Utilizing Conceptual Frameworks within PBL Is Associated with Increased Clinical Reasoning in Physical Therapy Students.
Purpose: Identifying curricular strategies to enhance clinical reflection and reasoning (CRR) is a top priority for physical therapy educators. Problem-based learning (PBL), a learner-centered setting solving complex problems in a group, is proposed to increase CRR. Similarly, explicit use of conceptual frameworks (CF), analytical tools to approach multifaceted topics, are suggested to develop CRR, although previous challenges in praxis are reported. As part of a longitudinal initiative to increase CRR amongst Doctorate of Physical Therapy (DPT) students, two courses were updated to incorporate explicit CF within PBL. Consequently, we hypothesize that using CF within PBL will be associated with increased self-reported CRR among DPT students, as measured by the Self-Assessment of Clinical Reflection and Reasoning (SACRR) survey when compared to traditional teaching methods. Methods/Description: Using a quasi-experimental pre- and post-test design, two consecutive cohorts of second year DPT students (n=93) completed the SACRR, a reliable and valid survey of CRR, at the beginning and end of their final 16-week didactic semester. The SACRR is a 26 closed-ended item survey (5-point Likert scale of “strongly agree”  to “strongly disagree” ), providing overall and four subdomain scores of “Knowledge/Theory Application”, “Decision Making Based on Evidence”, “Dealing with Uncertainty” and “Self-Reflection and Reasoning”. Control group ([CON]: n=35) received traditional teaching methods, while Intervention group ([INT]: n= 58) received explicit use of CF within PBL during orthopedic and pediatric courses. Though both INT group courses integrated PBL with the International Classification of Functioning, Disability and Health (ICF) model, the orthopedic course also emphasized the Systematic Clinical Reasoning in Physical Therapy Tool whereas the pediatric course underscored the Patient/Client Management model. To determine group similarity at baseline, a one-way analysis of variance (ANOVA) was performed. This was followed by a repeated-measures ANOVA to determine the effect of group and time on SACRR overall and subdomain scores. Following Mauchly’s test of sphericity, a Greenhouse-Geisser test adjustment was employed when examining interactions. Significance for all statistical analyses was accepted at p<0.05. Results/Outcomes: No group differences seen (p>0.05) at baseline for SACRR Overall (INTPre=101.5±7.4, CONPre=101.9±8.0), or subdomains of “Knowledge/Theory Application”( INTPre=18.8±2.1, CONPre=19.1±2.2), “Dealing with Uncertainty”(INTPre=27.1±2.7, CONPre=26.9±2.5), “Self-Reflection and Reasoning” (INTPre=16.2±1.3, CONPre=16.4±1.7) or “Decision Making Based on Evidence”( INTPre=35.2±2.9, CONPre=35.4±3.2). A significant group by time interaction was observed for INT group, with increased SACRR scores for Overall (INTPost=105.5±7.0, CONPost=100.3±7.0; p<0.001), and subdomains of “Knowledge/Theory Application” (INTPost=19.7±2.0, CONPost=18.2±2.9; p=0.001), “Dealing with Uncertainty” (INTPost=28.4±2.4, CONPost=26.3±2.3; p=0.001), and “Self-Reflection and Reasoning” (INTPost=16.9±1.5, CONPost=16.2±1.7; p=0.008). No significant group by time interaction observed for “Decision Making Based on Evidence” (INTPost=40.5±3.1, CONPost=39.6±2.9; p=0.1), although a significant main effect for time was observed for both cohorts (p<0.001). Conclusions/Relevance to the conference theme: Utilizing explicit CF within PBL is associated with increased self-reported CRR by DPT students as compared to those receiving traditional teaching methods. While both courses included PBL and the ICF, faculty were also able to integrated unique CF to complement their respective specialty areas. Particularly encouraging was an improvement in students perceived ability to cope with uncertainty, as this is historically problematic amongst health care trainees. Moreover, elucidating curricular strategies that advance CRR among DPT students is crucial, especially as trainees attempt to deliver optimal patient care in increasingly multi-faceted health care environments.