Simulated Patients as an Instructional Tool for Novice Physical Therapist Student Clinical Reasoning and Confidence
Purpose: The purpose of this study is to compare the modalities of simulation-based instruction, simulated patients (SPs) versus traditional peer role-play, on physical therapist students’ clinical reasoning during patient transfers and their confidence in performing acute care skills.Methods/Description: The design of this study is a randomized, experimental posttest-only design. IRB approval was obtained. Participants included 59 first-year physical therapist students enrolled in a DPT program in the southeast. Participants were randomly assigned to practicing patient transfer skills with SPs or peers during two, two-hour lab sessions. The instructional sessions interweaved simulation-based training guidelines and experiential learning theory. Outcome data were collected during a simulation experience using the Think Aloud Standardized Patient Examination (TASPE) and the Acute Care Confidence Survey (ACCS).Results/Outcomes: There was no statistically significant difference between the two groups for clinical reasoning (p = .17) and confidence (p = .96) using independent-samples t-tests. In other words, the students in the group receiving simulation-based instruction using SPs did not score significantly different on the TASPE or the ACCS than the peer role-play group.The TASPE was reliable for scoring among three examiners blinded to the treatment groups (r= .86, p < .0001). The ACCS yielded high internal consistency (Cronbach's alpha = .91).Conclusions/Relevance to the conference theme: Our Leadership Landscape: Perspectives from the Ground Level to 30,000 Feet: Based on the results of this study, low-fidelity, e.g., peer role-play, methods as compared to high-fidelity simulation, e.g. SP, appeared to be similar in its effect, and the former should continue to be considered by programs as it is often less costly. Results of this study support the use of simulation-based instruction as a viable instructional strategy as both groups demonstrated the ability to clinically reason during a standardized patient simulated experience and confidence in performing patient transfer skills in the future. Findings from this study can be used to help guide potential design of simulation-based instruction in entry-level PTE programs for preparation of clinical practice by ensuring the element of reflection or debriefing is included within the instruction or follows a simulated learning experience. Also, it is important to consider the expense of using simulation when designing instruction. When instructing foundational clinical skills such as patient transfer skills, it may be more beneficial financially to consider low-fidelity simulation such as peer role-play to bridge the gap between knowledge and practice than compared to higher-level cognitive and clinical tasks, such as deciding when to perform CPR on a patient with decreased responsiveness, not addressed within this study.References: 1. Nithman, R. W., Spiegel, J. J., & Lorello, D. (2016). Effect of high-fidelity ICU simulation on a physical therapy student's perceived readiness for clinical education. 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