Deliberate Practice in Simulated Environments and the Positive Impact on Student Assessment on Practical Performance
Purpose: The purpose of this study was to compare how the addition of structured deliberate practice in a simulated inpatient setting changed student physical therapist (SPT), and student occupational therapist (SOT) practical examination performance in an entry-level physical and occupational therapy course. Description: Prior to the Fall of 2017, scheduled class labs and practical examinations in the first-trimester course called Patient Client Care Management-I (PCCM-I), were conducted in a traditional classroom setting using standard high-low treatment tables. Students were expected to prepare for these practical examinations on their own time. By the Fall of 2017, scheduled class labs and practical examinations for PCCM-I were conducted in the newly added Center for Innovative Clinical Practice (CICP). The CICP includes a realistic inpatient ward with a variety of hospital devices, like functioning hospital beds. Furthermore, the lead instructor added deliberate practice1,2 methods to PCCM-I, and students were granted additional access to the CICP outside of class time. Deliberate practice (DP) is a method used to develop strong and consistent educational interventions based on information processing and use of behavioral theories for skill acquisition and improvement, and maintenance1. Deliberate practice in simulated environments has been shown to improve performance in clinical settings and results in safer patient outcomes1-3. DP in simulated settings were integrated into PCCM-I to engage students in skill acquisition. With lab instruction taking place in the CICP, students had several means to engage in DP through a) faculty demonstration of patient-related skills and interventions; b) peer-to-peer collaboration; and c) additional time for supervised practice in the CICP outside of class time. PCCM-I is a first-term course where SOT and SPT students work together in interprofessional learning. The course content covers fundamentals in functional mobility, patient handling, safety, and providing appropriate assistance where needed. Analysis of the number of student logged visits and time spent in the CICP and the number of retakes on practical examinations for bed mobility and transfers was studied. Prior to the development of the CICP for the campus, the number of retakes were numerous and required additional time for faculty to remediate students. With completion of the CICP, students were given the option for supervised practice outside of class time. The number of retakes were tracked in PCCM-I in the terms following the availability for DP in the CICP. Summary of Use: First-term PT and OT cohorts are assessed on practical performance for bed mobility and transfer skills. Prior to the buildout of the CICP, the number of retakes were tracked. Retakes were required due to a number of issues including critical patient safety or not achieving sufficient threshold for minimum competency in the skill or intervention. From the Fall 2014 and Summer 2017, there was an average of 7-8 retakes over the 7 trimesters. The lowest number of retakes was 4 and the highest number of retakes was 12 for any given term. Deliberate practice in simulated settings were highly encouraged after the buildout of the CICP. There was relationship associated with the decreased number of retakes and the number of logged visits and amount of time spent in deliberate practice in the CICP. As a result, the number of required retakes were significantly reduced. In the Fall 2017 term, there were more than 265 logged visits and 3 retakes required. In Spring 2018 there were 347 logged visits and 2 retakes. In Summer 2018 there were 305 logged visits and 8 retakes. Fall 2018 had approximately 325 logged visits and 2 retakes. Spring 2019 had approximately 360 logged visits and 3 retakes. Summer 2019 had 372 logged visits and 7 retakes. The average number of retakes during this time frame was 4 retakes over the 6 trimesters. The lowest number of retakes was 2 and the highest number of retakes was 8 during these terms. Importance to Members: The popularity of simulation, and the need for enhance clinical competencies was evident at the 2019 Combined Sections Meeting. For example, one platform presentation4 was held debating the merits of existing evidence on the effects simulation has on student physical therapist (SPT), and student physical therapist assistant (SPTA), preparedness for acute and critical care settings. In addition, to the aforementioned platform, a second platform presentation4 was held that described the need for improving competency-based education for SPTs and SPTAs. This study will provide some evidence on how well students performed on a practical examination in a basic skills course with the addition deliberate practice in a simulated learning environment. Improvements on practical examination may be one indicator of student preparedness for basic safety principles in an inpatient setting. In addition, although the Commission on Accreditation of Physical Therapy Education (CAPTE) does not equivocate patient simulation with integrated clinical experiences (ICE) for SPTs5 (Commission on Accreditation in Physical Therapy Education [CAPTE], Standard 6E) and SPTAs6 (CAPTE, Standard 6D), CAPTE does support the need for competency-based education for SPTs5 (Standard 4N) and SPTAs6 (Standard 6B). Deliberate practice in a simulated learning environment provides an opportunity for competencies to be checked in a safe place that simulates real-world practice settings. In this regard, simulated learning experiences, are ideal as they do not present the risk to PT and PTA programs, when SPTs and SPTAs practice on real patients. Furthermore, deliberate practice should be of interest as there is some preliminary evidence to show it to be more effective than tutoring7 and to enhance preparedness over traditional simulated experiences alone8. Therefore, this study should be important to SPTs, SPTAs, clinicians, faculty, and accreditors. Recommendations and guidance in current literature supports further pursuits and establishes foundational principles in the utilization of deliberate practice in simulated environments and this emerging aspect in rehabilitation education and best-practices for health-science programs.