Best Practices in Clinical Education: A Site Visit Decision-Making Model in Physical Therapist Education.

Stakeholders in health science education engage in site visits during student clinical education experiences, which may occur in person or remotely via videoconference, telephone, or email. Significant variability in practice highlights the need for a more consistent approach to conducting site visits based on evidence-based best practices. Site visits can be burdensome to both clinical and academic stakeholders considering the significant time and resources needed to conduct them effectively. Despite these obstacles, site visits have been shown to add value to the clinical experience for all parties involved. This paper presents the available literature in health science education regarding clinical site visits and describes how it was used to develop and implement a model of best practice for conducting clinical site visits in physical therapist education. The Site Visit Decision-Making Model is based upon findings from contemporary research exploring the interests of each stakeholder, as well as the multifaceted and purposeful decision-making process that takes place when conducting site visits in physical therapist clinical education. Implementation of this model may assist academic stakeholders in health science education in prioritizing which methods of communication for conducting site visits are most effective and efficient.

Clinical Site Visits: Perspectives of Clinical Instructors and Site Coordinators of Clinical Education.

INTRODUCTION: Site visits (SVs) are a common component of clinical education. The purpose of this paper was to explore clinicians' perspectives regarding SVs, including methods of communication used and their effectiveness, purposes of SVs, and the level of interaction between the stakeholders. REVIEW OF THE LITERATURE: Several communication methods are used to conduct SVs, with varying levels of "richness" and effectiveness. Previous studies have explored the perceptions of physical therapist (PT) students and Directors of Clinical Education regarding communication methods used during SVs, as well as reporting the purposes, effectiveness, and logistics. SUBJECTS: Clinicians, including clinical instructors (CIs) and Site Coordinators of Clinical Education, from across the United States, representing various geographical locations and settings were invited to participate. METHODS: An electronic survey was distributed to participants using information from 2 PT education programs and the Physical Therapist Clinical Performance Instrument database. RESULTS: A total of 273 responses were included in the analysis. Clinicians ranked in-person visits as their first choice of communication for future SVs (n = 157, 59.9%) and indicated that in-person communication was "very effective" (n = 143, 52.4%) when compared with videoconferencing (n = 55, 20.1%) and telephone (n = 49, 17.9%). Clinicians ranked verifying the competency level of the student and verifying site resources during the SV as "extremely important" or "important" (n = 257, 94.2% and n = 250, 91.5%, respectively). Answering CI's questions and providing support to the CI were also identified as "extremely important" or "important" (n = 262, 96% and n = 244, 89.4%, respectively). Analysis of open-ended responses revealed 5 themes: Communication is important, flexibility allows best fit for a situation, on-site visits offer a more complete picture, real-time dialog is preferred, and email can lead to misinterpretation. DISCUSSION AND CONCLUSION: Communication is a key component of the clinical-academic relationship. Although clinicians prefer in-person communication, flexibility is necessary when planning and conducting SVs. Future research recommendations include gathering student and clinician perceptions regarding faculty involvement in SVs, as well as gathering faculty perspectives regarding their participation in SVs. In addition, the impact of the pandemic on the future of SVs warrants further exploration.

Simulation-Based Education in Physical Therapist Education: A Survey of Current Practice.

OBJECTIVES: The purposes of this study were to describe the current use of (1) simulation in student physical therapist professional education programs and (2) standards of best practice (SOBP) for simulation-based education (SBE) in physical therapist education. METHODS: Two surveys were created about current use of SBE in student physical therapist professional education programs in the United States. The first survey contained questions about the program, including the best contact person regarding simulation. The second survey investigated simulation use within the context of SOBP. Survey data were analyzed using descriptive statistics. RESULTS: Survey 1 was sent to the program director at all fully accredited physical therapist programs (N = 236), and 143 responses were returned (61% response rate). Survey 2 was sent to the 136 individuals identified in Survey 1, and we received 81 completed surveys (60%). Over 90% of programs reported including SBE in their curricula, with 86% providing 3 or more experiences. A median of 1 core faculty at each program reported training in SBE, but 23% reported no training. A lack of training in specific elements of the SOBP for SBE was reported by 40% to 50% of faculty. Limited use of SOBP was reported, and use of outcome measures without validation was common. CONCLUSION: Although SBE is commonly used in physical therapist education, many faculties (1) do not have training in SBE, (2) do not consistently follow the SOBP, and (3) utilize unvalidated outcome measures. Limited faculty training in SBE and inconsistent inclusion of the SOBP suggest student learning in simulation is not optimized. IMPACT: These results show that, despite increased use of simulation in physical therapist education programs, there is a dearth of faculty trained in SBE and inconsistent use of SOBP. Addressing these deficiencies could help to optimize the benefits of SBE in physical therapist education.

