To connect theory and practice, this project provided real-world case studies through an e-learning package. Effectiveness of the e-learning for improving clinical reasoning ability was evaluated.
Designed with educational developers, constrained choice activities were used to focus students on key concepts and encourage considerations between competitive options for selection of the ones to be prioritised. Neurology faculty and physiotherapists involved in the teaching of relevant modules provided the e-learning content. For each case study presented within the e-learning, students were asked to select the participation restriction, prioritised activity limitation producing the participation restriction, and prioritised impairment producing the activity limitation. Based on a pre-determined decision tree, if their subsequent selection was not an appropriate match for the previous selection, they were prompted that their selection was incorrect. Progress to the next question was not allowed until an appropriate selection for that question level was made. If the responses given were all appropriate, the next questions presented related to the intervention. These were similarly based on a pre-determined decision tree. If the first intervention selected was suitable, the next questions asked to make the intervention more challenging or easier to perform.
Undergraduate physiotherapists enrolled in their first neurological physiotherapy module in 2024 were invited to participate, with the e-learning package available for two weeks at the close of the teaching term. The first neurological physiotherapy module taught stroke rehabilitation through lectures and practical sessions. Consenting students completed the e-learning, consisting of six case studies relating to people with stroke. Clinical reasoning ability was measured through two comparable case studies, with questions on the problem list and intervention, administered before and after e-learning. A blinded neurological physiotherapist was engaged to score the responses on pre-determined criteria. The maximum total score attainable for each case study was 12, with 6 points assigned each towards the problem list and intervention. A linear mixed-effects model was applied to investigate differences in clinical reasoning ability. Significance was set at p0.05.
Among 105 students who provided informed consent (66.9% of cohort), 75 (71.4%) completed the e-learning and comparable case studies. Of these, 93.3% (n = 70) demonstrated improved clinical reasoning. Total scores improved by 2.8 points post (SE=0.41, p0.0001; Baseline: Median=4.5, Q1-Q3=0.5-6.9). Scores on questions related to the problem list improved more than that related to intervention (Problem list: 1.8, SE=0.3, p0.0001, Baseline: Median=1.0, Q1-Q3=0.0-3.0); Intervention: 0.9, SE=0.2, p0.0001, Baseline: Median=0.75, Q1-Q3=0.0-2.0).
Constrained choice activities based on case studies delivered through an e-learning package significantly improved clinical reasoning ability in undergraduate physiotherapists.
The package can hone clinical reasoning skills without additional demands on faculty time. Future work may investigate e-learning timing in relation to tutorials.
education
self-directed learning
