A four-course sequence of clinical decision making (CDM) was redesigned to enhance the learning experiences and CDM skills of doctor of physical therapy students. Each course was designed to create an overall scheme of learning activities to allow the students to practice CDM.
Initial Design Phase: Identifed situational factors, designed learning goals, designed methods for assessment and feedback, and designed teaching and learning activities. Intermediate Design Phase: Created a thematic structure for the courses, created an instructional strategy, and created an overall scheme of learning activities. Final Design Phase: Developed a grading system, anticipated potential problems, wrote the course syllabus, and planned an evaluation of the course and teaching.
Initial Design Phase: Situational factors included class sizes of 35-40 graduate students. The courses were designed to allow the students to synthesize and integrate previously-learned material in a patient management context. Learning goals for the sequence included: a) to use a hypothesis-driven algorithm for patient management, b) to use evidence-based practice consistently in developing intervention strategies and tactics, c) to develop a sense of professional identity, d) to develop professional behaviors, e) to develop the ability to self-assess performance, and f) to analyze expert practice. Methods for assessment included critically appraised topics, documentation of patient management, development of patient education, a reflective paper on characteristics of expert practitioners, and self- and peer-assessment of professional behaviors. Learning activities included observing faculty as expert practitioners evaluating patients followed by the students using case studies to practice the patient management process from an initial evaluation to development of a home program using best evidence, and discussion of reading assignments. Integration of the primary components was achieved through the observation of experts treating real patients followed by active problem solving with similar case studies. Intermediate Design Phase: The thematic structure was the clinical decision making process. Instructional strategies included the observation of role models followed by active practice. Final Design Phase: The grading system emphasized authentic projects that are important clinically such as documentation, development of patient education, critically appraised topics, and assessment of professional behaviors. The students were invited to participate in an anonymous mid-term evaluation of the course and teaching. The standard end-of-course evaluation was used as well as student-lead focus groups. Two of the four courses in the CDM sequence have been completed with positive comments from students and involved faculty. Course evaluation scores improved meaningfully.
Conclusions/Relevance to the conference theme: Shaping the Future of Physical Therapy Education
Careful course design with an emphasis on active, authentic learning experience can enhance clinical decision-making skills.
Fink LD. Creating Significant Learning Experiences: An Integrated Approach to Designing College Courses. San Francisco: Jossey-Bass, 2003.