Comparing Hybrid Patient Simulation to Integrated Clinical Experiences in Acute Care Physical Therapy Education
Purpose: Patient simulation has been utilized in nursing education for decades to introduce clinical skills that will be necessary in a low risk environment. The utilization of simulation in physical therapy education warrants the study of this teaching technique as it pertains to the unique needs of physical therapy students as well. Though there is evidence to support its use, the support for simulation is limited with few quality studies available and none that specifically compare student preparation through simulation of patient scenarios to real life exposure during an integrated clinical experience that may be imbedded within a course. Methods/Description: Evidence-based teaching techniques focus on active learning and are associated with improved learning outcomes and student engagement. Simulation(SIM) allows students to actively engage and apply knowledge gained in the classroom in a way that is explicitly relevant. As part of a first year DPT Acute Care course, students participated in hybrid patient simulation. Patient simulation can take on varying levels of complexity. The goals for the first of two Acute Care courses were to expose students to the scope of practice within an acute care setting with minimally complex patients and allow them to practice examination skills gained throughout the curriculum as well as begin to develop clinical reasoning skills. For these reasons, high fidelity patient simulation was not necessary. One of the principles of simulation is to keep it as simple as possible and focus on only a few learning objectives. Community dwelling adults were recruited and trained to act the patient roles for the simulated patient cases and appropriate moulage applied based on simple acute care orthopedic cases. Forty-four students were paired and oriented to the simulation experience with education including the need to suspend disbelief and treat the scenario as real. A debrief immediately followed in which students were able to discuss their clinical reasoning, clarify any misinformation, and get performance feedback from a faculty member. This SIM group was compared to a group who participated in an integrated clinical experience. Integrated clinical experience(ICE) is the participation of students in patient care with a physical therapist mentor imbedded within a course. Unlike clinical rotations, students are typically limited to observation and for only a few hours. For the ICE group, students were paired and assigned to observe patient care at a local hospital as part of a DPT acute care class. Immediately upon conclusion of the quarter, students in each group went on their first clinical rotation for 4 weeks. As part of their clinical rotation, clinical instructors rate student performance using a Clinical Performance Instrument (CPI). Clinical instructors were also able to write free form comments on each performance category. The results of the CPI were utilized to assess student performance and preparation regarding their coursework in acute care. In addition, comments from course feedback were reviewed to determine student perception of each teaching method. Results/Outcomes: The current generation of students is accustomed to learning with technology and the use of simulation engages them with the material in a way that is familiar to them. They find simulation to be an enriching teaching technique as well as a way to improve their self-confidence. In this study, the use of simulation did not decrease student learning and allowed instructors to offer a consistent learning experience for all students participating in SIM. Students in ICE, reported that the content learned in the hospital was not engaging and the teaching skill of the clinical instructors varied. Clinical instructors rated students who participated in SIM higher than those who participated in ICE using the CPI. Conclusions/Relevance to the conference theme: Patient simulation need not involve high fidelity manikins. Simulation allows the educator to control for consistency in the learning environment and provide scenarios that students may not be exposed to. Simulation does not detract from learning of clinical practice skills that may occur during an integrated clinical experience with real patients. In fact, feedback from clinical instructors indicates that students were more confident and better prepared for their clinical rotations using SIM as a teaching technique compared to ICE. Simulation may be preferred to integrated clinical experiences for teaching students skills required in an acute care setting.