Tips for Using Immersive Cases: Borrowing from Simulations

Tips for Using Immersive Cases

BORROWING FROM SIMULATION

JoAnn Moriarty-Baron, PT, DPT

Immersive Cases Promote Clinical Reasoning Introduction Looking for creative ways to integrate clinical practice through cased-based learning into your classroom? Our new Immersive cases in Physical Rehabilitation are the perfect solution. Read on to learn more about how they not only create experiential learning activities that boost student engagement but also can be viable, less rigorous alternatives to full clinical simulation.

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Using Immersive Cases

Immersive Cases are a Bridge to Clinical Simulation The Immersive Cases provided in the Instructor Resources for O’Sullivan & Schmitz’s Physical Rehabilitation by George Fulk and Kevin Chui, align with many of the elements in the HSSOBP TM Simulation Design standard and offer a viable, less rigorous option that, with a few embellishments, approximates a simulation-based experience. The concept of clinical reasoning in Physical Therapy (PT) has been described as the integration of cognitive, psychomotor and affective skills as part of an adaptable biopsychosocial approach to patient/client management. 1 Although case-based learning experiences have long been used by PT educators to induce clinical reasoning, currently simulations are at the forefront of experiential learning and have been shown to improve students’ problem-solving, critical thinking, judgment and competence, self-efficacy and perceived readiness for clinical practice. 2 The Healthcare Simulation Standards of Best Practice (HSSOBP TM ), published by the International Nursing Association for Clinical Simulation and Learning (INACSL) in 2021, delineate the standards for effective simulations. 3 Adherence to these guidelines requires special equipment and training, financial resources, and extensive faculty time and investment. 2 Consequently, simulations may not be a feasible option for many PT programs and educators. If not simulation, how can educators provide engaging learning experiences that keep pace with current trends in health care education? At the start of each academic year, I ask students to share their goals for the semester or what they would like to gain from attending my class. Inevitably someone jokingly states that their goal is to “ just pass this class! ”. This opens a window of opportunity for me to express that my aim is not to “just” teach them the knowledge and skills needed to pass the exams or the course, but to prepare them for the National Physical Therapist Examination (NPTE-PT, licensure exam), and most importantly, shape them into to competent evidence-based, entry-level Physical Therapists. I go onto explain that successful entry into the profession requires that, in addition to acquiring knowledge, they develop an eye for movement analysis and establish the critical-thinking pathways essential for strong clinical reasoning skills. The journey is equally challenging for me and other DPT faculty since we must determine how to engage students in salient, pedagogically sound, evidence-based learning experiences that guide them to accomplish these goals. Usually, faculty perform some type of needs assessment through curriculum mapping or programmatic SWOT analysis to determine gaps in course content or competency weaknesses that trigger the creation of learning outcomes and objectives. An immersive case containing the appropriate scenario could offer a low-lift activity to address the identified need. Under this premise, compare learners participating in the immersive cases to those assigned the Observer role in a simulation and who benefit from the principles of observational learning. Since the immersive case videos show actual patient-therapist interactions in real-life environments, conceptual fidelity (realism) is high with an element of psychological fidelity. As the case unfolds, scaffolded prompts ask the learner to practice clinical reasoning. Learners subsequently receive formative feedback from the clinical expert encouraging self-assessment. Each case includes a final quiz which evaluates the effectiveness of the learning experience. The essential simulation standards of Prebrief and Debrief can be created and facilitated by the course instructor for immersive cases. The purpose of the Prebrief is to prepare and inform learners of the objectives of the learning activity, convey the ground rules for the experience, and importantly, establish psychological safety. Learners should comprehend content related to the scenario, be informed of the quiz, and be competent in the use of relevant technology prior to starting the Immersive Case. Importantly, students should feel safe to make mistakes inherent to the learning process. A comprehensive Prebrief will facilitate a more effective Debrief and the Debrief is where the magic happens! Feedback, guided reflection and personal exploration assist learners in self-assessment of attitudes, knowledge, and performance to

promote the development of critical-thinking skills and applied clinical reasoning. If using the Immersive cases in this way, educators should familiarize themselves with the HSSOBP TM standards for Facilitation and Prebriefing: Preparation and Briefing and The Debriefing process available at https://www.inacsl.org/healthcare-simulation-standards. As is, the Immersive Cases provide beneficial learning activities that assist PT educators in meeting their goals. Recall that I inform students that they must become proficient in test-taking skills needed to pass the National Physical Therapist Examination (NPTE). The NPTE format changed in January 2024 to better represent medically complex patients and include motion with movement analysis. The examination comprises 225 items including some with video and up to 45 scenario- based questions. 4 Assigning Immersive Cases that show a range of movement patterns is likely to improve students’ preparation for the NPTE. Furthermore, the Immersive Cases incorporate recommended outcome measures, Clinical Practice Guidelines, and other documents such the Core Outcomes Measure Physical Therapy report card that elucidate knowledge translation to ready students for clinical practice. Working with the Immersive Cases couldn’t be easier as they utilize Google forms and students merely need to have an account to run the program. Their responses are emailed directly to the instructor via a Gmail address.

