Debate develops physiotherapy students’ clinical reasoning
How can physiotherapy students be prepared for situations where theory and clinical reality do not quite align? In the Study Programme in Physiotherapy at KI, structured debate is used to allow students to test arguments, examine evidence and discuss complex clinical issues.
Moving from campus-based teaching to clinical placement can mean that students encounter a reality that does not always match what they have learned. The teachers at the Division of Physiotherapy wanted to make use of this in their teaching.
Over the past two semesters, they have therefore used structured debate in the course component Physiotherapy for Older People. The method is used after students have completed three weeks of clinical placement.
”As teachers, we have long seen that many students find it challenging to bring together the theoretical knowledge they gain on campus with the clinical reality they later encounter during their placement”, says Breiffni Leavy, assistant senior lecturer and docent at the Department of Neurobiology, Care Sciences and Society.
When theory meets practice
One concrete example is standardised assessments of older patients’ function. On campus, students learn the importance of systematically assessing aspects such as physical function, activity and health as part of evidence-based care. During clinical placement, however, they may discover that such assessments are not always carried out in everyday clinical practice.
The reasons may include lack of time, organisational conditions or established ways of working. Instead of avoiding the differences between theory and practice, the teachers use them as a starting point for discussion.
”The aim is not for students to find a single, simple right answer. We want them to practise their clinical reasoning and understand the complexity behind professional decisions”, says Breiffni Leavy.
Must argue from different perspectives
The debate takes place during a half-day seminar after the clinical placement period. Students are divided into groups of around five and are given a statement relating to assessment and investigation in geriatric physiotherapy.
The groups are tasked with arguing either for or against the statement, regardless of what the students themselves think. To build their arguments, they need to weigh up scientific evidence, experiences from clinical practice and the patient’s perspective.
”The debate format requires students to analyse evidence, take a position on complex issues and respond to other perspectives. It should be challenging”, says Breiffni Leavy.
For some students, the debate situation itself can be challenging. The work is therefore organised so that not everyone needs to have the same role. Some students debate, while others prepare arguments and possible counter-questions.
”In this way, everyone can contribute based on their strengths and take part. We also try to encourage students to enjoy themselves and not get too caught up in the rhetorical aspects”.
Positive reactions
According to Breiffni Leavy, the response so far has been largely positive.
”We were actually pleasantly surprised. Many students appreciated the format and engaged more than we had expected. They get to discuss real clinical dilemmas while the teaching becomes more active”.
At the same time, she emphasises that no teaching method suits everyone. The next step may therefore involve both developing the format and exploring how structured debate can be used on more occasions during the programme.
”We could use debate as a recurring formative learning activity in which students can try out, develop and receive feedback on their clinical reasoning. In this way, the method can contribute to the development of critical thinking and evidence-based practice during the programme”.
The work with the structured debate has been developed by Breiffni Leavy together with Anna-Karin Welmer and Elisabeth Rydwik at the Division of Physiotherapy.