Being an Acute Care Educator: The How, The What, and The Why

Kristin Curry Greenwood, PT, DPT, EdD, MS, GCS | Northeastern UniversityMatthew Nippins, PT, DPT, CCS | Northeastern University

Kathryn Panasci, PT, DPT, CBIS, CWS | Texas Tech University Health Sciences Center

Learning ObjectivesUpon completion of this course, you will be able to:

• Formulate a professional development plan for initiating or advancing your acute care faculty physical therapy education practice.

• Develop or revise your current acute care education teaching strategies to meet students’ acute care education needs.

• Adopt an evidence-based teaching method into your acute care curriculum.

CAPTE Required Elements for Faculty

Standard 4: The program faculty are qualified for their roles and effective in carrying out their responsibilities

4A. Each core faculty, program director, and clinical education director demonstrates:

Doctoral preparationContemporary expertiseEffective teaching and student evaluationCurrent license to practice PT in US jurisdiction

PT Standards and Required Elements, CAPTE 2016

Expectations for Educators

PT Standards and Required Elements, CAPTE 2016

Expectations for EducatorsCAPTE Required Elements for Faculty

Each core faculty:• 4B: Has a well-defined, ongoing scholarly agenda• 4C: Has a record of institutional or professional service

Each associated faculty:• 4D: Has contemporary expertise in assigned teaching and

has demonstrated effectiveness in teaching and student evaluation

Collective core and associated faculty include an effective blend of individual academic and clinical preparation (4K)

Expectations for EducatorsExpertise looked for when seeking to hire acute care educators

• Clinical experience and expertise• Clinical instructor (CI) experience• Credentialed CI• Certifications (ABPTS v. others)• Record of scholarship• Familiarity engagement with APTA and component chapters• ACUTE CARE EXPERIENCE

Faculty DevelopmentProfessional Development Plan: What to do to prepare your resume for future teaching

• Service expectations• Well-defined, ongoing scholarly agenda• Clinical certification• Academic doctoral degree

Defining Acute Care EducationWhat needs to be taught in acute care?

• Acute Care therapists think differently than other types of physical therapists in part because they make decisions when patients are often in medical crisis (Masley et al., 2011).

• This decision making process relies heavily on the therapist’s interprofessional relationships with the medical team, management of emotions and ability to make judgments in action that are best for an individual patient’s circumstances (Holdar, Wallin, & Heiwe, 2013; Masleyet al., 2011; M. Smith, Higgs, & Ellis, 2010).

• Acute Care Practice requires emotional intelligence and professional behaviors which has been identified in physicians and other health professions (Galal, Carr-Lopez, Seal, Scott, & Lopez, 2012).

Defining Acute Care EducationHow is it different from other DPT curricula?

• Spans all content areas of practice• Focuses on “acuity of condition” not patient diagnosis• Educating students to make “dynamic decisions” in the acute

care environment where patients’ presentations change (Masley et al., 2011)

Defining Acute Care EducationWhat is out there to guide how to teach acute care?

• Each individual physical therapist curriculum is guided by the Normative Model of Physical Therapist Education (American Physical Therapy Association, 2006).

• Nationwide Acute Care Practice Analysis (Gorman, 2010).

• Core competencies of Entry Level practice in Acute Care Physical Therapy (Greenwood et al.).

Educational Theory to assist with acute care education

• “Learning is What Matters Most” (Jensen, 2011). Jensen (2011) describes how students need to understand the situation, not just the decision.

• Simulation requires reflection, which has been theorized to assist students in learning critical thinking (Schön, 1987).

• Thought on action versus thought in action

Theory of Reflection

• Bandura’s social cognitive theory (1993) has been utilized to explain the role simulation has in enhancing students’ self-confidence and performance.

• Social cognitive theory posits a direct relationship between a student’s self-efficacy and his or her level or performance (Bandura, 1993).

Theory of Self-Efficacy

• Emotional intelligence refers to one’s ability to appropriately express and assess one’s own emotions, as well as understand the emotions of others (Salovey& Mayer, 1990).

• Clinical decision-making requires affective and professional behaviors associated with emotional intelligence (Goleman, 2006).

Emotional Intelligence Theory

• Kolb’s learning theory posits that a combination of experience, reflection, conceptualization, and experimentation are needed to foster learning (Kolb, 1984).

Kolb’s Learning Theory

• Transformative learning theory explains that a meaningful context can transport an adult learner ixntoa new reality by moving through ten purposeful stages of learning (Mezirow, 1991).

Transformative Learning Theory

• Learning occurs as a construct of culture, context and activity (Lave, 1988)

• Social interaction and community of practice are key. • Learning is unintentional “legitimate peripheral

participation. (Lave & Wenger, 1991)

Situated Learning Theory

Educational Models

• Bloom’s Taxonomy is a hierarchy of objectives and learning activities (Bloom, 1984).

• Webb’s Depth of Knowledge is that students gain the skills to perform in new situations, without prior knowledge based on relating previous thinking to new thinking (Webb, 2002).

• Understanding by design is an educational model created by Wiggins and McThie (1998).

