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Mauri-Stecca M.V.1, Leppe J.1, Besomi M.1, Sizer P.S.2
1Universidad del Desarrollo, School of Physical Therapy, Santiago, Chile, 2Texas Tech University Health Sciences Center, Center for Rehabilitation Research, School of Health Professions, Lubbock, United States
Background: Clinical reasoning (CR) refers to the combined processes of decision-making and clinically-related thoughts associated with efficient and successful examination and treatment approaches. Most CR teaching strategies involve implicit learning, asking the student or clinician to self-develop CR through time and exposure to clinical scenarios. However, there is a need for the intentional, explicit teaching strategies that ensure the acquisition and transfer of such cognitive tools into the real clinical setting.
Purpose: As an alternative for promoting CR awareness and engagement among clinicians, intentional, explicit teaching strategies should be incorporated into learning experiences. The purpose of this study was to develop a CR course that intentionally educated clinicians regarding specific CR concepts, acquisition stages, and cognitive forcing strategies that promoted a better understanding and facilitated CR transfer into the clinical setting. A second aim was to assess the learners' acquisition of CR awareness and engagement through short and midterm evaluations and compare scores between groups based on their years-of-experience.
Methods: Clinicians completed a 14 contact-hour educational experience that incorporated lectures and workshop experiences to explicitly teach CR. The mean scores of the pre- and post-course written competency examinations served as the learning experience dependent variable. Test scores distribution was calculated using skewness and kurtosis coefficients. A paired t-Test was used to establish significant differences between pre- and post-course examination scores. A Kruskall-Wallis Independent sample comparison test was used to establish significant differences for post-course test results among years-of-experience groups. Post-course evaluation surveys and 6-week post-course follow-up questionnaires were added for further analysis. An alpha level of ≤ 0.05 was used to establish statistical significance.
Results: Fifteen musculoskeletal physiotherapists (PT) with a mean age of 31 years (range 24-45 years) participated in this course. All participants worked a mean of 30.5 hours per week (range=2-44 hours) in the clinic. Four physiotherapists additionally served as academicians in both under- and post-graduate physiotherapy programs. According to years-of-experience, 20% of participants reported 1 year, 40% > 1 and equal or less than 8 years, and 40% > 8 years. Mean scores increased from 45% (SD=9.449) on the pre-course examination to 73% (SD=10.66) on the post-course examination. Skewness and kurtosis pre- / post-course values were - 0.220 / -1.13 and 1.52 / 0.11, respectively. The T-test revealed a significant increase from the pre- to post-course mean examination scores [t(14) = -12.896; p 0.001]. No significant difference among years-of-experience levels was found for post-course test results. Post-course evaluation survey and the 6-week post-course follow-up questionnaire results suggested that the knowledge and clinical tools were useful when applied in the clinic.
Conclusion(s): The inclusion of an intentionally taught CR course produced a statistically significant learning experience for its participants. Overall positive learning responses and the transfer into the clinical setting can be reached regardless of the clinicians level of experience.
Implications: Different teaching strategies can be incorporate into the professional development of CR. Intentional exposure to explicit CR principles and characteristics may facilitate acquisition among PT clinicians.
Funding acknowledgements: Not applicable
Topic: Education: methods of teaching & learning
Ethics approval: Approved by the Ethics Research Committee from the Medicine Faculty at the Universidad del Desarrollo-Clínica Alemana, Santiago-Chile
All authors, affiliations and abstracts have been published as submitted.