Summary

The Immersive Cases included in the latest edition of O’Sullivan & Schmitz’s Physical Rehabilitation offer PT educators a valuable, user-friendly resource to enhance students’ engagement and learning. The Immersive Cases: § Offer content on topic (s) not cover elsewhere in the course/curriculum such as dysautonomia and acute COVID-19 § Contain video of the administration of tests and measures and require learners to interpret the results § Provide feedback to promote learner self-reflection and growth § Require learners practice each element of the patient/client management model to develop a plan of care § Contain an ICF framework worksheet § Require learners take a quiz for formative assessment § Embed current recommendations for best practice, including selected tests and measures, Clinical Practice Guidelines, and the ANPT Core Outcomes Physical Therapy Report Card § Scaffold learning using prompts within the case § Feature video of clinical experts interacting with patients to promote observational learning in professional communication § Provide case-based learning which aligns with test questions on the 2024 FSBPT NPTE § Highlight patients’ movement patterns to prepare for video questions on the 2024 FSBPT NPTE § Contain many of the elements of effective Simulation design which can be embellished to include faculty-lead Prebriefing and Debriefing

IMMERSIVE CASE SERIES for O’Sullivan & Schmitz’s Physical Rehabilitation , 8th edition George D. Fulk, PT, PhD, FAPTA | Kevin K. Chui, PT, DPT, PhD, GCS, OCS, CEEAA, FAAOMPT The immersive case series adheres to a standardized format allowing clinical experts to skillfully lead students through the clinical decision-making process of evaluation and treatment of seven distinct patients experiencing one of six unique health conditions. Rooted in the International Classification of Functioning, Disability, and Health (ICF) framework, the cases are thoughtfully divided into eight segments, with the exception of Case E, which is presented as a condensed mini case. The segment composition varies from case to case with each segment incorporating an activity designed to refine students’ clinical decision-making skills. Throughout the case, subject matter experts remain a constant presence, providing invaluable guidance at every step. They draw attention to key points, ensuring students not only observe but also comprehend the nuances of each case. Case Coordinator Rebecca Martin, PT, DPT, PhD Board Certified Clinical Specialist in Neurologic Physical Therapy, Co-Chair ANPT CSM Program Committee Lead Consultant, Wildfire Global Consulting

Immersive Case A: A Patient with Long COVID/Post-Acute Sequelae of COVID-19 Presented by Dr. Jenna Tucker, PT, DPT, Board-Certified Clinical Specialist in Neurologic Physical Therapy Dr. Lauren Ziaks, PT, DPT, ATC, Board-Certified Clinical Specialist in Neurologic Physical Therapy

An interactive case that guides students through the interview, examination, evaluation, and development of a plan of care for a 25-year-female with long COVID/ post-acute sequelae of COVID-19. Students will prepare for the interview, plan for and observe portions of the examination, analyze examination results to create assessment statements and goals, and link interventions to goals. Throughout the case, students will be guided and receive feedback from a subject matter expert. The case builds on information from the examination section, chapters 1-9. The videos in the case show a clinical presentation of a patient with dysautonomia making the case an excellent activity for students as they learn about dysautonomia as it relates to other health conditions, such as traumatic brain injury, spinal cord injury, multiple sclerosis, or Parkinson disease.

Immersive Case B: A Patient with Acute COVID-19 Presented by Dr. Daniel Miner, PT, DPT, NCS, Board-Certified Clinical Specialist in Neurologic Physical Therapy

An interactive case that guides students through the interview, examination, and evaluation of a patient with acute COVID-19 in the intensive care unit setting. Students will complete an inpatient chart review, observe portions of a patient interview and cognitive screen, anticipate safety concerns prior to mobilizing a patient in the intensive care unit, analyze a functional systems review, utilize observational skills and vital sign information to determine if a patient can safely tolerate additional activity, create an activity-specific prognosis statement, and create goals appropriate for the acute care setting. Throughout the case, students will be guided and receive feedback from a subject matter expert. The case activities require familiarity of topics covered in chapters 1 and 2. The videos in the case show a clinical presentation of a patient with pulmonary dysfunction making the case an excellent activity for students as they review Chapter 12.

