Development and Assessment of a Web-Based Patient Simulation Program:

Student and Faculty Perspectives on the Usefulness and Usability of a Digital Health Educational Tool to Teach Standardized Assessment of Persons After Stroke: Mixed Methods Study

BACKGROUND

The VSTEP Examination Suite is a collection of evidence-based standardized assessments for persons after stroke. It was developed by an interdisciplinary team in collaboration with clinician users. It consists of 5 standardized assessments: 2 performance-based tests using the Kinect camera (Microsoft Corp) to collect kinematics (5-Time Sit-to-Stand and 4-Square Test); 2 additional performance-based tests (10-Meter Walk Test and 6-Minute Walk Test); and 1 patient-reported outcome measure, the Activities-Specific Balance Confidence Scale.

OBJECTIVE

This study aimed to describe the development of the VSTEP Examination Suite and its evaluation as an educational tool by physical therapy students and faculty to determine its usefulness and usability.

METHODS

A total of 6 students from a Doctor of Physical Therapy program in the United States and 6 faculty members who teach standardized assessments in different physical therapy programs from the United States and Israel were recruited by convenience sampling to participate in the study. They interacted with the system using a talk-aloud procedure either in pairs or individually. The transcripts of the sessions were coded deductively (by 3 investigators) with a priori categories of usability and usefulness, and comments were labeled as negative or positive. The frequencies of the deductive themes of usefulness and usability were tested for differences between faculty and students using a Wilcoxon rank sum test. A second round of inductive coding was performed by 3 investigators guided by theories of technology adoption, clinical reasoning, and education.

RESULTS

The faculty members' and students' positive useful comments ranged from 83% (10/12) to 100%. There were no significant differences in usefulness comments between students and faculty. Regarding usability, faculty and students had the lowest frequency of positive comments for the 10-Meter Walk Test (5/10, 50%). Students also reported a high frequency of negative comments on the 4-Square Test (9/21, 43%). Students had a statistically significantly higher number of negative usability comments compared with faculty (W=5.7; P=.02), specifically for the 5-Time Sit-to-Stand (W=5.3; P=.02). Themes emerged related to variable knowledge about the standardized tests, value as a teaching and learning tool, technology being consistent with clinical reasoning in addition to ensuring reliability, expert-to-novice clinical reasoning (students), and usability.

CONCLUSIONS

The VSTEP Examination Suite was found to be useful by both faculty and students. Reasons for perceived usefulness had some overlap, but there were also differences based on role and experience. Usability testing revealed opportunities for technology refinement. The development of the technology by interdisciplinary teams and testing with multiple types of users may increase adoption.

Investigating the clinical decision-making of nursing students using high-fidelity simulation, observation and think aloud: A mixed methods research study

AIMS

The aim of this study was to investigate nursing students' clinical decision-making by using high-fidelity simulation of a deteriorated patient scenario.

DESIGN

A convergent parallel mixed methods research design was used consisting of quantitative and qualitative data collection.

METHODS

Twenty-three students completed the Health Science Reasoning Test before and after the simulation between October 2015 and June 2016. They were presented with a simulated scenario and asked to 'think aloud' during and after the simulation. The students were audio-video recorded and observations were collected by the researcher.

RESULTS

There was a significant moderate increase in the 'deduction' and 'analysis' sub-scale scores and overall test score, suggestive of improved analytical decision-making processes through the simulation experience. Think-aloud and observation data identified that students predominantly applied 'forward' reasoning during the simulated 'patient's' deterioration, focusing mainly on cue acquisition. 'Backward' reasoning with a focus on cue interpretation was most prominent in the debriefing data, in line with the survey outcomes. Accurate cue interpretation of critical, key cues appeared more useful than the total number of cues in solving the main clinical case problem.

CONCLUSION

Students learn different clinical decision-making skills during the simulation compared to what they learn from debriefing. Using observation and think-aloud methods have significant benefits for researchers seeking to optimize the evaluation of the clinical decision-making process.

Experience of the Egyptian Physical Therapy Educators on the Online Teaching During COVID-19 Outbreak 2021

Physical distance was one of the safety measures that were applied during the outbreak of COVID-19 and universities all over the world were forced to shift toward online teaching (OT). The aim of the study was to answer six research questions related to the profile of OT in Egyptian Physical Therapy Colleges during the COVID-19 outbreak. A google form questionnaire was used to survey 102 Egyptian Physical Therapy Educators (EPTEs) who were engaged in teaching Physical Therapy undergraduate programs in Egyptian universities during the spring semester of the academic year 2020-2021. Results showed that the EPTEs frequently (N= 51; 58.0%) used OT both from work and home. Private universities showed a significant advantage over public universities regarding the provision of institutional training (N= 101, P= 0.003) and availability of institutional educational support centers (N=99, P= 0.0001). Most (N= 30; 63.8%) university website users were full or associate professors, while (N= 24; 53.3%) Microsoft Teams users were lecturers. The EPTEs who had a positive attitude toward the suitability of OT for practical and clinical instructions were a minority (N= 48; 22.9%) and (N= 24; 29.2%) respectively. The EPTEs perceived different themes for advantages, disadvantages, and challenges regarding their experience with OT. Less than one-tenth (N= 10; 9%) of EPTEs showed the highest positive attitude toward the readiness of their colleges for the application of OT. Most (N= 68; 68%) of the EPTEs reported the presence of negative effects on their social life and (N= 30; 30%) of them reported high levels of financial overwhelming. In conclusion, the EPTEs had a limited and primitive profile of experience with OT during the COVID-19 outbreak in 2021. OT might not be the perfect teaching approach for Egyptian Physical therapy Colleges, especially for practical and clinical courses .                       .

