Integration of a Clinical Reasoning Theater in the Laboratory Setting: Student Perceptions and Lessons Learned
Purpose: Clinical reasoning (CR) is a complex, ongoing and repetitive process consisting of collaboration and critical thinking and informed by evidence, experience, and contextual factors.1,2,3,4 In a comprehensive review of the literature, one identified strategy to teach and assess CR is the Think Aloud (TA). TA is viewed as a valid strategy to more concretely identify one’s cognitive processes.3,4,5,6,7 A variation of this is the “Clinical Reasoning Theater” (CRT) in which a licensed professional demonstrates CR with a real patient while actively engaging students in the process.8 Given the invisible CR process of expert clinicians and a need to explicitly define and demonstrate CR for students, CRT can be a tool to help teach CR to students.3,4,6,8 The aim of this case report is to describe the integration of the CRT into a physical therapy laboratory setting to facilitate the clinical reasoning abilities of students and to assess student perceptions around this teaching and learning strategy. Methods/Description: Two CRT experiences were embedded in the lab component of an entry-level physical therapy curriculum in the 4th out of 8 semesters. The first CRT was facilitated by an orthopedic physical therapy resident who evaluated a patient with a musculoskeletal health condition. The second CRT was facilitated by an expert pediatric physical therapist who treated a child with a complex clinical presentation. Both experiences aligned with content in the didactic curriculum. The first CRT was 50 minutes long with pauses for questioning of the resident by expert clinicians, without structured activities for student engagement. The second CRT was 80 minutes long with pauses for student practice of handling skills and student questions. Video footage of both CRTs was collected and will be used to demonstrate the facilitation of this teaching and learning strategy. Additionally, students were asked to complete both a pre-lab assignment and a guided observation worksheet. Following the second CRT, an anonymous 5 question survey was distributed to students to gather feedback on the learning experience. The survey consisted of ordinal rating scales and narrative responses which were systematically themed. Results/Outcomes: Second year physical therapy students participated in both CRTs (n=63), and 57% of students (n=36) completed the survey. 47.22% of respondents rated the CRTs as very to extremely effective in facilitating CR. The components of the CRT that students most frequently rated as helpful were the therapist’s demonstration of thinking out loud (32/36) and the observation of the therapist-patient interaction (29/36). Qualitative analysis of student responses correlated with ordinal ratings and highlighted the demonstration of reflection-in-action, hearing the “why”, comparison to personal thought processes, and exposure to the unfamiliar as helpful in facilitating CR. Four primary themes were identified from the student evaluations of the experience: more student engagement, smaller groups, more thinking out loud, and environmental set up. Conclusions/Relevance to the conference theme: Student feedback supports the value of a CRT to facilitate CR skills in a lab environment. Future directions for this teaching strategy should consider group sizes, thoughtful opportunities for active student engagement, and intentional identification of patients and therapists to optimize the learning experience. Additional efforts will also be made to evaluate the effectiveness of the CRTs through assessment of student CR.