DEVELOPMENT OF CLINICAL REASONING FOLLOWING CLINICAL EDUCATION EXPERIENCE IN 2ND YEAR PHYSICAL THERAPIST STUDENTS: A PILOT STUDY

N. Smith¹, A. Bartlett², J. Martin¹, S. Craven¹, K. Powell¹, H. Subasic¹

¹Winston Salem State University, Physical Therapy, Winston Salem, North Carolina, United States, ²California State University, Physical Therapy, Northridge, United States

Background: Clinical reasoning is a skill that utilizes problem-solving to develop an appropriate physical therapy diagnosis and prognosis. This skill is essential to develop during didactic and clinical education in Doctor of Physical Therapy (DPT) students. However, there is a paucity of information on how clinical experiences influence the development of clinical reasoning.

Purpose: The purpose of this study was to discover how clinical reasoning skills develop in 2nd year DPT students after placement in a second clinical education experience using a qualitative observational approach.

Methods: Researchers conducted purposeful sampling of 2nd year DPT students who had had 1 clinical placement. First, during the semester prior to participation in clinical placements, participants completed a case-based, video-recorded interview in order to elicit clinical reasoning sequence and strategies. During the interview, one researcher took field notes while the other researcher conducted the interview. Participants utilized a form to take notes, which was collected following the interview. Following the interview, participants engaged in their regularly scheduled clinical experiences. In the first week of the semester after returning from clinical placements, participants repeated the same case-based interview process that occurred prior to their clinical. Transcription of interviews occurred following the interviews. Researchers conducted data analysis using a qualitative, collective case approach with deductive and inductive coding on participant forms, transcribed interviews, and field notes. During analysis, researchers used an a prioricoding manual to deductively elucidate participants’ sequence and strategies of clinical reasoning. Perceptions regarding influential factors for clinical reasoning development were inductively coded. Researchers ensured trustworthiness by triangulation of data, member checking, and peer-debriefing.

Results: Prior to clinic entry, participants (n=8) utilized less-sophisticated reasoning strategies (trial and error) and followed a less structured process for data collection during examination. Following clinical placements, participants used more-sophisticated reasoning strategies (hypothetical deductive and pattern recognition) and followed a more structured process for data collection during examination. Following clinical placements, participants skipped initial and final problem generation in the reasoning process, however this did not affect their ability to achieve a correct clinical diagnosis. A persistent theme present prior to and post- clinical experience was that knowledge from classes influenced clinical reasoning. Differing factors that influenced clinical reasoning were found prior to and after clinical placement, consisting of personal experience and anxiety and clinical experience, respectively.

Conclusions: Clinical placement influences the development of clinical reasoning in physical therapist students, advancing both clinical reasoning sequencing and strategies. However, generalizability of this study may be limited due to sample size. Future research should increase the sample size, focus on comparison of programs that have different models for clinical fieldwork placements, and investigate whether didactic education regarding the clinical reasoning process or the amount of time spent in clinical education has more influence on clinical reasoning development.

Implications: Physical therapist educators should consider the progression of clinical reasoning that occurs during clinical placements as they design educational experiences to support the development of clinical reasoning in physical therapist students. Providing appropriate support may foster greater clinical reasoning expertise as students graduate and enter clinical practice.

Funding acknowledgements: There are no funding sources to report for this study.

Keywords:
Clinical Reasoning
Clinical Education

Topics:
Education: clinical
Education
Education: methods of teaching & learning

Did this work require ethics approval? Yes

Institution: Winston Salem State University

Committee: Institutional Review Board

Ethics number: IRB #22-0001