Euson Yeung

Establishing assessment criteria for clinical reasoning in orthopedic manual physical therapy: a consensus-building study

Abstract Objectives: Clinical reasoning (CR) represents one of the core components of clinical competence in Orthopaedic Manual Physical Therapy (OMPT). While education standards have been developed to guide curricular design, assessment of CR has not yet been standardized. Without theory-informed and rigorously developed measures, the certification of OMPTs lacks credibility and is less defensible. The purpose of this study was to use a theory-informed approach to generate assessment criteria for developing new assessment tools to evaluate CR in OMPT. Methods: A list of assessment criteria was generated based on international education standards and multiple theoretical perspectives. A modified Delphi method was used to gain expert consensus on the importance of these assessment criteria for the assessment of CR in OMPT. The OMPTs from 22 countries with experience in assessing CR were invited to participate in three rounds of online questionnaires to rate their level of agreement with these criteria. Responses were tabulated to analyze degree of consensus and internal consistency. Results: Representatives from almost half of the OMPT member organizations (MO) participated in three rounds of the Delphi. High levels of agreement were found among respondents regarding the importance and feasibility of most assessment criteria. There was high internal consistency among items within the proposed item subgroupings. Discussion: A list of assessment criteria has been established that will serve as a framework for developing new assessment tools for CR assessment in OMPT. These criteria will be important for guiding the design of certification processes in OMPT as well as other episodes of CR assessment throughout OMPT training.

Virtually present: The perceived impact of remote facilitation on small group learning

Background: The engagement of facilitators located remotely for small group learning has received little research attention. However, this approach could increase the pool of experts for small group learning, thus addressing challenges to sustainability faced by in-person models of small group facilitation. Aim: The objective of this study was to describe the experiences and perceptions of students regarding the use of remote facilitation for small group learning in a health education setting. Methods: This qualitative study involved three focus groups (n = 16) composed of students in the advanced neuromusculoskeletal teaching unit in the University of Toronto, Department of Physical Therapy. Focus groups were audio-taped and transcribed verbatim, and data were analyzed thematically. Results: Three main influences emerged related to the experiences of students regarding the use of remote facilitation for small group learning in a health education setting: technology (including audio and visual), facilitator (including quality of facilitation and facilitator expertise), and group dynamics (including ground rules, roles and responsibilities, and learning style). Each of these influences acted independently and interdependently to shape participants’ perceptions. Conclusion: This study prompts a widening of the concept of distance learning to also include distance teaching, which may have wide applicability to health profession programs.

Seven-Step Framework for Critical Analysis and Its Application in the Field of Physical Therapy.

Critical analysis (or the ability to recognize taken-for-granted assumptions and their effects) is a skill that requires teaching and practice. The purpose of this article is to introduce a framework for critically analyzing assumptions within physiotherapy and to illustrate its utility through application to two examples: a physiotherapy clinic logo and an outcome measure for health-related quality of life. This 7-step framework for critical analysis was created for a pilot project to develop reflexivity among senior physiotherapy students, and further developed through an iterative process of reflecting on its utility for advancing the field of physical therapy. The 7-step framework is an iterative process involving a cascade of seven steps as follows: (1) Name the specific aspect of practice being analyzed, (2) Identify the intended purposes of this aspect of practice, (3) Uncover the assumptions that support these intended purposes, (4) Identify who benefits, (5) Identify who is disadvantaged, (6) Link these specific ideas to society-level patterns, and (7) Conceive of alternatives that mitigate actual or potential harms. We emphasize that being theoretically critical does not equate to being negative. Rather, we use the word “critical” in the sense of thinking deeply and carefully about the intended and unintended consequences of actions (including common professional practices, ways of speaking, and visual representations) in order to reflect on and mature the field of physiotherapy. The purpose of critical analysis is to invite and promote dialogue that assists physiotherapy clinicians, researchers, and students to arrive at new insight about the impacts of their day-to-day actions.

Validity of a new assessment rubric for a short-answer test of clinical reasoning

BackgroundThe validity of high-stakes decisions derived from assessment results is of primary concern to candidates and certifying institutions in the health professions. In the field of orthopaedic manual physical therapy (OMPT), there is a dearth of documented validity evidence to support the certification process particularly for short-answer tests. To address this need, we examined the internal structure of the Case History Assessment Tool (CHAT); this is a new assessment rubric developed to appraise written responses to a short-answer test of clinical reasoning in post-graduate OMPT certification in Canada.MethodsFourteen physical therapy students (novices) and 16 physical therapists (PT) with minimal and substantial OMPT training respectively completed a mock examination. Four pairs of examiners (n = 8) participated in appraising written responses using the CHAT. We conducted separate generalizability studies (G studies) for all participants and also by level of OMPT training. Internal consistency was calculated for test questions with more than 2 assessment items. Decision studies were also conducted to determine optimal application of the CHAT for OMPT certification.ResultsThe overall reliability of CHAT scores was found to be moderate; however, reliability estimates for the novice group suggest that the scale was incapable of accommodating for scores of novices. Internal consistency estimates indicate item redundancies for several test questions which will require further investigation.ConclusionFuture validity studies should consider discriminating the clinical reasoning competence of OMPT trainees strictly at the post-graduate level. Although rater variance was low, the large variance attributed to error sources not incorporated in our G studies warrant further investigations into other threats to validity. Future examination of examiner stringency is also warranted.

Exploring the teaching and learning of clinical reasoning, risks, and benefits of cervical spine manipulation

ABSTRACT The aim of this study was to examine how risks and benefits of cervical spine manipulation (CSM) were framed and discussed in the context of mentorship and their impact on the perception of safe practice of CSM in clinical physiotherapy settings. A multi-method qualitative approach was employed, including a document analysis of established educational guidelines, observations of mentoring sessions, and individual face-to-face interviews with five mentees in the process of learning CSM, and four mentors with Orthopedic Manual Physical Therapy (OMPT) certification. Results demonstrated that participants’ clinical decision-making processes to perform CSM were primarily oriented to the mitigation of risk. Achieving proficiency in the “science” of clinical reasoning and the “art” of “feel” related to mastering technical skills were viewed as means to mitigating risk and enhancing confidence to use CSM safely in clinical practice. While the “art” of technical skill mastery was of high importance to mentees and considered important to developing competency in performing CSM, it was discussed as distinct from their clinical reasoning processes. Thus, promoting a more balanced and integrated use of the “art” and “science” of safe practice for CSM in OMPT training may result in greater confidence and judicious use of CSM by physiotherapists.

A narrative review on cervical interventions in adults with chronic whiplash-associated disorder

Introduction Whiplash injuries are common in society, but clinical interventions are inconclusive on the most effective treatment. Research and reviews have been completed with the goal of determining clinical interventions that are effective for whiplash injuries and disorders, but literature has not recently been summarised on best practices for cervical spine interventions for adults with chronic whiplash. Purpose The objective of this narrative review is to update and expand on previous works, to provide recommendations for clinical interventions and future research in the area of cervical spine rehabilitation for adults with chronic whiplash-associated disorder. Method The Arskey and O’Malley methodology was used for this narrative review. CINHAL, EMBASE, Medline, PsychInfo, Scopus, Web of Science, as well as grey literature, were searched from 2003 to April 2017. Two reviewers screened titles and abstracts for relevance to the review, and content analysis summarised the study findings. A total of 14 citations were included in the final review. Findings Exercise-based interventions targeted at the cervical spine appear most beneficial for adults with chronic whiplash-associated disorder (WAD). Invasive interventions still require more rigorous studies to deem their effectiveness for this population. Conclusion Further research is required to investigate and determine clinically relevant results for cervical spine intervention in patients with chronic WAD.

Negotiating learner-teacher boundaries in medical education

During a third year medical student seminar on renal failure, Dr. Sara Ender is facilitating a group discussion. One of the medical students, James, puts up his hand. ‘‘Sara, I have a question’’, he says. She is immediately aware that other students may be wondering why James used her first name. Was it intentional? Should she address it? We write this personal view from the perspective of both faculty and learners recently involved in a participatory curriculum development process. While the experience was rewarding on many levels, it has prompted our reflection on some of the unintended, perhaps challenging, outcomes related to more actively involving learners in these processes. Learner engagement is widely recognized as key to their achievement in higher education. Actively involving learners in the co-creation of curriculum offers one way to facilitate this engagement (Bovill 2013). Offering learners the opportunity to contribute their knowledge and experience to curricula in an authentic participatory process has many potential benefits, including: increasing learner responsibility for their own learning; engaging learners in critical exploration of teaching processes; enhancing learner performance; and improving faculty satisfaction (Huppatz 1996). While the argument for learner involvement in curricular design is not new within education and critical pedagogy literature (Rudduck & Fielding 2006), it remains an emerging idea within the higher education and medical education literature. Often, learner engagement in this context is reduced to gathering learner feedback through standard evaluation method, while greater more in-depth attention is paid to the opinions of faculty as ‘experts’ in faculty-led curricular design (Coates 2005). In an attempt to move beyond faculty-led curriculum design and in response to calls at our institution for learner involvement, we recently engaged in a participatory curriculum development process. Our team, consisting of faculty, postgraduate and undergraduate learners, aimed to develop an innovative faculty development program for teachers. The knowledge, perspectives, and experiences of each team member informed all aspects of the curriculum design process. The boundaries of the participatory process evolved organically. From the outset, faculty engaged in a deliberate sharing of roles and encouraged informality with the learners. Ownership and empowerment were fostered through co-creation of the program’s vision and decision-making by consensus. Learners’ opinions and real-life experiences informed and guided the development of the curriculum, resulting in a more relevant and authentic tool for clinical teachers. Reflecting on this experience, the faculty described an enriched understanding of the learner learning experience. Learners felt that the partnership afforded them opportunities to explore educational processes and theory while under the guidance of faculty role models, thus enhancing their current experiences as learners and creating a foundation for their future roles as teachers. Throughout the process, as relationships grew and trust was established, the traditional power differential between faculty and learners (Lempp & Seale 2004) was ‘flattened’. We no longer felt like experts (faculty) and novices (learners) but rather like colleagues working together towards a common goal. Indeed, our involvement in participatory curriculum development changed the nature and boundaries of our relationships. Although these changes furthered the curricular development agenda, they also produced unintended outcomes related to the manner in which we navigated between our different roles within the medical education system. Faculty were faced with feelings of vulnerability when they acknowledged that learners from the project would be present during their clinical teaching sessions, and thus evaluating their roles as effective teachers. Similarly, learners perceived a heightened expectation from faculty and felt increased pressure to perform in the clinical context when faculty from the project were present. Both faculty and learners shared concern that our previous experience working together may be construed as favoritism, and struggled with how to interact with each other in front of peers and colleagues. Learners who were on first name basis with faculty during the co-creation of