Phenomenological Hermeneutic Analysis of Clinical Reasoning in Novice Physical Therapists
RESEARCH REPORT
Request for Poster Presentation at CSM 2019
Title
PHENOMENOLOGICAL HERMENEUTIC ANALYSIS OF CLINICAL REASONING
IN NOVICE PHYSICAL THERAPISTS
Abstract:
Purpose/Hypothesis:
The purpose of this qualitative phenomenological hermeneutic investigation was to study the contextual relationship that a novice physical therapist has with clinical reasoning through a clinical vignette encounter. The guiding research question: How will novice physical therapists communicate their clinical reasoning when encountering a clinical vignette?
Human beings seek to gain an understanding of everyday interactions and occurrences within context; health care providers seek to gain meaning of each patient interaction within an ever-growing complex health care system. A clinician’s reasoning and problem-solving abilities are highly dependent upon context. The entry-level education of a physical therapist has a direct impact on a novice clinician’s reasoning abilities. Arriving at a clinical diagnosis and patient care plan most often requires collaboration through some form of conversation. These conversations most often involve language (verbal and non-verbal) which in turn communicates thoughts, feelings, and ideas. Phenomenological hermeneutics was determined to be the best methodology to interpret and make meaning of clinical reasoning as a concept in novice physical therapists.
Number of Subjects:
Licensed physical therapists in the state of Ohio who practiced less than 2000 hours. Inclusion criteria consisted of hours of practice, active licensure status, and the ability to participate in an online synchronous interview. Using available databases, 1440 physical therapists met the inclusion criteria and 128 responded to requests to participate. Twenty-eight (28) then agreed to participate in the semi-structured 90-min interview. Following the research timeframe and scheduling requirements, seven (7) participants were interviewed for this investigation.
Materials and Methods:
A phenomenological hermeneutic research design and thematic data analysis of the transcribed interviews were utilized to uncover both first and second order emergent themes. Semi-structured interviews (Appendix A) led to both verbal and non-verbal data, conducted via Skype and transcribed via Rev.com. Analysis and coding were completed using QSR NVivo. Thematic analysis revealed that clinical reasoning is a fusion of education, experience, and cognition.
Results:
Three first order and four second order themes emerged from the data thematic analysis. The first order themes were: cognition, interpretation and education. The second order themes were: confidence, experimentation, education, and practice setting. The context of practice setting, self-identity, confidence, and education were also identified as key contributors or factors relating to clinical reasoning as an interpretative cognitive concept.
Conclusions:
Clinical reasoning is both a cognitive concept and a skill that blends context, cognition, and interpretation. In the context of the novice physical therapist, clinical reasoning is also comprised of experimentation, confidence, practice setting, and education. Context dependent interpretation was an overarching thematic conclusion that emerged from the data. Future research investigations in the areas of context dependent interpretation would expand these findings and may include the interpretative understanding of reasoning between novice and expert clinicians.
Clinical Relevance:
As a context dependent, interpretation-based skill, clinical reasoning is a central skill of all physical therapists. This study highlights the unique interpretation that a novice physical therapist has when applying clinical reasoning skills to a clinical vignette. The study also highlights the thoughts, feelings, and emotions that newly graduated physical therapists have about clinical reasoning in their first year of clinical practice.
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References used in the Manuscript (currently in progress)
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APPENDIX A: INTERVIEW QUESTIONS
• What does clinical reasoning mean to you? • Can you conceptualize clinical reasoning? If so, what would that be?
• How might reasoning inform your decision-making as a practitioner?
• How does your clinical reasoning differ from your peers?
• How did you develop your clinical reasoning patterns?
[Lead with] Clinical reasoning has been defined and described as a skill. Use of the word skill implies that reasoning is a learned behavior, vs. a talent. What do you believe may have influenced your clinical reasoning skillset? • How was clinical reasoning addressed in your professional education? Your clinical education?
• If reasoning could be taught, how do you believe it could be taught?
• What separates your clinical reasoning from an expert’s?
• How is clinical reasoning important to good practice?
PRESENTATION OF CLINICAL VIGNETTE
• As you read the scenario, what if anything came to mind?
• What in the clinical vignette helps or aids you in reasoning?
• What in the clinical vignette is not helpful or distracts you in reasoning? • How would you describe the person depicted in the vignette?
• What problems would you foresee them having?
• What reasoning approaches would you take to evaluating this patient?
• How would you know that you have arrived at a correct diagnosis?
• How confident do you feel about the diagnosis you have derived?
• How would you approach treating this person?
• What factors do you consider when devising a treatment plan for this person?
• How might communication influence reasoning, if at all?
• What importance do you place on communicating clinical reasoning with the patient?
• What importance do you place on communicating clinical reasoning with peers?
• What most influenced you with your communication?
• What difficulties do you face with communicating clinical reasoning?
• Can you describe a time where communicating clinical reasoning was difficult?
• How did you handle the situation?
• What do you think is the answer to my question, “what is clinical reasoning?”