Physical Therapist Student Approaches to Learning During Clinical Education Experiences: A Qualitative Study

Journal of Physical Therapy Education, Spring 2008 by Healey, William E

Background and Purpose. Clinical education comprises nearly one-third of physical therapist (PT) students' professional education, yet research on PT students' learning approaches during clinical education (CE) experiences is limited. Research has suggested that deep-learning approaches result in enhanced student understanding and may lead to betterprepared graduates and FT practitioners. The purpose of this study was to describe PT students' and clinical instructors' perspectives of educational factors that may promote students' deep-learning approaches during CE experiences.

Subjects. Participants of this study were 10 PT students who had completed an intermediate, 5-week, full-time CE experience and 9 clinical instructors (CIs) identified as learner-centered in their teaching orientations.

Methods. Data were collected through individual, semistructured interviews in which participants were asked to define and describe factors that promoted student learning during CE experiences. Constant comparative qualitative methods were used to analyze and interpret interview data using concept maps for both the students and CIs.

Results. Three major themes emerged. First, challenging patient interactions promoted student learning. Patients, especially complex patients, provided students a rich context to apply their academic knowledge and skills. Second, the CI and clinical learning environment facilitated deep-learning approaches by providing a supportive, varied environment in which students felt safe to ask and respond to questions, make mistakes, and encounter additional learning opportunities. Last, students were able to construct individual frameworks of patient care in a deep manner when they were actively engaged in doing and reflecting, making links between past and current learning experiences, seeing the whole picture, and self-assessing and directing their learning toward areas needing development. Students and CIs reported that heavy workloads, the fast work pace, and limited time for reflection interfered with deep-learning approaches.

Discussion and Conclusion. PT students and educators can use the study findings to promote deep learning during students' professional education to better prepare graduates for the challenges of today's health care environment.

Key Words: Physical therapist students, Clinical education experiences.

INTRODUCTION

An increasingly complex and demanding health care environment has made physical therapist (PT) educators think differently about PT clinical education. Now, more than ever, PT graduates must demonstrate effective and efficient critical-thinking skills, problem-solving skills, and self-directed learning habits that ensure a quick and smooth transition from novice practitioner to reflective professional. For these reasons, academic and clinical faculties are interested in clinical education (CE) experiences that expedite desirable learning outcomes in students and future professionals.

One area of study that educators may find useful when creating experiences that achieve optimal student learning is research on understanding how students in higher education approach learning. A learning approach has been defined as a function of both learner characteristics (eg, prior knowledge, abilities, values, ways of learning) and teaching factors (eg, methods of teaching, assessment, course structure, curriculum).1 The student and teaching contexts, when combined, produce 3 approaches to learning that researchers have described as surface, strategic, and deep.2-4

Students who approach learning in a surface manner rely on memorization of details, have difficulty making sense and seeing connections, and are fearful of failure. Strategic approaches are characterized by students who are more concerned with the context rather than the nature of the task at hand, are competitive and determined to excel, and elect to use a deep or surface approach based on what they believe will lead to the most successful outcome. Deep approaches are characterized by students who actively seek to understand the meaning in what they are learning, relate and organize ideas into a complete whole, and are critical in analyzing the evidence and their decisions. Researchers have posited that deep approaches are most desirable and result in an enhanced level of understanding and higher academic performance, whereas surface and strategic approaches lead to lowerquality learning outcomes.3-9

Although researchers1-9 outside the US have studied students' approaches to learning in higher education since the late 1970s, investigations of US students' approaches to learning are sparse. Furthermore, studies of students' learning approaches in health care have focused primarily on medical and nursing student populations. In the first published study involving PT students' approaches to learning, Van Langenberghe10 reported that Dutch students in a problembased PT program possessed the same deep approaches to learning as medical students. In a study examining the influence of 3 different academic programs (hospital-based, polytechnic-based, or university-linked) with different curriculum philosophies (clinically-focused, problem-based learning, or university-modular) on British PT students' approaches to learning, Titchen11 reported an association between students' deep scores and problem-based learning, a similar finding to Van Langenberghe's10 study.