Impact of a multi-patient simulation event on physical therapy student confidence: a quasi-experimental study

Purpose: Simulation is a long-established learning and assessment activity in healthcare education. Simulation has been used to provide opportunities for students to experience complex patient interactions in a low-risk setting to prepare students to manage all the demands of total patient care as new practitioners. The purpose of this quasi-experimental, single cohort study, with pre–post quantitative survey analysis including theme frequency, was to determine how participating in a multi-patient simulation consisting of different clinical settings and diagnoses would impact physical therapy students’ confidence in clinical and decision-making skills. Methods: Thirty-three, entry-level Doctor of Physical Therapy students completed a simulation and debriefing across four different healthcare settings while addressing different aspects of patient management within each of these settings. Students completed two surveys before and after this simulation to measure their self-appraised confidence. Quantitative data from these surveys were analyzed using Wilcoxon tests and the free-response entries from the surveys were analyzed for theme occurrence frequency. Results: Students’ total clinical skill confidence scores decreased (P = 0.015), specifically in areas of strength testing (P = 0.008), postural assessment (P = 0.002), and planning an appropriate intervention plan (P = 0.033). Students’ total decision-making confidence scores did not significantly change; however, areas of improvement included recognizing physiological and psychological changes in patients in a timely manner (P = 0.025) and distinguishing between clinically important and lower priority impairments (P = 0.048). Occurrence of theme frequencies from free responses revealed a decrease in student confidence related to “flow and organization” as well as “evaluation.” Conclusion: While incorporating a multi-patient simulation improved some aspects of students’ self-appraised confidence in clinical decision-making skills, there was an unexpected decrease in students’ overall confidence

Perceptions and Reflections of a Professional Pianist: A Case Report on Learning Human Anatomy through Cadaveric Dissection

Anatomical knowledge of the human body is a prerequisite for effortless and expressive movement for musicians.  A 35-year-old professional pianist, with no prior experience in the medical field, voluntarily completed a cadaveric dissection module of the upper extremity and spine.  The pianist was able to explore the intricate connections between human anatomy and the performance of piano music, gaining knowledge to enhance music quality and to manage and prevent injuries.  This case describes the pianist’s perceptions and reflections and highlights the potential value of anatomical education for individuals in non-medical fields.  This is, to our knowledge, the first documented case of a musician learning anatomy through cadaveric dissection

Sports Rehabilitation and Interprofessional Collaboration

Background: The demand for interprofessional collaboration continues to grow due to changing priorities of the health care system.  The benefits of interprofessional collaboration are well documented; however, the methods of collaboration are often unclear and often difficult to put into practice.  While there is a growing number of studies on the impact of interprofessional collaboration in settings such as inpatient, intensive care units, and acute care, there are limited documented cases regarding the interprofessional management of a physical therapy patient in the outpatient orthopedic private practice setting.   Purpose: The purpose of this paper is to describe the reflections of a physical therapist and an athletic trainer in their experience with interprofessional collaboration, describe the barriers they have experienced that make interprofessional collaboration challenging, and to offer solutions to these barriers.  The barriers discussed in the paper include limited knowledge of and respect for other professionals’ skill set, high-productivity work environments, medical hierarchy, overlapping bodies of knowledge, discrepancy between professional reasoning, territorial behavior, and ineffective communication.  Discussion: It appears that contextual factors, such as community in which the professionals practice, the healthcare setting, and the practice environment, have a far less important impact to successful collaboration than the professionals’ attitudes and investment in the collaborative efforts.  Conclusion: Collaboration between a PT and an AT can lead to power struggles and suboptimal patient care if these barriers are not overcome and collaboration may be necessary to provide the highest quality of patient care

Duplicated Palmaris Longus Muscle With Insertion Onto The Transverse Carpal Ligament: A Case Report

The palmaris longus muscle is one of the most anatomically variable muscles in the human body, with incidence ranging from 0-63.9%.  While these anatomical variations are typically benign, they are of clinical importance as they can contribute to neurovascular and biomechanical dysfunction.  We report here a duplicated palmaris longus muscle with an insertion onto the transverse carpal ligament found during cadaveric dissection in a graduate anatomy course for physical and occupational therapy students.&nbsp