Acute Care & Interprofessional Education

●Team-based learning through:● Cases● Simulation● Reflective Writing● Concept Mapping

● Team-based Learning● Identifying roles and roles of other healthcare professionals

● Applying relationship building principles to form effective healthcare teams

● Communicate with all members of the healthcare team, patient and family in a way that promotes the team approach to address prevention and treatment of disease

»IPEP Competencies 2016

TWO CURRICULAR EXAMPLES WILL BE PRESENTED

• Curricular example 1: Texas Tech University

• Curricular example 2: Northeastern University

ACUTE CARE TEACHING METHODS

Online Discussion BoardBackground:● Wainwright SF, Shepard KF, Harman LB, Stephens J.

Novice and experienced physical therapist clinicians: a comparison of how reflection is used to inform the clinical decision-making process. Phys Ther. 2010;90:75-88.

● Orest MR. Clinicians’ perceptions of self-assessment in clinical practice. Phys Ther. 1995;75:824–829.

● Hayward LM, Greenwood KC, Nippins M, et al. Student perceptions and understanding of client-therapist interactions within the inpatient acute care environment: qualitative study. Phys Ther. 2015;95:235–248.

Online Discussion Board● Discussion Board

● Paired with clinical observation of a selected evaluation

● Students perform weekly reflective writing with guiding questions of different aspects of the evaluation

• Emphasis on critical thinking links to within the evaluation

• Interprofessional education also interwoven into the reflective writing

Online Discussion BoardSample discussion week:● Consider the systems review discussion from last week and the subjective

history discussion from week #1. Please look at the answers to these original guiding questions (including the additional questions in bold type) and revise them from your original posts (if needed), then post the revised answers:

● What questions led to specific tests and measures in the examination?● What from the systems screen led to specific tests and measures?● Was the order of the tests important and why?● Did certain tests lead to other tests during the exam?● What impairments did the tests and measures observed identify? Please

explain.● What did you learn about this particular aspect of the evaluation (tests

and measures), and what might you do with the learning in the future as a PT student and eventually as a PT?

Case IntegrationBackground:

• Dubey S & Dubey AK. Promotion of higher order cognition in undergraduate medical students using case-based approach. J Educ Health Promot. 2017;6:75. doi:10.4103/jehp.jehp_39_17

• Srinivasan M, Wilkes M, Stevenson F, Nguyen T, and Slavin S. Comparing problem-based learning with case-based learning: effects of a major curricular shift at two institutions. Aced Med. 2007;82(1):74-82.

Case IntegrationSample Lab Case: HPPT 8314 IPT

Lab objectives – students will:• Obtain relevant information from the mock chart

(physician dictated H&P and lab values)• Conduct a patient introduction and interview• Perform a systems screen on the patient• Determine and demonstrate relevant tests and measures• Complete the PT evaluation including diagnosis,

prognosis, goals and discharge planning• Develop an intervention treatment plan

Case IntegrationPractical Examination: HPPT 8314 IPT

Case-based demonstration of:• Critical thinking• Problem-solving• Depth of knowledge within this content area• Execution of psychomotor skills

Formal grading rubric

Concept MappingBackground:

• Concept maps should be introduced early in the curriculum to assist with students’ self-confidence and awareness of clinical decision-making (Torre et al., 2007).

• Decision trees utilized by Cahalin et al. (2011), have been successful in physical therapist education

Determine if Mrs. Mullen is safe to go home

What do I know from the

chart that

effects safety?

Fell at HomeUses cane

outside home

lives with daughter

has B fx and hx of knee

replacementAge

What do I

primarily need to

evaluate?

Balance, gait,

safety, awareness, strength,

fxl mobility

What am I

deciding between for d/c plan

What does she need

to do to go to OP,

which is least

amount of assistance

She needs to be

Independent because she

was Independent

prior

She fell at

HOME

Home PT is best choice due to

not I and safety

issues at home.

SimulationBackground:• The evolution of simulation education in physical therapist

programs over the last several years is preceded by success within physician education (McIndoe, 2012; Scalese, Obeso, & Issenberg, 2008).

• Simulation education involves the creation of realistic clinical scenarios through which physical therapist students can actively participate in patient management using actors or computerized manikins (Shoemaker, Riemersma, & Perkins, 2009).

• Use of medical simulation has shown positive outcomes in physical therapist students’ confidence, technical acute care skills and engagement with the acute environment (Ohtake, Lazarus, Schillo, & Rosen, 2013; Michael J. Shoemaker et al., 2011; N. Smith, Prybylo, & Conner-Kerr, 2012).

Simulation at TTUHSC• HPPT 8314 – IPT

• HPPT 8224 – Clinical Reasoning 2

Simulation at Northeastern● Utilized in four courses to assist with acute care education

● Simulated patients and patient manikins are utilized● Utilized for formative and summative learning activities

● Interprofessional and In silo● Case example, planning forms and video will be presented

Clinical Education• That aspect of the professional curriculum during which student

learning occurs directly as a function of being immersed within physical therapist practice. These experiences compromise all of the formal and practical “real-life” learning experiences provided for students to apply classroom knowledge, skills, and professional behaviors in the clinical environment.

