As physical therapy educators, we strive to prepare students not only for contemporary, clinical practice supported by research, but also for meaningful, individualized patient episodes of care. To accomplish this goal, curriculum designs should include, both deductive, clinical reasoning used in scientific process; and practical, narrative reasoning used to understand patient experiences within a biosocial context, in the educational process.
Currently, many physical therapist curricula present information on both aspects of reasoning; however, the content is often taught in separate courses and students are deprived in the classroom of the opportunity to combine both forms of reasoning to an individualized patient plan of care. In addition, in programs where the content is merged in one course, conceptual application is frequently aimed at the level of the generalized patient diagnostic group, rather than the level of an individual patient.
As a result, students must rely on clinical education to make the critical connections between the two forms of reasoning used in clinical practice. This often comes late in the educational process and places students at a disadvantage. Therefore, this proposal focuses on integrating clinical and practical reasoning into a student learning module that can be incorporated into both didactic and clinical curriculums across a variety of settings.
Theoretical concepts and frameworks to transform physical therapist education will be discussed and participants will be guided through application of the integrative module to further enhance understanding of its use in physical therapist education. In summary, use of this integrative classroom assignment will assist physical therapist students in meeting the demands for blending of both art and science present in contemporary, value-based healthcare.
Methods and/or Description of Project
In order to achieve the primary objective of blending the art and science of clinical practice into physical therapy education, an emphasis will be placed on the application of integrating narrative stories into evidence-based case study frameworks. The project will begin with exploring the learner’s view regarding the value of practical reasoning in a practice model that favors evidence-supported decision making. This information will be used to create an openness to exploring the topic of narrative thinking and practical reasoning. With this groundwork laid, information with respect to the theoretical foundation of narrative thinking and the evidence-based study framework used will be presented. Narrative thinking will explore various perspectives of narrative reasoning as well as drivers and barriers of reasoning development. The evidence-based study framework will include, as the main sections, the ICF model, examination, diagnosis and prognosis, interventions, and anticipated outcomes.
Examples, of a current learning module employed in a physical therapist curriculum, will be used to illustrate the project's usefulness in furthering physical therapist student decision making skills. The module will involve a three step process where small groups of students will first seek to understand the individual patient story and its relationship to the ICF Model. This will empower students to connect with the patient history as well as unique patient and/or family traits that inform the clinical picture. Second, students will explore the available literature and consider management recommendations for patients with a similar diagnosis and/or clinical features. Finally, the last step in the process will involve student reflection and further consideration of the patient case to determine individualized recommendations. This process is repeated across the case study for decisions in patient examination, diagnosis and prognosis, interventions, and anticipated outcomes.
Following the explanation of the integrative model along with examples to assist with application of the concepts, participants will be asked to sit in groups with similar clinical interests and begin to form a patient narrative story. A framework will be provided to guide development of the process. Finally, after the time for narrative development and small group discussion, conclusions and questions and answers will complete the educational session.
This presentation is intended to provide instruction on a teaching module that can be used by physcial therapist educators to assist physical therapy students in furthering the development of critical thinking skills. By encouraging integration of narrative reasoning with critical review of the literature and scientific reasoning, students are urged to blend both types of reasoning into an individualized plan of care that is needed in today's value-based healthcare. The teaching method is also intended to blend the art and science of physical therapy and further student preparation for clinical practice.
Conclusions/Relevance to the conference theme: Through the Looking Glass: Transforming Physical Therapy Education
Participants will experience a multi-modal learning session that will allow them to integrate deductive and personal reasoning strategies used in the classroom to deepen student understanding of patient management at both a diagnostic and individual level. The integrated, dual reasoning process used will empower participants to transform current teaching methods in order to better prepare students to participate in value based patient care in the US healthcare system. Collectively, the information in this course will provide a framework to assist educators with structuring clinical decision making and encourage the use of both the available research and individualized information from the patient's unique story. These changes will assist students in better understanding both the art and science of physical therapist practice that is not only needed, but necessary in order to ensure that students are adequately prepared for clinical education experiences and achieve the innovation we desire in clinical practice.
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Upon completion of this session, participants will be able to:
-Compare and contrast key constructs in clinical reasoning and practical reasoning.
-Discuss the opportunities and challenges of integrating scientific and practical reasoning in physical therapist education.
-Discuss how integration of practical reasoning and narrative thinking could function as a “transformative power” across education preparing professionals for clinical practice.
-Identify the components of the evidence-based case study framework that correspond to the ICF Model and the PT Patient Management Model and their relationship to the narrative story.
-Design a narrative story that enhances practical reasoning skills in physical therapist practice.
-Integrate a narrative story with the evidence-based case study framework to enhance a student’s ability to meaningfully apply individual patient stories to evidence based clinical practice.
The instructional methods include multimodal touchpoints in order to reach learners across various learning styles using a social constructivist theoretical framework. The presentation begins with use of an audience poll to establish personal connection to the purpose of the presentation. The presentation continues with lecture to provide background information on theoretic foundations in narrative thinking and the evidence based-case study framework. Further lecture follows to provide examples of application of the concepts of narrative thinking to the evidence-based case study format. Throughout the application, both narrative thinking and clinical reasoning are emphasized. This will encourage students to consider the individual, the body of literature, and practice decision making in patient management. Next, the participants engage in small group discussion to promote application of the content and beginning development of narrative stories that could be incorporated into physical therapy coursework or clinical practice. The session ends with a conclusion as well as questions and answers.
0 - 5 minutes (5 minutes): Introduction, Audience Poll, and Purpose
5 - 15 minutes (10 minutes): Theoretic Foundations in Narrative Thinking
15 - 25 minutes (10 minutes): Evidence Based-Case Study Framework
25 - 30 minutes (5 minutes): Use in Class-Drivers and Barriers and Audience Poll
30 - 35 minutes (5 minutes): Narrative Thinking and the ICF
35 - 50 minutes (15 minutes): Narrative Thinking and Patient Examination, Diagnosis and Prognosis
50 - 65 minutes (15 minutes): Narrative Thinking and Patient Management and Outcomes
65 - 80 minutes (15 minutes): Small Group Discussion and Practice Developing a Narrative Story
80 - 85 minutes (5 minutes): Conclusion
85 - 90 minutes (5 minutes): Questions and answers