Standardized Patients and Communities of Practice: A Realistic Strategy for Integrating the Core Values in a Physical Therapist Education Program

Journal of Physical Therapy Education, Fall 2006 by Hayward, Lorna M, Blackmer, Betsey, Markowski, Alycia

Background and Purpose. Physical therapist (PT) educators are challenged to develop strategies that teach and reward student development of professional core values critical to effective patient-provider relationships. While teaching and evaluating student acquisition of clinical excellence, academicians may not utilize strategies for examining skill development in the professional or affective domain. The purposes of our project were to: (1) design a pedagogic model that explicitly teaches and rewards student development of professional core values such as compassion, caring, integrity, and communication within a patient-provider interaction; (2) design and pilot grading rubrics to assess student acquisition of both clinical and professional core values; and (3) examine the feasibility of incorporating the model into a "Clinical Integration II" course within a professional (entry-level) Doctor of Physical Therapy (DPT) program.

Method/Model Description and Evaluation. Our model uses standardized patients (SPs) augmented by asynchronous electronic dialogue within communities of practice (CoP). SPs are laypersons trained to mimic a patient condition. A CoP is a group of individuals who learn by communicating and working toward a goal that is of mutual interest. To stimulate the critical and holistic thinking required for the delivery of care, 17 PT students communicated within a CoP to answer questions related to a home care patient case. Five students participated in a 20-minute, videotaped interaction with an SP trained to mimic a patient in the home care setting. Grading rubrics developed by faculty and pilot tested by students, faculty, and SPs provided a 360-degree feedback loop on student-SP interactions.

Data Collection. Data collected from course faculty, student participants, and SPs was gathered via CoP discussion threads, student surveys, anecdotal discussion, and 2 formal debriefing sessions. Data were analyzed using a qualitative methodology to identify, code, and categorize the principle patterns.

Outcomes. We implemented our SP-CoP model during the Spring 2005 semester in a "Clinical Integration II" course. Analysis of the discussion thread comments among 4 students and a faculty mentor in one CoP revealed a dialogue that focused on the core professional values. A 360-degree feedback mechanism provided information about the teaching-learning process to both students and faculty. The development of instruments with integrated grading rubrics must explicitly reward student attainment of Core Value behaviors and skills. As a result of the pilot, faculty will formally incorporate the model into "Clinical Integration II." Wider application within the curriculum will require additional pilot testing.

Discussion and Conclusion. Administration, faculty, students, and SPs enthusiastically supported formally incorporating the SP-CoP model into the Northeastern University DPT curriculum. SPs provided realistic and authentic teaching experiences for students, enabled them to cohesively integrate prior learning, and allowed faculty to assess core value acquisition. A 360-degree assessment loop provided students with a diversity of perspectives on their ability to deliver patient care that is integrated, efficient, and compassionate.

Key Words: Standardized patients, Communities of practice, Physical therapist education, Core values, Reflection.

INTRODUCTION

As educators in the academic setting, our goal is to graduate physical therapists (PTs) who demonstrate the technical skills necessary for clinical excellence, as well as the professional competence required to interact with people of diverse backgrounds, disabilities, and generations. A challenge for academic educators is to design pedagogy that explicitly teaches and rewards student awareness of the ways in which affective domain attitudes and professional behaviors such as empathy, integrity, compassion, caring, and communication within a patient-provider interaction affects treatment outcomes.1,2 Teachers are often reluctant to assess students in the affective domain, which includes attitudes, values, and character development, because students view these qualities as private. According to Shepard and Jensen,' students need to understand what is expected of them with respect to affective behaviors. Clinical educators are expected to use clinical performance instruments (CPIs) to measure professional attitudes and behaviors in physical therapist students.4 However, academic faculty members are less likely to teach and assess these skills in the classroom.3 Reasons for this gap may include the subjective quality of affective behavior, or attitudes that are also "difficult to identify, quantify, and assess."4(p37)

Along with its Vision 2020 statement,5 the American Physical Therapy Association (APTA) also released a document, Professionalism in Physical Therapy, Core Values,6 describing the professional expectations of a Doctor of Physical Therapy (DPT) program graduate. In the Core Values, professionalism is defined as a combination of clinical knowledge and competency, as well as professional behaviors and administrative skills. The professional expectations are depicted by 7 core values: accountability, altruism, compassion and caring, excellence, integrity, professional duty, and social responsibility.6 It is important that DPT curricula facilitate the development of the core professional values because they underpin our actions.