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Being an Acute Care Educator: The How, The What, and The Why
Kristin Curry Greenwood, PT, DPT, EdD, MS, GCS | Northeastern UniversityMatthew Nippins, PT, DPT, CCS | Northeastern University
Kathryn Panasci, PT, DPT, CBIS, CWS | Texas Tech University Health Sciences Center
Learning ObjectivesUpon completion of this course, you will be able to:
• Formulate a professional development plan for initiating or advancing your acute care faculty physical therapy education practice.
• Develop or revise your current acute care education teaching strategies to meet students’ acute care education needs.
• Adopt an evidence-based teaching method into your acute care curriculum.
Conflict of Interest
● The presenters have no conflict of interest to disclose
CAPTE Required Elements for Faculty
Standard 4: The program faculty are qualified for their roles and effective in carrying out their responsibilities
4A. Each core faculty, program director, and clinical education director demonstrates:
Doctoral preparationContemporary expertiseEffective teaching and student evaluationCurrent license to practice PT in US jurisdiction
PT Standards and Required Elements, CAPTE 2016
Expectations for Educators
PT Standards and Required Elements, CAPTE 2016
Expectations for EducatorsCAPTE Required Elements for Faculty
Each core faculty:• 4B: well-defined, ongoing scholarly agenda• 4C: record of institutional or professional service
Each associated faculty:• 4D: contemporary expertise in assigned teaching and
demonstrates effectiveness in teaching and student evaluation
Collective core and associated faculty include an effective blend of individual academic and clinical preparation (4K)
Expectations for Educators
Expertise looked for when seeking to hire acute care educators
• Clinical experience and expertise• Clinical instructor (CI) experience• Credentialed CI• Certifications (ABPTS v. others)• Record of scholarship• Familiarity engagement with APTA and component chapters• ACUTE CARE EXPERIENCE
Faculty Development
Professional Development Plan: What to do to prepare your resume for future teaching
Let’s discuss…• Service expectations• Well-defined, ongoing scholarly agenda• Clinical certification• Academic doctoral degree
Defining Acute Care Education
What needs to be taught in acute care?
• Acute care therapists think differently than other types of physical therapists in part because they often make decisions when patients are in medical crisis (Masley et al., 2011).
• This decision making process relies heavily on the therapist’s interprofessional relationships with the medical team, management of emotions, and ability to make judgments in action that are best for an individual patient’s circumstances (Holdar, Wallin, & Heiwe, 2013; Masleyet al., 2011; M. Smith, Higgs, & Ellis, 2010).
• Acute care practice requires emotional intelligence and professional behaviors which have been identified in physicians and other health professions (Galal, Carr-Lopez, Seal, Scott, & Lopez, 2012).
Defining Acute Care Education
How is it different from other DPT curricula?
• Spans all content areas of practice• Focuses on “acuity of condition,” not patient diagnosis• Educates students to make “dynamic decisions” in the acute
care environment where patients’ presentations change (Masley et al., 2011)
Defining Acute Care Education
What is out there to guide how to teach acute care?
• Each individual physical therapist curriculum is guided by the Normative Model of Physical Therapist Education (American Physical Therapy Association, 2006).
• Nationwide Acute Care Practice Analysis (Gorman, 2010).
• Core Competencies of Entry-Level Practice in Acute Care Physical Therapy (Greenwood et al.).
Educational Theory to assist with acute care education
• “Learning is What Matters Most” (Jensen, 2011). Jensen (2011) describes how students need to understand the situation, not just the decision.
• Acute Care requires reflection, which has been theorized to assist students in learning critical thinking (Schön, 1987).
• Thought on action versus thought in action
• Dr. Groopman contextualizes this thinkingfor patient care and is an excellent read for acute care educators.
Theory of Reflection
goodreads.com/book/show/185897.How_Doctors_Think
• Bandura’s social cognitive theory (1993) has been utilized to explain the role simulation has in enhancing students’ self-confidence and performance.
• Social cognitive theory posits a direct relationship between a student’s self-efficacy and his or her level of performance (Bandura, 1993).
Theory of Self-Efficacy
http://can-do.co.za/
• Emotional intelligence refers to one’s ability to appropriately express and assess one’s own emotions, as well as understand the emotions of others (Salovey& Mayer, 1990).
