Choose-Your-Own-PT-Adventure: LMS Embedded Low-Stakes Simulation Approach to Teach Early Clinical Decision Making
Purpose
Early in physical therapy education programs, students must learn psychomotor skills along with concurrent clinical decision-making; both of which require very new styles of learning. LMS-embedded evidence-based Choose-Your-Own-PT-Adventure patient cases allow students to authentically practice skills, foster exploration and decision-making in a low-stakes environment, encourage peer mentorship, and remove authoritative oversight of the learning process. Working with the patient cases has led to self-agency, innovation, and risk taking in our students as early as the first semester of our program.
Methods/Description:
Patient cases are based on the ÒChoose-Your-Own-AdventureÓ book series with an unfolding story line. In these books, the reader is given a brief part of the plot, and then picks from a couple of alternatives to read the rest of the story. This process is repeated until the reader gets to one of the endings. One can read the book several times, making different choices, and getting essentially a different story. The patient cases are designed in a similar way to allow students to be curious about their patient, and to collect examination information in any order they want in a no-stakes fashion. They can also go through a case as many times as they choose, picking different tests each time to see how they could make their data collection more efficient. In this manner, they are allowed to ÔfailÕ (i.e., pick less important tests) in a safe environment. To begin, students are provided a brief patient scenario, and then work in groups to develop a hypothesis about the affected structure in their virtual patient. Next, they enter the Òchoose-your-own-PT-adventureÓ posted on the course learning management system (LMS) to collect palpation, range of motion, muscle length testing, and strength testing information to test their hypothesis. For each test, students receive results and a short narrative explaining the value of the information gathered to assist in determining the PT diagnosis for the patient. The students then create a list of tests that provided the most information (highest priority) and create an order in which the tests could be most efficiently performed. They also synthesize the information to determine the structure(s) most likely affected in the patient, and the functional consequences of that deficit. Finally, they create a video of one student in the group acting as the student physical therapist performing the series of tests on a patient (another student) with the third student recording the interaction. Groups then perform a peer review of another groupÕs video to provide feedback and learn from one another.
Results/Outcomes:
At the end of the course each year, students complete an anonymous survey assessing the extent to which working on the Choose-Your-Own-PT-Adventure cases lead to achievement of desired outcomes, which include: 1. Developing hypotheses regarding disorder / dysfunction based on applied anatomy, 2. Selecting correct tests and measures based on stated hypotheses, 3. Integrating findings from tests and measures to determine the involved structure, and 4. Physically performing selected tests to improve psychomotor skills and gain an appreciation of physical exam sequencing. Consistently across cohorts, the median score for all outcomes was Ôstrongly agreeÕ. Subjectively, students commented that these cases made clinical application more apparent, and provided a sense of direction. Students frequently reported that they appreciated the ability to practice their problem-solving skills. These patient simulation cases provided immediate feedback to students regarding their choices of tests, and they found this process decreased overall stress.
Conclusions/Relevance to the conference theme:
These outside-of-class LMS-embedded simulated patient cases allowed students to develop an independent thought process in a safe, supported manner in a way that could have never been achieved in the classroom. While the example presented here relates to the physical therapy exam, this technology / model could be used for a number of different patient interactions for both student physical therapists and student physical therapist assistants. Early clinical decision-making approaches such as these can facilitate Òa culture of patient-centered care in physical therapy educationÓ.