Flexor Carpi Radialis Brevis: A Case Report

The flexor carpi radialis brevis is a rare anomalous muscle, with incidence ranging from 1.6-7.5%.  While this anatomical variation is typically benign, it is of clinical importance as it can contribute to neurovascular and musculoskeletal dysfunction.  Surgeons should be made aware of this variation during distal radius volar plating procedures and carpal tunnel releases.  The flexor carpi radialis brevis muscle may also cause confusion when interpreting imaging results.  We report here a rare case of bilateral flexor carpi radialis brevis muscles that travel through the carpal tunnel found during cadaveric dissection in a graduate course for physical therapy students.  To our knowledge, this is the second published example of a flexor carpi radialis brevis muscle traveling through the carpal tunnel

Using expletives to enhance therapeutic outcomes: A case report

# Background Swearing deserves attention in the physical therapy setting due to its potential positive effects on pain, physical performance, and therapeutic alliance. The purpose of this case report is to describe the strategic use of swearing in the clinical setting. # Case Presentation A 44-year-old female completed an episode of physical therapy after undergoing patellofemoral arthroplasty. Swearing was formally included into the plan of care, and the patient swore out loud during the most challenging and painful interventions. # Results The patient reported that repeating a swear word was funny, distracted the patient, and made the patient feel more confident. The patient and physical therapist self-reported a strong therapeutic alliance. # Conclusion There is evidence repeating a swear word out loud can strengthen the therapeutic alliance, improve physical performance, and decrease pain. This is, to our knowledge, the first report of a patient swearing during an episode of physical therapy care

A Communicating Branch Between the Musculocutaneous Nerve and the Median Nerve: A Case Report

Anatomical variations of peripheral nerves are commonly reported in the literature.  While typically benign, they are of clinical importance as they can contribute to atypical clinical presentations, cause difficulty with imaging and nerve conduction studies, and lead to surgical challenges for surgeons.  We report here a communicating branch between the musculocutaneous nerve and median nerve found during cadaveric dissection in a Doctor of Nursing Practice course in the Department of Nurse Anesthesia at Samford University.  Although the case described here is among the most common anatomical variations of the peripheral nerves, there are classification systems for this variation that need to be recognized and applied by anatomists, clinicians, and surgeons

Bilateral Long Head of the Triceps Brachii Muscle Innervation via Axillary Nerve: A Case Report

The radial nerve has traditionally been considered the innervation of the long head of the triceps brachii (LHT). However, cadaveric studies have discovered LHT innervation via the axillary nerve in roughly 6-15 % of shoulders. A cadaver with exclusive axillary nerve innervation to the LHT bilaterally was discovered during cadaveric dissection in a graduate course at Samford University. This anatomical variation may have clinical implications for surgeries, shoulder dislocations, and quadrilateral space syndrome. Axillary nerve injuries may additionally present with shoulder extension and elbow extension weakness if this variation is present.&nbsp

Effect of Motor Learning Theory-Assisted Instruction Versus Traditional Demonstration on Student Learning of Spinal Joint Manipulation

Purpose: A high-velocity low-amplitude thrust joint manipulation (HVLAT) is an intervention used by clinicians to treat spine pain. HVLAT is an entry-level skill included in the curriculum of physical therapist education programs. The objective of this study was to investigate the effects of utilizing a motor learning theory assisted teaching strategy on physical therapy student HVLAT confidence and skill acquisition as compared to a traditional lab. Method: Thirty physical therapy students were divided into two groups. One group received a traditional lab. The other group received a lab involving sequential partial task practice (SPTP) strategy in which students engaged in partial task practice over several repetitions with different partners. Student confidence and skill acquisition was determined through comparison of pretest and posttest surveys and performance on skills assessments. Results: The traditional lab and SPTP lab groups demonstrated similar response from pretest to posttest related to their HVLAT confidence. Student grades on their skills assessment measuring skill acquisition showed no significant differences between the lab groups. Discussion: The findings suggest that the SPTP lab strategy was as effective as a traditional lab structure for developing physical therapy student HVLAT confidence and skill acquisition. The majority of students in both lab groups reached a level of confidence that allowed them to feel comfortable teaching someone else these HVLAT skills. It is up to the instructors involved in delivering HVLAT content in physical therapist education programs to determine what learning activities are best suited to meet their specific objectives

A Physical Therapist Who Swears: A Case Series

Swearing deserves attention in the physical therapy setting due to its potential positive psychological, physiological, and social effects. The purpose of this case series is to describe 2 cases in which a physical therapist swears in the clinical setting and its effect on therapeutic alliance