Integrated clinical experience with concurrent problem-based learning is associated with improved clinical reasoning among physical therapy students in the United States

A quasi-experimental nonrandomized pretest-posttest design was used with a convenience sample of 42 participating student PTs during their third and final year of didactic coursework in the Midwest of the United States. Students participated in two 8-week PBL courses, with concurrent ICE throughout. The ICE stemmed from a departmental-sponsored and faculty-supervised SRFC that provided pro bono physical therapy services 2 afternoons per week to underserved individuals within the community. Clients across the lifespan were treated, including those with neurologic and orthopedic diagnoses. Third-year students were paired with an underclassman and faculty supervisor for all clinical care. Simultaneously, the students completed two 8-week PBL courses with small-group case-based sessions totaling 6 hours per week for 16 weeks. The Self-Assessment of Clinical Reflection and Reasoning (SACRR) survey, with 26 items rated on a 5-point Likert scale, ranging from 5 (strongly agree) to 1 (strongly disagree), is a reliable and valid tool for examining students’ self-reported perceptions of CR development across multiple curricular designs in allied health training, including physical therapy. The pretest-posttest survey analyses included changes in SACRR individual item responses and overall scores (aggregate of all items) between the beginning and the end of the 16-week session.本研究采用准实验非随机前测-后测设计，研究对象为美国中西部地区修读第三学年（亦是最后一学年）理论授课课程的42名便利抽样入选的物理治疗专业学生（Physical Therapy students, 下称PT生）。参与学生修读两门各为期8周的基于问题的学习（Problem-Based Learning, PBL）课程，全程同步开展沉浸式临床体验（Immersive Clinical Experience, ICE）。该ICE依托院系资助、教师带教的服务学习临床中心（Service-Learning Clinical Facility, SRFC）开展，该中心每周2个下午为社区内服务资源匮乏人群提供免费公益物理治疗服务，服务对象覆盖全年龄段，包括神经科与骨科病症患者。所有临床照护环节均由三年级学生与低年级学生及临床带教教师配对完成。与此同时，学生每周累计开展6小时的小组案例研讨课，完成上述两门为期8周的PBL课程，总时长达16周。临床反思与推理自我评估量表（Self-Assessment of Clinical Reflection and Reasoning, SACRR）包含26个条目，采用5点李克特量表计分（5=完全同意，1=完全不同意），是一款信效度良好的工具，用于评估联合健康培训（包括物理治疗专业）中，学生对多种课程设计下临床反思（Clinical Reflection, CR）发展的自我感知情况。本次前测-后测量表分析涵盖了16周课程开始与结束时，SACRR各条目作答情况及总得分（所有条目得分总和）的变化。