outcome measures in the patient management continuum may be less than what they perceived. In particular, students appeared to have difficulty with differentiating the role of data collected during the examination phase which is used to direct specific treatment decisions, with the specific role of outcome measures designed to measure the success of intervention. Many of the measures included in the CPG were introduced to students in previous courses which emphasized the role of OMs in the evaluation phase to develop a patient problem list. These previous learning experiences may have served to bolster the students’ confidence with administration while limiting students’ development of an accurate understanding of the specific role of an outcome measure. Strategies for providing a better foundation for understanding the role of outcome measures prior to this course were discussed and on-going assessment of student learning will be implemented as part of a continuous quality improvement process. Conclusions/Relevance to the conference theme: A new clinical practice guideline recommending core outcome measures for adults with neurologic conditions was successfully integrated into the curriculum of an entry level physical therapy program. This integration resulted in high levels of self-perceived student confidence with administration and interpretation of the outcome measures, but revealed limitations in students’ ability to differentiate the role of clinical measures at different stages of the patient management continuum. Changes to how and when information regarding outcome measures is presented to students will be implemented to further student understanding of outcome measure use in physical therapy.