Using Case-Based Learning to Teach Clinical Decision Making

Sass KJ, University of Iowa Graduate Program in Physical Therapy and Rehabilitation Science, Iowa City, IA. Supported by a Carver College of Medicine Educational Development Fund grant.

 Purpose: 

Clinical decision-making/reasoning is a complex process.  Clinical reasoning skills need to be taught to and reinforced with students to develop their individual clinical reasoning processes.   Our purpose is to use CBL as an effective method of promoting active learning, and teaching the problem solving and life-long learning skills that are essential to evidence-based practice of physical therapy.   

 Description:

At the University of Iowa Graduate Program in Physical Therapy and Rehabilitation Science, there are four consecutive CBL courses in the entry-level DPT curriculum. Each CBL course is taken in conjunction with the traditional curriculum. Every semester is comprised of two case study presentations, each covered over the course of four weeks, followed by two Simulated Patient Instructor (SPI) experiences which allow the students an opportunity to practice new examination intervention and clinical reasoning skills in a controlled patient environment.. Five to seven students are assigned to each small group along with a trained facilitator.   Student responsibilities include examining each case study, identifying learning issues, developing personal learning goals, and contributing to the learning of the other group members through written and oral learning issue reports.  The facilitator is responsible for promoting participation by all group members, keeping the group focused and on task, encouraging independent thinking, and evaluating student performance.  Following each case study, the students have a SPI encounter that presents similarly to the patient/client situation addressed in that case.    The SPIs are trained to portray a certain condition and/or situation to the students.  The SPIs are also trained in providing effective feedback to the students regarding their performance of psychomotor skills, interpersonal skills and professional behaviors.   As the students progress through the physical therapy curriculum and the four CBL courses, the cases become increasingly more complex, demanding higher levels of clinical reasoning.  The need to use available evidence as part of this process becomes a focal point in the latter case studies.  Evaluation of student performance is completed twice a semester by the facilitator, the SPI and peers.  Students also provide feedback to the facilitators and SPIs.

 Summary of Use:

CBL is used in the entry-level DPT curriculum at the University of Iowa.  There are four consecutive courses offered each semester of the program that are used to promote clinical reasoning skills, active learning strategies and life-long learning skills to students

 Importance to Members: 

 Students need to learn and practice a systematic approach to clinical problem solving, as described in this CBL course series.  As the profession of physical therapy changes to become a doctorate-level profession with increased autonomy, it is imperative that the graduates from our educational programs have the essential skills needed for clinical decision-making. The mastery of these foundational skills paves the way for these graduates to become life-long learners with expertise in the practice of physical therapy.

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