Background and Purpose. Little quantitative research exists describing the effectiveness of instructional strategies for developing medical screening and patient referral abilities of physical therapist (PT) professional degree students. The purpose of this study was to compare the effectiveness of 2 patient case-based instructional strategies designed to promote these abilities: (1) a traditional lecture (TL) format and (2) student/faculty role-playing (RP) sessions.

Methods/Model and Description and Evaluation. Fifty-one first-year Master of Physical Therapy (MPT) students enrolled in a cardiopulmonary course volunteered to participate in the study. Four patient cases were presented in either a TL or RP format. After completion of the instructional unit, students took a written examination, rated their levels of confidence in medical screening and patient referral abilities, and completed a unit evaluation assessing the instructor’s behavior and teaching methods.

Outcomes. Compared to the TL group, the RP group: (1) achieved higher overall scores on the written examination (P = .01), and on questions representing the Application level of Bloom’s Taxonomy (P = .01); (2) reported higher self-confidence in medical screening and patient referral abilities (P

Discussion and Conclusion. The RP group’s examination performance, self-confidence, and satisfaction appeared to be enhanced by the teaching strategy, rather than student characteristics or instructor bias. Our results suggest that case-based active learning activities including RP strategies should be incorporated into physical therapist education program curricula to develop medical screening and patient referral skills.

In order to assume the role of diagnostician, the physical therapist (PT) student must learn how to recognize patients for whom a referral to other health care professionals is warranted. The importance of physical therapists fulfilling this role is illustrated in several published patient case reports where early identification of patients requiring the expertise of a physician resulted in a more timely diagnosis of diseases associated with morbidity and mortality.1-9 The diseases described in these case reports included cancers, infections, and acute exertional rhabdomyolysis, reflecting the possible urgent nature of the referral of patients presenting with suspicious findings.

The term medical screening has been used to describe this process resulting in the patient referral (most often to a physician or a physician extender, such as a nurse practitioner or a physician assistant).10,11 Medical screening includes the collection of data relevant to this aspect of clinical decision making (eg, patient medical and family history, investigation of symptoms, review of systems, and systems review) during the examination element of patient/client management.11,12 The decision of whether to proceed with intervention or to initiate a referral is the first phase of the differential diagnostic process utilized by physical therapists.13 The importance of this step is underscored by the fact that it is described throughout the Guide to Physical Therapist Practice under the “Five Elements of Patient/Client Management Model,” in the Standards of Practice for Physical Therapy and Criteria, and in the Guide for Professional Conduct.12

Once the PT decides to refer a patient to another health care provider, he or she must: (1) determine the urgency of the action (eg, concerns of a life-threatening nature or nonurgent concerns); (2) decide what type of practitioner should be contacted (eg, physician, nurse practitioner, clinical psychologist, etc); (3) prioritize the list of patient concerns to be communicated from most important to least important; and (4) effectively make the referral itself. Davis14 noted the importance of the physical therapist’s communication skills; the PT must know how best to contact the practitioner (eg, written note, phone call, etc) and how to request the needed consultation. The PT’s clear articulation of relevant patient data is essential for the consulted practitioner to take appropriate action. Such data includes patient demographics and findings of concern from the history, physical examination, and tests and measures, with the findings prioritized in order of importance. The effectiveness of the referral also depends on the physical therapist communicating in a professional manner, that is, introducing himself or herself properly and using appropriate terminology. Finally, the referral must be made in a timely fashion.10 This process sounds relatively easy and straightforward, but in clinical practice arenas it can be extremely complicated. The challenge to PT educators is determining how to best foster the development of medical screening and patient referral skills.

Stith et al15 presented a professional (entry-level) curriculum designed to prepare physical therapist diagnosticians. These authors noted the importance of identifying clusters of symptoms and signs associated with significant medical conditions that mimic the musculoskeletal disorders commonly treated by physical therapists. Moreover, they emphasized the need for students to recognize the “red flag” manifestations that would result in the immediate referral of the patient to a physician. DavisH presented a model for teaching diagnosis to postprofessional PT students. This model is based on the premise that passage of direct access legislation and the assumption of primary care roles by physical therapists both necessitate the identification of clinical “red flags” and referral to other health care practitioners when warranted.