Alternating Integrated and Full-Time Clinical Experiences is Associated with Increased Self-Assessed Clinical Reflection and Reasoning in Doctorate of Physical Therapy Students.
Purpose: Clinical reflection and reasoning (CRR) is a key educational domain for physical therapy curricula and a core competency for entry level practitioners. Although curricular models aimed to enhance and quantify CRR vary widely, the influence of clinical education is consistent. Notably, an integrated clinical experience has been suggested to enhance CRR by offering a clinical learning environment with concurrent didactic coursework. This is in contrast to a full-time clinical experience where students complete a six to twelve-week rotation solely in the clinical environment, which is also suggested to have positive implications for CRR development. Investigations examining self-reported changes in CRR that alternate integrated and full-time clinical experiences are limited. As a result, we hypothesize that alternating integrated and full-time clinical experiences will demonstrate increased self-reported CRR, as measured by the Self-Assessment of Clinical Reflection and Reasoning (SACRR), in doctorate of physical therapy students (DPTs).Methods/Description: The reliable and valid SACRR was administered to 45 voluntary DPTs in the middle of their second (SACRRPre) and third year (SACRRPost) of training. Between SACRRPre and SACRRPost testing, students alternated between two 8-week integrated rotations involving a faculty led pro-bono clinic experience and concurrent problem-based learning coursework with two 10-week full-time clinical rotations. The SACRR is a 26 closed-ended item survey, scored on a 5-point Likert scale from “strongly agree” (5) to “strongly disagree” (1). The SACRR provides an overall score, and four subsection scores including; “Knowledge/Theory Application”, “Decision Making Based on Evidence”, “Dealing with Uncertainty” and “Self- Reflection and Reasoning”. Paired t-tests were used to examine SACRRPre and SACRRPost overall and subsection scores. Significance for all statistical tests was accepted at p<0.05.Results/Outcomes: All data are presented as means ± SD. Alternating integrated and full-time clinical experiences demonstrated significant improvements in SACRR overall score (SACRRPre=102.3 ± 8.2; SACRRPost= 108.3 ± 8.3; p<0.001). Further, all subsection scores including “Knowledge/Theory Application” (SACRRPre=18.9 ± 2.5; SACRRPost=20.4 ± 2.5; p<0.01), “Decision Making Based on Evidence” (SACRRPre=39.7 ± 3.5; SACRRPost=41.6 ± 3.2; p<0.001), “Dealing with Uncertainty” (SACRRPre=26.9 ± 2.9; SACRRPost=28.9 ± 2.3; p<0.001), and “Self-Reflection and Reasoning” (SACRRPre=16.8 ± 1.6; SACRRPost= 17.4±1.8; p<0.05) demonstrated significant improvements upon post testing.Conclusions/Relevance to the conference theme: Our Leadership Landscape: Perspectives from the Ground Level to 30,000 Feet: Alternating integrated and full-time clinical experiences demonstrate an increase in self-reported CRR, as measured by SACRR overall and subsection scores, in DPTs entering their final year of entry level training. Monitoring the impact of curricular design choices on self-reported CRR may enhance the ability of physical therapy educators to foster improved cognitive and psychomotor skills.References: Christensen N, Black L, Furze J, Huhn K, Vendrely A, Wainwright S. (2017) “Clinical reasoning: survey of teaching methods, integration, and assessment in entry-level physical therapist academic education.” Phys Ther. 97(2):175-186. Coker, P. (2010). "Effects of an experiential learning program on the clinical reasoning and critical thinking skills of occupational therapy students." J Allied Health. 39(4): 280-286. Baker, S. E., et al. (2017). "Systematic Clinical Reasoning in Physical Therapy (SCRIPT): Tool for the Purposeful Practice of Clinical Reasoning in Orthopedic Manual Physical Therapy." Phys Ther. 97(1):61-70. Holdar, U., et al. (2013). "Why do we do as we do? Factors influencing clinical reasoning and decision-making among physiotherapists in an acute setting." Physiother Res Int. 18(4): 220-229. Seif, G., et al. (2014). "The development of clinical reasoning and interprofessional behaviors: service-learning at a student-run free clinic." J Interprof Care 28(6): 559-564. Engelhard C, McCallum C. (2015). “A description of current curricular design models used in physical therapy clinical education and their relationship to pass rate on the national physical therapy examination.” IJAHSP; 13(4). Scaffa, M. E. and T. M. Smith (2004). "Effects of Level II Fieldwork on Clinical Reasoning in Occupational Therapy." Occup Ther Health Care. 18(1-2): 31-38.