A Comparison of Two Strategies for Teaching Medical Screening and Patient Referral in a Physical Therapist Professional Degree Program

Journal of Physical Therapy Education, Spring 2006 by Boissonnault, William, Morgan, Barbara, Buelow, Jill

The medical screening lecture began with an overview of unit activities, a review of the medical screening principles (from the other second-semester course), and a discussion of strategies related to making an effective referral. Then, potential examination findings associated with cardiovascular and pulmonary conditions (eg, ischemic heart disease, vascular claudication, abdominal aortic aneurysm, and pneumonia) were compared and contrasted with findings of common neuromusculoskeletal conditions (eg, rib dysfunction, neurogenic claudication, and mechanical back pain).

The categories of examination findings discussed for each disorder included:

(1) disease risk factors (eg, patient age, family history, and tobacco use),

(2) symptom location(s),

(3) symptom description (eg, ache, tightness, pressure),

(4) symptom pattern (eg, insidious onset, constant versus intermittent, and night pain),

(5) review of systems (symptoms other than pain -eg, dyspnea, fatigue, or sweats), and

(6) physical examination and tests and measures findings (observation, active/passive movement assessment, balance, vital signs, etc).

The laboratory experience for both groups included the use of the same 4 patient cases designed to explore the medical screening process, as well as communication strategies related to referring patients to physicians. The 4 cases included life and non-life-threatening patient scenarios, including potential unstable angina, pleurisy, intermittent claudication, and degenerative joint disease. Each of the 4 written cases included the following information: the presenting medical diagnosis; patient age and sex; a summary of the patient's health history, including illnesses, surgeries, injuries, family history, medication and substance use; general health findings; a description of symptoms noted on a body diagram; and a summary of the physical examination and tests and measure data. Based on the collected patient data differential diagnoses and plans of care for each patient were discussed, including the decision to treat, treat and refer, or refer the patient only, and, if referral was in order, what was the urgency of the medical concerns. This was followed by a discussion of what would be verbally communicated to a physician in order to justify the plan of care decision.

Study Procedure

All students (N = 67) attended the abovedescribed 2-hour lecture. In the laboratory session for TL student group, the instructor presented each of the 4 patient cases in a lecture format including the resultant plan of care as well as the relevant information to be communicated to a physician. At the end of each of the 4 case presentations, the instructor led a 10-minute discussion regarding the medical screening process and the resultant physician communication.

In the laboratory session for the active learning RP group, the students were divided into groups of 4, with each group assigned 1 of 4 written patient cases. The groups of students, the "therapists," were given 10 minutes to review and discuss the provided patient data and then 20 minutes to interview their respective "patients." Four volunteers from the second-year student class and the program's core academic faculty (when necessary) were assigned to role-play 1 of the 4 patients. The mock "patients" were given a script (history and physical examination findings) for reporting clinical data when questioned by the "therapists." The lead author was consulted by the "patients" during the interviews if questions arose regarding appropriate responses. Following the interview the "therapists" were given 15 minutes to discuss among themselves the data collected, develop a plan of care, and decide what information should be communicated to the patients' referring physicians to support the patient plan of care. Last, each group had 10-15 minutes to lead a class discussion, to summarize their patient case and plan of care.