Development, implementation, and evaluation of an evidence and simulation-based acute care course focused on affective and clinical decision-making skills
Purpose: Growing use of various modes of simulation in physical therapist (PT) education necessitates further exploration into best use and outcomes of this resource-intensive pedagogy. This educational session will present evidence-based experience on delivering a curriculum that integrates simulation with a focus on developing affective and clinical decision making skills specific to the acute care setting in an efficacious manner. In this session, we will move beyond the excitement of the available bells and whistles of simulation technology, with a focus on achieving essential objectives for the professional level PT student. Difficulties during PT student clinical education experiences occur most frequently in the affective domain, specifically in the acute care setting. The Core Competencies for Entry Level Practice in Acute Care provide guidance for curricular design, but some PT education programs lack specific coursework targeted towards the acute care setting or development of affective skills. To respond to this deficit, a new course was designed for a DPT program to specifically focus on unique challenges students face in the acute care setting including communication, multitasking, and decision making skills. This course was built on current evidence in the use of simulation as a pedagogical approach to effectively deliver content specific to these complex skills and behaviors. The acute care course discussed in this session is part of a larger program of simulated-based learning experiences (SBLEs) threaded throughout a DPT curriculum designed to build affective skills and provide opportunities to develop skills in reflective practice and clinical decision making.Methods and/or Description of Project: Three consecutive cohorts of DPT students were followed to determine the efficacy of the implementation of an evidence-based, simulation-based acute care physical therapy course. The course consisted of introductory lectures followed by 6 weeks of progressively complex SBLEs. High-fidelity simulations were conducted with simulated patients, rather than manikins, along with structured briefing and debriefing sessions and opportunity for documentation. Standardized family and healthcare team members were integrated into each scenario to challenge the students’ affective skills, clinical decision making, and ability to multi-task within the acute care simulation. Debriefings provided opportunity for reflection-on-action, and were structured following evidence based recommendations for objective oriented debriefing with an advocacy + inquiry + curiosity methodology. The first cohort of students served as a control group and did not participate in the course; the second cohort participated in the first iteration of the course, and the third cohort participated in the second iteration of the course. All students completed the Acute Care Confidence Survey (ACCS) prior to and following the semester and again at the midterm of their first full-time clinical education experience in an acute care setting. All students completed the clinical performance instrument (CPI) at both midterm and final points of the clinical experience. Following their clinical experiences, students participated in focus groups that explored their perspectives of the value of the course in preparation for their acute care clinical experience. Modifications were made to the course between the first and second years based upon initial outcomes and student feedback.Results/Outcomes: Students consistently demonstrated increased self-efficacy for acute care clinical practice following the course based upon ACCS outcomes. This increased confidence continued into their clinical experiences. Ongoing analysis of the CPI indicates trends towards advanced clinical performance in the acute care setting following the simulation training. Preliminary thematic analysis indicates that the SBLEs allowed students to be prepared for the unpredictable nature of acute care clinical practice In this session, we will present the results of our ongoing analysis, including an understanding simulation from the student’s perspective, themes from the qualitative analysis, and course modifications implemented based upon student feedback.Conclusions/Relevance to the conference theme: Our Leadership Landscape: Perspectives from the Ground Level to 30,000 Feet: This educational session’s focus on evidence-based delivery of SBLEs with a focus on using this pedagogical approach specific to affective skills development in the acute care setting directly relates to the conference theme of Leading through innovation and simulation. The presenters’ experience in simulation-based learning and clinical education provides a unique perspective from the ground level, understanding the challenges of implementing SBLEs and seeing the big picture of where simulation may best fit into a DPT curriculum targeted towards areas of identified difficulty in PT clinical education. We have taken a proactive response to managing identified difficulties to better prepare students to maximize learning during acute care clinical experiences.References: American Council of Academic Physical Therapy. Strategic Initiative Panels: Final Reports from: Common Terminology Panel Integrated Clinical Education Panel Student Readiness