• Clinical decision-making requires effective and professional behaviors associated with emotional intelligence (Goleman, 2006).
Emotional Intelligence Theory
www.skillsyouneed.com/general/emotional-intelligence.html
• Kolb’s learning theory posits that a combination of experience, reflection, conceptualization, and experimentation are needed to foster learning (Kolb, 1984).
• Fanning and Gaba (2008) cite Kolb as a foundational basis for simulation instruction.
Kolb’s Learning Theory
study.com/academy/lesson/david-kolb-learning-style-experiential-learning-theory-quiz.html
• Transformative learning theory explains that a meaningful context can transport an adult learner into a new reality by moving through ten purposeful stages of learning (Mezirow, 1991).
Transformative Learning Theory
https://www.slideshare.net/tjcarter/class-4-mezirows-transformative-learning-theory
• Learning occurs as a construct of culture, context, and activity. (Lave, 1988)
• Social interaction and community of practice are key. • Learning is unintentional legitimate peripheral
participation. (Lave & Wenger, 1991)
Situated Learning Theory
hlwiki.slais.ubc.ca/index.php/Situated_learning_theory
Educational Models
• Bloom’s Taxonomy is a hierarchy of objectives and learning activities (Bloom, 1984).
• Webb’s Depth of Knowledge is that students gain the skills to perform in new situations, without prior knowledge, based on relating previous thinking to new thinking (Webb, 2002).
• Understanding by design is an educational model created by Wiggins and McThie (1998).
Bloom’s Taxonomy
storify.com/azidah/bloom-taxonomy/elements/94f184e5f4f32abc525b931b
Webb’s Depth of Knowledge
maverikeducation.blogspot.com/
Understanding by design
www.blinn.edu/acadtech/training/selfhelp/pedagogy/backwards_design.htm
Acute Care & InterprofessionalEducation
Team Based
Learning
Cases
Simulation
Reflective Writing
Concept Mapping
Acute Care & InterprofessionalEducation● Team-based Learning
● Identifying roles and roles of other healthcare professionals
● Applying relationship building principles to form effective healthcare teams
● Communicate with all members of the healthcare team, patient, and family in a way that promotes the team approach to address prevention and treatment of disease
»IPEC Competencies 2016
TWO CURRICULAR EXAMPLES
Year 1
Year: 32 Total: 32
Fall Spring
PT 5101 Foundations of PTPT 5102 Foundations of PT LabHLTH 5450 ResearchHLTH 5451 Research Rec.PT 5131 Gross AnatomyPT 5132 Gross Anatomy LabPT 5160 Psychosocial Aspect of PTPT 5161 Psychosocial Aspect Seminar
3140413117
Summer A
PT 5140 PathologyPT 5141 Recitation/PathologyPT 5138 NeurosciencePT 5139 Neuroscience LabPT 5133 KinesiologyPT 5134 Kinesiology LabPT 5501 Pharmacology for PTs
404131215
Summer B
Summer A Courses Continue
Year II
Year: 23Total: 55
Fall PT 5150 Motor Control/DevelopmentPT 5151 Motor Control/Dev. Lab
PT 5503 Cardiovascular & Pulm MgmtPT 5504 Cardiovascular & Pulm Mgmt LabPT 5111 Professional Development for Co-opPT 5145 Intro to Healthcare SystemsPT 5450 Introduction to Therapeutic Activities
414112215
**Spring
PT 6964Co-op Work Experience(16wks)
**Summer A
PT 6964Co-op Work Experience cont(8wks)
Summer BPT 6243 Health Assessment PT 6244 Health Assessment RecPT 5515 Integumentary Systems PT 5516 Integumentary Sys Lab
PT 5540 Clinical Integration 1
302128
Year III
Year: 50Total:105
FallPT 5505 Musculoskeletal Mgmt I PT 5506 Musculoskeletal Mgmt I LabPT 5209 Neurological Rehab IPT 5210 Neurological Rehab I LabPT 5227 PT Project IPT 6241 Medical Screening for PTPT6000 Leadership, Admin., Mgt.
