Academic journal article Journal of Allied Health

Physical Therapy Students' Self-Reports of Development of Clinical Reasoning

Academic journal article Journal of Allied Health

Physical Therapy Students' Self-Reports of Development of Clinical Reasoning

Article excerpt

A Preliminary Study

Reports of student perceptions about the efficacy of educational tools used by academic and clinical instructors to facilitate clinical reasoning are limited. Physical therapist students' (PTSs') perceptions of tools for developing clinical reasoning and problem-solving skills were surveyed to determine the effectiveness of various teaching methods and to identify factors associated with clinical reasoning development. The purposes of this descriptive investigation were to determine (1) if factors, such as learning mode, life experience, and curriculum, influence PTS' perception of their clinical reasoning mastery; (2) the relative roles of academic and clinical instructors and the value of their pedagogic tools in assisting PTS with clinical reasoning development; and (3) how PTS rate their degree of mastery of clinical reasoning as they progress through training. A survey was mailed to 17 physical therapy schools in New York and 2 in New Jersey; 156 PTS near graduation responded, yielding a 22% response rate. The survey instrument had 6 open-ended and 19 multiple-choice questions. Frequency analysis showed (1) PTS' opinion about how they would teach clinical reasoning varied with their preferred learning mode, (2) prior life experiences were associated with clinical reasoning for some individuals, (3) academic and clinical instructors contribute to development of clinical reasoning, (4) the best pedagogic tools involved case study presentations/ assignments using actual patients or videotapes, and (5) PTS gained confidence in their clinical reasoning ability while progressing through clinical education experiences. Results support inclusion of diverse pedagogic tools, such as case studies, and emphasizing a variety of learning modes to facilitate PTS' development of clinical reasoning. J Allied Health. 2003; 32:227-239.

CLINICAL REASONING is "defined as the cognitive processes, or thinking, used in the evaluation and management of a patient."1 Problem solving refers to "the steps involved in working toward a problem solution."1 Educators in the health professions have studied effective pedagogic tools to facilitate students' ability to use clinical reasoning or problem solving.2-11 Nonetheless, reports of student perceptions about the efficacy of pedagogic tools used by academic and clinical instructors to facilitate problem solving and clinical reasoning have been limited.2-11

Clinical reasoning and critical thinking are related and important skills to develop in the classroom and the clinic. Critical thinking requires an attitude of inquiry and cognitive skills.12 Critical thinking is the ability to determine problems, evaluate alternative solutions, and incorporate valid evidence to support decisions.12,13 Critical thinking is valued as an integral part of effective patient care by health care professions such as nursing14,15 and medicine, but the literature supporting it is theoretical in nature.11,16-22 The American Physical Therapy Association (APTA) endorses the development of critical thinking as reflected in the Physical Therapist Clinical Performance Instrument, which states "a physical therapist clinician performing at entry-level utilizes critical thinking to make independent decisions concerning patient needs and provides quality care with simple or complex patients in a variety of clinical environments."23 The concept is integrated further into educational outcomes in an APTA publication, A Normative Model of Physical Therapist Professional Education.24 In this publication, clinical reasoning, clinical judgment, hypothesis generation, and reflective practice are part of the professional practice expectations.24

Schon21 elaborated on reflective practice. He described the phenomenon of reflection-in-action, whereby the expert practitioner creates hypotheses about unique cases and uses prior knowledge to make decisions. The novice clinician lacks past experience but can develop these clinical reasoning skills through practice guided by an expert who shares the thought processes behind clinical decisions. …

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