Changes in Clinical Reflection and Reasoning Among Physical Therapy Students: A Three-Year Longitudinal Study
Purpose/Hypothesis: Advanced clinical reflection and reasoning (CRR) is crucial to meet the healthcare needs of society. As such, assessment of curricula aiming to enhance CRR of physical therapy (PT) trainees is warranted. Unfortunately, few studies have examined changes in self-perceived CRR among PT students using a three-year longitudinal approach. Thus, the purpose of this study is to examine associations between curricular design and changes in self-perceived CRR among PT students from program entry to the first, second and third year of training. We hypothesize PT students will demonstrate increased self-perceived CRR from program entry to exit and throughout three years of training. Number of Subjects: n=26 Materials and Methods:With IRB approval, the reliable and valid Self-Assessment of Clinical Reflection and Reasoning (SACRR) survey was given to 26 PT students at program entry (Entry) and during the middle of first (Yr1), second (Yr2) and third year (Yr3) of study at a large public university in the Midwestern United States. SACRR includes 26 closed-ended items on a 5-point Likert scale (1=“strongly disagree” to 5=“strongly agree”), with overall score and subdomain scores for “Dealing with Uncertainty”(Uncertainty), “Self-Reflection and Reasoning”(Reflection), “Knowledge/Theory Application”(Theory) and “Decision Making Based on Evidence”(Evidence).Year 1 includes didactic foundational science and clinical courses. Year 2 involves alternating 8 to 10-week full-time clinicals and 8-week problem-based learning(PBL) courses. Year 3 entails two 8-week PBL sessions, a board exam preparatory course, and two 8-week full-time clinicals. Throughout the program, students participate in a faculty led pro-bono PT clinic with orthopedic, neurologic and pediatric services. Wilcoxon Signed-rank tests used to examine changes in paired SACRR overall and subdomain scores between Entry to Yr1, Yr2, and Yr3 (significance accepted at p<0.05). Results: Data presented as means±SD. A significant increase in SACRR overall and 3 of 4 subdomain scores seen from Entry to Yr3 (Overall=Entry:101.0±7.4, Yr3:112.2±8.1, p<0.001; Uncertainty=Entry: 26.3±2.8, Yr3: 28.8±2.4, p<0.001; Reflection=Entry:16.3±1.5, Yr3:17.6±1.6, p<0.01; Evidence=Entry:39.4±3.1, Yr3: 42.0±3.0, p<0.001). Between Entry and Yr2, an increase in SACRR overall score was seen (Entry:101.0±7.4, Yr2:105.0, p<0.05), with no change in subdomains. No change observed in overall or subdomains scores between Entry and Yr1 Conclusions: Alternating PBL and full-time clinical rotations during Yr2 and Yr3 is associated with increased self-perceived CRR among PT students. No change in self-reported CRR seen during Yr1 of classroom didactics. Additionally, students’ perceived use of theoretical frameworks was limited through Yr3, underscoring the need to enhance explicit teachings around this valuable concept. Clinical Relevance:By examining associations between curricula and key educational domains, such as CRR, PT faculty may elucidate pedagogical techniques promoting advancement of requisite cognitive and psychomotor skills.