414134219
Spring
PT 6221 Neurological Rehab IIPT 6222 Neurological Rehab II LabPT 6223 Musculoskeletal Mgmt II PT 6224 Musculoskeletal Mgmt II LabPT 5226 PT Professional Seminar IIPT 5229 PT Project IIPT 5230 PT Lifespan Mgmt Geri/Pedi
414122317
Summer APT 6441 Clinical Education I - 8wks
6
Summer BPT 6215 Assistive TechnologyPT 6216 Assistive Technology Lab
PT 6250 Clinical Integration 2PT6231-6237 Adv. topics elective
31228
Year IV
Year: 18Total:123
Fall DPT – 3 YearsPT 6442 Clinical Education II- 14 wksPT 6251 Diagnostic Imaging: online
639
SpringPT 6443 Clinical Education III - 14 wks 9
Summer Fall Spring
Year 1 HPPT 8100 ‐ Professional DevelopmentHPPT 8203 ‐ Functional AnatomyHPPT 8500 ‐Gross Anatomy
HPPT 8201 ‐ History and Systems ScreeningHPPT 8205 ‐ Evidence‐Based Practice 1HPPT 8209 ‐ Clinical Applied Physiology
HPPT 8301 ‐ Foundational Skills and AssessmentHPPT 8303 ‐ BiomechanicsHPPT 8407 ‐ Pathophysiology
HPPT 8212 ‐ PharmacologyHPPT 8216 ‐ Physical Agents and Modalities
HPPT 8310 ‐ Therapeutic ExerciseHPPT 8314 ‐ Inpatient/Integumentary PT PracticeHPPT 8318 ‐ Neuroscience
HPPT 8414 ‐ Cardiopulmonary PT Practice
Year 2 HPPT 8120 ‐ Communication and Clinical Education
HPPT 8123 ‐ Clinical Reasoning 1HPPT 8228 ‐Motor Control
HPPT 8222 ‐ Clinical Experience I (4 wks)
HPPT 8231 ‐ Diagnostic ImagingHPPT 8329 ‐ Human Development
HPPT 8425 ‐Musculoskeletal PT Practice I
HPPT 8521 ‐ Neuromuscular PT Practice
HPPT 8114 ‐ Evidence‐Based Practice 2HPPT 8226 ‐ Orthotics and ProstheticsHPPT 8327 ‐ Health Care and Business Management
HPPT 8422 ‐ Pediatric PT PracticeHPPT 8426 ‐Musculoskeletal PT Practice II
Year 3 HPPT 8142 ‐ Assistive and Adaptive Technology
HPPT 8224 ‐ Clinical Reasoning 2HPPT 8240 ‐ Differential DiagnosisHPPT 8246 ‐ Advanced Topics in PT
HPPT 8144 ‐ Professional Project
HPPT 8453 ‐ Clinical Internship 1 (8 weeks)HPPT 8455 ‐ Clinical Internship 2 (8 weeks)
HPPT 8160 ‐ Graduate Seminar
HPPT 8456 ‐ Clinical Internship 3(8 weeks)HPPT 8458 ‐ Clinical Internship 4 8 weeks)
ACUTE CARE TEACHING METHODS
Online Discussion Board
Background:● Hayward LM, Greenwood KC, Nippins M, et al. Student
perceptions and understanding of client-therapist interactions within the inpatient acute care environment: qualitative study. Phys Ther. 2015;95:235–248.
● Wainwright SF, Shepard KF, Harman LB, Stephens J. Novice and experienced physical therapist clinicians: a comparison of how reflection is used to inform the clinical decision-making process. Phys Ther. 2010;90:75-88.
● Orest MR. Clinicians’ perceptions of self-assessment in clinical practice. Phys Ther. 1995;75:824–829.
Online Discussion Board
● Discussion Board● Small group discussion involving multiple settings● Paired with clinical observation of a selected evaluation
● Students perform weekly reflective writing with guiding questions of different aspects of the evaluation
• Emphasis on critical thinking links to within the evaluation
• Interprofessional education also interwoven into the reflective writing
Online Discussion Board
Sample discussion week:● Consider the systems review discussion from last week and the subjective
history discussion from week #1. Please look at the answers to these original guiding questions (including the additional questions in bold type) and revise them from your original posts (if needed), then post the revised answers:
● What questions led to specific tests and measures in the examination?
