Academic performance-based sequencing of inpatient and outpatient placements enhances learning in physiotherapy undergraduates: a controlled study

To evaluate whether performance-based sequencing of clinical placements improves learning outcomes compared with randomized sequencing in undergraduate physiotherapy education. Undergraduate physiotherapy students from six universities in China were randomly assigned to experimental and control groups. The experimental group’s placement order (inpatient or outpatient) was determined based on theoretical and clinical performance, while the control group’s order was randomized. Mini-Clinical Evaluation Exercise (Mini-CEX), theoretical performance evaluation and the Clinical Reasoning and Reflection Self-Rating Scale (SACRR) were evaluated before and after placement using t-test. 112 students participated in the study. Both groups showed significant improvements in clinical and theoretical performance post-placement. The experimental group had greater improvements in Mini-CEX scores (41.02 ± 12.37 vs. 38.35 ± 9.65, p = 0.031), with significant gains in history taking (p = 0.005), professionalism (p = 0.006), and counseling (p = 0.007). Theoretical test scores improved more in the experimental group (from 51.83 ± 9.89 to 69.00 ± 8.93 vs. 54.56 ± 7.62 to 66.52 ± 10.71, p = 0.038). The SACRR scores also showed greater improvements in the experimental group (92.13 ± 11.72 to 109.48 ± 10.63 vs. 91.30 ± 10.02 to 97.93 ± 10.63, p < 0.001), with significant gains across all subdomains. Sequencing clinical placements according to student performance yielded greater improvements in history taking, professional attitude, and communication skills, as well as theoretical knowledge and clinical reasoning, compared with randomized sequencing. These findings suggest that performance-based placement scheduling can strengthen key patient interaction and reasoning competencies in physiotherapy students.