Students’ Perceptions of Clinical Dilemmas Based on Discussion Board Responses: What Can We Learn?
Purpose
To determine themes related to clinical encounters with patients that created a dilemma for students during long-term clinical rotations, as reflected in their discussion board postings.
Methods/Description
Subjects were entry-level Doctor of Physical Therapy students who graduated in 2013 (n=18), 2014 (n=26), and 2015 (n = 28) who had completed 10 weeks of clinical education prior to this rotation. Procedures: Qualitative analysis was used to analyze individual discussion board responses to the following question: “Share your thoughts regarding a conflict or patient dilemma you’ve had on your clinical rotation. What did you learn? How did you respond?” Data Analysis: QDA Miner 4.0, a qualitative software program, was used to analyze individual discussion board responses. Each response was entered into the program individually. Keywords were identified by the researchers and entered for each theme. The program's keyword retrieval function was used to highlight each code within the responses. Each highlighted item was manually coded with the correct theme. Program analysis revealed frequency and percentage of coded responses.
Results/Outcomes
A total of 72 students (n=26 in the acute care setting, n=26 in the neuro-rehab setting, n= 19 in the outpatient orthopedic setting, and n=1 in women’s health) responded to this question. Dilemmas were categorized as patients’ misunderstandings (14%), poor patient attitudes (18%), patients’ lack of incentive to participate (24%), need for more patient (22%) or family (22%) education.
Conclusions/Relevance to the conference theme: Through the Looking Glass: Transforming Physical Therapy Education
Misunderstandings involved problems that were easily solved. For example, one patient felt she had gotten worse from the last treatment, but after consulting with the student, the patient realized other factors, rather than treatment, led to this conclusion. Listening and open discussion resolved the misunderstandings. Patients’ negative attitude resulted in poor participation and was frustrating for the student physical therapist. Students quickly determined both patient and family education were very important to patient success. Most of the need for patient education involved use of assistive devices. However, family education involved either learning about the patient from the family, educating the family about the patient’s abilities, or explaining the reason therapy was needed, especially in settings where the family was constantly present (e.g., acute care setting). Clinical Relevance: Clinical education is an enlightening learning opportunity for students. Dilemmas occur but are manageable through improved patient-family-health care worker communication and education, which are vital to prevention of misunderstandings.
References
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