● What from the systems screen led to specific tests and measures?
● Was the order of the tests important and why?
● Did certain tests lead to other tests during the exam?
● What impairments did the tests and measures observed identify? Please explain.
● What did you learn about this particular aspect of the evaluation (tests and measures), and what might you do with the learning in the future as a PT student and eventually as a PT?
Online Discussion Board: Themes
Clinical Decision Making
Acute Care Environment
Communication
Preparation
Patient Interaction
Online Discussion Board
● “I realized how important a systems review is in generating a holistic approach to a patient evaluation”
● “I learned the importance of having a plan before entering the room, although it’s important to be prepared for that plan to change.”
● “It’s a fast paced and busy environment, and that’s even before we entered the room.”
● “The therapist has to adapt to different situations, depending on the patient status. If the patient had a stroke that affected cognitive areas of the brain the therapist may need to ask the same question in different ways.”
Case Integration
Case-based learning (CBL) background:● Structured, interactive, guided-inquiry in small-groups● Learner-centric approach with emphasis on teamwork,
creative problem solving, and discovery● Intended to build on existing knowledge through
sharing, questioning, and discussion● Learners are allowed to struggle, define, and resolve
the problem with facilitator guidance● Shared responsibility to bring closure to main learning
points● Faculty and resource intensive
Srinivasan et al, 2007; Dubey & Dubey, 2017
Case Integration
Research demonstrates that CBL:● provides intrinsic motivation● promotes deep learning and creative problem solving● stimulates scientific inquiry● allows for open-ended exploration● encourages debate, discussion and exploration of
ambiguity in efficient, goal-directed manner● integrates knowledge and practice● develops a collaborative approach to learning
Srinivasan et al, 2007; Dubey & Dubey, 2017
Case Integration● Srinivasan et al, 2007:
● Preferred by 89% faculty and 84% students over problem-based learning (PBL)
● Faculty recognized the value of PBL in stimulating self-directed learning, but preferred the consultant role of facilitator in the CBL method
● Dubey & Dubey, 2017:● 92% of faculty reported CBL improved student
learning abilities● 100% of faculty found it a beneficial tool for learning● 100% students reported a better understanding of
the material
Case IntegrationSample Lab Case:Therapist performs:
• Chart review• ID problems, considerations, precautions, CI• Patient interview• Systems screen and selected tests & measures• Documentation of entire evaluation• Development of a 30 minute treatment plan
Faculty available throughout lab session
Debriefing & discussion
Concept Mapping
Background:
• Concept maps should be introduced early in the curriculum to assist with students’ self-confidence and awareness of clinical decision-making (Torre et al., 2007).
• Decision trees utilized by Cahalin et al. (2011), have been successful in physical therapist education
• Concept mapping provides the opportunities for students to show YOU their thinking instead of showing you they understand YOUR thinking.
Determine if Mrs. Lunt is safe to go home
What do I know from the
chart that
affects safety?
Fell at HomeUses cane
outside home
lives with daughter
has B fx and hx of knee
replacementAge
What do I
primarily need to
evaluate?
Balance, gait,
safety, awareness, strength,
fxl mobility
What am I
deciding between for d/c plan
What does she need
to do to go to OP,
which is least
amount of assistance
She needs to be
Independent because she
was Independent
prior
She fell at
HOME
Home PT is best choice due to
not I and safety
issues at home.
Simulation
Background:• The evolution of simulation education in physical therapist
programs over the last several years is preceded by success within physician education (McIndoe, 2012; Scalese, Obeso, & Issenberg, 2008).
• Simulation education involves the creation of realistic clinical scenarios through which physical therapist students can actively participate in patient management using actors or computerized manikins (Shoemaker, Riemersma, & Perkins, 2009).
• Use of medical simulation has shown positive outcomes in physical therapist students’ confidence, technical acute care skills, and engagement with the acute environment (Ohtake, Lazarus, Schillo, & Rosen, 2013; Michael J. Shoemaker et al., 2011; N. Smith, Prybylo, & Conner-Kerr, 2012).
