Teaching Clinical Reasoning Using a Master Class Format
The purpose of this platform presentation is to introduce an innovative instructional strategy, the master class, to physical therapy educators who teach clinical reasoning.
The master class format is modeled after music pedagogy in which the instructor teaches in small group by having one student at a time perform in the role of physical therapist while the instructor assumes the role of patient. The students perform physical therapy examination, diagnosis, prognosis and interventions in a simulated clinical environment in front of their peers who serve as clinical instructors and consultants if the student in the role of PT needs assistance. Each student is in the role of PT for approximately 30 minutes and multiple groups run simultaneously with lab assistants trained to serve as instructor/patient. As the semester or course sequence progresses, scenarios become more complex, and students become the “master” by serving as patient/instructor.
This methodology has been used successfully in two Orthopedics courses within an entry-level physical therapy program. Primary benefits are fivefold. First, clinical reasoning is facilitated by instructor/patient responses that require “PT” decisions and action in real time, as well as by oral questioning from the instructor or student observers. Second, students are required to perform in front of their peers on a “patient” who knows how to respond in a more realistic manner as compared to classmates which gives relevance to the master class and facilitates pre-class preparation. Third, practical examination anxiety is reduced by practicing in a similar higher-stakes environment which may improve graded practical exam performance. Fourth, students as observers learn by watching a peer perform patient management and by the instructor feedback to that student. Finally, the instructor is able to gauge group clinical reasoning, communication abilities, and psychomotor skills which informs instruction design and assessment of learning.
Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education
Teaching clinical reasoning can be challenging. Students struggle with the abstract nature of course content, algorithms, paper patients and concept/mind mapping. Published studies provide useful examples of clinical application, novice and expert characteristics, and explanations of process, and mock clinics help students apply clinical reasoning processes while integrating skills, but can lack specific and accurate expert feedback. The master class instructional design effectively simulates clinical practice while providing a platform for teaching to the specific needs of students, reflecting in action and on action, and providing immediate feedback to correct cognitive, communication, and psychomotor errors. This may improve the depth and efficiency of learning and thereby facilitate excellence in practice.
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