Simulation-Based Education in Physical Therapist Education: Perspectives From the Strategic Initiative Panel on Simulation in Physical Therapist Education.

In the summer of 2018, The American Council of Academic Physical Therapy appointed 9 individuals versed in simulation education to form the Strategic Initiative Panel on Simulation to (1) investigate the use of simulation in physical therapist education, (2) explore the role of simulation in meeting accreditation standards and curriculum elements related to clinical education and interprofessional education, and (3) describe models and best practices for the use of simulation in physical therapist education. Over the 3 years of Strategic Initiative Panel on Simulation work, the panel identified several significant gaps in simulation education and research practice. This paper clarifies the essential elements required to optimize the delivery of simulation-based education in physical therapy following best practices, frames the existing challenges to move the profession forward, and recommends specific actions needed to address the many continued questions related to the effective use of simulation-based education in physical therapist education.

Simulation-Based Education in Physical Therapist Professional Education: A Scoping Review.

OBJECTIVES: The purposes of this study were to (1) describe and summarize the use of simulation-based education (SBE) with student physical therapists in the international literature and (2) describe the application and integration of standards of best practice (SOBP) for SBE reported in published physical therapy education research. METHODS: Ovid MEDLINE, CINAHL, Web of Science, and ERIC databases were searched. The search included any published study that involved the use of SBE with student physical therapists. Because this was a scoping review, only descriptive statistics were compiled; no methodological quality assessment was performed. RESULTS: This scoping review revealed a significant increase in literature describing SBE with student physical therapists in the past 10 years. Simulation was used to address learning objectives across a variety of content areas and clinical settings. Communication skills were the most common objectives for simulation. Limited use of SOBP, published in 2016, was reported, and use of author-generated outcome measures without validation was common. CONCLUSIONS: Although there has been an increase in literature reporting the use of SBE with student physical therapists across many practice areas and settings, many articles reported limited use and integration of published SOBP and frequently utilized outcome measures that had not been validated. IMPACT: The findings show that limited use of validated outcome measures and SOBP constrain the capacity for reproducing studies, comparing findings among studies, and completing systematic reviews that could inform and optimize best practices for the use of SBE in physical therapist professional education. Further research on SBE in physical therapy would benefit from investigations that integrated and reported the use of SOBP for standardized patients, simulation design, and delivery and assessment of learning outcomes over time at multiple Kirkpatrick learning levels.

Promoting Professional Behaviours in Physical Therapy Students Using Standardized Patient Feedback.

Purpose: Physical therapy (PT) students receive feedback on their professional behaviours from academic and clinical faculty. Another avenue for providing feedback to PT students is by using standardized patients (SPs). Very little research is available on the impact of SPs' specific feedback on whether, and how, PT students learn professional behaviour, and what research is available has focused on clinical competencies, communities of practice, and broad assessments of professional behaviours. The purpose of this study was to record PT students' perspectives on how combined verbal and written SP feedback affected their professional behaviours. Method: The sample of convenience consisted of seven students enrolled in a PT professional education programme in the northeastern United States before starting their first full-time clinical experience. The students agreed to participate in an SP experience focused on professional behaviours. This study used a phenomenological approach to understand the students' perspectives on receiving a combination of verbal and written SP feedback. Results: The students' perspectives on receiving SP feedback were categorized into four themes: seeing through the patient's eyes; SPs offer unique contributions to student learning; timely, verbal feedback adds a deeper understanding of professional behaviours in preparation for the clinic; and verbal feedback promotes student self-efficacy of professional behaviours. Conclusions: Using SPs' written and verbal feedback in the curriculum can be a valuable tool for enhancing the development of PT students' professional behaviour.

