ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, 2014; 28(4): 365–367 ! 2014 Informa UK Ltd. DOI: 10.3109/13561820.2014.891978


Virtual patient care: an interprofessional education approach for physician assistant, physical therapy and occupational therapy students Michael J. Shoemaker1, Christina M. Platko1, Susan M. Cleghorn2 and Andrew Booth3 1

Department of Physical Therapy and 2Department of Occupational Therapy, Grand Valley State University, Grand Rapids, MI, USA, and Department of Physician Assistant Studies, Cook-DeVos Center for Health Sciences, Grand Valley State University, Grand Rapids, MI, USA

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The purpose of this retrospective qualitative case report is to describe how a case-based, virtual patient interprofessional education (IPE) simulation activity was utilized to achieve physician assistant (PA), physical therapy (PT) and occupational therapy (OT) student IPE learning outcomes. Following completion of a virtual patient case, 30 PA, 46 PT and 24 OT students were required to develop a comprehensive, written treatment plan and respond to reflective questions. A qualitative analysis of the submitted written assignment was used to determine whether IPE learning objectives were met. Student responses revealed three themes that supported the learning objectives of the IPE experience: benefits of collaborative care, role clarification and relevance of the IPE experience for future practice. A case-based, IPE simulation activity for physician assistant and rehabilitation students using a computerized virtual patient software program effectively facilitated achievement of the IPE learning objectives, including development of greater student awareness of other professions and ways in which collaborative patient care can be provided.

Interprofessional care, interprofessional collaboration, interprofessional education

Introduction The use of simulation as a case-based learning activity to achieve interprofessional education (IPE) objectives is difficult because it is resource-intensive with regard to cost, facilities, faculty time, and aligning curricular and student schedules (e.g. Shoemaker, Beasley, & Cooper, 2011). Computer-based virtual patients, however, are able to overcome these barriers by allowing small groups of students to meet at their convenience rather than trying to coordinate a single date and time for multiple professions to meet with or without a faculty facilitator. Although the use of virtual patients in health profession education has been previously reviewed (Cook, Erwin, & Triola, 2010) no study has reported on their use for IPE involving the providers of medicine and rehabilitation. The purpose of this retrospective case report is to highlight learners’ responses to a virtual patient-based IPE activity directed at the following learning objectives for second-year physical therapy (PT), physician assistant (PA) and occupational therapy (OT) students: (1) Collaborate as an interprofessional team in the diagnosis and management of a virtual patient; (2) Develop an understanding of the underlying philosophical approach to diagnosis and management of a disease process by other professions; and (3) Identify opportunities for collaboration

History Received 2 July 2013 Revised 17 October 2013 Accepted 4 February 2014 Published online 4 March 2014

among physical therapists, physician assistants and occupational therapists in the care of a patient with diabetic peripheral neuropathy.

Background The present paper is a retrospective qualitative case report describing the use of a virtual patient case as a self-directed learning experience during the fourth semester for 30 PA, 46 PT and 24 OT students at Grand Valley State University, Michigan, USA. The VirtualPT and DxR Clinician (DxR Development Group, Carbondale, IL) internet-based virtual patient software was utilized for this IPE activity. One of the cases available for purchase is nearly identical in the VirtualPT and DxR Clinician programs and contains the same patient history and examination elements for a middle-aged male adult with diabetic peripheral neuropathy, with the VirtualPT providing rehabilitation-specific examination items and the DxR Clinician providing more detailed laboratory examination. Since the VirtualPT and DxR Clinician are designed for PT and PA students, the case in both software programs was edited to include historical and examination data relevant to occupational therapy, including a variety of social history, basic and instrumental activities of daily living, and leisure interest items. Students were assigned to a group, with each group consisting of one occupational therapy student and one to two students from physical therapy and physician assistant studies.

Methods Correspondence: Michael J. Shoemaker, Department of Physical Therapy, Grand Valley State University, 301 Michigan St, Grand Rapids, MI 49503, USA. E-mail: [email protected]

Following participation in this IPE activity, each of the 24 groups were required to develop a comprehensive, written treatment plan.


M. J. Shoemaker et al.

J Interprof Care, 2014; 28(4): 365–367

Table I. Representative quotes for identified themes. Theme Benefits of collaborative care

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Role clarification

Relevance for future practice

Sample quote ‘‘Since we all have a different focus, we pay attention to different details. Thus, we are more effective when we work together as a team because we have multiple perspectives from which to collect information. Also, when we work together we can coordinate care that complements other team members’ care plans without being redundant. This is important since there are areas in which we overlap; knowing what each discipline is doing allows teams members to prioritize care appropriately.’’ (OT student) ‘‘This experience was helpful in being reminded how important it is to collaborate with other members of the health care team. It seems that sometimes we get caught up in focusing only on the medical aspect or only on the therapy aspect and we need to remember that both of these need to be combined in order to effectively give our patients the best care available.’’ (PA student) ‘‘While there were differences in the management plan, there was significant amount of overlap between the plans. For example, all disciplines regarded the importance of monitoring changes in sensation. The PAs and PTs both included the importance of checking the feet for foot ulcers. The PTs and OTs would both (be) looking into assistive devices, but for different functional purposes.’’ (PT student) ‘‘I knew that the PT/OT’s can do assessment but I did not know that they are also educated about many major disease processes, as well as a complete history. Knowing the level of skills, coursework and knowledge we all have to offer allows us to know that we can rely on each other for proper diagnoses and collaboration while building an accurate treatment plan.’’ (PA student) ‘‘While I had a general understanding of the disciplines of PT and PA it was a rewarding and valuable experience to learn more about the scope of practice. Simulations like this increase the amount of knowledge and possible the level of respect that individuals have for other disciplines’’ (OT student) ‘‘This experience helped us learn more about what each profession does so it will help in the future when we have a patient that could benefit from another profession’s services. We all feel a little less hesitant now about approaching the other profession and asking for a consult or referral.’’ (PT student) ‘‘By appreciating what other professions have to offer, we will be more apt to utilize their expertise with more complex patients.’’ (PA student)

