DEVELOPING JUNIOR PHYSIOTHERAPY STUDENTS MUSCULOSKELETAL ASSESSMENTS WITH SENIOR STUDENTS AS STANDARDISED PATIENTS IN SINGAPORE: BEFORE AND DURING THE COVID-19 PANDEMIC

E.J. Rigby¹, A. Goff¹, C.P. Tan¹

Background: As physiotherapy student numbers increase in Singapore, a challenge may be sufficient exposure to clinical education. Research outside of Asia has identified that involving senior students as standardised patients is a cost-effective teaching method to benefit junior students’ confidence, communication, patient empathy and knowledge of, musculoskeletal assessments. Traditionally, exposure to standardised patients is in face-to-face clinical simulations; however, due to the COVID-19 pandemic, these clinical simulations had to be moved online to create a telehealth learning environment.

Purpose: The primary aim of this study was to determine the impact of using senior students as standardised patients for junior physiotherapists self-perceived communication, confidence and preparedness for musculoskeletal clinical placements within a Singapore context. The secondary aim of this study is to determine the impact of moving junior physiotherapy students clinical simulation with standardised patients to an online, telehealth environment.

Methods: Cohort study design comparing before- and during COVID-19 student cohorts. For the before COVID-19 cohort, four clinical simulation tutorial sessions using senior students as standardised patients occurred in the third trimester of the first year of a four-year BSc Physiotherapy programme. Students worked in groups to undertake patient interviewing, physical exam and treatment when appropriate under the facilitation of a member of the teaching staff. Pre-post surveys using pre-defined 5-point Likert scales were completed by students attending tutorials to address: i) confidence in the assessment process, ii) preparedness for clinical placements, iii) ability to identify own strengths and weaknesses, iv) ability to establish rapport with patients, v) ability to provide information and education to patients and, vi) ability to act in a professional manner. For the during COVID-19 cohort, the same tutorials and pre-post surveys were repeated; however, tutorials occurred in and online, telehealth environment. T-tests (p-value < .001) were used to compare for differences pre-post for each tutorial and cohort, as well as compare each cohort on an item basis for each tutorial.

Results: Before COVID-19 cohort (n=131 students), mean response rate was 66% presurvey and 37% post-survey. Generally, students statistically significantly improved pre-post face-to-face interaction with standardised patients for all outcomes, except for one tutorial. During COVID-19 cohort (n=199 students), mean response rate was 33%. Generally, students reported no changes for self-reported outcomes pre-post online interaction with standardised patients for 2 tutorials, and fewer than half the items for another 2 tutorials. As a direct comparison, the before COVID 19 cohort reported statistically significantly higher scores in 3 out of 4 tutorials for all items compared to the online tutorials.

Conclusion(s): Face-to-face clinical encounters with senior students as standardised patients are effective at improving self-reported measures for confidence and ability to perform musculoskeletal assessments, however online encounters are not.  

Implications: Educational institutions may need to offer additional support to junior physiotherapy students to develop essential clinical skills due to the disruption of COVID-19 on the learning environment. Methods to optimise and facilitate online encounters with standardised patients need further development before routine use by educational institutions.

Funding, acknowledgements: No funding was received.

Keywords: Standardised patient, peer simulation, physiotherapy

Topic: Education: methods of teaching & learning

Did this work require ethics approval? Yes

Institution: Singapore Institute of Technology (SIT)

Committee: Singapore Institute of Technology Institute Review Board

Ethics number: 2019155