Using Simulated Patients to Develop Physical Therapy Student Abilities in Patients with Integument Issues
Background and Purpose:
Patients seek physical therapy (PT) for functional issues that at first glance present as a deficit in motor control or a neuromusculoskeletal dysfunction. However, breakdown within the integumentary system related to chronic disease can also contribute to activity limitations. In PT education, creating student learning activities to develop knowledge, skills, and behaviors (KSBs) along with critical thinking and reasoning abilities for when treating patients with multisystem conditions is important for clinical readiness. While doctor of physical therapy (DPT) students receive feedback on their KSBs from academic faculty during paper-based case studies and in laboratory settings, working directly with standardized patients (SPs) provides additional real-time performance feedback. The purpose of this case reports is to identify how faculty developed and implemented a unique simulation event for second year DPT student using SPs to illustrate how the integumentary system can affect human movement function. Faculty collected assessments of KSBs associated with participation in this event.
Case Description:
For the last outcome of a 2-credit course concentrating on the diagnosis and management of integumentary system conditions, faculty worked with the school’s simulation team to create a focused, case-based scenario for pairs of students to collaboratively execute aspects of the patient/client management model within a 1.10 hour long session with SPs. Diverse SPs recruited represented a population who reasonably could have both Diabetes Mellitus-Type 2 and Coronary Heart Disease. Faculty provided SPs with a script that detailed the medical and physical issues as well as the chief complaints in advance. On the day of the event, the SPs were coached in all aspects of the case, instructed on the written student feedback tool, and had a moulage representing a small diabetic ulcer placed on the plantar aspect of the foot, which was covered by footwear. For the student experience, one day before each had written instructions that included an outline of the patient’s basic health and medical information, and the reason for seeking PT care: balance and fall issues. Faculty mocked up a standard form consistent with the patient/client management model for use during and after the event. During the SP encounter, the first of two-person student team engaged in a twenty-minute focused patient history and screening examination, while the second student collected additional tests and measures across major body systems. The SPs completed their written behavioral feedback after each student completed their activities. Next, the team delivered to the SP a plan of care that included patient education. Verbal feedback by the SP directly to the pair concluded the learning event. Subsequently, students were directed to submit individual peer assessments, personal reflections, and a team-written SOAP note of their patient encounter.
Outcomes:
Thirty-six students participated in this event and completed the assignment. Students rated this event as one of the program’s best simulation experiences and marked the experience as strongly meeting the course and session objectives. Students reported that the use of a templated form with the patient/client management model provided an excellent framework to guide them. Participating faculty and students alike strongly felt examination skill performance was sound but detected that there were challenges in test selection and organization within the data collection time. Peer assessments concurred with personal perceptions. More than 75% of the students noted that they initially focused more on their need to complete the tasks assigned than to listening to the patient’s concerns and questions. The majority of the students reported initially not considering an impairment in the integumentary system as a contributing source even with the patient’s medical history. Most students noted that applying sound sterile techniques and general infection control throughout the session and more time to verify patient understanding when providing education were the skills they most needed to improve. All students concurred with SP written feedback on professional behaviors as well as their verbal and non-verbal communication skills. Students appreciated that the oral feedback provided an interactive opportunity for the SP and student team to revisit select aspects of the experience and engage in active learning and remediation unique to the simulation.
Discussion:
Incorporating SPs within a simulation event allowed 2nd year DPT students to work through the case differently than if the task was in a paper-only format. Students were challenged to apply knowledge of the medical conditions, assess the patient’s status, and perform the examinations and interventions within a limited timeframe, and consider how different systems contribute to functional abilities. Having SPs immediately provide written and verbal feedback helped students address interpersonal communication and accept advice for performance improvement. Summarizing the experience through a submitted assignment allowed students to reflect on strengths and areas to improve. This case study indicates further research is needed to determine the extent simulation can assist in meeting curricular outcomes that aim to increase student KSB competency in the presence of multi-system interactions that includes a deficit in the integumentary system.