A profession-wide collaboration to embed role-play simulation into Australian entry-level physiotherapy clinical training

The effect of replacing 1 week of content teaching with an intensive simulation-based learning activity on physiotherapy student clinical placement performance

BACKGROUND

Simulation-based learning (SBL) activities are increasingly used to replace or supplement clinical placements for physiotherapy students. There is limited literature evaluating SBL activities that replace on-campus teaching, and to our knowledge, no studies evaluate the role of SBL in counteracting the negative impact of delay between content teaching and clinical placements. The aims of this study were to (i) determine the effect on clinical placement performance of replacing 1 week of content teaching with a SBL activity and (ii) determine if a delay between content teaching and clinical placement impacted clinical placement performance.

METHODS

This study is a retrospective cohort study. Participants included students in the first two clinical placements of a graduate-entry, masters-level program. Six hundred twenty-nine student placements were analysed-285 clinical placements where students undertook a 20-h SBL activity immediately prior to clinical placement were compared with 344 placements where students received traditional content. Of the placements where students received the SBL, 147 occurred immediately following content teaching and 138 had a delay of at least 5 weeks. Performance on clinical placement was assessed using the Assessment of Physiotherapy Practice (APP).

RESULTS

There was a significant main effect of SBL with higher APP marks for the experimental group (3.12/4, SD = 0.25 vs 3.01/4, SD = 0.22), and post hoc analysis indicated marks were significantly higher for all seven areas of assessment. Students whose placements immediately followed content teaching performed better on mid-placement APP marks in two areas of assessment (analysis and planning, and intervention) compared to students for whom there was a delay. There were no statistically significant differences in relation to delay for end of placement APP marks.

CONCLUSION

Replacing 1 week of classroom teaching with a targeted, SBL activity immediately before placement significantly improved student performance on that clinical placement. A negative impact of delay was found on mid-placement, but not the end of placement APPs. Findings of improved performance when replacing a week of content teaching with a targeted SBL activity, and poorer performance on mid-placement marks with a delay between content teaching and clinical placement, may have implications for curriculum design.

Using stakeholder input to inform scenario content: an example from physiotherapy

Background

Simulated learning environments (SLEs) are being embraced as effective, though potentially costly tools, by health educators in a variety of contexts. The selection of scenarios, however, can be arbitrary and idiosyncratic.

Methods

We conducted a stakeholder audit to determine priorities for student learning which would inform scenario design. The process consisted of (1) the identification of stakeholders, (2) consultation with stakeholders to identify their priorities, (3) determination of priorities that could be addressed in the SLE being developed, and (4) incorporating these priorities into scenarios.

Results

The identified stakeholders were the funding body, educational institution and discipline, regulatory agency, accreditation agency, external clinical placement providers, employers of new graduates, patients, and learners. Stakeholder input included a combination of surveys, consultation of online resources, and semi-structured interviews. Identified areas where student learning could be improved included (1) all students not having experience of all populations or ‘essential’ conditions, (2) situations where adverse events had occurred, (3) working with people from diverse backgrounds or those with psychosocial issues including those in chronic pain, (4) communication, (5) situation awareness, and (6) ethical issues.

Conclusions

Ten scenarios were developed considering the stakeholder input. Facilitator notes were written to ensure all facilitators addressed the areas that had been identified. Where possible, simulated patients, with diverse backgrounds, were hired to portray roles even though such areas of diversity were not explicitly written into the scenarios. Whilst the example concerns physiotherapy students within Australia, the principles may be applicable across a range of health disciplines.

Electronic supplementary material

The online version of this article (10.1186/s41077-019-0102-0) contains supplementary material, which is available to authorized users.

The validity of a professional competence tool for physiotherapy students in simulation-based clinical education: a Rasch analysis

BACKGROUND

Despite the recent widespread adoption of simulation in clinical education in physiotherapy, there is a lack of validated tools for assessment in this setting. The Assessment of Physiotherapy Practice (APP) is a comprehensive tool used in clinical placement settings in Australia to measure professional competence of physiotherapy students. The aim of the study was to evaluate the validity of the APP for student assessment in simulation settings.

METHODS

A total of 1260 APPs were collected, 971 from students in simulation and 289 from students in clinical placements. Rasch analysis was used to examine the construct validity of the APP tool in three different simulation assessment formats: longitudinal assessment over 1 week of simulation; longitudinal assessment over 2 weeks; and a short-form (25 min) assessment of a single simulation scenario. Comparison with APPs from 5 week clinical placements in hospital and clinic-based settings were also conducted.

RESULTS

The APP demonstrated acceptable fit to the expectations of the Rasch model for the 1 and 2 week clinical simulations, exhibiting unidimensional properties that were able to distinguish different levels of student performance. For the short-form simulation, nine of the 20 items recorded greater than 25 % of scores as 'not-assessed' by clinical educators which impacted on the suitability of the APP tool in this simulation format.

CONCLUSION

The APP was a valid assessment tool when used in longitudinal simulation formats. A revised APP may be required for assessment in short-form simulation scenarios.