Physical Therapy and Rehabilitation

Physical Therapy and Rehabilitation

ISSN 2055-2386
Original Research

Teaching Students the Art of Working with Patients with Cognitive Impairments: A Comparison between the Use of Standardized Patients vs a One-time Clinical Experience

Shaun Varrecchia1 and Carol A. Maritz2*

*Correspondence: Carol A. Maritz

1. Assistant Professor of Physical Therapy, Samson College of Health Sciences, University of the Sciences, Philadelphia, PA 19104 USA.

Author Affiliations

2. Associate Dean and Professor of Physical Therapy, Samson College of Health Sciences, University of the Sciences, Philadelphia, PA 19104 USA.


Background: Working with individuals with cognitive impairment can be an uncomfortable experience for students in the health professions. Using a one-time clinical experience to expose them to this population is a common strategy used to increase comfort and improve skills. Unfortunately, relying on outside facilities to provide this experience introduces variability that can negatively affect outcomes.

Objective: The purpose of this study was to compare the outcomes associated with a standardized patient (SP) encounter with a one-time clinical education experience in order to determine the optimal learning opportunity for students.

Methods: Eighty-two DPT students participated in a session where they practiced communication skills and assessment procedures on individuals simulating cognitive impairment. Each group of students performed a brief interview with the SP, administered the Mini-Cog test to screen for cognitive impairment, and completed two performance-based functional outcome measures common in physical therapy. At the completion of the session the SPs stepped out of character and gave the student groups verbal feedback about their performance. Feedback was focused on student communication skills and ability to provide clear instructions while adapting to changes in the SP’s cognition.

Results: In order to assess the overall effectiveness of the SP experience, we compared learning outcomes with the one-time clinical experience. The total number of students participating in one of these experiences between 2016 and 2018 was 219. A strong positive trend of improvement is seen between each of the years and between the clinical site and standardized patient experiences. The ability to perform cognitive tests was considerably higher with the SPs than the clinical experiences. Chi-square tests of independence were used to compare students who reported achieving each of the goals of the activity and those who did not across each of the years. Significant relationships were found between achievement of outcomes and the year of participation and type of experience for all five outcomes reported. Effect size surpassed Cohen’s definition of “small” (Cramer’s V ≥ 0.1) for all five outcomes. Effect size was largest for performed cognitive tests,” with 𝛘2 (2, N=219)=74.24, p<0.00001 and 𝞿=0.58. Student comments regarding each of the experiences was analyzed and compared using qualitative methods. Unique to 2018, was the emergence of the word “feedback.” The opportunity to receive feedback was cited in 31 comments in the 2018 SP encounter. Other words emerging in 2018 include “real,” “realistic,” “convincing,” and “accurate”.

Conclusion: Overall, there was high level of agreement among the students that the SP experience helped them recognize cognitive impairment and communicate with individuals with cognitive impairment. Students strongly agreed that the SP portrayal was realistic and that the feedback they provided was valuable to their learning. When comparing the SP encounter to the one-time clinical experience, faculty found that the SP experience was more pedagogically sound. Students were actively engaged throughout the entire process especially during the feedback phase.

Keywords: Standardized patients, Communication skills, Formative feedback

ISSN 2055-2386
Volume 7
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