Premise reflection during the final physical therapy clinical internship after a reflective case management course
The purposes were to 1) determine rate of premise reflection in online survey responses obtained during the final doctor of physical therapy (DPT) clinical internship after a reflective case management course and 2) determine inter-rater reliability for identifying premise reflection in the survey responses.
This survey study with theme analysis and reliability analysis included 3 consecutive DPT classes (130 students, 260 responses). After a mandatory reflective case management course in the last academic semester, students were surveyed online during the subsequent final clinical internship.
In the course, students selected a case from past clinical education experiences for detailed reflection on the content (data), process (conduct), and premise (underlying assumptions). Team-based learning, expert or multidisciplinary consultation, evidence-based literature reviews, and reflective writing facilitated discussion of different views and individual reflection. Premise reflection, defined as reconsideration of underlying assumptions leading to new perspectives/planned actions, was not a course requirement.
The online survey was voluntary and not associated with any grade. Two open-ended questions asked how student attitudes/behaviors had changed without asking for examples of premise reflection. Four investigators trained on a separate set of student writing using published guidelines for identifying premise reflection in reflective writing for individual rating and consensus discussions. Preliminary reliability testing had moderate inter-rater reliability. Each investigator then independently identified examples of premise reflection and applied topic labels for each survey response.
Response rate and frequency of premise reflection were reported for each investigator, class, and total sample. Common themes were identified using a grounded theory approach. Inter-rater reliability for identifying premise reflection was calculated using intraclass correlation coefficients and kappa statistics.
84.4% of students responded with 23 examples of premise reflection identified in the 260 survey responses, an overall rate of 8.8%: 11.9% (Class 1), 5.7% (Class 2), and 9.1% (Class 3). Rates of premise reflection identified by each investigator ranged from 1.9-6.5%. Three main themes emerged: wellness beyond PT (n=4), evidence-based practice (n=8), and the role of the physical therapist (n=18). Inter-rater reliability among the 4 investigators was low-moderate using a consistency definition with ICC2,1=0.66 for average measures and kappa=0.22–0.36 for agreement between each pair of investigators.
Conclusions/Relevance to the conference theme: Shaping the Future of Physical Therapy Education
Premise reflection in the final DPT internship occurred in 3 main themes: wellness beyond physical therapy, evidence-based practice, and professional roles of the physical therapist. As in past research, premise reflection was uncommon in student writing. To document and develop premise reflection in surveys during clinical internships, multiple readers are recommended.
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