Response of Physical Therapy Faculty to Students' Affective Domain Behaviors That Influence Clinical Reasoning
Physical therapistsÕ (PTs) clinical reasoning (CR) incorporates cognitive, affective, and psychomotor behaviors to gather and interpret data; make hypotheses or recognize patterns and illness scripts; and collaborate with patients/clients and the health care team. Clinical and academic faculty address concerns about studentsÕ affective domain behaviors less often than concerns in other domains; unaddressed problems are likely to continue. The purpose of this qualitative study was to explore facultyÕs responses to studentsÕ affective domain behaviors influencing CR. The research questions for this portion of the study were: 1) How did faculty respond to studentsÕ affective behaviors? 2) What factors influenced facultyÕs responses? 3) What have faculty learned by addressing studentsÕ affective behaviors?
A trained facilitator using a semi-structured interview guide gathered data through core and associated faculty focus groups. Discussions were recorded and transcribed for analysis with constant-comparative methods using NVivo¨ software. We compared individually coded transcripts to develop defined codes. Data from coded transcripts were gathered into categories which led to development of themes.
Participants represented 6 Doctor of Physical Therapy (DPT) education programs and over 10 areas of PT practice. Full-time academic service for core faculty (6 men; 19 women) ranged from <1 to >10 years; associated facultyÕs (1 man; 7 women) academic service ranged from 2 to >10 years. Faculty observed affective domain behaviors impacting development of CR during all years of DPT education, in interactions with patients, faculty, and classmates, and in clinical and classroom settings. The following themes were identified: ¥ÊFaculty described the emotional responses they experienced and actions taken in response to studentsÕ affective behaviors. Actions included: providing written or verbal feedback; providing verbal reassurance and/or guidance; altering activities to foster studentsÕ success; referring students to other resources; discussing with colleagues; and removing students from patient care. ¥ÊReflection-in-action informed facultyÕs decision-making and response to events. Learning through reflection-on-action informed future decisions and improved confidence to act. ¥ÊThe immediate context of the behavior, facultyÕs personal and professional values, and their beliefs about learning significantly influenced responses. ¥ÊFaculty reported learning that: affective behaviors are critical to clinical success; inappropriate behaviors must be addressed when they are initially observed; affective domain behaviors can be taught and learned; and studentsÕ academic performance does not predict their affective capabilities. ¥ÊFaculty reported that addressing inappropriate affective behaviors is uncomfortable, requires significant time and emotional energy, and the optimal response isnÕt always apparent; however, addressing studentsÕ affective behaviors can lead to rewarding outcomes for students and faculty.
Conclusions/Relevance to the conference theme:
Promoting patient-centered physical therapy care requires all faculty to foster studentsÕ development in the cognitive, psychomotor, and affective domains. In this study, both core and associated faculty reported similar experiences when addressing studentsÕ affective behaviors influencing CR. Reflection in- and on-action underlays facultyÕs ability to address problematic affective behaviors and to learn from their experiences. Addressing problematic behaviors can be rewarding despite the time and emotional energy required.