Faculty Spotlight: Danielle Struble-Fitzsimmons on Incorporating Simulation and Case Studies in Physical Therapy to Improve Inclusivity and Student Learning

by | Jun 13, 2024

Danielle Struble-Fitzsimmons, Assistant Professor of Rehabilitation and Regenerative Medicine (Physical Therapy) and Director of Clinical Education, was awarded an Office of the Provost’s Innovative Course Design grant for her project “Incorporating Simulation and Case-Based Learning Strategies to Improve DPT Integumentary Education.” 

The innovative course design project was grounded in the teaching and learning principles of simulation, case-based learning, and authentic assessment. The project centered on the Doctor of Physical Therapy (DPT) course “PHYT M8311: Management of Integumentary Impairments” which focuses on physical therapy management for individuals with integumentary impairments, i.e., impairments to their skin and its associated structures including the hair, nails, and glands. Dr. Struble-Fitzsimmons worked with the Center for Teaching and Learning to expand the lecture and laboratory components of the existing course by adding ten diverse skin-tone integumentary-focused anatomic simulation models with related case studies, with the intention of: 1) extending opportunities for hands-on practice of skills related to physical therapist examination and treatment of integumentary conditions, 2) improving integumentary-related clinical decision making in case-based scenarios, and 3) addressing known diversity gaps in integumentary-related academic materials. 

Below, Dr. Struble-Fitzsimmons describes her experience.

Why did you redesign this course?

The assessment and management of integumentary-related impairments is a key component of the physical therapist scope of practice. While some licensed physical therapists specialize in wound care, physical therapists working in all areas of clinical practice are required to demonstrate foundational knowledge and skills related to integumentary dysfunction. In 2023, the American Physical Therapy Association (APTA) Academy of Clinical Electrophysiology and Wound Management released updated guidelines for academic DPT programs to improve content consistency and prepare students for entry-level practice; these guidelines recommend the use of simulation and case-based design.

Integumentary dysfunction and wounds present differently on skin of various colors and tones. There is a significant body of research describing the lack of representation of diverse patient characteristics in related medical education materials (including textbooks and medical journals), particularly regarding skin color and tone, with non-white skin being significantly under-represented in visual materials. This gap in academic preparation translates to health disparities for patients of color who have wounds or other integumentary conditions. Studies have shown that healthcare practitioners have difficulty diagnosing skin conditions in individuals with darker skin tones, resulting in delayed diagnosis and less favorable outcomes for patients. To reduce these health inequities, academic programs must incorporate learning materials that reflect the diverse patients that students are being trained to care for. 

What were the goals and objectives for your course?

This course redesign integrated new technology (anatomical simulation models) and case-based learning strategies to improve student learning outcomes. Students were expected to:

  1. Perform integumentary examination of a) edema b) wound and peri-wound characteristics and c) wound size on anatomical simulation models.
  2. Perform dressing interventions to various anatomically simulated wounds including a) arterial b) venous c) pressure d) skin graft and e) diabetic/neuropathic.
  3. Interpret data from the patient history, systems review, and tests and measures to identify a physical therapy diagnosis for integumentary-based case studies.
  4. Formulate a comprehensive plan of care for integumentary impairments that considers the unique psychosocial and cultural factors in patient case studies.

What resources did you and your team need to redesign the course?

CTL services were requested to assist with: 1) case-study learning design, 2) development of rubrics for student feedback and assessment, and 3) development of post-experience surveys for students and lab instructors. A total of 10 anatomical simulation models and 2 storage cases were purchased with grant funds.

How was the student experience enhanced?

The simulation models provided students a consistent opportunity to learn and practice new psychomotor skills. The lab sessions were structured using a timed and rotating “station” model approach that paired small groups of students with 1-2 lab instructors. Each station had designated learning objectives, included use of related simulation equipment, and emphasized hands-on skill development. The lab instructors provided brief group instruction or skill demonstration, but their primary goal during each session was to offer students individualized instruction and performance-related feedback.

The patient cases were threaded through the lecture and lab content to again provide consistency and promote deeper learning and engagement. The weekly case-study homework assignments included 1-2 patient cases, 2-3 related medical journal articles, and 2-3 open-ended questions that emphasized clinical decision-making (for example, selection of tests) and psychosocial aspects of care delivery (for example, social support, weight bias, and financial barriers). Students used the materials to answer short, open-ended questions to integrate these topics. In addition, the cases were used as the foundation of the final lab session, which emphasized cognitive (clinical decision making) and psychomotor (hands-on assessment and treatment skills) learning objectives.

This is a new way of teaching for you, but also for your students. How did they react to this new approach?

The final outcomes exceeded the initial expectations for both the simulation equipment and patient case studies. Students and lab instructors engaged meaningfully with the equipment during lab sessions. Non-scientifically, students appeared to have a lot of fun in the labs! They came prepared, asked questions, and demonstrated interest in the content. 100% of students successfully passed the course final lab practical, demonstrating successful skill acquisition.

Students also had positive feedback about the case studies and were noted to put great effort into the related homework assignments, often writing more length and content than required, indicating a sincere commitment to their learning.

What evidence showed the effectiveness of this new course design?

Below are the results from student surveys that were conducted.

Anatomical Simulation Models

Patient Case Studies

Additional Student Feedback: (Prompt: What were the BEST things about this course?)

“Super organized; lab was structured in a great way for learning.”

“The conciseness. I never felt like time was wasted while plenty of time was made for repetition and practice. The simulation models really helped to solidify the content provided in lecture.”

“It was really helpful to have the 3D models in lab. It’s one thing to look at pictures, it’s another to have something I can touch and feel in front of me.”

“The lab simulation models! And I loved how we rotated through different stations to analyze each different type of wound. This class was extremely interesting to me as it opened up a new scope of practice that physical therapists partake in. It really expanded my knowledge and gave me new ideas for where I may want my career to go in the future.”

Students in Dr. Struble-Fitzsimmons’ course with an anatomical simulation model.

Do you have any advice for other faculty who are considering redesigning their courses? 

A key element to the success of this redesign was the feedback that I received from the CTL Learning Designers. Both Nigel [Frazier] and Alexis [Cho] listened to me, supported my vision, and provided meaningful insight and suggestions related to course operations, learning strategies, technology, and feedback. For me, the key takeaways from this overall experience were: 1) backward design promotes learning and impact, 2) feedback solicitation from multiple stakeholders at multiple points is important, and 3) a willingness to try new instructional practices can be challenging, but is well worth the effort.