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Case study assignment to develop information literacy in physiotherapy

This is an attempt to explore how the concept of information literacy can be developed within the context of a physiotherapy case study assignment. It shows how, with a little extra thought and planning, we can embed non-discipline-specific graduate attributes into a physiotherapy-specific assignment. If we want students to use evidence-informed clinical practice, we should give them opportunities to use the evidence available to them to solve the real-world problems they encounter on placement.

As part of the case study assignment, we will explore the following information literacy frames that are (naturally) embedded. These frames are discussed in more depth later, in the context of the assignment:

  • Scholarship as a conversation
  • Research as inquiry
  • Authority as contextual and constructed
  • Information creation as a process
  • Searching as exploration
  • Information has value

A brief outline of the case study assignment (note that this structure can be modified according to context). If you’re not familiar with case study methods, see here for a good overview (there are many more examples online with many minor variations).

  1. Students identify a practical problem based on their own experience in clinical practice. It should be a problem that they are actually able to address i.e. not something that someone else is responsible for.
  2. Design a simple case study that will help them figure out a potential solution to the problem, and then test that solution in practice. Here is a basic worked example:
  3. The student identifies that they are having a problem communicating with a patient who has expressive aphasia (an inability to process outgoing verbal communication, making the interview and subsequent dialogue difficult).
  4. The student then formulates a research question that may look something like: “How can I improve communication with a patient who has expressive aphasia?”
  5. They conduct a brief literature review, extracting a variety of approaches that others have experimented with. This literature review may require the lecturer (or someone from the library) to provide a workshop. Concerns about this loss of lecture time to “cover content” should be alleviated with the knowledge that this so-called “loss” of time will be offset by students’ increased ability to manage their own learning in the future.
  6. Students should be explicit about why certain approaches are included and others excluded from the literature review findings. For example, an approach that makes use of advanced technology may be excluded because the local context makes the use of such an approach unrealistic.
  7. Test each of their research-informed approaches in their clinical practice, making notes about which ones worked and which ones didn’t. They will need to decide what data to gather and how to analyse it in order to make choices about what “works” looks like.
  8. Conduct further research (formal or informal) to try and explain why certain techniques worked better than others. Or why none of them worked at all.
  9. Present a conclusion explaining the problem and how the problem was addressed in practice.
  10. Students receive peer feedback on their drafts in various stages of the process and are encouraged to ask questions regularly about how they want to “test” their ideas in practice.

Through this process, physiotherapy students are given opportunities to “discover” certain threshold concepts that are related to clinical and evidence-based practice, and professional development including, for example, the ideas that:

  • Clinical problems often have non-trivial, complex solutions.
  • Resolving problems into answerable questions gives students agency in the world.
  • The solution to those problems requires that they use facts as tools i.e they cannot simply learn facts from books but must use those facts to solve clinical problems they encounter.
  • Simply solving a problem with evidence does not explain why the solution worked i.e. students must do additional work to understand the underlying rationale for why the solution was or was not effective.

An understanding of these threshold concepts may help students develop a sense of agency in their clinical practice, and open up a pathway to lifelong learning and professional development through a deeper understanding of evidence-based practice. We can now explore how each of the information literacy frames can help us to understand the case study assignment in context.

Scholarship as a conversation

Knowledge practices we are trying to develop: Students need to recognise that knowledge and information are presented in different formats and that these formats constitute different voices in the co-construction of knowledge within a community. By evaluating evidence from different sources (e.g. YouTube, clinician opinion, research papers, blog posts) for their case studies and making strategic decisions about which voices to incorporate in their decision making, students come to understand that their work is about providing another voice in the conversation.

Dispositions in students we are trying to develop: Students should understand that the work they do in these case studies makes them active contributors to knowledge – even if that knowledge is only personal knowledge – rather than simply passive consumers of it. For this, they need to be open to the idea that they have agency and that their own voices have value. In physiotherapy practice, the concept of evidence-based practice enables practitioners to see how evidence informs practical decision-making, and how that evidence could be varied and different in nature. Therefore, they could also be empowered to contribute a line of thinking to the scholarly conversation of the topic they have chosen to explore in their case studies.

