Barriers and Facilitators to Clinical Reasoning before and during a Clinical Placement

The aim of this study was to undercover the specific barriers and facilitators to acquiring clinical reasoning skills for physiotherapy students both in classroom settings as well as during their clinical placements. The aim of this study was to undercover the specific barriers and facilitators to acquiring clinical reasoning skills by physiotherapy students both in classroom settings as well as during their clinical placements.

A generalized qualitative approach was undertaken. We conducted semi-structured interviews with final year physiotherapy students, employing a purposeful sampling method to capture their CR experiences before and after a five-week clinical placement. The interviews were recorded, transcribed verbatim, and analyzed using qualitative thematic analysis. Examples of questions from the interview guide included: Did you receive any education on CR during your physiotherapy program? What would be the most effective way for a supervisor to support you in enhancing your CR skills during a clinical placement?

Six final year master’s entry physiotherapy students were interviewed. Facilitators to acquire CR skills before clinical placements included development of CR decision tools such as algorithms or flow sheets of common conditions and program courses identifying CR as part of the learning activities and objectives. During a clinical placement participants found that immediate feedback provided by their supervisors was very helpful in developing CR.

Barriers before placement included not being exposed to the steps involved in the  CR process and evaluation based on more traditional rote learning and not CR skills. Barriers to improving CR skills during a placement included clinical supervisors being overly directive and not allowing students to ‘try out’ or think aloud their CR process in a safe supportive learning environment before providing the student with ‘the’ answer.

Our study highlights the pivotal role of effective learning methods in nurturing CR skills among physiotherapy students. Collaborative case discussions in the classroom and practical experiences were identified as facilitators, while challenges such as inadequate feedback and clinical supervisor interference were noted.

The ability to demonstrate and use CR skills have allowed the physiotherapy profession to grow and shift from technician roles to one of independent health care professionals. Therefore, future research is needed ro explore additional instructional approaches and examine the impact of specific feedback mechanisms and supervisor-student dynamics to improve these skills. By addressing these areas, physiotherapy educators can better support students in honing their CR skills, ultimately improving patient care but also this helps to maintain and enhance the reputation of the profession.