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

For our study, student evaluation was done immediately after the unit was completed, thus a legitimate question would be, "Will the differences in abilities and self-confidence carry over to future clinical science courses and ultimately to the clinical setting?" As the medical screening and patient referral skills are applied repeatedly in the subsequent clinical science courses and are utilized during the students' clinical experiences, the students' proficiency and efficiency should improve. Based on our study's design we cannot state whether this carryover would in fact occur.

Lastly, although the written examination was based on items used by the primary author at other institutions for many years, we did not assess retest reliability using students. However, the instrument was judged to be valid by content experts and the examination scoring appears to have been consistent. Despite these limitations, our findings provide evidence to support the use of patient cases, combined with role-playing to enhance student medical screening and patient referral abilities.

Future Research

Our results suggest further research investigating this topic is warranted. In addition to replicating our study with a larger sample and assessing the potential long-term impact on student's medical screening and patient referral abilities, future research could compare the RP method to other teaching strategies for this important content area. Investigating the optimal timing of introducing this educational experience in the curriculum would also be of interest. This ties in with Stith and colleagues'15 recommendation of a curriculum to prepare PT diagnosticians that emphasized an immediate introduction of students to their role as diagnosticians and an early exposure to the medical screening process. The authors propose that this early introduction would not only allow for the development and refinement of these important abilities throughout the remainder of the curriculum, but also would allow for nurturing the attitude that comprehensive medical screening and patient referral are a routine part of physical therapist practice.

Conclusions

With the passage of direct access legislation and the increased responsibilities associated with physical therapists assuming important roles in primary care health care delivery models, therapists should have expertise related to the identification of medical "red flags" that would lead to the referral of patients to other practitioners.14 Medical screening and patient referral is an important component of the diagnostic process for practicing physical therapists.10,11,13,15 The challenge to PT education program faculty is to prepare practitioners to fulfill the role of diagnostician.15 Although numerous teaching strategies exist to enhance student preparation in this area of practice, this study provides evidence that the patient case-based method combined with RP to teach medical screening and patient referral process is more effective in improving a student's ability than a TL format.