Bridging the Gap in Clinical Reasoning: Enhancing Physiotherapy Education Through an Adapted International Framework

This study aimed to identify barriers and experiences of students during their engagement with the framework, make targeted adaptations based on these findings, and evaluate whether the revised framework better supports students’ learning and enhances their clinical reasoning skills.

The study was conducted in two phases:

• Phase 1: The framework was piloted with 140 students. A qualitative realist evaluation was performed through three focus group meetings with students (n=12). Each session was transcribed and analyzed using thematic analysis to identify key barriers.
• Phase 2: Based on the findings, the framework was adapted and implemented with 110 students during the following academic year. Changes included: (1) Development of an online evidence-based practice library, (2) Clearer collaboration guidelines, (3) Streamlined tasks with more group discussions, (4) Enhanced communication of learning outcomes, and (5) Aligned assessments across partner institutions. A mixed-method survey, using the start–stop–continue approach, was used to evaluate the effectiveness of the adapted framework.

In Phase 1, five main themes emerged: prior knowledge, cooperation, methodology, learning outcomes, and assessment, highlighting barriers such as varied backgrounds and lack of clarity in tasks. In response, we introduced targeted adaptations. 

In Phase 2, after implementing the revised framework, 66 students (60%) rated their improvement in CR, decision-making, and reflective abilities at 7/10 (SD = 1) on a 0-10 Likert scale, indicating significant progress. Students also rated the assignment’s effectiveness in promoting lifelong learning as 4/5 (where 5 = strongly agree). Qualitative feedback emphasized the value of interactive group sessions and real-time instructor support. Comments included: 

• “Listening to colleagues’ opinions and ways of thinking really added value”, 
• “Teachers were open to answering questions during group sessions, which helped a lot" and 
• “The pairing moments were not only educational but also fun. When you stopped by to answer questions, it really helped clarify the assignment.”

The adapted framework significantly improved students’ clinical reasoning and reflective skills by addressing key barriers and fostering a more cohesive learning experience. The focus on collaboration, interactive discussions, and real-time feedback created a dynamic educational environment, preparing students for the complexities of clinical practice.

This adaptable framework provides a scalable model for CR training in diverse educational settings. It fosters interprofessional collaboration, critical thinking, and lifelong learning—skills essential for future physiotherapists. Future developments will include integrating immersive online case studies and expanding international collaborations to further enrich the learning experience.