Human Nature and Research Paradigms: Theory Meets Physical Therapy Practice

Human nature is a very complex phenomenon. In physical therapy this complexity is enhanced by the need to understand the intersection between the art and science of human behavior and patient care. A paradigm is a set of basic beliefs that represent a worldview, defines the nature of the world and the individuals place in it, and helps to determine criteria used to select and define research inquiry. A paradigm guides scientific inquiry, not only in the manner in which an investigation is performed, but also in how the investigator defines truth and reality and how the investigator comes to know truth or reality. A paradigm guides the types of research questions that will be posed, the methodological approach to the inquiry, and criteria for assessing the trustworthiness of the inquiry. Research plays an important role in enabling physical therapists to fully embrace the values of the profession, including evidence-based practice and client-centered care, in making informed clinical decisions. However, to do so, the research provided must include not only the views of the researchers, but also the lived experiences of the clients as well. This paper provides the reader with a solid foundation in the positivist/post-positivist, constructivist, and critical theorist research paradigms and how they apply in physical therapy practice. Research perspectives in physical therapy are explored, as are implications for future practice in physical therapy

Exploring Standardized Patients’ Perspectives on Working with Medical Students

Little is known about how working with emerging medical professionals affects Standardized Patients’ (SPs’) professional identities, yet understanding the SP-medical student interaction could be useful for screening SPs, supporting SP professional identity formation, and bridging the SP and medical student cultures. This project provides the unique perspective of SPs involved in the growth of medical students into physicians. Qualitative methods were used to understand the SPs’ perspectives. Two researchers, without evaluative relationships with the SPs, conducted 2 one-hour focus group interviews (n=3; n=9) using a semi-structured interview protocol. Interviews were audio-recorded and transcribed verbatim. Three researchers independently analyzed the transcripts to identify clusters of meaning and codes. Codes identified by consensus and analysis continued until saturation was reached, followed by identification of categories and themes. To ensure credibility and trustworthiness of the results, investigators used triangulation of methods and researchers, prolonged engagement with the data, and presentation of thick rich descriptions as evidence of each theme. A number of themes were identified in these focus group interviews. SPs experienced a transformation of purpose and the emergence of a new professional identity, including genuine professional, guide, teacher, counselor and surrogate parent. They discovered personal meaning and mutuality in their relationships with students, like the satisfaction of helping others, benefiting society, and growing personally. SPs found themselves reacting to student behaviors in a variety of ways including admiration, dislike, surprise, and discomfort. Finally, SPs confronted challenges in moving between their simulated and real selves. This analysis provided insights into transformations SPs underwent as a result their work. It revealed a self-actualization process in which SPs experienced an emergence of new roles and a discovery of new meaning in their relationships similar to the professional identity formation process of students. Understanding this process may prove useful to SP educators in knowing how to best nurture identity, train SPS, reinforce job meaningfulness and increase SP recruitment and retention. SP perspectives about their students’ behaviors may be useful to SP educators in acclimatizing them to the simulation process

Acting on Reflection: the Effect of Reflection on Students’ Clinical Performance on a Standardized Patient Examination

BACKGROUND: Little evidence exists to support the value of reflection in the clinical setting. OBJECTIVE: To determine whether reflecting and revisiting the “patient” during a standardized patient (SP) examination improves junior medical students’ performance and to analyze students’ perceptions of its value. DESIGN: Students completed a six-encounter clinical skills examination, writing a guided assessment after each encounter to trigger reflection. SPs evaluated the students with Medical Skills and Patient Satisfaction checklists. During the last three encounters, students could opt to revisit the SP and be reevaluated with identical checklists. PARTICIPANTS: One hundred and forty-nine third year medical students. MEASUREMENTS: Changes in scores in the Medical Skills and Patient Satisfaction checklists between first visit and revisit were tested separately per case as well as across cases. RESULTS: On the medical skills and patient satisfaction checklists, mean revisit scores across cases were significantly higher than mean first visit scores [12.6 vs 12.2 (pooled SD = 2.4), P = .0001; 31.2 vs 31.0 (pooled SD = 3.5), P = .0001)]. Sixty-five percent of the time, students rated “reflect–revisit” positively, 34% neutrally, and 0.4% negatively. Five themes were identified in the positive comments: enhancement of (1) medical decision making, (2) patient education/counseling, (3) student satisfaction/confidence, (4) patient satisfaction/confidence, and (5) clinical realism. CONCLUSIONS: Offering third year medical students the option to reflect and revisit an SP during a clinical skills examination produced a small but nontrivial increase in clinical performance. Students perceived the reflect–revisit experience as enhancing patient-centered practices (counseling, education) as well as their own medical decision making and clinical confidence

Teaching and learning in physical therapy/ Plack

xxii, 257 hal.: ill.; 35 cm

Teaching and learning in physical therapy/ Plack

xxii, 257 hal.: ill.; 35 cm