Simulation at TTUHSCHPPT 8314 – IPT• Mock ICU set up
• Inpatient neuro case (standardized patient - SP)
• Inpatient orthopedic case (SP)
HPPT 8123 – Clinical Reasoning 1• OP and inpatient cases (SP) ~ Coming Summer 2018!!
HPPT 8224 – Clinical Reasoning 2• Inpatient case (SP)
• OP neuro case (SP)
• OP ortho case (SP)
Simulation at Northeastern
● Implemented in four courses to assist with acute care education
● Simulated patients and patient manikins are utilized●Utilized for formative and summative learning activities
● Interprofessional and In silo
Foundations Professional Development
Acute Care and Cardiopulm
Neurological Management
Clinical Education• The aspect of the professional curriculum during which student
learning occurs directly as a function of being immersed within physical therapist practice. These experiences compromise all of the formal and practical “real-life” learning experiences provided for students to apply classroom knowledge, skills, and professional behaviors in the clinical environment.
• 6L: The curriculum plan includes clinical education experiences for each student that encompass, but are not limited to:
• CAPTE does not require acute care clinical education experiences
PT Standards and Required Elements, CAPTE 2016
For the clinician with the desire to be an academic...
WHAT CAN I DO TO PREPARE?
●APTA credentialed CI● Students, Students, Students
●Record of service ● Engage with Academy of Acute Care
Physical Therapy and Education Section as well as State Chapter
●Board specialty / certifications●Research / scholarship
● Read and research ●Adjunct opportunities
For the academic...
WHAT CAN I DO TO FURTHER MY EXPERTISE IN ACUTE CARE EDUCATION?
●Pursue Development Opportunities for Acute Care Education● Bridge the Gap, Simulation Training
●Increase continued involvement in Service● Engage with Academy of Acute Care
Physical Therapy and Education Section as well as State Chapter
●Research / scholarship ●Seek opportunities through JACPT and other avenues
HELPFUL RESOURCES○ University of Washington○ https://collaborate.uw.edu/ipe-teaching-
resources/ipe-cases-curriculum-for-students/simulation-team-training-toolkit/
○ Acute Care Competencies http://www.acutept.org/page/corecompetencies
○ IPEC guidelines○ https://www.ipecollaborative.org/recommended-
links.html
Question and Answer Session
Final Questions
References1. Bednarek B, Downey P, Williamson A, Ennulat C. The use of human simulation to teach acute care skills in acardiopulmonary course: A case report. Journal of Physical Therapy Education. 2013;28(3):27-34.
2. Blinn College website from: Wiggins, Grant, and Jay McTighe. Understanding by Design. Expanded 2nd Edition. Alexandria, VA: ASCD, 2005. Slide 20.
3. Can Do! Maintenance. Power of Can Do Attitude. http://can-do.co.za/. Slide 12.
4. Dubey S & Dubey AK. Promotion of higher order cognition in undergraduate medical students using case-based approach. J Educ Health Promot. 2017;6:75. doi: 10.4103/jehp.jehp_39_17
5. Francis, EM. Webb’s Depth of Knowledge. H.O.T./D.O.K. blog.maverikeducation.blogspot.com. Slide 19.
6. Gorman SL, Wruble Hakim E, Johnson W, et al. Nationwide acute care physical therapist practice analysisidentifies knowledge, skills, and behaviors that reflect acute care practice. Phys Ther. 2010;90(10):1453-1467. doi:10.2522/ptj.200903855.
7. Greenwood K, Nicoloro D, Iversen M. Reliability and validity of the acute care confidence survey: An objectivemeasure to assess students’ self-confidence and predict student performance for inpatient clinical experiences. Journal of Acute Care PT. 2014;5(1):1-10.
8. Guide to Physical Therapist Practice. Guide 3.0 Alexandria, VA: American Physical Therapy Association; 2014.http://guidetoptpractice.apta.org.
9. Gwyer J , Hack L , Jensen G , Segal R , Boissonnault W. Future directions for educational research in physical therapy. Journal of Physical Therapy Education. 2015;29(4):3-4.
10. Hayward, L. Greenwood, K. Nippins, M. Canali, A. Student perceptions and understanding of client-therapistinteractions within the acute inpatient environment: a qualitative study. Physical Therapy Journal. 2015; 95(2):235-248.
