Petrha+: A Serious Game to Enhance Physiotherapy Students' Clinical Reasoning

Background And Context

Developments in physiotherapy professional competencies (WCPT-ER, 2013) in undergraduate physiotherapy education include a focus on the interactions with patients and clients and the process that spans from the first contact to measure an intervention’s results. For teaching purposes, this process can be broken down into several tasks that involve collecting data from patient history, patient files, and physical examination (including assessments of the main functions of the body, activity limitations, participation restrictions). Then, the collected information is processed to establish a physiotherapy diagnosis, rehabilitation goals, choosing rehabilitation means and techniques, implementing therapeutic actions, and re-assessment. Most parts of this process can be emulated using simulation approaches that span from the low-tech, low-budget paper case, through virtual cases or mannequins, right to standardized patients both in mixed and real lab contexts (Jull et al., 2011; Pritchard et al., 2016).

Simulations using actors as patients in undergraduate physiotherapy training courses helps students gain familiarity with clinical encounters or care environments like those they will find in real life, without risk for the patient, for the healthcare professional or for the student (Murphy et al., 2015; Phillips et al., 2017). However, these simulated clinical situations present some limitations. In addition, the scenario of students role-playing with peers might present some limitations, regardless of its usefulness. For example, when roles lack realism, students do not behave as they might in a real situation; they may have poor acting skills, inadequate preparation, uncertainty about the quality of peer feedback, or lack of clarity in instructions that make the experience less believable (Nestel & Tierney, 2007).

Actors as patients can be very realistic and be good for evaluation purposes because of their ability to standardize the assessment environment but are expensive (Paparella-Pitzel et al., 2009). Moreover, because a large number is needed to cover all health conditions, they take a long time to train and get tiered, all of which makes them inadequate for large-scale training. Finally, patients in a class context have the advantage and richness of its reality but must be accompanied by staff, and like with actors, they get tiered, which limits repetition. The approaches described above, although limited as stand-alone solutions, can complement each other if delivered for a specific purpose alongside the curriculum. Despite their value as learning tools, they have similar limitations when it comes to delivering diversity and repetition to a large number of students. Their use is also limited because they are mostly bound to the school’s premises.