CLINICAL REASONING STRATEGIES OF PT STUDENT CLINICIANS USING TELEHEALTH

E. Rotor¹, A.N. Bandong¹, R. Lazaro^2,1

¹University of the Philippines Manila, College of Allied Medical Professions, Manila, Philippines, ²California State University Sacramento, Department of Physical Therapy, Sacramento, United States

Background: The global pandemic in 2020 led academic institutions in the Philippines to use online learning for both course-related work and clinical-related activities. Although telehealth has been a concept and practice for some time, this was a novel form of service delivery for physical therapy (PT) student clinicians and clinical educators as they adapted to the shift in teaching and learning of clinical practice.
Clinical reasoning (CR) is an inherent competency for entry-level PTs to make wise decisions in practice. Development of CR is dependent on the context of practice. For PT student clinicians, the context of telehealth means not having direct physical contact with patients, use of telecommunication technology, and not having a physical environment for teaching and learning. The typical clinical cues and triggers for decision making found in practice placements pre-pandemic may not be as evident. It is therefore important to determine the extent by which these individuals are utilizing CR to guide their patient care decisions considering this new mode of teaching and learning within a healthcare delivery environment.

Purpose: The purpose of this study was to explore clinical reasoning of PT student clinicians using a telehealth mode of service delivery. The authors aimed to determine the CR strategies used, and the factors that affected the development of CR.

Methods: Qualitative methods used to obtain data for this study included observation of video sessions and interviews of students. Eight PT clinical students who agreed to participate in the study submitted a videotaped session with their patient. Video analysis was conducted where researchers tagged strategies of CR observed. Structured Interviews were conducted with the eight students to determine perceptions of their experience of CR through telehealth services. Thematic analysis was conducted for the interviews.

Results: The most commonly used CR strategies were Procedural (n=73), Interactive (n=52) and Teaching for reasoning (n=48). These strategies were observed when 1) Modifying activities for patients, 2) Establishing patient rapport and trust, and 3) Deciding on instructional methods for patients. Factors that affected development of CR involve the following themes: 1) Adjusting to a virtual clinical setting and 2) Having a backdoor communication with clinical supervisor. Collaborative, diagnostic, narrative and predictive CR strategies were found to have been used much less.

Conclusions: Clinical reasoning exhibited by PT clinical students in telehealth enables them to modify treatment options in response to patient and environment context. There is a need to engage students in more CR strategies that could result in better collaboration and understanding of patient needs and problems.

Implications: The global pandemic paved the way for the telehealth mode of service delivery to find its niche in PT practice. Telehealth is vital and advantageous for some patients and clients. Clinical educators could take advantage of developing clinical reasoning skills that allow for better understanding of the patient’s PT needs and problems and the environment and context in which this occurs.

Funding acknowledgements: UP Manila Academic Program Improvement Grant

Keywords:
Clinical reasoning
Telehealth
Clinical education

Topics:
Education: clinical
Service delivery/emerging roles

Did this work require ethics approval? Yes

Institution: University of the Philippines Manila

Committee: Research Ethics Board Review Panel 1

Ethics number: UPMREB 2021-150-01