Objectif : les étudiants en physiothérapie reçoivent des commentaires sur leurs comportements professionnels de leurs professeurs théoriques et cliniques. Les patients standardisés (PS) sont un autre moyen d'obtenir de tels commentaires. Très peu de recherches indiquent si les étudiants en physiothérapie acquièrent des comportements professionnels après avoir reçu des commentaires des PS et précisent la manière dont ils le font. Les études publiées portent sur les compétences cliniques, les communautés de pratique ou les évaluations générales des comportements professionnels. La présente étude visait à consigner si, de l'avis des étudiants en physiothérapie, les commentaires écrits et verbaux des PS avaient une incidence sur leurs comportements professionnels. Méthodologie : échantillon de commodité composé de sept étudiants inscrits à un programme de formation professionnelle en physiothérapie du nord-est des États-Unis avant leur première expérience clinique à temps plein, qui avaient accepté de participer à une expérience de PS axée sur les comportements professionnels. La présente étude favorisait une approche phénoménologique pour comprendre les points de vue des étudiants à l'égard de la réception d'une combinaison de commentaires verbaux et écrits de la part des PS. Résultats : les chercheurs ont classé les points de vue des étudiants sur la réception des commentaires des PS en quatre catégories : regard des patients; apport unique des PS sur l'apprentissage des étudiants; ajout d'une compréhension plus approfondie des comportements professionnels en préparation à la clinique grâce aux commentaires verbaux; promotion de l'efficacité des comportements professionnels des étudiants grâce aux commentaires verbaux. Conclusion : l'inclusion des commentaires écrits et verbaux des PS dans le programme d'enseignement peut être précieuse pour perfectionner le comportement professionnel des étudiants en physiothérapie.

Physical Therapist Student Readiness for Entrance Into the First Full-Time Clinical Experience: A Delphi Study.

Background: To consistently prepare physical therapist students for their first full-time clinical experience, the entry-level curriculum must provide and assess competency in the essential knowledge, skills, attitudes, and professional behaviors. Objective: The purpose of this Delphi study was to develop consensus on a core set of elements that should be demonstrated by physical therapist students prior to entry into their first full-time clinical experience. A second aim was to obtain the recommended competency levels and assessment methods. Design: The study was conducted using the Delphi method. Methods: Purposive selection and snowball sampling techniques were used to recruit clinical instructors, recent graduates, directors or academic coordinators of clinical education, and academic faculty. Four web-based survey rounds were used to achieve consensus, defined as agreement among ≥80% of respondents. The first round gathered demographic information on respondents and identified elements that were deemed essential; the second collected information about clarity and redundancy in the elements provided; the third asked participants to rank their agreement with elements and themes; and the fourth gathered the level of competency that physical therapist students should demonstrate prior to beginning a first full-time clinical experience. Results: Consensus revealed 95 elements, categorized under 14 themes, which were deemed essential for readiness for the first clinical experience. Levels of competency for each element were identified. Limitations: Participants might not have represented all academic programs, practice settings, and geographic locations. Conclusion: This study identified the specific knowledge, skills, attitudes, and professional behaviors in which all physical therapist students in the United States need to demonstrate competency before their first clinical experience, regardless of school or setting, which would allow learning experiences to be tailored appropriately.

Using human simulation to prepare physical therapy students for acute care clinical practice.

UNLABELLED: The acute care setting requires a unique skill set for all health care providers, including Doctor of Physical Therapy (DPT) students. This study explores high-fidelity human simulation (HFHS) training in a DPT education program to achieve learning objectives specific to preparation of DPT students for acute care clinical practice. METHODS: Twenty-three DPT students participated in a HFHS acute care experience, provided feedback about the learning experience, and completed a survey regarding preparedness for clinical practice. Student feedback was interpreted to gain content validity of the learning experience, and descriptive statistics were used to analyze survey results. RESULTS: In this pilot study, students identified four learning objectives met during the simulation experience: interprofessional communication, preparation of the treatment environment, patient safety, and discharge planning. Following the experience, 91.5% of the students reported more confidence in interprofessional communication, and 67% were more knowledgeable in discharge disposition. All students agreed that simulations should be part of the curriculum, and 95.2% reported simulation valuable in preparation for clinical practice. CONCLUSIONS: As a result of HFHS training in the DPT program, students' educational objectives were met, and simulation was deemed valuable in integrating prior learning and providing an enhanced understanding of the acute care setting. The findings support continued investigation of the effectiveness of simulation to prepare DPT students for acute care clinical practice.