Clinical Reasoning Symposium. Education Section of the American Physical Therapy Association

Document Type

Conference Proceeding




PURPOSE : The purpose of this research was to find out if a team building exercise carried out by student groups will facilitate learning how to make clinical decision involving concepts from the International Classification of Function (ICF).

SIGNIFICANCE: Scant literature exists regarding the concept of integrating student and expert team case-based learning with the ICF to develop clinical decision-making skills.

SUBJECTS: Subjects were 213 first-year physical therapy students in the DPT program at UNMC in the first semester of the curriculum of years 2013-2016.

METHODS AND MATERIALS: A patient case was developed which included clinical decision-making steps using concepts from the ICF. The authors were surveyed in order to rank the decision-making steps in order of priority and identify ICF concepts involved. The ranking was performed again after review of first round results and feedback. Students were expected to view an online ICF presentation produced by the APTA. Each student attended small group concurrent sessions each facilitated by a faculty member to accomplish the following as individuals: complete a pre-test of ICF knowledge, rank 15 case decision items in order of priority, and identify each item's ICF category (health condition, impairment, activity limitation, or participation restriction). Students, using group discussion, then re-ranked the decision items and categorized ICF components. They compared their individual rankings and ICF categorizations with those of the expert panel, and calculated the absolute values of the ranking differences and the number of correct categorizations of the items in the ICF scheme. They also compared their group rankings and categorizations with those of the expert panel. Individual students then completed a post-test and later a 12-question electronic survey find out their opinions about the usefulness of the exercise.

RESULTS: For the 200 students participating, the mean of differences between sums of individual ranks and those of the expert panel was 41.7 (range 12-83), with a median of 42. The mean of ICF category matches for all students was 6.8 (range 2- 12 out of 15) with a median of 7. The mean of the sums of group rank differences was 28.2 (range 8-46), with a median of 26, and the mean of the group ICF matches was 9.1 out of 15 (range 6-12), median 9. For 16 of 19 groups the sum of group rank differences was lower than the mean of the individual rank differences. In addition, 18 of 19 groups had higher ICF category matching rates than those of individuals. Pre-test score for ICF knowledge for all students was 5.2/8 (mean), and post-test mean was 5.87/8, a significant difference. In the post event survey, 89 of 129 respondents believed that group discussion was either successful or very successful in learning how the ICF assists decision-making, and 106 of 129 believed that the activity was either successful or very successful in learning to prioritize clinical decisions.

CONCLUSIONS: The first-year physical therapy students in the UNMC PT program discovered that team decision-making usually results in improved congruence with the decisions of an expert panel. Comparison of pre- and post-test scores show that knowledge of use of the ICF was enhanced. Students generally believed that the activity was useful to their understanding of how the ICF may be used for clinical decision-making.