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Huhn K.1, Black L.2, Christianson N.3, Gilliland S.4, Flannery Wainwright S.5
1Husson University, School of Physical Therapy, Bangor, United States, 2Creighton University, Omaha, United States, 3Samuel Merritt University, Sacramento, United States, 4Chapman University, Irvine, United States, 5Thomas Jefferson University, Philadelphia, United States
Background: Clinical reasoning is a complex skill integral to the practice of physical therapy. In the literature critical thinking, reflection and metacognition have been identified as components of clinical reasoning yet no definition appears to capture the full nature or complexity of clinical reasoning. This diversity of definitions can be a hindrance to research related to clinical reasoning. A concept is defined as an idea of something formed by mentally combining all of its characteristics or particulars (Webster's dictionary). We propose that clinical reasoning be considered a concept rather than a discrete skill or something that can be defined succinctly. Concept analysis has been recommended as a research methodology when the goal is to analyze, define, develop and evaluate concepts (Tofthagen 2010). A concept analysis can also be used to describe a concepts' characteristics and its relations to other concepts Methods of concept analysis-a comparative study(Nuopponen 2010). A clear understanding of how these germane concepts are related and how they differ can potentially improve our understanding of the clinical reasoning process used by physical therapists. A more unified and comprehensive understanding of clinical reasoning will support a more comprehensible research agenda to improve our knowledge of best practices related to teaching and assessing clinical reasoning.
Purpose: The purpose of this work is to synthesize a comprehensive description of clinical reasoning in physical therapy to improve our understanding of this highly complex and essential process.
Methods: Rodgers evolutionary approach to concept analysis was chosen as it is an appropriate method for concepts that are dynamic, contextually dependent and possess some pragmatic purpose. Scopus, a citation and abstract database of over 50 million records in the areas of science, technology, medicine, social, health and life sciences was searched using the terms clinical reasoning" or critical thinking or critical reasoning or diagnostic reasoning or clinical problem solving or practical reasoning. We included articles from physical therapy, medicine, nursing, psychology, health professions, pharmacy, dentistry and veterinary medicine. The search returned 1,831 results. After results were searched for duplicates, letters to editors, conference proceedings and relevance to the concept being analyzed 428 citations remained. These were retrieved and each article was read and analyzed for surrogate terms, related concepts, antecedents, consequences, attributes and contextual factors related to the concept. Thematic analysis was completed by category and organized and reorganized until a comprehensive and relevant description of each category was realized. Categories were examined for areas of agreement and disagreement across disciplines
Results: A comprehensive description of the concept of clinical reasoning in physical therapy was achieved. Similarities and differences between the concept of clinical reasoning in physical therapy and clinical reasoning in other health professions were also identified.
Conclusion(s): The concept of clinical reasoning in physical therapy has evolved and continues to emerge however this concept analysis provides a basis on which focused future work can be built.
Implications: A deeper understanding of clinical reasoning in physical therapy can enhance future work on best practice for teaching and assessing this highly complex entity.
Funding acknowledgements: The study is not funded
Topic: Professional issues
Ethics approval: Ethics approval not required
All authors, affiliations and abstracts have been published as submitted.
