This session introduces physical therapy faculty to: (1) a cost-effective method to fashion wound models to promote physical therapy student competency related to principles, psychomotor skills, clinical reasoning and documentation of wound care through active engagement in simulation experiences, (2) specific simulated learning activities using models beginning with facilitation of simple psychomotor skills and isolated components of documentation, and progression to activities that incorporate broad aspects of patient/client management, including clinical reasoning, development and progression of plans of care, documentation, and communication and collaboration with healthcare team members, and (3) utilization of simulation models, standardized answer keys and grading rubrics to provide objective evaluation of student clinical performance and problem solving.
Methods and/or Description of Project
A systematic review of literature examining simulation learning experiences in entry-level physical therapy curricula reveals that simulations facilitate skill development and clinical reasoning while promoting student confidence and reducing anxiety related to clinical education experiences.1 Simulation experiences allow novice students access to learning experiences that can be controlled to assure safety.2 Complexity of simulated activities can readily be adapted to match students’ current level of education and experience.1,2 The learning experiences can be controlled to facilitate the four stages of learning as defined by Kolb: (1) concrete experience through hands-on skill performance; (2) reflective observation through self-reflection and/or incorporating feedback from external sources; (3) abstract conceptualization through development of new ideas; and (4) active experimentation as new ideas are implemented.1
Simulation experiences are reproducible, so that all students have the same experience, thus offering objectivity to performance evaluation. Simulation experiences also fulfill the three principles of objective testing, including: (1) standardized tasks and instructions; (2) critical aspects of performance and accepted ranges of responses established prior to performance evaluation; and (3) scoring performed by a single examiner in a standardized manner. This reproducibility also provides the opportunity to identify problems in the physical therapy curriculum by revealing systematic bias in student performance.2
Wound care can be an intimidating area of practice for many physical therapy students. Individuals may have concerns about their reaction to a patient’s wound, including but not limited to appearance and odor of the wound. Also, there are potential risks, including exposure to blood and body fluids, contamination, and patient pain experiences. Thus simulation experiences offer a safe learning environment in which the wound qualities can be introduced to students in a graduated fashion, while avoiding risk to patient safety and comfort.
Simulation experiences for the development of knowledge and skill related to wound care may be accomplished using wound models. While commercially available wound models can be quite expensive,3 we formed wound models using Crayola Air-Dry Clay and acrylic paints. Small instruments, such as toothpicks and plastic flatware were used to create the contours and textures of the wounds. The clay models required approximately one week to dry completely before painting with acrylic paint using craft-style paintbrushes of various sizes. “Partner” wounds were created to represent wounds at different stages of healing, as well as with and without signs and symptoms of infection. An experienced physical therapist performed a physical examination of each wound model and recorded all objective measures. Scenarios were developed for each wound, in which additional characteristics of the wound, such as pain level and amount, color, consistency and odor of exudate were provided. Based on these scenarios, the range of appropriate wound care interventions was determined. These examination findings and intervention plans served as answer keys for documentation assignments completed by the students.
Using the wound models, students can safely engage in skill practice from the first day of class when they are introduced to the critical components of wound examination. They can initially work in small groups to perform a wound examination and document the findings following a specified format. Activates are progressed to incorporate all aspects of wound management, including treatment planning and progression, collaboration with members of the healthcare team, and documentation. Models can also be used in practical examination settings to assess psychomotor, cognitive and affective performance.
Fabrication of wound models by program faculty was cost effective and provided a large inventory of wounds of differing etiologies and at different stages of healing, allowing every student progressive simulated hands on experience beginning the first class session. Lecture time was reduced by 50%. Students developed basic competency in psychomotor skills, and demonstrated ability to make clinical decisions in response to changes in wound condition. They demonstrated ability to accurately and concisely document all aspects of wound care. In a post course evaluation, 50% of students specifically identified simulation experiences using the fabricated wound models as the most effective aspect of the course contributing to their understanding of wound examination and management. More than 77% of students rated the wound models as effectively or very effectively contributing to their understanding of wound examination and evaluation of wound progress.
Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education
Physical Therapy students must be well-prepared to engage in clinical care as generalist practitioners using the best available evidence upon completion of their didactic education. Productivity demands in clinical settings require that students begin their internships with novice competency in all aspects of professional development: psychomotor, affective and cognitive. The use of simulation experiences have been shown to be highly effective in medical and health care provider education.1,2 As demonstrated by the outcomes following the introduction of fabricated wound models and simulation activities in our curriculum, excellent performance in all domains of learning and student satisfaction outcomes can be achieved using low tech inexpensive “home-made” models.
Mori B, Carnahan H, Herold J. (2015). Use of Simulation Learning Experiences in Physical Therapy Entry-to-Practice Curricula: A Systematic Review. Physiotherapy Canada, 67;2:194-202.
Ladyshewsky R, Jones M, Baker R, Nelson L. (2000). Evaluating Clinical Performance in Physical Therapy with Simulated Patients. Journal of Physical Therapy Education, 14;1:31-37.
Anatomy Warehouse. www.anatomywarehouse.com Accessed April 18, 2016.
By the conclusion of this session, participants, working in small groups, will:
1. Create a wound model using Crayola air-dry clay.
2. Illustrate wound characteristics on a clay model using acrylic paints.
3. Develop an answer key itemizing characteristics of a wound model.
4. Construct a rubric for grading of wound documentation.
5. Create 2 simulation experiences incorporating wound models.
6. Appraise how the use of simulation experiences facilitate the four stages of learning as defined by Kolb.
7. Appraise how simulation experiences fulfill the three principles of objective testing.
Hands-on practice making and painting models.
Group activities to develop answer keys, grading rubrics, and simulation activities.
Discussion/sharing of activities and strategies.
Provide written examples of simulation activities, answer keys, documentation grading rubrics, final practical exam outline and grading rubric.
10 min Description of wound model fabrication technique using models at various stages of development.
20 min Participants fabricate a model using Crayola air dry clay.
15 min Participants paint a prepared model.
25 min Participants examine one prepared model to develop an answer key and documentation grading rubric.
15 min Discussion regarding how simulation experiences facilitate the stages of learning and fulfill the principles of objective testing.