Building Reflective Practice into a Hybrid Physical Therapy Course

In designing the clinical neuromuscular course for the hybrid DPT educational entry level program, we aimed to integrate opportunities for students to enhance the cognitive aspect of clinical reasoning during their asynchronous coursework. This included a scaffolded milestone assignment- which is a series of smaller assignments meant to build on each previous assignment- to promote reflective practice throughout the course. 

One course objective was to develop reflective practice for working with individuals following a stroke, traumatic brain injury, or spinal cord injury. This was facilitated through several strategies: 

1. Real-World Reflections: At the end of each module, the instructor (RH) provided three reflections on how the material influenced her clinical practice, including one challenge she still faces (e.g., discussing gait recovery post-spinal cord injury or managing interactions with a person post stroke who is in denial). These reflections appeared at the end of each of the 10 modules, encouraging students to see practical applications and ongoing challenges in clinical work.
2. Muddy Points Discussion: In alternating modules, students posted two key learnings and one unresolved question called a "muddy point." They also responded to a peer’s post, helping clarify each other’s unresolved questions. This collaborative reflection was designed to stimulate deeper cognitive engagement with the material.
3. Milestone Assignments: Students completed three reflective milestone assignments, where they assessed two different published protocols for home exercise programs for the upper extremity in the stroke and spinal cord injury populations. The final milestone required them to compare and contrast these protocols and discuss how they might use both in practice.

Measuring clinical reasoning is difficult, but student feedback provided insight into the success of the reflective strategies. When asked “Class activities encouraged active learning (student engagement with material; student/instructor reflection) 96% of the students who completed the post course teaching evaluation (30 of 87 students) respondents either agreed or strongly agreed with the statement.  

 Some comments included: 

• “The milestone reflections were most helpful. I could express my muddy points and receive clarification from peers.”
• “The real-world reflections were valuable because they demonstrated how the information is applied in practice and that even the instructor is still learning.”

Integrating reflective practice into a hybrid DPT curriculum was well-received and promoted student engagement with clinical reasoning.

As physical therapy education expands into online and hybrid spaces, leveraging technology to promote clinical reasoning and reflective practice provides opportunities for  novel approaches to enhance learning.