Education Leadership Conference (ELC)

Document Type





PURPOSE: Educators are responsible for developing clinical reasoning skills in Physical Therapy (PT) students. Simulated virtual experiences allow specific skills, such as clinical reasoning, to be learned and tested (Holdsworth, 2016). PT students prefer a combination of learning from e-modules and lecture formats (Gardner, 2016). Feedback is a critical component for consolidated learning; however, there is no consensus on the best timing of feedback (Schute, 2008). The purpose was to evaluate the impact of immediate versus delayed feedback through an e-module in PT students' accuracy in identifying the primary hypothesis, severity and irritability level for a virtual patient case. The secondary aim was to examine the longitudinal impact of the e-module by looking at the same outcome measures after a standardized patient (SP) simulation in addition to overall course grade METHODS: The e-module was designed to facilitate clinical reasoning by asking students to generate a hypothesis for the clinical case scenario, with subjective and objective examination results, then to determine the patient's level of severity and irritability. Second year entry-level PT students were randomized to either receive immediate feedback throughout the case, or delayed feedback at the conclusion of the e-module. Fisher’s exact test was utilized to detect any difference between feedback groups’ performance on the e-module, SP simulation, or course grade, as well as any student demographic differences between groups. Students rated and qualitatively commented on satisfaction on learning activity. RESULTS: 53 students gave consent and participated in the study. There was no statistical difference between age, ethnicity, and prior experience between feedback groups. (p>.05). Women were overrepresented in the immediate feedback group (p=.0473). There was no statistical association for identifying the correct hypothesis, severity, or irritability ratings between feedback groups for the e-module and SP simulation or between course grade performance and feedback group assignment. (p>.05). The average student evaluation score was 8.59/10 on a scale (1 “not helpful at all” and 10 “incredibly helpful”) and qualitative comments were positive regardless of feedback timing. Students commented that the open-ended format of the hypothesis development questions challenged them more than a traditional multiple-choice exam format. CONCLUSIONS: Based on the results, the timing of feedback had no effect on outcomes in 2nd year PT students. Students in both groups valued the opportunity to learn and assess their clinical reasoning skills within the e-module. As students prepare for clinical practice, reducing the frequency of feedback allows students to test their knowledge, in a low-stakes environment, to help prepare for situations where they will not have immediate feedback available. More opportunities for students to practice clinical reasoning at their own pace, in a digital medium that is appealing to this generation of digital natives, could be valuable for preparing students for clinical education.

UNMC E-Learning Gallery link to the immediate feedback version of the e-module: