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
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