Impact of a Simulated Case Conference on Student Self Efficacy in Patient Management
Purpose:
An effective physical therapist must be able to efficiently evaluate, manage, and communicate plans of care to patients, family members, and other health care providers. While entry level students are often able to develop intervention plans for a simple patient case, their ability to manage a complex patient case that requires attention to psychosocial factors, coordination of care with other providers, and communication with the patient and family is limited. Additionally, student confidence in their ability to communicate effectively has been shown to be limited. Previous studies have presented models in which simulated cases were used to improve interprofessional education, but there are few, if any examples in which a case simulation module was used to educate physical therapists on communicating with complex patients and their families to engage in shared informed decision making and advocacy. Our aim in this study was to measure the impact of a simulated case conference on students’ self confidence in the management of a complex patient with a neurologic disorder.
Methods/Description:
Seven patient cases of varying neurologic disorders across the lifespan were developed by a team of faculty in a clinical neurologic management course offered in the second year of a three year Doctor of Physical Therapy program. Each patient presented with participation restrictions, activity limitations, and psychosocial factors (environmental and personal) which added complexity to the case. Each case assignment included written chart notes, video of a patient interview, and video of the patient performing a relevant task. 94 students in the course were divided into groups of 2 and assigned one of the seven patient cases. Students prepared for a conference regarding the case which would be attended by 3 faculty members who played the role of the patient, a family member, and one additional health care provider (physician, social worker, speech therapist). Prior to and after the case conference, students were asked to rate their level of confidence on a 4-point scale ranging from not confident to very confident. The survey assessed five areas: (1) presenting insights and clinical reasoning to a comprehensive management team, (2) presenting insights and clinical reasoning to a patient and their family, (3) identifying essential quality of life issues that are affecting a patient, (4) development of physical therapy interventions for a person with acute, chronic or progressing neurologic condition and (5) development of a physical therapy intervention plan taking into consideration patient resources, physical capability, motivation, timeline and family dynamics.
Results/Outcomes:
Of the 94 students who participated in the case conference, 64 students responded to the surveys. At post test, students reported more self confidence in their ability to (1) present their insights in a case conference to other medical professionals, (2) identify essential quality of life issues affecting a patient, (3) develop a physical therapy plan for patients with neurologic conditions, and (4) develop a physical therapy intervention plan taking into consideration the patient’s psychosocial factors. At post test, students reported a decrease in self confidence in their ability to present their insights to a patient and/or their family. There was a 64% increase in students who rated themselves as confident or very confident in their ability to present their insights to other medical professionals while there was a 21% decrease in students who rated themselves as confident or very confident in their ability to present their insights to a patient and/or their family.
Conclusions/Relevance to the conference theme:
Use of a simulated case conference resulted in an increase in student confidence to present their interventions for a patient with a neurologic disorder to medical professionals. Meanwhile, the simulated case conference resulted in decreased student confidence in their ability to present their interventions to patients and their families. This decrease in confidence may have resulted from a lack of student awareness of the challenges of shared informed decision making and advocacy within a complex patient case prior to the case conference. Physical therapy programs may consider this method to help students self assess their ability to communicate with their patients and their families and create strategies to improve effective patient communication for students.