Professional Development IV

Scholar Year: 2022/2023

Courses

Head Teacher Responsability Carmen Sofia Frade Caeiro Head Diogo Ramos dos Santos Colaborador Inês Charrua Pires dos Santos Colaborador Diogo André da Fonseca Pires Gestor de Ano

Weekly workload Hours/week T TP P PL TC S E EL OT TPL O OT/PL Type of classes 8 Lectures Type Teacher Classes Hours Orientação Tutorial Totals 4 32,00 Carmen Caeiro   2,00 Diogo Santos   2,00 Inês Santos   4,00

Teaching language

Portuguese

Intended learning outcomes (Knowledges, skills and competencies to be developed by the students)

At the end of the curricular unit, the student must demonstrate:
- Knowledge and understanding about:
Clinical reasoning strategies in the scope of physiotherapy practice;
The role of interactive reasoning on the purposeful establishment and management of the therapeutic relationship and its contribution to develop a better understanding of the patient`s illness experience;
The role of collaborative reasoning on the development of therapeutic alliances;
- Clinical Reasoning to:
Analyse clinical reasoning strategies in the context of physiotherapy practice;
Analyse and interpret different forms of interaction in the therapeutic relationship;
- Critical and independent thought to:
Critically analyse attitudes and behaviours in the context of professional practice;
Critically analyse the purpose of interaction between health professionals and patients/relatives/care givers as well as the impact of the development of interactive and collaborative reasoning competences on the health model of practice.

Syllabus

Clinical reasoning is the major theme of this unit. It includes tutorial sessions that explore the following topics:
Instrumental and communicative approaches to clinical reasoning: clinical reasoning strategies;
Instrumental and communicative approaches to clinical reasoning: national and international contexts;
Clinical reasoning: attitudes and behaviours in clinical practice;
Interactive reasoning and models of therapeutic relationship;
Therapeutic alliance;
Collaborative reasoning and decision making;
Patient centred practice: definition and impact on clinical practice

Demonstration of the syllabus coherence with the UC intended learning outcomes

This curricular unit is focused on the development of interactive and collaborative clinical reasoning competences. The syllabus include the range of clinical reasoning strategies that may be used by physiotherapists in clinical practice and explore in more depth: the interactive reasoning, as a clinical reasoning strategy that is focused on the purposeful establishment and ongoing management of therapist-patient rapport; and, the collaborative reasoning, as a clinical reasoning strategy focused on nurturing of a consensual approach towards the interpretation of examination findings, the setting of goals and priorities, and the implementation and progression of treatment. The role of these clinical reasoning strategies on the development of therapeutic alliances is also discussed.
In order to integrate the most updated scientific knowledge on this topic, the importance of the therapeutic alliance as a predictor of outcomes in physiotherapy is also analysed.
The models of therapeutic relationship are discussed and patient-centred practice is introduced.
The contents included in this curricular unit promote the development of competences in the area of clinical reasoning, as well as the development of reflection competences for clinical practice in order to foster effective therapeutic relationships and patient-centred care.

Teaching methodologies

The methodology is based on reflection using the principles of transformative learning as a framework of reference. It takes place in tutorial sessions, which are guided by a tutor. The students are presented with several episodes of interaction between health professionals and patients. In this context, arts and literature are used to promote competences of observation, empathy and reflection (considered essential competences to promote patient-centered practice). The analysis of artefacts from arts and literature is informed by the discussion of documents addressing the contents focused on this curricular unit. Reflexive writing is also used in order to promote students` reflection about their role as physiotherapists as well as patients` roles in the context of therapeutic relationships.

Demonstration of the teaching methodologies coherence with the curricular unit's intended learning outcomes

Aiming to promote the combination between evidence-informed practice and a more humanised practice, the contents of this unit are based on representations of clinical practice that include clinical interactions described by patients, health professionals or researchers (using arts and literature).
The use of arts and literature facilitates the analysis and understanding of clinical practice in a cultural and social context, providing insights into how this context impacts on the illness experience and on health care. Through arts and literature students develop competences to analyse a range of clinical reasoning strategies and critically analyse the therapeutic relationship. This methodology increases students` sensitivity to understanding the singularity of patients` context and the meaning they give to illness. It also helps student to manage the therapeutic relationship and develop therapeutic alliances that facilitate patients` collaboration on the decision-making. Reflexive writing focused on previous experiences with patients in clinical placements is also used as a strategy to promote students` competences to critically analyse their attitudes, behaviours and clinical reasoning.
The combination of this methodology with the analysis and discussion of specific bibliography in the area of clinical reasoning, facilitates the development of critical and independent thought about the purpose of interaction with patients and about the impact of the development of interactive and collaborative reasoning strategies in health care.

