Preparing students for management of the patient with multimorbidities

Purpose/Hypothesis : Chronic disorders are the main challenge facing healthcare systems worldwide with the distribution of multimorbidities rising. Educational programs must consider ways to prepare students to address the needs of patientsÕ with multimorbidity otherwise referred to as the ÒcomplexÓ patient. The purpose of this investigation was to assess the effectiveness of the use of complex integrative case studies in facilitating Doctor of Physical Therapy (DPT) student learning and clinical preparedness.Number of Subjects : Seventy one DPT students in two separate cohorts participated in their final didactic semester.Materials/Methods : Faculty developed an Integrated Longitudinal Case-Based Learning (ILCBL) model that contains 45 inter-related cases spanning 4 generations. From these 45 cases, four were implemented as complex cases in the final didactic semester of the curriculum. The complex cases were: (1) collaboratively developed by 2 core faculty and involved co-morbidities in multiple systems (multimorbidities); (2) composed of 5 progressive parts and (3) linked to a specific lecture in an advanced course. The complex cases were then completed as an in-class small group activity. Quantitative and qualitative data were collected related to student perceptions of their knowledge, skills, attainment of curricular goals and self-efficacy. Descriptive statistics was used to analyze the quantitative data. The qualitative data was reviewed independently by two researchers and examined for themes.Results : Student outcomes revealed the complex cases were effective in providing a realistic clinical challenge in the assessment, plan of care development and treatment of a patient with multimorbidities. 91% of students surveyed reported that complex cases required them to synthesize material from multiple courses and 95% felt the learning approach challenged their critical thinking. A high percentage of students gained confidence (71.8%) in their ability to examine and treat a patient with multimorbidities expressing an improved self-efficacy. The open ended student responses revealed consistent themes that supported the survey results. Examples of themes included: the complex cases required integration of previously taught material, challenged critical thinking skills and promoted a holistic patient approach.Conclusions : From a studentÕs perspective, the complex cases were effective in promoting their critical thinking for patientsÕ with multimorbidities requiring them to consider the individual rather than the condition. StudentsÕ indicated that previous didactic courses had not required them to consider this level of complexity, thus practicing clinical decision-making in this format provided students a learning opportunity that was not previously experienced.Clinical Relevance : Educational models need to prepare students to manage complex cases. This model demonstrated an approach designed to achieve this goal. As autonomous healthcare providers, entry-level therapists need to be prepared to manage patients with chronic disease who have multiple comorbidities.

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  • Control #: 2016108
  • Type: Poster
  • Event/Year: CSM2015
  • Authors: Amy Watson, Amy J. Bayliss, Valerie Strunk, Mary T. Loghmani, Peter Altenburger
  • Keywords: Case study design|Physical therapist education|Student learning

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