Panel. http://acapt.org/docs/default-source/reports/panel-reports---compiled-for-membership.pdf?sfvrsn=2. Updated 2018. Accessed March 7, 2018. Greenwood K, Nicoloro D, Iversen M. Reliability and validity of the acute care confidence survey: An objective measure to assess students' self-confidence and predict student performance for inpatient clinical experiences. J Acute Care Phys Ther. 2014;5(1):1-10. Greenwood K, Stewart E, Hake M, Mitchell et al. Defining entry-level practice in acute care physical therapist practice. J Acute Care Phys Ther. 2017;8(1):3-10. Lopreiato J. Healthcare simulation dictionary. http://www.ssih.org/dictionary. Updated 2016. Accessed July 21, 2017. Mezirow JA. Fostering Critical Reflection in Adulthood: A Guide for Educators of Adults. San Francisco, CA: Jossey-Bass; 1994. Mori B, Carnahan H, Herold J. Use of simulation learning experiences in physical therapy entry-to-practice curricula: a systematic review. Physiother Can 2015;67:194–202. Ohtake PJ, Lazarus M, Schillo R, Rosen M. Simulation experience enhances physical therapist student confidence for managing a patient in the critical care environment. Phys Ther 2013;93:216–228. Parker B, Myrick F. Transformative learning as a context for human patient simulation. J Nurs Educ. 2010;49:326-332. Rudolph, J. W., Simon, R., Raemer, D. B. and Eppich, W. J. Debriefing as Formative Assessment: Closing Performance Gaps in Medical Education. Academic Emergency Medicine, 2008;15: 1010–1016. Rudolph, J.W., Simon, R., Rivard, P., Dufresne, R., Raemer, D. Debriefing with Good Judgement: Combining Rigorous Feedback with Genuine Inquiry. Anesthesiology Clinics, 2007;25: 361-376. Silberman N, Litwin B, Panzarella K, Fernandez-Fernandez A. High fidelity human simulation improves physical therapist student self- efficacy for acute care clinical practice. J Phys Ther Educ. 2016;30(1):14-24. Silberman N, Litwin B, Panzarella K, Fernandez-Fernandez A. Student clinical performance in acute care enhanced through simulation training. J Acute Care Phys Ther. 2016;7(1):25-36. Silberman N, LaFay V, Hansen RL, Fay P. Physical Therapy Student Difficulty in Clinical Education Settings: Incidence and Outcomes. J Phys Ther Educ. 2018. In Press. Stockert B, Ohtake PJ. A national survey on the use of immersive simulation for interprofessional education in physical therapist education programs. Simul Healthc. 2017;12(5):298-303.Course Objectives: Upon completion of this education session, participants will be able to: 1. Utilize standard terminology in simulation for teaching, education, assessment, and research to enhance communication in healthcare simulations. 2. Discuss current evidence integrating simulation into PT education. 3. Define benefits of SBLEs in preparing students for an acute care clinical experience. 4. Describe strategies to create simulation scenarios that provide opportunity for integration of affective skills, multitasking and clinical decision making. 5. Identify creative ways to utilize resources to efficiently deliver SBLEs.Instructional Methods: The following instructional methods will be used during this educational session: - Lecture/formal presentation - Video presentation of exemplar simulations - Demonstration/Simulation of sample course content including briefing and debriefing - Interactive discussion with attendeesTentative Outline/Schedule: Presentation of background information (10 min) - Establish need for increased instruction in both affective skills and acute care physical therapy. - Present evidence to support simulation as an evidence-based pedagogical approach to address those needs. Discussion on simulation terminology (10 min) - Discussion of importance of using standardized language in simulation - Differences between high and low fidelity simulations - Provide relevant definitions and references Description of course development and learning objectives including: (10 min) - Evidence from current literature - Core competencies for entry level practice in acute care PT - Minimum required skills for entry level PT practice - ACAPT Student readiness task force results - PT Student difficulty in clinical educational incidence and outcomes - Clinician perspectives of PT student learning needs in preparation for clinical experiences Transformative learning theory to support pedagogical choice of simulation to reach learning objectives (10 min) Determining available resources (10 min) - Use of simulated patients versus manikins - Training for educators/facilitators in simulation methodology and debriefing - Resources utilized/recommended Course description: (10 min) - Description of progressive simulations - Structure of each simulation – brief, simulation, debrief, document - Brief discussion on advocacy + inquiry + curiosity debriefing - Feedback from students and lessons learned in the first iteration - Modifications made to the second iteration Video presentation and/or sample simulation (10 min) Present research project outcomes/course assessment (10 min) - Clinical performance ratings - ACCS ratings - Focus group themes Take home messages (10 min) - Objective based learning – what is your greatest need? - What can you teach in simulation that you are struggling with elsewhere in your curriculum? - Integrating affective and clinical decision making skills into SBLEs - How to be creative with your resources - Understanding low fidelity vs. high fidelity and other standard terminology in simulation - How to choose the best mode of simulation for your learning objectives