Using the Integrated Standardized Patient Examination to Assess Clinical Competence in Physical Therapist Students

Background and Purpose. To test the success of integrated curricula and “clinical readiness” of students in Doctor of Physical Therapy (DPT) programs, meaningful measurements of student competence are necessary. Competence testing must include an authentic clinical encounter. Standardized patients (SP) have long shown to be reliable teaching and assessment tools in health professional education and should be explored with DPT students. Method/Model Description and Evaluation. This paper analyzes a new performance assessment tool, the Integrated Standardized Patient Examination (ISPE), specifically designed for assessing clinical competence in DPT students. Students performed 2 ISPE cases; one portraying a herniated lumbar disc (HD) and the other a status post-cerebral vascular accident (CVA). A maximum of 30 minutes was allotted to conduct a history, to respond to 4 “integration” questions asked by the SP, and to perform a targeted examination. Expert physical therapist (PT) evaluators, the investigator, and students scored each section and an overallencounter quality section. The SP also scored the overall-encounter section. All participants filled out a feedback survey about the experience. Outcomes. Acceptable reliability was demonstrated via interrater agreement on items that used a dichotomous scale, whereas the items requiring the use of the 4-point rubric were somewhat less reliable. For the entire scale, both cases had a significant correlation between the expert-investigator pair of raters; for the CVA case (r = .547, P < .05); and for the HD case (r = .700, P < .01). On the overall encounter section, the SPs scored students higher than the other raters. Students' self-assessments were most closely aligned with the investigator. Content validity was gathered in the process of developing cases and patient scenarios. Discussion and Conclusion. Future studies should examine the effect of rater training upon reliability. Criterion or predictive validity could be further studied by comparing students' performances on the ISPE with other estimates of students' competence. The unique integration questions of the ISPE were judged by experts and students to have good content validity; confirming that integration—a most crucial element of clinical competence—can be practiced, assessed, and used to determine student clinical competence.