Assessment methodologies and evidences

For the successful completion of this unit, the student must attend 80% of the tutorial sessions and must have at least 9,5/20 in the argumentative essay, where students are requested to establish a position on the integration of interactive and collaborative clinical reasoning strategies in clinical practice.

The assessment also includes students` performance on tutorial sessions.

The final classification is based on the following formula:

FC= AE*18/20 + PTS

Where:
FC= Final Classification
AE= Argumentative Essay
PTS= Performance on Tutorial Sessions, which may correspond to 0 (minimum), 1 (proficient) and 2 (excellent)

If the student does not have success, a new argumentative essay is required at exam (normal or appeal)
In this scenario, the classification of this unit is calculated based on the classification obtained in the argumentative essay (100%) and does not include performance on tutorial sessions.

Attendance system

For working students (with registered status) the assessment will consist in:
- argumentative essay (100%)

Bibliografia

1. Babatude, F., MacDermid, J., MacIntyre, N. (2017) Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy: a scoping review of the literature. BMC Health Services Research. 17, 375.
2. Cruz, E., Moore, A., Cross, V. (2012a). Clinical reasoning and patient-centred care in musculoskeletal physiotherapy in Portugal – A qualitative study. Manual Therapy, 17(3), 246-250.
3. Cruz, E., Moore, A., Cross, V. (2012b). A qualitative study of physiotherapy final year undergraduate students` perceptions of clinical reasoning. Manual Therapy, 17(6), 549-53.
4. Cruz, E., Caeiro, C., Pereira, C. (2014) A narrative reasoning course to promote patient-centred practice in a physiotherapy undergraduate programme: a qualitative study of final year students. Physiotherapy Theory and Practice. 30(4), 254-260.
5. Edwards, I., Jones, M., Carr, J., Braunack-Mayer, A., Jensen, G. (2004a). Clinical Reasoning Strategies in Physical Therapy. Physical Therapy. 84, 312-330.
6. Edwards, I., Jones, M., Higgs, J., Trede, F., Jensen, G. (2004b). What is Collaborative Reasoning? Advances in Physiotherapy, 6, 70 -83.
7. Fisher, K., Tan, A., Matlock, D., Saver, B., Mazor, K., Pieterse, A. (2018) Keeping the patient in the center: common challenges in the practice of shared decision making. Patient Education and Counseling, 101, 20-26.
8. Higgs, J., Jensen, G., Loftus, S., Christensen, N. (2019) Clinical Reasoning in the Health Professions (4th ed.). Sydney: Elsevier.
9. Hall, A., Ferreira, P., Maher, C.G., Latimer, J, Ferreira, M. (2010) The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review. Physical Therapy, 8(90), 1099-1110.
10. Jones, M., Rivett, D. (2019) Clinical Reasoning in Musculoskeletal Practice (2nd ed.) Edinburgh: Elsevier.
11. Kinney, M., Seider, J., Beaty, A. B., Coughlin, K., Dyal, M., Clewley, D. (2020) The impact of the therapeutic alliance in physical therapy for chronic musculoskeletal pain: a systematic review of the literature. Physiotherapy Theory and Practice. 36(8), 886-898.
12. Lin, I., Wiles, L., Waller, R. et al. (2020) Patient-centred care: the cornerstone for high-value musculoskeletal pain management. Editorial. Br. J. Sports Med. 0(0), 1- 3.
13. Rademakers, J., Delnoij, D., Nijman, J., Boer, D. (2012) Educational inequalities in patient-centred care: patients` preferences and experiences. BMC Health Services Research, 12 (261).

Observations

During the unit other learning resources will be suggested.