Can We Teach Acute Care Physical Therapy at Home? Teaching Adjustments in the Time of COVID

Abstract

Title: Can We Teach Acute Care Physical Therapy at Home? Teaching Adjustments in the Time of COVID Authors: Trojanowski, Suzanne; Sherman Erica; Huang, Min Hui Background: Students in the physical therapy program have undergone many adjustments to their curriculum as a result of the COVID-19 pandemic. Amongst those is limited face-to-face teaching on campus. The purpose of this study is to examine if an altered delivery of a lab-based acute care physical therapy course impacts a student’s confidence and preparedness for a transition into a full-time acute care clinic education experience (CEE). Actions, Methods, or Interventions: Students enrolled in a physical therapy medical-surgical course were given kits to take home in order to practice and execute skills commonly encountered in acute care physical therapy practice. Kits included an IV pole, empty oxygen tank carrier, foley bag, IV bag, non-skid socks, tape, a simulated chest tube, and a simulated telemetry box. Students were given cases weekly and were required to execute a physical therapy initial evaluation that was video recorded and submitted for a course grade with individualized feedback. Each week, one student was assigned to present the case to a small group of 10 students and one instructor. The case presentation format followed the SITUPS structure (Summarize the case; Identify relevant family or social issues; Think through differential diagnosis; Uncover areas of uncertainty; Plan the evaluation and management; Select an issue for self-directed learning). In addition to the case presentation, each student who presented completed additional coursework including documentation, using an instructor developed template, and reflection on examination performance. In week one of the course all students completed documentation and reflection assignments as preparation for the week they were presenting. Weeks two through week 12 students rotated through as the presenter. Week 13 all students completed a documentation and reflection assignment. Students were invited to complete a survey at the end of the course that examined their pre-clinical confidence and perceived preparedness. The survey used the Acute Care Confidence Survey, as well as additionally developed questions. The survey assessed preparedness from class activities (7 items), preparedness to achieve Acute Care Core Competencies (12 items), and confidence to execute tasks using the Acute Care Confidence Survey (15 items), which is a valid and reliable measure of student confidence in the acute care environment. Each item was rated on a Likert scale from 10 (very unprepared or very uncertain) to 100 (very prepared or very certain). The 10-100 scoring scale was used because it is consistent with the original measurement scale of the Acute Care Confidence Survey. Results: Fourteen physical therapy students consented to participate in the study. The scores for each category of the survey were (1) preparedness from class activities = 78.9 ± 8.1, (2) preparedness to achieve acute care core competencies = 79.7 ± 2.8, and (3) Acute Care Confidence Survey = 83.8 ± 6.3. The students reported that: (1) from the class activities, they were most prepared in documenting an initial acute care evaluation (mean = 85.9; SD = 8.3) and least prepared in writing the reflection about his/her performance on an initial acute care evaluation (62.9 ± 24.3), (2) relating to preparedness in core competence, they were most prepared in maintaining a safe environment for self (86.5 ± 9.7) and least prepared in executing sound decision making for complex acute care patients (68.9 ± 15.9), and (3) relating to confidence, they were most certain in putting on blood pressure cuff (94.6 ± 10.3), and least prepared in deciding if a person needs subacute rehab (76.4 ± 11.2) and safely performing a maximum assistance transfer from bed to wheelchair (76.4 ± 11.2). Lessons Learned: Despite logistical challenges of performing acute care skills at home, students can gain appropriate experience and confidence from this style of coursework design. Repeated practice of skills may contribute to feelings of confidence and preparedness prior to clinical internships. Results of this survey can be used to intentionally design coursework to address areas in which students feel least confident. Future Application and Next Steps: After students complete their acute care clinical rotations, students will complete a post-rotation survey as well as participate in focus group interviews. Survey results will be compared to the Clinical Performance Instrument, which is a grading tool used in assessing student performance on clinical rotations.