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Smith N1, Bartlett A2, Oliver K3
1Winston Salem State University, Winston Salem, United States, 2Nazareth College, Physical Therapy, Rochester, United States, 3North Carolina State University, Learning Design and Technology, Raleigh, United States
Background: Within the profession of medical education, research has demonstrated that computer-based instructional scaffolding can assist learners in developing the practices of clinical reasoning (CR). However, there is a paucity of research in the profession of physical therapist (PT) education on using computer-based instructional scaffolding principles to facilitate CR. Further, research is non-existent within PT education on the use of mobile technology to facilitate CR.
Purpose: Therefore, this study describes the development, implementation, and evaluation of a mobile application to determine what impact it had on first-year PT student CR.
Methods: In developing the mobile application, the researcher utilized the five components of the ADDIE instructional design model. In order to facilitate physical therapist students' implementation of the sequence and strategies of scientific CR, principles of the scientific reasoning framework scaffolding model and the Hypothesis Oriented Algorithm for Clinicians II-1 were incorporated. Three different domains of scaffolding using both hard and soft scaffolds were included in the application: sense making, process management, and reflection and articulation. Six first year PT student-participants were recruited for the study. After informed consent was collected, an audio recorded pre-task based interview was collected to detect the initial reasoning process used by the participants. Then, the student-participants had four sessions with the mobile application. Finally, a second post task-based interview was conducted to detect possible changes in the reasoning process. During all phases of the study, researcher field notes were taken. All data that were collected were evaluated using inductive and deductive qualitative narrative analysis methodology, and trustworthiness was ensured by peer debriefing, member checking, and data triangulation.
Results: The mobile application had four main effects upon CR, namely: improving the sequence of reasoning used by all student-participants, increasing the use of higher-order, more sophisticated reasoning strategies, improving the correctness of diagnostic reasoning, and changing perceptions of needed supports for CR. Perceptions of needed CR supports identified were that knowledge support, past experience, collecting appropriate data, sense making, process management, confidence, and articulation and reflection are all necessary to support CR. Effects of the mobile application identified by student-participants were: allowing for knowledge support, supporting sense-making and process management, allowing repeated practice, supporting articulation and reflection, and increasing their ability to identify and focus upon the problem. Suggestions were made by student-participants for improving the mobile application that included increasing the number of cases in the application for more practice opportunities, to correct application errors, and to improve support for prescribing treatment.
Conclusion(s): This study provides the first evidence in PT education that a mobile application using a case based approach and instructional scaffolding can improve and is perceived to improve PT CR, in congruence with literature in other professions. Further demonstrated are student perceptions of needed supports for CR. Future research should focus upon more advanced PT students to determine if congruent results can be obtained.
Implications: Finding appropriate methodologies to teach CR, such as the mobile application studied, may assist student learning and improve CR, thereby decreasing diagnostic error.
Keywords: M-learning, Clinical reasoning, Instructional Scaffolding
Funding acknowledgements: This study was partially funded by a internal grant from Winston Salem State University.
Purpose: Therefore, this study describes the development, implementation, and evaluation of a mobile application to determine what impact it had on first-year PT student CR.
Methods: In developing the mobile application, the researcher utilized the five components of the ADDIE instructional design model. In order to facilitate physical therapist students' implementation of the sequence and strategies of scientific CR, principles of the scientific reasoning framework scaffolding model and the Hypothesis Oriented Algorithm for Clinicians II-1 were incorporated. Three different domains of scaffolding using both hard and soft scaffolds were included in the application: sense making, process management, and reflection and articulation. Six first year PT student-participants were recruited for the study. After informed consent was collected, an audio recorded pre-task based interview was collected to detect the initial reasoning process used by the participants. Then, the student-participants had four sessions with the mobile application. Finally, a second post task-based interview was conducted to detect possible changes in the reasoning process. During all phases of the study, researcher field notes were taken. All data that were collected were evaluated using inductive and deductive qualitative narrative analysis methodology, and trustworthiness was ensured by peer debriefing, member checking, and data triangulation.
Results: The mobile application had four main effects upon CR, namely: improving the sequence of reasoning used by all student-participants, increasing the use of higher-order, more sophisticated reasoning strategies, improving the correctness of diagnostic reasoning, and changing perceptions of needed supports for CR. Perceptions of needed CR supports identified were that knowledge support, past experience, collecting appropriate data, sense making, process management, confidence, and articulation and reflection are all necessary to support CR. Effects of the mobile application identified by student-participants were: allowing for knowledge support, supporting sense-making and process management, allowing repeated practice, supporting articulation and reflection, and increasing their ability to identify and focus upon the problem. Suggestions were made by student-participants for improving the mobile application that included increasing the number of cases in the application for more practice opportunities, to correct application errors, and to improve support for prescribing treatment.
Conclusion(s): This study provides the first evidence in PT education that a mobile application using a case based approach and instructional scaffolding can improve and is perceived to improve PT CR, in congruence with literature in other professions. Further demonstrated are student perceptions of needed supports for CR. Future research should focus upon more advanced PT students to determine if congruent results can be obtained.
Implications: Finding appropriate methodologies to teach CR, such as the mobile application studied, may assist student learning and improve CR, thereby decreasing diagnostic error.
Keywords: M-learning, Clinical reasoning, Instructional Scaffolding
Funding acknowledgements: This study was partially funded by a internal grant from Winston Salem State University.
Topic: Education; Robotics & technology
Ethics approval required: Yes
Institution: Winston Salem State University
Ethics committee: Institutional Review Board
Ethics number: 2986-17-033
All authors, affiliations and abstracts have been published as submitted.
