The Effect of Integrated Clinical Experiences on Dpt Students’ Interpersonal Communication and Acute Care Confidence
Purpose/Hypothesis: Doctor of Physical Therapy (DPT) programs employ components of both didactic and clinical education to prepare students for entry-level physical therapy practice. Although the placement and timing of didactic and clinical components within a curriculum varies between programs, traditionally the bulk of clinical education experiences have been positioned during the latter half of DPT programs. This model allows for students to receive most of their didactic education before being immersed in patient care. Despite this trend, research suggests that early exposure to clinical environments provides students with critical skills necessary for professional practice, reinforces classroom learning to authentic patient situations, and promotes opportunities for skill development and professional growth.1,2 Additionally, clinical education integrated into early aspects of the DPT curriculum may promote readiness for full-time clinical experiences3-4, which may be particularly important in the less-familiar and more complex acute care environment. As part of the Commission on Accreditation in Physical Therapy Education (CAPTE) requirements for PT education, DPT clinical education must now include both integrated and full-time clinical experiences. Integrated clinical experiences (ICEs) are defined as clinical experiences that occur before the completion of the didactic component of the curriculum.5 Although ICEs are now a required component of DPT education, the recommended structure of these experiences and their effects on DPT students is not well documented. The purpose of this study was to describe the structure of two part-time, multiple exposure, hands-on clinical experiences integrated into a DPT program and to track changes in acute care confidence and interpersonal communication demonstrated by a cohort of DPT students before and after these experiences.
Number of Subjects: A cohort of DPT students (n=36) enrolled in the physical therapy program (2017-2019) at an academic medical center
Materials and Methods: DPT students participated in two ICEs that were incorporated into the second and sixth academic semesters, respectively, of an eight semester DPT program. For ICE 1, students spent four half-day experiences paired with clinical preceptors in acute care (two experiences), inpatient rehabilitation (one experience), and outpatient (one experience) settings. For ICE 2, students spent six half-day experiences with clinical preceptors in acute care (two experiences), inpatient rehabilitation (two experiences), and outpatient (two experiences) settings. For both ICEs, students were engaged in hands-on practice and were required to complete a checklist of professionalism and skill-based objectives derived from multiple courses and elements that determine readiness for first full-time clinical experiences6. The ICEs took place in clinics and hospitals associated with the academic medical center. Confidence in physical therapy provision in the acute care environment was measured using the Acute Care Confidence Survey7 (ACCS) and interpersonal communication was measured via the Interpersonal Communication Questionnaire3,8 (ICQ). Outcomes were assessed pre- and post-ICE 1 and pre- and post-ICE 2.
Results: All 36 students in the cohort completed both the ACCS and the ICQ, for a 100% response rate on both surveys. The cohort consisted of 13 males (36.1%), 23 females (63.9%), seven persons of color (19.4%), and 29 individuals who were white, non-Hispanic (80.6%). On the ACCS, students scored an average of 53.4 (out of a possible 100) prior to ICE 1, 72.7 after ICE 1, 71.1 just prior to ICE 2, and 86.15 after ICE 2. Results of paired t-tests were statistically significant between pre/post ICE 1 and 2, with p< 0.001 for the average total score and for each of the 15 items on the ACCS. The average score on the ICQ just prior to ICE 1 was 3.9 (out of a possible 5), 4.4 after ICE 1, 4.3 just prior to ICE 2, and 4.6 after ICE 2. Paired t-tests revealed statistically significant improvements in the confidence and anxiety subscales pre/post ICE 1 and 2, with p<0.05 for each. 7 of the 8 items on the ICQ were also statistically significant pre/post ICE 1, and 5 of the 8 items were statistically significant pre/post ICE 2, with p<0.05 in each case.
Conclusions: Findings demonstrate that students gain self-confidence in the acute care environment when involved in hands-on ICEs aimed at the practice of skills learned in the didactic portion of the curriculum. Additionally, students demonstrated improved interpersonal communication with patients during this time. Improvements in these areas were not seen between ICEs, indicating that didactic content alone did not improve these outcomes.
Clinical Relevance: The traditional design of physical therapy education separates didactic learning and clinical experience. The integration of part-time clinical experiences into the didactic semester, especially when carried out in less familiar environments such as acute care, may allow students to gain valuable experience in interpersonal communication and appears to improve self-efficacy in treatment provision.
References: • Hakim EW, Moffat M, Becker E, et al. Application of educational theory and evidence in support of an integrated model of clinical education. J Phys Ther Educ. 2014;28(S1):13-21.
• Weddle ML, Sellheim DO. Linking the classroom and the clinic: a model of integrated clinical education for first-year physical therapy students. J Phys Ther Educ. 2011;25(3):68-79.
• Mai JA, Stern DF, Hollman JH, Melzer BA, Thiele AK, Rosenthal RS. Examining the impact of an integrated clinical experience (ICE) on interpersonal skills prior to the first, full-time clinical internship: cool as ICE. J Phys Ther Educ. 2014;28(3): 81-97.
• Brueilly KE, Nelson TK, Gravano TN, Kroll PG. The effect of early contextual learning on student physical therapists’ self-perceived level of clinical preparedness. Acute Care Perspectives. 2009: 18(3): 6-13.
• Commission on Accreditation in Physical Therapy Education (CAPTE). Standards and Required Elements for Accreditation of Physical Therapist Education Programs. http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Accreditation_Handbook/CAPTE_PTStandardsEvidence.pdf Revised December 7, 2017. Accessed June 20, 2019.
• Timmerberg JF, Dole R, Silberman N, et al. Physical therapist student readiness for entrance into the first full-time clinical experience: a delphi study. Phys Ther. 2019;99:131–146.
• Greenwood KC, Nicoloro D, Iverson MD. Reliability and validity of the Acute Care Confidence Survey: an objective measure to assess students’ self-confidence and predict student performance for inpatient clinical experiences. J Acute Care Phys Ther. 2014;5(1):1-10.
• Lewis M, Bell J, Asghar A. Use of simulated patients in development of physiotherapy students’ interpersonal skills. International Journal of Therapy and Rehabilitation. 2008; 15(5): 221-227.