Building Resilience through Reflection: The Progression of Reflection Skills in Doctoral Physical Therapy Students
Purpose: Clinical reasoning and reflection are skills required for physical therapy (PT) students to become autonomous practitioners.1 Reflection, which involves thinking about, analyzing, and gaining meaning from an experience, may be an effective way to improve students’ clinical reasoning and judgment, reduce clinical errors, and develop expertise.2-5 What pedagogy best develops these skills is unclear, but recent work found that adding external reflection articulation to a case based learning activity promoted improvement in clinical reasoning in second year PT students.1 Authentic learning experiences such as standardized patients (SP) and integrated clinical experiences (ICE) have also been reported to foster the development of psychomotor, communication, and reasoning skills.6-10 Review of videotaped records of a SP encounter may allow students additional opportunities for reflection. The ability to revisit past performance at various points in the curriculum allows students to reflect on current and past levels of clinical skill, providing opportunities to observe personal growth. It may also provide insight into how reflection abilities develop over time. The purpose of this study was to investigate, describe, and compare reflection characteristics observed in a longitudinal sample of Doctoral PT students following a prescribed reflection activity in the first (D1) and third (D3) year.Methods/Description: This study included analysis of two consecutive cohorts (n= 135) of D1 students and one cohort of D3 students (n=68). During the D1 year, students conducted an examination on and instructed a SP in basic mobility. Students then reviewed their videotaped performance using an instructor developed rubric11 and completed a written reflection. During the D3 year, students regraded the video from their D1 year using the same rubric. Students also completed an ICE, graded their current performance on the same rubric, and compared/contrasted the differences between their performance from the D1 to D3 year. Student reflections and rubrics were qualitatively analyzed using an iterative process of coding, categorizing, and analyzing responses using NVivo software.Results/Outcomes: Qualitative analysis suggests that each cohort may exhibit unique characteristics related to reflection.12 Students in the D1 year demonstrated limited depth when self-assessing and frequently used general terms to describe their performance even when provided with structure.11.12 Students in the D3 cohort appeared surprised by their growth, identified previously overlooked errors, and provided more specific performance-based examples. They were able to articulate action plans for personal improvement.Conclusions/Relevance to the conference theme: Our Leadership Landscape: Perspectives from the Ground Level to 30,000 Feet: Better understanding of reflection characteristics unique to student cohorts may provide insight into best teaching practices and curricular development. Providing students with the opportunity to visualize development over time with tangible evidence may facilitate a growth mindset.References: 1. Trommelen R, Karpinski A, & Chauvin S. Impact of Case Based Learning and Reflection on Clinical Reasoning and Reflection Abilities in Physical Therapy Students. Journal of Physical Therapy Education. 2017;31(1):21-30. 2. Greenfield B, Bridges P, Phillips T, Adams E, Bullock D, Davis K, et al. Reflective Narratives by Physical Therapist Students on their early clinical experiences: A deductive and inductive approach. Journal of Physical Therapy Education. 2015; 29(2):21-31. 3. Furze J, Gale J, Black L, Cochran T, & Jensen G. Clinical Reasoning: development of a grading rubric from student assessment. Journal of Physical Therapy Education. 2015;29(3):34-45. 4. Rochmawati E., Wiechula R. Education strategies to foster health professional students' clinical reasoning skills. Nursing and Health Sciences. 2010;12(2):244. 5. Furze J, Black L, Hoffman J, Barr JB, Cochran TM, & Jensen GM. Exploration of students clinical reasoning development in professional physical therapy education. Journal of Physical Therapy Education. 2015;29(3):22-32. 6.Murphy J. Using focused reflection and articulation to promote clinical reasoning; an evidence based teaching strategy. Nurse Education Perspectives. 2004;5:226-231. 7. Levett-Jones TL. Facilitating reflective practice and self-assessment of competence through the use of narratives. Nurse Education in Practice. 2007;7:112-119. 8.Mai J, Stern D, Hollman J, Melzer B, Thiele A, & Rosenthal R. Examining the Impact of an Integrated Clinical Experience (ICE) on Interpersonal Skills Prior to the First, Full Time Clinical Internship: Cool as ICE. Journal of Physical Therapy Education. 2014;28(3):81-97. 9. Hale LS, Lewis DK, Eckert RM, Wilson CM, Smith BS. Standardized patients and multidisciplinary classroom instruction for physical therapist students to improve interviewing skills and attitudes about diabetes. Journal of Physical Therapy Education. 2006;20(1):22-27. 10. Silberman NJ, Panzarella KJ, Melzer BA. Using human simulation to prepare students for acute care clinical practice. Journal of Allied Health. 2013;42(1):25-32. 11. Broggi M, Wall T, Wetherbee E, Ferrero S, Cusson M. Patterns of Physical Therapy Students Behaviors During a First Standardized Patient Experience. Poster presented at: Educational Leadership Conference, October 2-4, 2015; Baltimore MD 12. Broggi M, Wall T. Development of clinical reflection skills in physical therapy students: a curricular thread. Poster presented at: Clinical Reasoning Symposium. July 2017; Omaha Nebraska