• 6L: The curriculum plan includes clinical education experiences for each student that encompass, but are not limited to:

• CAPTE does not require acute care clincial education experiences

PT STANDRARDS AND REQUIRED ELEMENTS

WHAT CAN I DO TO PREPARE?

Question and Answer Session

Final Questions

References1. Bednarek B, Downey P, Williamson A, Ennulat C. The use of human simulation to teach acute care skills in acardiopulmonary course: A case report. Journal of Physical Therapy Education. 2013;28(3):27-34.

2. Dubey S & Dubey AK. Promotion of higher order cognition in undergraduate medical students using case-based approach. J Educ Health Promot. 2017;6:75. doi: 10.4103/jehp.jehp_39_17

3. Gorman SL, Wruble Hakim E, Johnson W, et al. Nationwide acute care physical therapist practice analysisidentifies knowledge, skills, and behaviors that reflect acute care practice. Phys Ther. 2010;90(10):1453-1467. doi:10.2522/ptj.200903855.

4. Greenwood K, Nicoloro D, Iversen M. Reliability and validity of the acute care confidence survey: An objectivemeasure to assess students’ self-confidence and predict student performance for inpatient clinical experiences. Journal of Acute Care PT. 2014;5(1):1-10.

5. Guide to Physical Therapist Practice. Guide 3.0 Alexandria, VA: American Physical Therapy Association; 2014.http://guidetoptpractice.apta.org.

6. Gwyer J , Hack L , Jensen G , Segal R , Boissonnault W. Future directions for educational research in physical therapy. Journal of Physical Therapy Education. 2015;29(4):3-4.

7. Hayward, L. Greenwood, K. Nippins, M. Canali, A. Student perceptions and understanding of client-therapistinteractions within the acute inpatient environment: a qualitative study. Physical Therapy Journal. 2015; 95(2):235-248.

8. Holdar U, Wallin L, Heiwe S. Why do we do as we do? Factors influencing clinical reasoning and decision-making among physiotherapists in an acute setting. Physiotherapy Research International. 2013;18(4):220-229.doi:10.1002/pri.1551de

9. IPEC Core Competencies for Interprofessional Collaborative Practice: 2016 Update. https://nebula.wsimg.com/2f68a39520b03336b41038c370497473?AccessKeyId=DC06780E69ED19E2B3A5&disposition=0&alloworigin=1. Updated 2016. Accessed November 30, 2017.

10.Jensen G M. 42nd Mary McMillan Lecture: Learning: what matters most. Physical Therapy. 2011;91(11):1674-1689.

11. Lave J. Cognition in Practice: Mind, Mathematics and Culture in Everyday Life. Cambridge, United Kingdom: Cambridge University Press; 1988.

12. Lave J & Wenger E. Situated Learning: Legitimate Peripheral Participation. Cambridge, United Kingdom: Cambridge University Press; 1991.

13. Masley PM, Havrilko CL, Mahnensmith MR, Aubert M, Jette DU, & Coffin-Zadai C. Physical therapist practice in the acute care setting: A qualitative study ... including invited commentary with author response. Physical Therapy. 2011;91(6):906-922. doi: 10.2522/ptj.20100296

14. Mori B, Carnahan H, & Herold J. Use of simulation learning experiences in physical therapy entry-to-practice curricula: a systematic review. Physiotherapy Canada. 2015;67(2):194-202. doi:10.3138/ptc.2014-40E

15. Orest MR. Clinicians’ perceptions of self-assessment in clinical practice. Phys Ther. 1995;75:824–829.

16. Physical therapist clinical performance instrument (PT CPI). American Physical Therapy Association. http://www.apta.org/PTCPI/. Updated March 24, 2015. Accessed November 2017.

17. PT Standards and Required Elements. Commission on Accreditation in Physical Therapy Education. http://www.capteonline.org/AccreditationHandbook/. Updated July 15, 2016. Accessed November 14, 2017.

18. Reeves S, Zwarenstein M, Goldman J, Barr H, Freeth D, Koppel I, et al. The effectiveness of interprofessional education: key findings from a new systematic review. J Interprof Care. 2010;24(3):230-41.

19.Silberman NJ, Litwin B, Panzarella K, Fernandez-Fernandez A. Student clinical performance in acute careenhanced through simulation training. Journal of Acute Care Physical Therapy. 2016;7(1):25-36.

20. Srinivasan M, Wilkes M, Stevenson F, Nguyen T, and Slavin S. Comparing problem-based learning with case-based learning: effects of a major curricular shift at two institutions. Aced Med. 2007;82(1):74-82.

21. Torre DM, Daley BB, Stark-Schweitzer T, Siddartha S, Petkova J & Ziebert M. A qualitativeevaluation of medical student learning with concept maps. Medical Teacher. 2007;29(9/10):949-955.doi:10.1080/01421590701689506

22. Wainwright SF, Shepard KF, Harman LB, Stephens J. Novice and experienced physical therapist clinicians: acomparison of how reflection is used to inform the clinical decision-making process. Phys Ther. 2010;90:75-88.