Assessment of Medical Screening and Clinical Reasoning Skills by Physical Therapy Students in a Simulated Patient Encounter

Purpose: Physical therapists (PTs) screen their patients for medical issues that may present as musculoskeletal conditions. In physical therapy education, learning activities followed by assessment of skills and clinical reasoning is important. The purposes of this study are to 1) demonstrate the feasibility of the use of standardized patients (SPs) and standardized physicians (SPhs) during a practical examination focused on medical screening, and 2) report outcomes related to the students’ abilities to screen for medical issues and make clinical decisions about referral to a physician. Methods: Students evaluated a standardized patient in an outpatient setting model. After receiving a patient scenario, students chose and performed examination items to identify signs that did not fit with the presenting musculoskeletal complaint. Student performance was scored by the standardized patients based on minimum interview and examination items required. Students discussed the concerns with the standardized patient and stated why the physician needed to be contacted. Students then called the standardized physician to discuss concerns and provide a recommendation. Results: For the interview portion, 22.8 ± 18.9% of students chose all required interview questions and gathered needed information. Most students (75.5 ± 14%) missed 2 or fewer interview items. For the examination portion, 16.7 ± 16.3% chose all items and performed them correctly with 59.1 ± 16.3% missing 2 or fewer items. Students did well communicating with the standardized patient about calling the physician, with 87.0 ± 5.3% scoring 100%. Scores across the affective/communication components were strong (98.7 ± 1.7%). Students were clear when speaking with the physician and made appropriate recommendations based on data collected. Overall feedback from students was positive, but many wanted more time with the standardized patient. Conclusions: This practical examination allowed students to apply medical screening and differential diagnosis skills in a simulated outpatient encounter. Upon reviewing outcomes for history and examination items, the most challenging part appears to be clinical reasoning. Students had difficulty determining all questions to ask and which items to perform, which reflects that they are novice practitioners. This practical examination was designed to encourage reflection in action, as seen in experienced clinicians, in order to help students progress in their clinical reasoning abilities.