● Intermediate learner : Continued use of deductive strategies with initial integration of inductive strategies such as clinical narratives with more structure. ● Prior to graduation : Both deductive and inductive strategies could be utilized, including CRGR, clinical narratives, and possibly introduction of the SCRIPT. ● Early clinician : Some deductive tools but more inductive tools, including the CRGR, SCRIPT, and clinical narratives. ● Expert clinician : Clinical narratives. use of the ICF model, clinical algorithms, or clinical practice guidelines, which provide the learner with questions to answer or frameworks that can guide the reasoning process of the learner. On the other hand, if the learner is more advanced in his or her knowledge, skills, and abilities, inductive reasoning strategies, including pattern recognition and open-ended questions, are helpful in facilitating the clinical reasoning process of the learner. As described earlier, a gold standard for assessing clinical reasoning skills does not currently exist. Given this dilemma, the clinical instructor or mentor will likely need to use more than one tool to effectively determine learner performance. If the learner is a student, the Clinical Performance Instrument can be used to broadly provide some input on clinical reasoning skills, but only 1 of 18 items on the CPI applies to clinical reasoning skills. Grading rubrics such as the Clinical Reasoning Grading Rubric can also be used to assess performance. Writing a clinical narrative is another assessment option that can highlight the more experienced learner’s thoughts. Additional research is needed to better understand how to effectively facilitate and assess clinical reasoning capabilities in learners. However, implementing the strategies discussed in this course is a great starting place that will continue to move the profession forward in providing optimal treatment for patients.
The same could be true for a learner who may be in his or her second semester of physical therapy education but has a family member with a particular health condition so this learner could be considered more of an intermediate or prior-to-graduation learner. Examples of assessment tools across the physical therapy curriculum include: ● Early learner : Use deductive reasoning skills including the TAPSE, CRGR, clinical narratives with significant guidance and structure. Conclusion In order to optimally develop appropriate learning experiences in the clinical education environment, the clinical instructor or mentor needs to communicate with the academic institution or the learner directly to understand what content knowledge and psychomotor skills the learner already possesses as a baseline assessment. This may be determined by previous coursework, experience with various patient populations and when on- site, direct observation of competence and skills. The on-site evaluation of the learner helps the clinical instructor or mentor determine an educational diagnosis of the learner. Essentially, this diagnosis is a summary of areas of weakness for the learner. In addition to understanding the baseline knowledge and skills of the learner, the clinical instructor or mentor must demonstrate effective interpersonal skills and communication, professionalism, competence in evaluating the learner’s performance, and excellent reflective capabilities. These characteristics lead to a successful and positive experience for both the clinical instructor/mentor and the learner. An understanding of the learner’s knowledge, skills, and abilities, as well as time frame in the learning process helps the clinical educator or mentor determine what type of clinical reasoning strategies could be most effective. If the learner is in the early stage of the curriculum or learning process, deductive reasoning strategies that provide more structure for the learner are most effective. These deductive strategies could include The following patient example will be used to illustrate the concepts in both case studies. The first will demonstrate the SNAPPS model, while the second case study will show how to use both deductive and inductive reasoning skills. Case information A 44-year-old female patient reports right lateral knee pain when training for a marathon. She reports the “achy” pain began 2 months ago when she was running down hills but now the pain is present anytime she runs or walks down stairs. She has tried icing her knee after running to reduce the pain. She states her pain is a 7/10 on the visual analog scale when running, describes her pain as “achy Case study 1: Use of the SNAPPS model Since the student has covered the musculoskeletal system in her didactic curriculum at school, the clinical instructor asks the student to take the lead in performing the initial examination with this patient. The clinical instructor tells the student to use the SNAPPS model to discuss her thoughts with the instructor, articulate her clinical reasoning, and engage in additional learning relevant to the patient case. This is a six-step process in which the student and instructor engage in the following 5-minute process: S The student briefly SUMMARIZES the patient history and current findings (approximately 2 to 3 minutes). N The student NARROWS the differential diagnosis to two to three relevant possibilities. A The student ANALYZES the differential diagnosis, comparing and contrasting the possibilities. P The student PROBES the instructor by asking questions about what he or she does not understand.
CASE STUDIES
and sometimes sharp,” and has reduced her mileage from 60 miles per week to 10 miles per week without much pain relief. She has a history of a left tibial fracture with insertion of an intramedullary rod to stabilize the fracture. The patient denies any back pain, history of cardiac or immune system issues, or other health problems. She has been running for 20 years. The patient is a physical therapist in an acute hospital setting where she transfers patients on a daily basis. The patient’s goal is to run the New York City Marathon, which is 2 months from the time the therapist and student initially evaluate her. P The student PLANS management for the patient. S The student SELECTS a case-related issue for self-directed learning. The table below highlights an example of using the SNAPPS model in the clinical setting with a student. As you read through the model applied to a case, think about the following questions: ● How can you facilitate the clinical reasoning process of the learner? ● What types of questions can you ask to help the learner develop independent thinking skills (open-ended versus close-ended questions). ● How can you help the learner answer his or her own questions? Can you ask a question to help the learner combine or clarify knowledge? ● What characteristics of an effective clinical instructor or mentor can you use to make this a positive and successful learning experience?
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Book Code: PTCA2622B
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