Behind the Curtain: Enhancing Clinical Reasoning through Effective Clinical Mentoring in Acute Care Practice
Purpose
Multiple consensus-based and peer-reviewed documents have been developed to describe acute care practice expectations along the continuum from entry-level practice through advanced practice, yet clinicians, educators, and students may not be prepared for clinical experiences, residencies, or fellowships where they treat acutely or critically ill patients.
Methods and/or Description of Project
Edwards et al, developed a model of clinical reasoning in physical therapy that describes both a diagnostic and narrative reasoning process for physical therapists. The diagnostic reasoning portion of this model is more familiar to practicing therapists where clinical reasoning strategies are directed toward the identification of the patient’s diagnosis, prognosis, and interventions. Less familiar is the narrative reasoning strategies whose outcomes are directed at the therapist’s communications with all involved parties. The application of these strategies during a clinical internship to develop clinical reasoning skills is key in managing the learning environment. Interprofessional communication strategies focusing on enhancing patient safety and quality care such as SBAR and other TeamSTEPPS tools exist but these tools may have applications to mentoring students especially in acute care settings.
Results/Outcomes
Translation of knowledge into skillful practice resulting in effective clinical mentoring which facilitates and enhances clinical reasoning in the fast-paced, dynamic acute care population can be challenging for clinical instructors. This course will provide participants within acute care practice, specific strategies to effectively and efficiently structure learning experiences during internships, to promote effective clinical reasoning skills and appropriate interprofessional interactions.
Conclusions/Relevance to the conference theme: Through the Looking Glass: Transforming Physical Therapy Education
Training of students in acute care practice requires the application of clinical reasoning skills within the context of effective and efficient clinical mentoring in the dynamic, fast-paced nature of the setting. It is imperative that clinical instructors know how to utilize interprofessional communication tools to facilitate patient-centered, safe, quality plans of care. This course will provide clinical instructors in acute care with current evidence-based interprofessional communication tools and a clinical reasoning framework in order to organize clinical mentoring sessions in such a way to transform acute care clinical education teaching.
References
Atkinson HL, Nixon-Cave K. A tool for clinical reasoning and reflection using the International Classification of Functioning, Disability and Health (ICF) framework and patient management model. Phys Ther. 2011;91:416–430
Greenfield BH, Bridges PH, Hoy S, Metzger R, Obuaya G, Resutek L. Exploring experienced clinical instructors’ experiences in physical therapist clinical education: a phenomenological study. J Phys Ther Edu. 2012; 26(3):40-47.
Gilliland S. Physical therapist students’ development of diagnostic reasoning: a longitudinal study. J Phys Ther Edu. 2017; 31(1) 31-48.
Housel N, Gandy J, Edmondson D. Clinical instructor credentialing and student assessment of clinical instructor effectiveness. J Phys Ther Edu. 2010;24(2)26-34.
Buccieri KM, Pivko SE, Olzenak DL. How does a physical therapist acquire the skills of an expert clinical instructor? J Phys Ther Edu. 2011;25(2)17-25. American Physical Therapy Association. The Physical Therapy Clinical Instructor Educator Credentialing Manual. Alexandria, VA: American Physical Therapy Association; 2012.
Greenwood K, Stewart E, Milton E, Hake M, Mitchell L, Sanders B. The core competencies for entry-level practice in acute care physical therapy. Acute Care Section-APTA website. http://c.ymcdn.com/sites/www.acutept.org/resource/resmgr/Core_Competencies_of_Entry-L.pdf Published December 7, 2015. Accessed March 7, 2016.
Gorman SL, Ryan JM. How clinical reasoning can and should impact interprofessional communication to address behaviors that hinder acute care practice. J Acute Care Phys Ther. 2014;5(1):18-29.
Gorman SL, Wruble Hakim E, Johnson-Pugh W, Basu S, Harris KS, Christ MH, Holtgrefe K, Rush J, Simpson MS, Bryan Coe J. Nationwide acute care physical therapy practice analysis: knowledge, skills and behaviors reflective of acute care specialized practice. Phys Ther. 2010:10(90);1453-1467.
TeamSTEPPS®: Strategies and Tools to Enhance Performance and Patient Safety. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/index.html.Updated September 2015. Accessed March 7, 2016.
Course Objectives
Upon completion of this course, you will be able to:
1. Apply the diagnostic and narrative clinical reasoning model to simulated clinical mentoring case studies within the acute care setting.
2. Effectively create and manage student, resident, and fellow experiences at various levels of learning in the acute care setting to improve interprofessional skills related to patient safety and quality of care.
3. Appropriately apply the communication strategies discussed in the APTA credentialing course and in TeamSTEPPS in the acute care setting.
4. Discuss efficient and effective methods for modeling clinical reasoning and reflection to facilitate learning in the acute care clinical environment.
Instructional Methods
Teaching Method: Small Group Discussions
Assessment of Learning: Practical Application, Small Group Discussion
Tentative Outline/Schedule
Introduction & Background (5 minutes) Erin Thomas
Current Clinical Educational Practice Related to the APTA Credentialing Program (15 minutes) Tonya Apke
Review of TeamSTEPPS and SBAR Communication Strategies and Application to Clinical Mentoring and Clinical Reasoning (15 minutes) Sharon Gorman
Small Group Vignettes (illustrating specific acute care mentoring & learning issues with problem solving discussion to use concepts/techniques discussed, minimum of 2 for 20 minutes each, 40 minutes total) All presenters
Q & A (10 minutes) All presenters
Wrap up (5 minutes) All Presenters