11. Holdar U, Wallin L, Heiwe S. Why do we do as we do? Factors influencing clinical reasoning and decision-making among physiotherapists in an acute setting. Physiotherapy Research International. 2013;18(4):220-229.doi:10.1002/pri.1551de
12. Image of How Doctors Think, Groopman J. www.goodreads.com/book/show/185897.How_Doctors_Think. Slide 11.
13. IPEC Core Competencies for Interprofessional Collaborative Practice: 2016 Update. https://nebula.wsimg.com/2f68a39520b03336b41038c370497473?AccessKeyId=DC06780E69ED19E2B3A5&disposition=0&alloworigin=1. Updated 2016. Accessed November 30, 2017.
14.Jensen G M. 42nd Mary McMillan Lecture: Learning: what matters most. Physical Therapy. 2011;91(11):1674-1689.
15. Kirk K. Kolb’s Cycle of Experiential Learning. Study website. study.com/academy/lesson/david-kolb-learning-style-experiential-learning-theory-quiz.html. Slide 14.
16. Lave J. Cognition in Practice: Mind, Mathematics and Culture in Everyday Life. Cambridge, United Kingdom: Cambridge University Press; 1988.
17. Lave J & Wenger E. Situated Learning: Legitimate Peripheral Participation. Cambridge, United Kingdom: Cambridge University Press; 1991.
18. LinkedIn Slideshare website. Mezirow’s Transformative Learning Theory. www.slideshare.net/tjcarter/ class-4-mezirows-transformative-learning-theory. Slide 15.
19. Masley PM, Havrilko CL, Mahnensmith MR, Aubert M, Jette DU, & Coffin-Zadai C. Physical therapist practice in the acute care setting: A qualitative study ... including invited commentary with author response. Physical Therapy. 2011;91(6):906-922. doi: 10.2522/ptj.20100296
20. Mori B, Carnahan H, & Herold J. Use of simulation learning experiences in physical therapy entry-to-practice curricula: a systematic review. Physiotherapy Canada. 2015;67(2):194-202. doi:10.3138/ptc.2014-40E
21. Orest MR. Clinicians’ perceptions of self-assessment in clinical practice. Phys Ther. 1995;75:824–829.
22. Physical therapist clinical performance instrument (PT CPI). American Physical Therapy Association. http://www.apta.org/PTCPI/. Updated March 24, 2015. Accessed November 2017.
23. PT Standards and Required Elements. Commission on Accreditation in Physical Therapy Education. http://www.capteonline.org/AccreditationHandbook/. Updated July 15, 2016. Accessed November 14, 2017.
24. Reeves S, Zwarenstein M, Goldman J, Barr H, Freeth D, Koppel I, et al. The effectiveness of interprofessional education: key findings from a new systematic review. J Interprof Care. 2010;24(3):230-41.
25. Silberman NJ, Litwin B, Panzarella K, Fernandez-Fernandez A. Student clinical performance in acute careenhanced through simulation training. Journal of Acute Care Physical Therapy. 2016;7(1):25-36.
26. Srinivasan M, Wilkes M, Stevenson F, Nguyen T, and Slavin S. Comparing problem-based learning with case-based learning: effects of a major curricular shift at two institutions. Aced Med. 2007;82(1):74-82.
27. Situated Learning Theory. HLWIKI International website. Three main characteristics of situated learning. http://hlwiki.slais.ubc.ca/index.php/Situated_learning_theory. Slide 16.
28. Skills You Need. Understanding and Developing Emotional Intelligence. www.skillsyouneed.com/general/ emotional-intelligence.html. Slide 13.
29. Torre DM, Daley BB, Stark-Schweitzer T, Siddartha S, Petkova J & Ziebert M. A qualitativeevaluation of medical student learning with concept maps. Medical Teacher. 2007;29(9/10):949-955.doi:10.1080/01421590701689506
30. Wainwright SF, Shepard KF, Harman LB, Stephens J. Novice and experienced physical therapist clinicians: acomparison of how reflection is used to inform the clinical decision-making process. Phys Ther. 2010;90:75-88.
31. Ziden, AA. Bloom Taxonomy. Bloom Taxonomy. storify.com/azidah/bloom-taxonomy/elements/94f184e5f4f32abc525b931b. Slide 18.
