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Cunningham S.1, Litwin B.2, Fernandez-Fernandez A.2, Canbek J.2, Jackson R.3
1Radford University, Department of Physical Therapy, Roanoke, United States, 2NOVA Southeastern, Physical Therapy, Fort Lauderdale, United States, 3The Jackson Clinics, Middleburg, United States
Background: Access to advanced instruction, fundamental to promoting educational development, is limited throughout the country of Kenya. To assist with promotion of skill advancement and development of clinical reasoning, the Kenya Medical Training College Higher Diploma Program offered the first post- graduate residency program in 2012. The residency program and associated mentoring is provided by volunteer instructors from the United States of America. Although theoretically accepted, there is limited research that supports the ability of residency education to progress clinical reasoning skills. The current research is limited to the residency graduates' subjective perception of clinical reasoning development as a result of training.
Purpose: The purpose of this study was to describe the progression of clinical reasoning related to the performance of an examination, evaluation, diagnosis, prognosis, and intervention for musculoskeletal conditions following completion of the 18-month residency program in Nairobi, Kenya.
Methods: A sample of convenience was utilized for this study. Residents completed a live patient examination at the initiation of the residency program to assess baseline skills and clinical reasoning in October 2014. The assessment tool, previously assessed for reliability and validity, contains 64 items within five categories: examination, evaluation, diagnosis, prognosis, and intervention. Following completion of the 18-month residency curriculum, 14 of the original 17 residents participated in a final live patient examination in October 2016. A comparison of scores was performed to determine the progression of skills related to examination, evaluation, diagnosis, prognosis, and intervention of a patient musculoskeletal limitations.
Results: Descriptive statistics, including frequency counts for each of the 64 items on the examination were utilized to describe the residents performance. Each behavior was analyzed for significant differences between the two assessments, baseline and graduating scores. Furthermore, overall pass rates were analyzed using the dependent t- test to determine if the residents achieved significantly higher scores following completion of the program compared to baseline. The average score on the practical examination was 40.82 percent upon entering the program and 86.78 percent at graduation (p .001).
Conclusion(s): There was a significant improvement in scores on the Practice Dimensions Examination when comparing baseline and final live patient practical examinations of physiotherapists participating in the residency program suggesting the program was successful in improving clinical reasoning skills.
Implications: The results of this study contribute to the limited knowledge regarding development of clinical reasoning through residency training. The development of clinical reasoning skills is associated with the progression from novice to expert practitioner. The introduction of programs that influence the ability of existing physiotherapists in developing countries to provide treatment efficiently and effectively may ultimately assist in serving physical therapy needs of the wider community.
Funding acknowledgements: Not Applicable.
Topic: Education: continuing professional development
Ethics approval: Kenya Medical Training College Ethics and Research Committee, Institutional Review Board of Radford University and NOVA Southeastern Institutional Review Board
All authors, affiliations and abstracts have been published as submitted.
