Transforming physical therapy education: a look at computer-based simulation

Simucase Education Division

Posted November 8, 2019

Emily Gherghel, PT, DPT, Maura Lavelle, MS, OTR/L, Katie Ondo, MA, CCC-SLP, CHSE

Support for Simulation-Based Education in Physical Therapy

Physical therapy education has undergone significant changes over the last two decades with the mandated shift from master’s level programs to doctoral degrees (American Physical Therapy Association, 2015). Education programs responded to these standards by increasing program length and clinical education experiences (Macauley, 2018; Commission on Accreditation of Physical Therapy Education [CAPTE], 2017); however, there were no major changes made to curriculum or content delivery methods. Educators are charged with enhancing students’ ability to work in an evolving healthcare landscape while striving to support CAPTE standards, including those for technology, innovation, interprofessional collaboration, and student assessment. Computer-based simulation is one innovative teaching technique that can address these standards while enhancing experiential learning opportunities. The implementation of computerbased simulation in physical therapy education programs has the potential to improve student competence and clinical decision-making and, in turn, improve the level of care provided to patients by physical therapy practitioners.

Clinical Practice Gaps and Simulation Modalities

Physical therapy education programs that largely focus on students’ ability to complete an isolated task or skill may result in clinical practice gaps because they do not fully support the development of critical thinking and decision-making skills (Macauley, 2018). Many students in the same program lack equitable learning opportunities due to limited exposure to low incidence populations (Huhn & Deutsch, 2011). Simulation-based education, which recreates clinical scenarios, is often used to efficiently deploy problem-based learning strategies to support clinical competency while increasing exposure to clinical scenarios. Evidence shows that simulation-based learning can improve student capability and clinical decision-making in physical therapy education programs (Macauley, 2018; Huhn & Deutsch, 2011), and the incorporation of simulation into curriculum is growing across the profession. In addition, research has shown that replacing a portion of a musculoskeletal clinical experience with simulation does not affect student development or competency (Watson et al., 2012).

Computer-based simulation can address multiple challenges experienced by physical therapy education programs (e.g., the inability to locate live patient actors, the need to establish standard measures of proficiency and clinical situation safety, the demand for deliberate practice) (Huhn & Deutsch, 2011). Computer-based simulation may also reduce the risk of instructor bias, as student decisions are evaluated with a rubric, depending on the platform used (Huhn & Deutsch, 2011). Although computer-based simulation has not frequently been used in physical therapy programs, the need for an innovative method to fulfill practice gaps has been well documented (Huhn & Deutsch, 2011; Portney, 2014).

Self-Efficacy and Computer-Based Simulation

Simulation allows for a controlled environment for students to engage in clinical scenarios without putting patients at risk (Sabus & Macauley, 2016). This has been particularly effective in settings with low tolerance of error such as acute care. One study found that students using computer-assisted learning (CAL) had significant improvements in self-efficacy to practice in acute care settings as compared with students who did not complete CAL (Costello, Ruckert, Lyons, Cotton, & Birkmeier, 2017). In a study that set out to determine the impact of an interactive computer module case on self-perceived clinical reasoning skills, students were surveyed using the Self-Assessment of Clinical Reflection and Reasoning with improvements noted after the activity (Seif, Brown, & Annan-Coultas, 2013).

Clinical Reasoning and Computer-Based Simulation

Multiple studies have demonstrated that computer-based simulation has the potential to improve students’ clinical reasoning skills throughout an episode of care. As compared with a live group discussion, virtual patient simulation resulted in higher competency scores among physical therapy students on objective measures with no significant difference in clinical reasoning as measured by the Health Science Reasoning Test (Huhn, McGinnis, Wainwright, & Deutsch, 2013). In another study, students practiced home assessments and task modifications in a virtual platform (Second Life®) while showing a high level of decision-making in assignment criteria of creating functional goals (Sabus, Sabata, & Antonacci, 2011). One physical therapy program modified existing software, which was used for simulations for medical students, for use in physical therapy practice. The computer-based simulation was implemented in a therapeutic exercise course, which was traditionally taught as a text-based course with an instructor. The aim of the new approach was to introduce clinical reasoning concepts while teaching the clinical content, and the results were favorable. As compared with the traditional group, students in the simulation group had higher practical exam scores in aspects of clinical reasoning, averaged less overall time spent to learn the concepts, and had high satisfaction rates. The simulation group also required fewer resources and faculty to lead the course (Huhn & Deutsch, 2011).

Interprofessional Education and Computer-Based Simulation

Not surprisingly, computer-based simulation can also help fulfill CAPTE interprofessional education standards. A case study provided evidence of improvement in communication skills as scored by the Situation-Background-Assessment-Recommendation (SBAR) tool after students used a virtual simulator (TeachLivETM) to interact with the client’s caregivers/parents and other care team members (Taylor et al., 2017). A second study used a virtual program (Second Life) to facilitate an interprofessional student case discussion. Participants reported that the advantages of the experience included discussion, flexibility, and convenience. Sixty percent of participants believed that this was an effective method of conducting the small group learning session (Seefeldt et al., 2012). The literature also demonstrates that physician assistant, physical therapy, and occupational therapy students who use computerized virtual patient software can achieve interprofessional education learning objectives (Shoemaker, Platko, Cleghorn & Booth, 2014).

Computer-Based Simulation and CAPTE Standards

The benefits of computer-based simulation suggest potential for this mode of learning to serve as a staple in physical therapy education. CAPTE encourages innovation through the use of technology for content delivery (CAPTE, 2019) and outlines expected student outcomes without specifying how these outcomes should be met, which offers programs the freedom to decide (CAPTE, 2017). In one study, faculty reported concerns that available computer-based simulations do not reflect physical therapy practice and framework accurately and that ideal integration in curriculum has yet to be established (Huhn & Deutsch, 2011). The need remains for a physical therapy-framed computer-based simulation technology to help programs fill the gaps.

Simucase® is an online simulation platform that allows users to practice assessment and intervention skills with real patients presented in a virtual manner. Simucase simulations have been developed and reviewed by subject matter experts, include CAPTE-outlined Standards and Required Elements, and follow the structure of the International Classification of Functioning, Disability, and Health (World Health Organization, 2001) for all aspects of patient care. Users make decisions throughout the simulations, receive immediate feedback to help scaffold learning, and participate in a thorough debrief with faculty on completion, all of which are crucial to supporting clinical competence (Fraser & Greenhalgh, 2001). Simucase also fulfills CAPTE performance measurement standards because faculty can track student progress toward specific program-expected outcomes in each area of patient management.

Conclusion

CAPTE requires clear rationale for what an innovative method in physical therapy education intends to accomplish. The use of computer-based simulations can improve student clinical reasoning, and the incorporation of Simucase in physical therapy education can help programs fulfill CAPTE requirements. By providing risk-free and easily accessible simulations designed for physical therapy practice, Simucase has the potential to transform content delivery in physical therapy education.

References

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