New Graduate Nurse Experiences in Clinical Judgment: What Academic and Practice Educators Need to Know

AIM

The aim of the study was to determine if use of a structured reflection exercise using a clinical judgment framework would result in more practice-ready new graduate nurses (NGNs).

BACKGROUND

Clinical judgment is a critical skill for all nurses, yet it is identified as a deficit in NGNs.

METHOD

Seventy-four NGNs in two groups participated in this mixed-methods study in their first year in practice. Scores from two quantitative measures were collected for all participants. The Lasater Clinical Judgment Rubric framed the structured intervention.

RESULTS

Although the quantitative data showed no significant differences between the groups, use of the reflection exercise indicated a positive impact on NGNs. Qualitative data revealed four themes that present challenges for preparation of NGNs: enhancing communication, finding interprofessional support, responding to complexity of care, and appreciating the role of the nurse.

CONCLUSION

Implications provide guidance for academic and practice educators to smooth the transition into practice.

Patterns of Clinical Reasoning in Physical Therapist Students

BACKGROUND AND PURPOSE

Clinical reasoning is a complex, nonlinear problem-solving process that is influenced by models of practice. The development of physical therapists' clinical reasoning abilities is a crucial yet underresearched aspect of entry-level (professional) physical therapist education.

OBJECTIVES

The purpose of this qualitative study was to examine the types of clinical reasoning strategies physical therapist students engage in during a patient encounter.

METHODS

A qualitative descriptive case study design involving within and across case analysis was used. Eight second-year, professional physical therapist students from 2 different programs completed an evaluation and initial intervention for a standardized patient followed by a retrospective think-aloud interview to explicate their reasoning processes. Participants' clinical reasoning strategies were examined using a 2-stage qualitative method of thematic analysis.

RESULTS

Participants demonstrated consistent signs of development of physical therapy-specific reasoning processes, yet varied in their approach to the case and use of reflection. Participants who gave greater attention to patient education and empowerment also demonstrated greater use of reflection-in-action during the patient encounter. One negative case illustrates the variability in the rate at which students may develop these abilities.

CONCLUSIONS

Participants demonstrated development toward physical therapist--specific clinical reasoning, yet demonstrated qualitatively different approaches to the patient encounter. Multiple factors, including the use of reflection-in-action, may enable students to develop greater flexibility in their reasoning processes.

Online technology use in physiotherapy teaching and learning: a systematic review of effectiveness and users' perceptions

BACKGROUND

The use of online technologies in health professionals' education, including physiotherapy, has been advocated as effective and well-accepted tools for enhancing student learning. The aim of this study was to critically review the effectiveness, and user perceptions of online technology for physiotherapy teaching and learning.

METHODS

Following databases were systematically searched on the 31(st) of August 2013 for articles describing implementation of online technologies into physiotherapy teaching and learning: ERIC, CINAHL, Web of Science, Academic search complete, ProQuest Nursing and Allied Health Source, Medline, Embase, and Scopus. No language, design or publishing date restrictions were imposed. Risk of bias was assessed using the 2011 Mixed Methods Appraisal Tool checklist (MMAT).

RESULTS

A total of 4133 articles were retrieved; 22 articles met the inclusion criteria and were accepted for final analysis: 15 on the effectiveness of technology, and 14 on users' perceptions. Included studies used three designs: case study (14 articles), controlled trial (3), and randomized controlled trial (5). Studies investigated both pre-registration physiotherapy students (1523) and physiotherapy professionals (171). The quality of studies ranged from 67 to 100 % on the MMAT checklist which can be considered moderate to excellent. More than half of the studies (68 %) received scores greater than 80 %. Studies typically investigated websites and discussion boards. The websites are effective in enhancing practical skills performance, and discussion boards in knowledge acquisition, as well as in development of critical and reflective thinking. Students' perceptions of the use of websites were mostly positive, providing students with entertaining, easy accessible resources. Perceived barriers to the use of websites included difficulties with internet connection, insufficiently interactive material, or personal preference for paper-based materials. Discussion boards were perceived as deepening students' thinking and facilitating reflection, allowing for learning from multiple perspectives, and providing easy communication and support.

CONCLUSIONS

The results of this review suggest that online technologies (i.e., websites and discussion boards) have many benefits to offer for physiotherapy teaching and learning; There was minimal evidence of barriers for the use of online technologies, however, addressing the identified ones could enhance adherence to use of online technologies in health professionals' education.

Virtual reality simulation: using three-dimensional technology to teach nursing students

The use of computerized technology is rapidly growing in the classroom and in healthcare. An emerging computer technology strategy for nursing education is the use of virtual reality simulation. This computer-based three-dimensional educational tool simulates real-life patient experiences in a risk-free environment, allows for repeated practice sessions, requires clinical decision making, exposes students to diverse patient conditions, provides immediate feedback, and is portable. The purpose of this article was to review the importance of virtual reality simulation as a computerized teaching strategy. In addition, a project to explore readiness of nursing faculty at one major Midwestern university for the use of virtual reality simulation as a computerized teaching strategy is described where faculty thought virtual reality simulation would increase students' knowledge of an intravenous line insertion procedure. Faculty who practiced intravenous catheter insertion via virtual reality simulation expressed a wide range of learning experiences from using virtual reality simulation that is congruent with the literature regarding the barriers to student learning. Innovative teaching strategies, such as virtual reality simulation, address barriers of increasing patient acuity, high student-to-faculty ratio, patient safety concerns from faculty, and student anxiety and can offer rapid feedback to students.