Reflective Journal Writing to Obtain Student Feedback about Their Learning during the Study of Chronic Musculoskeletal Conditions

Article excerpt

The purpose of this qualitative study was to obtain feedback from physical therapy students about their learning while studying chronic musculoskeletal conditions. All 48 students wrote weekly entries in reflective journals to document what and how they learned during an 8-week academic unit in a 24-month, postbaccalaureate, problembased program. Students identified significant learning events and described their observations, impressions, and reactions to what and how they learned and how they would respond to the same or similar events in the future. The journals were read independently by two physical therapy instructors who used a qualitative method to code the content of the weekly entries. They worked together to categorize the codes and develop themes. Five themes were identified: (1) realization that a different approach is needed to treat patients with chronic versus acute musculoskeletal conditions, (2) adjustment to group learning, (3) adoption of new coping strategies, (4) appreciation of the influence of students' values and beliefs on patient care, and (5) awareness of the various roles within physical therapy practice. The results indicated that the students had positive shifts in attitude about elderly clients and clients with chronic conditions, that they continued to adjust their learning and coping skills, and that they better understood the scope of practice of physical therapists. Journal writing can be used to obtain important feedback on how students learn and to promote their reflective thinking. J Allied Health. 2004; 33:17-23.

PROBLEM-BASED LEARNING is a method of education in which learning is initiated by paper problems (scenarios/cases). In the health sciences, students are presented with a client scenario and work in small tutorial groups to identify the learning required to understand the problem and plan the assessment and treatment. Students use various resources to acquire the needed knowledge or skills and then return to their tutorials to discuss important concepts. Students' performance is evaluated regularly and frequently by themselves, by their peers, and by the tutor. The goals of the health care scenarios are to provide a context for learning, to activate prior knowledge, to motivate students, and to stimulate discussion.1 The learning process is student centered and self-directed and designed to improve communication, self-evaluation, and critical analysis. The tutor acts as a facilitator of the learning process, not as a content expert.

Qualitative and quantitative research techniques have been used to describe the effects of problem-based learning on students in health professions. Topics discussed have included student identification of learning issues, accessing and using resources and satisfaction,2 problem solving and retention of knowledge,3,4 and approaches to studying.5 In occupational therapy6 and physical therapy,7 students have been asked, at the end of their education program, about their adaptation to problem-based learning. None of these articles examined physical therapy students' perceptions of how they learned, however, while they were experiencing the problem-based learning process.

In physical therapy educational programs, the curricula frequently begin with basic skills and knowledge, such as anatomy, physical assessment, and treatment including the principles of exercise. The emphasis is often on an acute "fix-it" mindset to begin with and on simple rather than complex conditions. In the baccalaureate physical therapy program at McMaster University, students followed a similar program for their first two units (semesters) of study, then, in unit 3, they were expected to deal with more chronic, complex issues and to integrate knowledge from a variety of sources and disciplines. Unit 3 was designed to help students with this transition, but we had never evaluated specifically the effect of the various learning/teaching strategies and how students changed their attitudes and ways of thinking throughout the unit. …