The usability of virtual patients to facilitate clinical reasoning in physiotherapy

Abstract

Clinical reasoning is essential for effective physiotherapy practice, but its complexity makes it difficult to teach and learn. The literature suggests it is learnt within the practice environment and improves with patient-centred experience. However, physiotherapy education has a diminishing availability of practice-based learning. Patient simulation is used within medicine to counteract the decline in practice-based learning and to ease the theory-practice gap. This thesis explores the use of patient simulation to ease the theory-practice gap within physiotherapy. The literature relating to clinical reasoning, technology enhanced learning, simulation and virtual patients was reviewed. An institutional focus study was undertaken which explored the implementation of technology enhanced learning in physiotherapy education and detailed the development of a virtual patient simulation. A case study approach was used to explore the usability of virtual patient simulation to facilitate clinical reasoning and ease the theory-practice gap. Twenty-six physiotherapy students participated. Three virtual patients were made available for three months for self-directed learning. Data was collected using focus groups and the think-aloud method was employed to capture the verbalised thought processes of nine participants while assessing a virtual patient. This was supported by electronic data capture methods within the virtual patient software. Thematic analysis was used to interpret the qualitative data sets. Findings showed the fidelity of virtual patients facilitated clinical reasoning and eased the theory-practice gap. Participants perceived the virtual patient concept had merit and should be used in peer learning as part of their curriculum. Usability issues were identified and improvements suggested The think-aloud method revealed the value of educators supervising physiotherapy students verbalise their clinical reasoning, to identify errors and improve learning.