Improving Student Performance and Confidence in Preparation for Clinical Experience Remediation: A Case Report.
Background and Purpose: Physical therapy educators have the obligation to prepare students for clinical education; however, there is no widely accepted structured, evidence-based strategy to prepare for remediation in the event of a failed clinical experience. This case study will illustrate one example of strategies used for a physical therapy student.
Case Description: Following failure of the final clinical experience, a physical therapy student was offered a 10-week independent study course designed to facilitate improvement in identified areas of performance deficits prior to repeating the final experience. Final Clinical Performance Instrument ratings identified the student was below expectations in all areas, but most significantly: Professional Behavior, Accountability, Communication, Professional Development, Clinical Reasoning, and Educational Interventions. Additionally, the student self-identified significant confidence issues. The independent study course included six recorded simulated case encounters, student reflections, use of an International Classification of Functioning, Disability and Health planning worksheet to foster critical thinking, counseling for interpersonal skills, and mentored sessions with faculty. The Physiotherapist Self-Efficacy Questionnaire was utilized to capture student confidence throughout the independent study course.
Outcomes: The independent study course is currently in process. To date, the faculty mentors have noted improvements within the cognitive and psychomotor domains as well as improved accuracy of student assessment. Self-reported student confidence levels increased in two of the three subcategories of the Physiotherapist Self-Efficacy Questionnaire at midterm: musculoskeletal and neuromuscular tracks. Final Clinical Performance Instrument results and Physiotherapist Self-Efficacy Questionnaire will be analyzed to determine further impact of the independent study course and report changes in performance and/or confidence.
Discussion: In the absence of an evidenced-based strategy of remediation following a failed clinical experience, it is important to consider student confidence and self-assessment in addition to cognitive and psychomotor domains in addressing student performance. Integrating the Physiotherapist Self-Efficacy Questionnaire to simulated case encounters coupled with active reflection and faculty-led mentoring sessions provided opportunities for the student to improve complex critical thinking skills as well as active self-reflection strategies. Educators may find this approach to remediating an unsuccessful clinical experience useful for those students who have identified confidence to be a barrier to learning.