Immersive Case C: A Patient with Stroke Presented by Dr. Christina Garrity, PT, DPT, Board-Certified Clinical Specialist in Neurologic Physical Therapy

An interactive case that guides students through the interview, examination, evaluation, diagnosis, and writing of goals and the plan of care for a 49-year-old male who experienced a stroke 10 years ago and is now attending skilled physical therapy for high intensity gait training. Students will plan for the interview and chart review, select appropriate tests and measures, carefully examine gait, write an assessment statement, select appropriate frequency and duration for a plan of care, create appropriate goals, analyze gait to determine if high intensity gait training activities should be advanced or regressed, and select appropriate ways to advance interventions as appropriate. Throughout the case, students will be guided and receive feedback from a subject matter expert. This case builds on information presented in Chapter (enter number and exact name of stroke chapter).

Immersive Case D: A Patient with Multiple Sclerosis Presented by Dr. Rebecca Martin PT, PhD, DPT, Board-Certified Clinical Specialist in Neurologic Physical Therapy

An interactive case that guides students through the interview, examination, evaluation, diagnosis, writing of goals, and creation of a plan of care for a 37-year-old female with a 5-year history of multiple sclerosis in the outpatient setting. Students will plan for and observe portions of a patient interview, analyze a functional systems review, use findings of a functional systems review to select other relevant tests and measures, practice differential diagnosis between multiple sclerosis and amyotrophic lateral sclerosis, write an assessment statement, create appropriate goals, choose and observe appropriate compensatory and restorative interventions, and plan a discharge. Throughout the case, students will be guided and receive feedback from a subject matter expert. This case builds on information presented in Chapter 16. Immersive Mini-Case E: A Patient with Mild Parkinson Disease Presented by Dr. Tara McIsaac, PT, PhD Dr. Jamie Nesbit, PT, DPT, NCS, GCS, Board-Certified Neurologic Clinical Specialist in Geriatric Physical Therapy, Board- Certified Geriatric Clinical Specialist An interactive mini-case that helps students learn how to integrate aspects of the ICF model with theory, evidence for practice, patient/client values, needs, and preferences to guide patient-centered care and clinical reasoning. Students will be guided through the process of patient intake, examination, interventions, and follow-up for a patient with mild Parkinson disease. This case builds on information presented in Chapter 18. Immersive Case F: A Patient with Freezing of Gait Due to Parkinson Disease Presented by Dr. Tara McIsaac, PT, PhD Dr. Jamie Nesbit, PT, DPT, NCS, GCS, Board-Certified Neurologic Clinical Specialist in Geriatric Physical Therapy, Board- Certified Geriatric Clinical Specialist An interactive case that guides students through the interview, examination, evaluation, and interventions for a patient who experiences freezing of gait due to Parkinson disease. Students will plan for and observe portions of a patient interview, analyze a systems review, analyze patient movements, create an assessment statement, make appropriate referrals, write patient goals, and select appropriate interventions. Throughout the case, students will be guided and receive feedback from a subject matter expert. This case builds on information presented in Chapter 18.

Immersive Case G: A Patient With a Lower Extremity Limb Loss Following Amputation Presented by Dr. Luke Utley, PT, DPT Dr. William Riddick, PT, DPT, GCS, Board-Certified Clinical Specialist in Geriatric Physical Therapy An interactive case that guides students through the interview, examination, evaluation, diagnosis, writing of goals, and creation of a plan of care for a 28-year-old male with recent amputation. Students will plan for and observe portions of a patient interview, complete a gait analysis, analyze prosthetic componentry, anticipate effects of body structure impairments on prosthetic design and function, analyze a transfer, select appropriate goals, and choose safe and effective cueing during early and advanced prosthetic use training. Throughout the case, students will be guided and receive feedback from a subject matter expert. This case builds on information presented in Chapter 22. References 1. Huhn K, Gilliand L, Black L, Wainwright N. Clinical Reasoning in Physical Therapy: A concept analysis. PTJ. 2019;99:440-456. 2. Maile S, Silberman N, Kupczynski L. Classroom-Based Simulation: Participants and observers perceive high psychological fidelity and improved clinical preparedness. J Phys Ther Educ.202;35:210-217. 3. INACSL Standards Committee, Hallmark, B., Brown, M., Peterson, D., Fey, M., Decker, S., Wells-Beede, E., Britt, T., Hardie, L., Shum, C., Arantes, H., Charnetski, M., & Morse, C. (2021). Healthcare Simulation Standards of Best Practice® Premble. Clinical Simulation in Nursing , https://doi.org/10.1016/j.ecns.2021.08.006. 4. Federation of State Boards of Physical Therapy (fsbpt) The When, Why and How of 2024 NPTE redesign with Lorin Mueller and Colleen Lettvin. Available at https://www.youtube.com/watch?v=uPs-ky0oHSM. Accessed on September 19, 2024. 5. Tutticci N, Theobald K, Ramsbotham J, Johnston S. Exploring the observer and clinical reasoning in simulation: A scoping review. Nurse Education in Practice.2022;59:1-9.

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