Karen Huhn

Demonstration of a web-based patient simulation program for use in Allied Health Education Programs
 Session III, Friday 8:00 - 9:00

Biography

Karen Huhn, PT MS has been a physical therapist for 19 years. She is a member of the Technology Task Force of the American Physical Therapy Association. She is currently a faculty member in the Doctor of Physical Therapy Program at the University of Medicine and Dentistry of New Jersey where she is also a doctoral candidate. Her doctoral research is on using a web-based patient simulation program to teach clinical reasoning skills to physical therapy students.

Abstract

Clinical reasoning is an integral skill required for effective physical therapy practice. Research has identified significant practice in real patient situations as a key factor in developing clinical reasoning skills. Limitations of current educational tools require the development and evaluation of new educational strategies to promote clinical reasoning skills. Web-based patient simulation programs have been used successfully in other fields but have not yet been developed or tested for physical therapy education. This paper describes the development, feasibility and pilot testing of a web-based patient simulation program for physical therapy education.

Summary Statement: This presentation will demonstrate a web-based patient simulation program appropriate for use in Allied Health Education Programs. The design process as well as feasibility and integration into an all ready existing course will be discussed. Data regarding student satisfaction and efficacy will also be presented. Description of Project: The terms clinical reasoning, clinical decision making and critical thinking have been used interchangeably in the literature with each being used to describe the process of gathering information in order to solve a clinical problem. Physical therapy educators are charged with the daunting task of helping students develop effective and efficient clinical reasoning skills.

Currently, students are exposed to patient scenarios through paper and pencil cases and their brief clinical experiences. Each of these methods has their limitations. Paper and pencil cases typically require the information be provided to the students rather than them having to find it themselves thereby limiting the amount of reasoning required of the students. Clinical experiences are generally limited to three 8-12 week experiences and have the added concern of patient safety issues. Medical, dental and nursing educators have used computerized patient simulations to provide students with realistic patient situations without putting patients at risk (Bryce, King, Jeremy, & Myers, 1997; Di Giulio, Fregonese, Casetti, Cestari, & Chilovi, 2004; Fouad, 1999; Hayes, 1996; Sakowski, 2001). These simulations have been found to be at least as effective as conventional methods of instruction and in some case a more efficient method of learning (Fouad, 1999; Sakowski, 2001).

To date, there have been no studies evaluating the effectiveness of computerized patient simulations in physical therapy education. In order to assess the efficacy and efficiency of web-based patient simulation programs to teach clinical reasoning skills to physical therapy students, an all ready existing web-based patient simulation program was modified to meet the needs of physical therapy education. In partnership with DxR Development Group, the creators of DxR Clinician, changes were made to the original template to be consistent with physical therapy practice. Major modifications included the addition of a Test and Measures category, a Functional Mobility category and a physical therapy intervention category.

Additional changes included modification to the scoring paradigm to allow for assessment of goals and intervention choices. A focus group of four students and five faculty members completed a sample case using the modified physical therapy template. Based on feedback received from this group minor modifications were made to the program and technical issues with the intervention category were resolved. To assess the feasibility of integrating the software into an all ready existing course, a class of forty-five students was asked to complete a case as part of a course entitled Clinical Inquiry I. Prior to completing the DxR case, students participated in an instructional session that provided them with an overview of the program as well as how to navigate through a case. Two weeks after the instructional session, the students met as a class in a computer lab and completed a single DxR case. Subjects completed a satisfaction questionnaire that assessed their preference for using computers to learn as well as their thoughts on the interface of the program, ease of use of the program and desire to use more web-based simulations. Despite a technical issue, student satisfaction with the program was high with several requesting additional cases and the majority reporting a preference for learning with computers. Based on the results of the feasibility study it was decided to proceed with a pilot study.

Traditionally, in a course entitled Therapeutic Exercise, students complete a series of facilitator led text-based cases in small groups of 7-9 students. For the purposes of this study, the class was randomly divided into two groups; one completed three cases using the traditional text-based cases and the other completed three DxR web-based simulation cases. The content of the cases were kept consistent with only the delivery method varied.

Three outcome measures were used. The Health Science Reasoning test (HSRT) was chosen as an outcome measure as it was specifically designed to test critical thinking skills of allied health students. The HSRT provides an overall quantitative score of clinical reasoning skills as well as five sub-scale scores for Analysis, Evaluation, Inference and Inductive and Deductive reasoning. Analysis as used on the HSRT is the students’ ability to comprehend and express the meaning or significance of a wide variety of experiences while Evaluation is the students’ ability to state the results of one ones reasoning. The Inference sub-scale measures the students’ ability to identify and secure elements needed to draw reasonable conclusions. The Deductive Reasoning sub-scale measures the students’ ability to determine when the assumed truth of the premises necessitates the truth of the conclusions and Inductive Reasoning measures the student’s ability to determine when the arguments conclusion is warranted but not necessitated (Facione, 2007).

A second outcome was time on task. Time to complete the text-based cases was monitored by the facilitator and the software provided time to complete a case as part of the scoring system. Time spent will be correlated to performance scores to provide data on efficiency of learning. An additional outcome measure will be student performance on a standardized patient encounter. Outcome: The program was successfully integrated into an all ready existing course without significant interruption to the course content or flow. Over the course of a semester, twenty two students completed three web-based cases while twenty-four completed the same cases in a traditional small group facilitator led format. Students still need to complete one outcome test (May 22) before data can be analyzed and further results reported. Importance to other institutions: This project demonstrated collaboration between clinical faculty and software designers to develop a useful, relevant educational tool. We were able to demonstrate the ability to integrate technology into a course that was traditionally a small group problem-based format.