Research as inquiry

Knowledge practices we are trying to develop: Students must select a problem they are confronted with in their own clinical practice, and for which there is no simple solution. An inappropriate question might be: “What is the correct technique for a patient with this condition?” This question would not really require any real process of inquiry, and may also fool the student into thinking that every specific patient presentation has only one possible solution. This can be developed when students see that certain problems have multiple – and often contradictory – solutions. When they see that these solutions are offered by experts, they need to question how those solutions were derived, and what biases and influences led to their development. We encourage students not to ask simple questions that could be answered with any textbook but to find difficult problems that no textbook will have the answer to. By creating their own answers through an inquiry-based process, students learn skills of lifelong learning that will allow them to solve most clinical practice problems they will encounter in their careers, not by memorising answers but by synthesizing solutions from multiple sources.

Dispositions in students we are trying to develop: Students must engage with the inquiry process with an open mind since there should be no simple solutions to their questions. They should develop an understanding that the skills and processes they learn in this assignment are actually blueprints that can be carried over to both other clinical problems, but also personal issues in their lives. They should learn how to find alternative options for finding new information when other paths have proven unfruitful. They should come to understand that answering these questions requires significant effort, and that easy answers are unlikely to be useful ones.

Authority as contextual and constructed

Knowledge practices we are trying to develop: For students to understand different types and levels of authority (are research papers “better” than textbooks, which are “better” than blog posts?), and make choices about how to privilege certain types of authority in different contexts. We allow students to make use of different sources of evidence to support their clinical practice, including research papers, textbooks, anecdotes from clinicians, YouTube videos, etc. The conclusion of their case study shows them that they can also create new understandings – even if only in a limited and closed context – and that their voices have value and a certain kind of authority that is based in their personal experience.

Dispositions in students we are trying to develop: We encourage students to actively seek out alternative points of view, and to find different kinds of evidence and to recognise different levels of authority. All work must be cited and ideas credited.

Information creation as a process

Knowledge practices we are trying to develop: Students are guided through the process of evaluating certain kinds of information and how that information was created. For example, the opinion of the expert clinician regarding a treatment technique is not the same as the opinion of a student, even though they are both opinions. The process of creating the opinion is different, one relying on years of pattern recognition and the other on a heuristics (cognitive shortcuts). Students are also encouraged to reflect on the process that led them to their own conclusions and to understand that the conclusion may have been different had they found different information sources. Their “answer” to the problem is therefore not the “correct” solution but one of a variety of possible outcomes that are all dependent on how they made certain choices during the process.

Dispositions in students we are trying to develop: Students are encouraged to find varying levels of credibility and authority in the information they use to support choices and to understand that those levels are based on indicators. They must work to negotiate the uncertainty of their findings, and that their own biases and choices led to this particular conclusion, and that a different choice would have led to a different outcome.

Searching as strategic exploration

Knowledge practices we are trying to develop: Students must convert their clinical problem into an answerable research question. They then use the question to derive keywords that are used to conduct searches. They are taught how to search and what sources might provide useful information. However, they are also encouraged to look beyond the boundaries of formal evidence and to find alternative points of view. The question they ask informs their decisions about what information to include in their findings. They must understand that searching for information must be directed by a need to resolve their clinical problem and the search is therefore guided by the case study objective.

Dispositions in students we are trying to develop: Students case studies can be – and in fact are encouraged to be – creative in terms of both identifying a question and finding a solution. Some students are looking at methods of meditation to reduce stress felt during clinical exams, while others are trying to find methods of treating patients when the traditional methods cannot be used. Each student has their own “itch to scratch” and the case studies are therefore very diverse. Each student is therefore on their own journey of discovery.

Information has value

Knowledge practices we are trying to develop: Students are confronted with the idea that different information has different value, and that how that value is determined can be complicated. In an age where the perception may be that all information is equal (equally free from licensing restrictions and equally authoritative), they struggle to make sense that different information has different value and that the value of the information is often based on context. Students must cite appropriately all information sources that are used in the creation of their case studies, in accordance with established research practices. They also come across the notion that some information is not easily accessible and may be behind a paywall. This allows us to have useful conversations about how academic knowledge is created and then disseminated, and how that process impacts (or doesn’t impact) society.

Dispositions in students we are trying to develop: We expect our students to respect the work of others through citation, but also to respect their own process of knowledge creation (even if that knowledge creation is only in their own minds). It is important for them to understand that they MUST create personal knowledge by using facts as tools to change their own practice and behaviour. The value of the knowledge that they create is different to the value of the raw information used to create the knowledge.

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