Simulating the Acute Care Environment in the Academic Setting: Impact on Student Knowledge, Skills and Behaviors
Purpose: Students struggle making the transition from classroom to clinic especially in the acute care setting where quick clinical decisions combined with complex psychomotor skills are required. Evidence suggests incorporating authentic learning experiences into the PT didactic curriculum can help bridge this gap. The purpose of this report is to describe the impact of embedded experiential learning activities on students’ perceptions of their knowledge, skills and behaviors related to mobilizing a patient in the acute care setting.Methods/Description: Faculty developed 3 lab sessions based on 2 acute care patient cases (S/P CABG; S/P elective THA with urgent stent placement) which were embedded in a cardiopulmonary course. Our musculoskeletal lab was used as an inpatient acute care setting. Some equipment was purchased or already in use by the program and some was homemade. Student learning objectives were to: 1) perform an environmental scan in the acute care setting and recognize potential safety issues, 2) safely mobilize the patient from a hospital bed with multiple lines, tubes and monitoring devices and, 3) recognize changes in physiologic parameters and respond accordingly to ensure patient safety. An 18 question survey consisting of open-ended questions and questions rating the perceived impact (none, minor, moderate, major) of the 3 labs on student knowledge/skills/behaviors on patient related activities was administered to 2nd year DPT (43) students at the conclusion of lab 3.Results/Outcomes: The survey response rate was 65%. The majority of students reported at least a moderate positive impact on bed mobility, transfer and gait training, guarding skills, creating a safe environment, modifying treatment based on patient physiologic response, and perceived self-confidence. Students also indicated the labs had a major effect on their ability to manage multiple lines and tubes, their awareness of monitoring devices and overall patient safety. Responses to open-ended questions revealed students gained a better understanding of equipment use, the need for planning and setting up the environment, the importance of continually assessing monitoring devices, and the need for psychomotor practice. Students commented they were most surprised and challenged by the need for planning and adjusting their plan in the moment, as well as the complexity involved with managing lines and tubes. Upon completion of the labs, students reported their greatest concern was transfer of the lab skills to real patient interactions and overall patient safety.Conclusions/Relevance to the conference theme: Our Leadership Landscape: Perspectives from the Ground Level to 30,000 Feet: Students perceived the labs to be helpful in preparing them to practice in the acute care setting. Although a simulated environment, the lines and tubes labs gave the student additional opportunities to practice mobilizing a patient in a low stakes scenario. Both students and faculty felt the labs were a worthwhile learning activity. Faculty plan to follow up on the impact of this learning activity on the student’s first acute care clinical experience.References: Black L, Jensen GM, Mostrom E, et al. The first year of practice: An investigation of the professional learning and development of promising novice physical therapists. Phys Ther. 2010;90(12):1758-1773. Brueilly KE, Nelson TK, Gravano TN, Kroll P. The effect of early contextual learning on student physical therapists' self-perceived level of clinical preparedness. Acute Care Perspectives. 2009; Fall:6-8. Greenwood KC, Nicoloro D, Iversen MD. 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. Ohtake J, Lazarus M, Schillo R, Rosen M. Simulation experience enhances physical therapist student confidence in managing a patient in the critical care environment. Phys Ther. 2013;93(2):216-228. Silberman NJ, Litwin B, Panzarella KJ, Fernandez-Fernandez A. High fidelity human simulation improves physical therapist student self-efficacy for acute care clinical practice. J Phys Ther Educ. 2015;29(4):14-24.