Ready or Not? Using Simulation to Assess Core Competencies Prior to the First Clinical Experience
Purpose:
The PT profession is moving towards developing a standardized framework that delineates essential student performance competencies recommended prior to full-time clinical experiences. A recent Delphi study published in Physical Therapy by Timmerberg, Dole, Silberman, et. al,identified essential knowledge, skills, attitudes (KSA’s) and professional behaviors that students should possess prior to immersion in their first full-time clinical experience.
Simulation provides students across health professions with formative learning opportunities to perform, and receive feedback on, communication and professional skills in real-life applications. This academic PT education program has used extended student- patient encounters for over a decade to assess student readiness for upcoming full-time clinical education experiences. Three years ago the Gap-Kalamazoo Communication Skills Assessment Form (GKCSAF) was embedded as a validated tool to support the development of professional communication skills.
The purpose of this educational session is to describe how one PT education program is currently using simulation to assess student ability to demonstrate essential KSAs to ensure readiness for a first-time clinical experience. Strengths and gaps in performance in communication abilities, self-assessment, receipt and use of constructive feedback, and a readiness to engage in learning inform next steps in student professional development before full-time clinical experiences.
Methods and/or Description of Project:
The Integrated Standardized Patient Examination (ISPE) takes place following three academic semesters of didactic coursework, prior to the students’ first full-time clinical experience. This examination allows the student to gather history information, conduct a brief and limited physical examination, to demonstrate essential skills (goniometric measurement, gait training and instruction in a therapeutic exercise) and to provide patient education in response to questions posed. The student-patient encounter is observed and assessed real-time by an academic faculty member and a clinical instructor (CI) using rubrics to guide their observations. The GKCSAF is completed by the CI, the standardized patient (SP) and the student following the patient interaction. The academic faculty complete a more detailed assessment focused on eliciting specific information during the history and performing foundational skills and interventions. After completion of these rubrics and following discussion between academic faculty and CI who observed the student-patient encounter, the CI engages in a dialogue with the student to assess their self-assessment and clinical reasoning skills.
In order to determine the efficacy in use of the ISPE to determine student readiness for a first-time clinical experience the ISPE rubrics (CI, SP, academic faculty member and student) and related assessment activities were compared with each of the themes and the KSAs described in the Delphi student readiness study. Student performance on the first year ISPE follow-up activities (created to support gaps in performance and/or an intentional focus for continued growth), and student performance on the first clinical experience in 2016-2018 were analyzed to determine a possible relationship between lessons learned from participation in the ISPE and readiness for a first clinical experience.
Results/Outcomes:
The items in the ISPE rubrics and related assessment activities corresponded to all but one of the fourteen themes and most of the elements identified in the Delphi study. The only theme not directly assessed was documentation. For all other themes students were assessed using 2-5 assessment tools used in the ISPE.
Between 2016 and 2019 in addition to routine ISPE activities, 20% or more of each cohort have participated in individualized meetings with AF (to discuss gaps in communication and interpersonal skills), small group skills remediation sessions (for example, performance of goniometry, performance of mobility skills, selection and performance of therapeutic exercises) and re-takes of the ISPE. Review of student written reflections post-ISPE and related activities conveyed student perceptions of their own strengths, gaps, and identification of areas to incorporate or refine during their upcoming clinical experience. Communication and interpersonal skills were a focus of the vast majority of the personal self-assessments.
All students demonstrated competence at or above expected level of competence during their Clinic I experience and there were no “surprises” on site visits with regards to new identification of gaps in KSA’s or professional behaviors.
Conclusions/Relevance to the conference theme:
This session will address the intersection of competency-based education and simulation under the umbrella theme, Charting a New Course.
A simulated standardized patient examination has proven to be a successful mechanism to assess essential KSAs and professional behaviors of students prior to their first full-time clinical experience. Furthermore, the ISPE process appears to not only assess student readiness but also to further prepare students for their first-time clinical experiences by improving their metacognitive and reflective abilities. The ISPE process includes assessments, self-reflections, and remediation activities that prompt such behaviors and lead to development of goals for an upcoming clinical experience. Engagement of clinicians as partners in this activity promotes student and CI readiness for participation in full-time clinical education experiences.