Use of the Clinical Reasoning Assessment Tool to Inform DPT Student Assessment: A Qualitative Study
Purpose/Hypothesis: Clinical reasoning (CR) is a multifaceted skill set crucial to optimal patient care. The ability to assess the development of CR skills in an entry-level doctor of physical therapy program (DPT) continues to be challenging due to the complexity of this necessary skill (e.g., thinking, decision-making). The clinical reasoning assessment tool (CRAT) was developed to assess students’ progress in the development of CR. The purpose of this qualitative study was to explore how DPT program faculty and clinical instructors (CIs) define and assess students’ CR using the CRAT in multiple didactic and clinical settings of a DPT program. Number of Subjects: Fourteen DPT program faculty and CIs with experience using the CRAT were purposively sampled to understand their perspectives and experiences regarding CR assessment in DPT students. Materials and Methods: To achieve the study purpose, a guide was used to collect qualitative data in three audio recorded focus groups (80±5 min) with a total of 14 participants. Thematic saturation was obtained and transcripts were analyzed in a team-based approach using a framework analysis to identify emergent themes. Results: Faculty and CIs from didactic and clinical settings similarly defined CR as the process of interpreting data from a clinical encounter, integrating best evidence, knowledge and past experience while providing a strong rationale for patient focused decision making. Additionally, three main themes emerged as being essential for evaluation of students’ CR using the CRAT: 1) student skillset including foundational knowledge, clinical based skills and general experience; 2) student self reflection and ability to articulate a rationale for decision-making; and 3) student consideration of patients’ needs as the focus of clinical decision making. Faculty and CIs described the CRAT as being a helpful tool to frame critical discussions surrounding students’ CR abilities and patient care decisions. Additionally, faculty and CIs described these critical discussions as an essential component to the development and assessment of CR. Conclusions: Study findings suggest that CR is a multifaceted skillset that evolves over the course of DPT education and that faculty/student dialogue is necessary for assessment of student CR. Importantly, the CRAT provided an important framework to guide this dialogue and further guide development of CR in DPT students. Clinical Relevance: The CRAT may be a useful assessment tool that can focus dialogue in clinical and didactic components of a curriculum in order to facilitate CR development. Additionally, the CRAT may be used to frame questions that facilitate students’ reflection, rationale, and justification for decisions, ultimately informing assessment of CR.