The written submission from each interprofessional group also included responses to reflective questions from each student in the group. Examples of questions for reflection included: (1) How did your perceptions change with regard to what each discipline had to offer this type of patient? (2) How will this experience impact your future collaboration with other members of the health care team? The written submissions were analyzed using a collaborative analysis as described by Miles and Huberman (1994), where the student reflections were independently coded by two authors to determine underlying key terms, resting key phrases, and relevant clusters, and to identify themes. This retrospective use of student records was approved the Human Research Review Committee at Grand Valley State University.

Findings Student responses from four reflective questions revealed three themes: (1) Benefits of collaborative care, including the belief that a team approach is more holistic which results in comprehensive treatment planning and a more complete and accurate picture of the patient. (2) Role clarification, where the majority of students specifically reported improved knowledge of the role and scope of practice of the other professions, as well as areas of overlap between professions. (3) Relevance of the IPE experience for future practice, with students reporting an increased comfort level and confidence in collaborating with other health care professions and that they may be more likely to use those other professions as resources and/or referrals. Table I presents example quotes that supported each theme that, in turn, indicated accomplishment of the IPE simulation learning objectives.

Discussion Despite an increase in published articles investigating simulation in health professional IPE, there is a paucity of research describing the use of virtual patients IPE between medicine and rehabilitation. Furthermore, there are few articles providing strategies for overcoming the various barriers to large,

simulation-based IPE activities (Shoemaker et al., 2011). The present paper, sought to describe how a virtual patient simulation software program was readily adapted to achieve IPE learning objectives for PA, PT and OT students. Thematic analysis revealed attainment of the learning objectives specific to this IPE experience: collaboration as an interprofessional team, understanding the underlying philosophical approach to diagnosis and management by other professions, and identification of opportunities for future collaboration. The first theme, benefits of collaborative care, provides evidence of achievement of the third learning objective. Specifically, student reflections demonstrate an understanding for the need of broadening perspectives of the patient while reducing redundancy of services during the evaluation. Theme two, role clarification, identifies increased clarity and depth of understanding of each disciple’s approach to evaluation and treatment as a result of participation in the IPE and directly supports the second learning objective. Finally, the theme of relevance on future practice addresses the first learning objective through students’ increased comfort level working in an interprofessional team with an increased understanding of how and when they may refer a patient to a different profession. Although these findings are highly consistent with previous work investigating the use of simulation to facilitate IPE (Zhang, Thompson, & Miller, 2011) and other case-based IPE activities (Barnett, Hollister, & Hall, 2011), the findings described in the present paper suggest that similar learning objectives may be obtained through less resource-intensive methods. Therefore, PA, OT and PT education programs should consider incorporating virtual patient-based IPE activities into their curricula, especially if the software program is already available and in use within a single profession. There are several limitations to this case report. First, it is a retrospective analysis of an assignment not designed or intended for research purposes which limits the data available to analysis. Second, this is a case report of a single student cohort’s experience at a single institution which limits generalizability. Third, the thematic analysis is subject to investigator bias,

DOI: 10.3109/13561820.2014.891978

although the same themes were independently derived by two authors.

Declaration of interest The authors report no declarations of interest. The authors alone are responsible for the writing and content of this paper.


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Barnett, G., Hollister, L., & Hall, S. (2011). Use of the standardized patient to clarify interdisciplinary team roles. Clinical Simulation in Nursing, 7, e169–e173.

Virtual patient care and interprofessional education


Cook, D., Erwin, P., & Triola, M. (2010). Computerized virtual patients in health professions education: A systematic review and metaanalysis. Academic Medicine, 85, 1589–1602. Miles, M.B., Huberman, A.M. (1994). Qualitative data analysis. 2nd ed. Thousand Oaks, CA: Sage Publications. Shoemaker, M., Beasley, J., & Cooper, M. (2011). A method for providing high-volume interprofessional simulation encounters in physical and occupational therapy education programs. Journal of Allied Health, 40, e15–e21. Zhang, C., Thompson, S., & Miller, C. (2011). A review of simulationbased interprofessional education. Clinical Simulation in Nursing, 7, e117–e126.

Virtual patient care: an interprofessional education approach for physician assistant, physical therapy and occupational therapy students.

The purpose of this retrospective qualitative case report is to describe how a case-based, virtual patient interprofessional education (IPE) simulatio...
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