Beginning at the End: Fostering Clinical Reasoning Development through Patient Simulation Early in Curriculum
Purpose: Current ideas in healthcare curricula question whether foundational knowledge should precede psychomotor skill acquisition and clinical reasoning (CR). In physical therapy education, early patient management skills are often taught in isolation and may lack patient context. However, constructivist learning theory supports developing knowledge and skill simultaneously in the context with which the skill will be used. Evidence regarding CR development suggests early exposure to patient context in the form of simulation provides authenticity to foster the development of CR skills. Additionally, CR development depends on the early learner having frameworks, such as the International Classification of Functioning Disability and Health (ICF) to organize patient information. The purpose of this special interest report is to describe an evidence-based, patient simulation CR assessment occurring early in an entry-level physical therapist DPT curriculum. Description: Foundational patient management courses at the University of Colorado foster CR by providing students with relevant clinical context through: video case examples, in-class patient volunteers, and use of the ICF model to organize patient information. Coursework culminates in a large scale, practical assessment designed to simulate a patient encounter through the use of standardized patients role played by near-peers. Students perform a chart review, physical examination, and create and implement a plan of care for a novel patient case. Students utilize the ICF model throughout the encounter to guide decision making, rationalize decisions, and guide self-reflection. Additionally, students receive structured faculty and near-peer feedback. The grading rubric is structured to emphasize CR skills, self-reflection, and clinical decision making. Summary of Use: The innovative nature of this assessment provides a unique opportunity for students to formulate a CR process and apply clinical skills in a simulated patient encounter early in their training. Evaluative data include qualitative and quantitative data from course evaluations, and recorded and transcribed student interviews. Students are highly satisfied with the assessment, and value the simulated experience. Students report unease prior to the assessment, but following state, “you’re not ready for it until you do it and then you figure out how to be ready for it”, referring to engaging in a CR process early. Lastly, this assessment and rubric has successfully identified students who require remediation to develop CR skills prior to moving to advanced courses. Importance to Members: Early development of a CR process using patient simulation and a structured framework is important to ease the cognitive overload associated with developing these skills, and aligns with evidence regarding CR development. This assessment process may serve as a model for other programs to create similar experiences for early learners to develop CR skills.