Blended learning to improve clinical decision making skills of physiotherapy students

Background: Clinical decision making (CDM) is recognized as an important component of professional development, but many healthcare students experience difficulties with it. Teaching methods to develop this skill are under-researched and little structure exists to guide students and clinicians through this complex process. Purpose: We aimed to set up a clinical reasoning (CR) course in the fourth-year physiotherapy curriculum of the Vrije Universiteit Brussels (86 students). Therefore, we used a blended learning approach with high interaction between students and with special emphasis on critical thinking (meta-cognition). Methods: We implemented the 'Physical Therapy Clinical Reasoning and Reflection tool'1 by using the Think - Pair - Share method. Students required coming to campus on three occasions. During the first contact, a clinical problem was presented. Subsequently, students individually prepared (at home) a CR exercise based on pre-defined questions aiming to enhance CDM skills, taking into account evidence-based practice (Think). For this, students were encouraged to use an online forum to stimulate interaction. Next, groups of four to five students physically met on campus, discussed their CDM process, and submitted a consensus report (Pair). Finally, each group presented their findings in a plenary session (Share). Students' feedback regarding usability and feasability of this educational method was aquired by using an online survey. Results: A total of 76 (88%) students provided feedback of which the most important: 1. Implementation of this method earlier in the curriculum would be appropriate. 2. The strict time frame during the first part of the assignment made sure that most students were active during this part of the project. 3. After the plenary session the teachers´ feedback was very appreciated, more feedback between parts 2 and 3 of the assignment would be appreciated. 4. The use of multiple case reports and discussion fora of small groups enhanced interaction. 5. This teaching method was a good preparation for the clinical internships. 6. 42% of students state that they will use this manner of CR ´most of the times´ in their professional career, 38% stays neutral. 7. Only 20% of the students reported not to have progressed in their CDM skills. Conclusion(s): This educational framework aimed to enhance CR skills and was much appreciated by students, especially as a preparation for the clinical internships. However, rather than subjective feedback, more objective, easy-to-use measurement instruments are needed to investigate the effectiveness of our framework to enhance CR in physiotherapy. Implications: We developed a framework that is ready to use in practice, based on the think-pair-share model (blended learning). In our framework the degree of complexity is easy to adjust to the participants' level of knowledge and thus applicable to both students and clinicians. CDM is an evolving skill that takes years (career), not just a lesson to be learned.