Use of Quantitative Measures for Doctorate of Physical Therapy Program Assessment and Development of Critical Thinking
Purpose: Due to its importance in physical therapy (PT) practice, the American Physical Therapy Association has called for advances in curricular design targeting the development of critical thinking (CT) and clinical reasoning (CR). Although validated and reliable measures of CT have been identified and used in PT educational research, studies quantifying CT and CR to drive program development and curricular change are limited. One Midwest public university is undertaking a longitudinal study to measure components of CR within a doctorate of physical therapy (DPT) program to assess, inform progressive change, and reevaluate the effectiveness of teaching strategies within the curriculum.Methods/Description: CT and self-reflection are consistently identified as key components of CR. To inform both aspects, the California Critical Thinking Skills Test (CCTST) and Self-Assessment of Clinical Reflection and Reasoning (SACRR) survey were utilized to identify strengths and weaknesses among students in each cohort, as well as progression of skill development. Additionally, traditional metrics of student assessment, graduate Grade Point Average and National Physical Therapy Examination scores, were included in the curricular evaluation process. Faculty feedback regarding the implementation process was obtained.Results/Outcomes: CT and CR acquisition, using the CCTST and SACRR, were measured at baseline prior to curricular changes. Despite maturation of academic and clinical experiences, shared challenges were seen across cohorts, indicating the need for targeted intervention. Additionally, CT skill growth was not as robust as hypothesized. Analysis of the existing CT teaching process identified an immersion approach with skills integrated into traditional subject matter. Faculty transitioned to an explicit mixed-model approach which communicates principles of CT prior to and alongside subject matter. Evidence-based teaching strategies included one-on-one faculty training sessions, a faculty training toolkit, use of shared CT language amongst faculty and students, and new in-class teaching techniques and online modules. To focus specific teaching and learning strategies, faculty were informed of the identified strengths and weaknesses. Faculty feedback was used to determine varied techniques utilized and ease of application. Results demonstrate that early intervention can significantly improve emphasized areas of weakness, overall CT skills, and percentile-rank amongst other heath science graduate students. Furthermore, faculty reported minimal difficulty employing the new strategies.Conclusions/Relevance to the conference theme: Our Leadership Landscape: Perspectives from the Ground Level to 30,000 Feet: Educators may feel that CR is difficult to assess and therefore, are challenged to monitor curricular influence. By systematically measuring CT and self-reflective behavior, the impact of andragogical shifts can be effectively evaluated. This institution offers an approach to quantitatively assess curricular design aimed at ultimately improving student CT and CR acquisition through targeted intervention strategies.References: Bartlett DJ, Cox PD. Measuring change in students’ critical thinking ability: implications for health care education. J Allied Health. 2002; 31(2): 64-69. Brudvig TJ, Mattson DJ, Guarino AJ. Critical thinking skills and learning styles in entry-level doctor of physical therapy students. J Phys Ther Educ. 2016; 30(4): 3-10. Dasari, B.D. (2006) Evaluation of clinical reflection and reasoning skills in undergraduate occupational therapy students. In, 14th Congress of the World Federation of Occupational Therapists, Sydney Australia, 23-28 Jul 2006. Facione PA. Critical Thinking: A Statement of Expert Consensus for the Purposes of Educational Assessment and Instruction. Research Findings and Recommendations. Newark, DE: American Philosophy Society; 1990. Pg. 3. Facione N, Blohm S, Howard K, Giancarlo C. California Critical Thinking Test: User Manual and Resource Guide (Revised). Millbrae, CA: California Academic Press. 2016. 1-85. Gilland, S. and Wainwright, S.F. (2017)“Patterns of clinical reasoning in physical therapist students.” Phys Ther. March 24. doi: 10.1093/ptj/pzx028. [Epub ahead of print] Gwyer, J. Hack LM. The continuing conversation on educational research in physical therapy. J Phys Ther Educ. 2016; 30(2): 5. 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. Huang G, Newman LR, Schwartzstein RM. Critical thinking in health professions education: summary consensus statements of the millennium conference 2011. Teach Learn Med. 2014; 26(1): 95-102. Zettergren KK. Changes in critical thinking scores: an examination of one group of physical therapist students. J Phys Ther Educ. 2004; 18(2): 73-79.