Date Presented 4/17/2015
This study examines how a lab experience with patient educators (PEs) affected reasoning 1 yr later during students’ Level II fieldwork. Results suggest that students have increased self-awareness, confidence, and empathy, which contributes to advance reasoning. A model of clinical reasoning is presented.
SIGNIFICANCE: To prepare graduate students for clinical internships, instructors need effective strategies to promote clinical reasoning and translation of knowledge from the classroom to practice. This study examined the enduring impact of a hands-on lab experience on student’s clinical reasoning more than 1 yr after the experience while students were on Level II fieldwork.
INNOVATION: The use of patient educators (PEs) promotes an innovative method of integrating interactive learning into a curriculum. A PE has a specific condition and is trained in how to teach students evaluation and treatment procedures. The impact of learning on clinical reasoning resulted in the origination of the Clinical Reasoning Development Model, incorporating levels of reasoning and self-awareness, confidence, and empathy.
RESEARCH QUESTION: Our research question was as follows: How does an active learning lab with PEs affect the clinical reasoning of students 1 yr after the experience?
RATIONALE/BACKGROUND: Traditional didactic lectures are less able to enhance retention of knowledge and critical reasoning when compared to interactive teaching methods. In an effort to integrate more interactive learning opportunities into curriculum, some programs have incorporated hands-on experience with standardized patients and/or PEs. Although studies have addressed the short-term benefits of hand-on experiences, this study explored how a hands-on lab, conducted 1 yr prior to Level II fieldwork, affected students’ clinical reasoning during fieldwork.
METHOD: This phenomenological study explored the lived experiences of students using qualitative interviewing. The research team created five interview questions with additional prompts. Following institutional review board (IRB) approval, all eligible participants were contacted, and 8 students consented to participate. Interviews were conducted face to face or by using Skype® or FaceTime®. Face-to-face interviews were held at the university library or the public library.
For validation, verbatim transcripts were provided to participants for verification and member checking. The investigator used memo writing and open coding to extract themes relevant to the research questions. The research team discussed the primary analysis for depth. Reflective statements were identified. Analyst triangulation was used to increase the rigor of the study. Three primary themes emerged: self-awareness, confidence, and empathy. The quotes from the transcriptions were organized into four sequential plot categories: Before the Interaction, During the Interaction, Immediate Change, and Impact on Clinical Internship.
RESULTS: The results reveal a narrative of the process experienced by students from before the PE lab through fieldwork. The results led to the original Clinical Reasoning Development Model, representing factors derived from the experience. The results support enduring benefits in the areas of self-awareness, confidence, and empathy, which, in turn, lead to increased clinical reasoning skills.
CONCLUSION: The results suggest that hands-on experiences with PEs have enduring effects on students’ clinical reasoning and that the experience affected their practice during Level II fieldwork.
