Application of the Dual Processing Theory to the Development of Clinical Reasoning in Physical Therapy Students


Clinical reasoning is a necessary skill for students to develop in order to become safe and effective practitioners. The dual processing theory has been the most successful theory at explaining the reasoning of clinicians (Djulbegovic et al., 2014). It consists of both type I, intuitive, and type II, analytical, processes. The purpose of this presentation is to convey the use of the dual processing theory to operationalize the construct of clinical reasoning for development in physical therapy students.


This platform presentation will include a review of the current literature regarding the dual processing theory and its application to clinical reasoning. Emphasis will be on the type II, analytical processes of reasoning.


Methods for development of clinical reasoning in physical therapy students will be presented. Emphasis will be placed on strategies for cognitive debiasing through training of metacognition.

Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education

Educators of physical therapy students strive to educate students who possess the knoweldge and skill necessary to become effective practioners. Of equal importance is fostering clinical reasoning of physical therapy students given the impact that clinical reasoning has on safe and effective treatment of patients. Without proper understanding of the cognitive components of clinical reasoning, educators lack the instructional strategies to target improvements and assess change in clinical reasoning. Additionally, operationalization of clinical reasoning grounded in cognitive science allows for enhanced educational research.


Croskerry, P., & Nimmo, G. R. (2011). Better clinical decision making and reducing diagnostic error. J R Coll Physicians Edinb, 41(2), 155-162. doi:10.4997/JRCPE.2011.208

Croskerry, P., & Norman, G. (2008). Overconfidence in clinical decision making. Am J Med, 121(5 Suppl), S24-29. doi:10.1016/j.amjmed.2008.02.001

Croskerry, P., Singhal, G., & Mamede, S. (2013). Cognitive debiasing 1: origins of bias and theory of debiasing. BMJ Qual Saf, 22 Suppl 2, ii58-ii64. doi:10.1136/bmjqs-2012-001712

Djulbegovic, B., Elqayam, S., Reljic, T., Hozo, I., Miladinovic, B., Tsalatsanis, A., . . . Cannon-Bowers, J. (2014). How do physicians decide to treat: an empirical evaluation of the threshold model. BMC Med Inform Decis Mak, 14, 47. doi:10.1186/1472-6947-14-47

Djulbegovic, B., Hozo, I., Beckstead, J., Tsalatsanis, A., & Pauker, S. G. (2012). Dual processing model of medical decision-making. BMC Med Inform Decis Mak, 12, 94. doi:10.1186/1472-6947-12-94

Heick, J. D., Boissonnault, W. G., & King, P. M. (2013). Physical therapist recognition of signs and symptoms of infection after shoulder reconstruction: a patient case report. Physiother Theory Pract, 29(2), 166-173. doi:10.3109/09593985.2012.714444

Kerry, R., & Taylor, A. J. (2009). Cervical arterial dysfunction: knowledge and reasoning for manual physical therapists. J Orthop Sports Phys Ther, 39(5), 378-387. doi:10.2519/jospt.2009.2926

Mamede, S., Schmidt, H. G., & Penaforte, J. C. (2008). Effects of reflective practice on the accuracy of medical diagnoses. Med Educ, 42(5), 468-475. doi:10.1111/j.1365-2923.2008.03030.x

Mamede, S., Splinter, T.A., van Gog, T., Rikers, R.M., & Schmidt, H.G. (2012). Exploring the role of salient distracting clinical features in the emergence of diagnostic errors and the mechanisms through which reflection counteracts mistakes. BMJ Qual Saf, 21(4), 295-300. doi:10.1136/bmjqs-2011-000518

Mamede, S., van Gog, T., van den Berge, K., Rikers, R. M., van Saase, J. L., van Guldener, C., & Schmidt, H. G. (2010). Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. JAMA, 304(11), 1198-1203. doi:10.1001/jama.2010.1276

May, S., Greasley, A., Reeve, S., & Withers, S. (2008). Expert therapists use specific clinical reasoning processes in the assessment and management of patients with shoulder pain: a qualitative study. Aust J Physiother, 54(4), 261-266.

Pelaccia, T., Tardif, J., Triby, E., & Charlin, B. (2011). An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory. Med Educ Online, 16. doi:10.3402/meo.v16i0.5890

Sasaki, M. (2005). Cervical cord compression secondary to ossification of the posterior longitudinal ligament. J Orthop Sports Phys Ther, 35(11), 722-729. doi:10.2519/jospt.2005.35.11.722

Stowell, T., Cioffredi, W., Greiner, A., & Cleland, J. (2005). Abdominal differential diagnosis in a patient referred to a physical therapy clinic for low back pain. J Orthop Sports Phys Ther, 35(11), 755-764. doi:10.2519/jospt.2005.35.11.755

Sylvain, J., & Reiman, M. P. (2015). Differential diagnosis and management of an older runner with an atypical neurodynamic presentation: a case for clinical reasoning. Int J Sports Phys Ther, 10(2), 234-245.

Van Wyngaarden, J. J., Ross, M. D., & Hando, B. R. (2014). Abdominal aortic aneurysm in a patient with low back pain. J Orthop Sports Phys Ther, 44(7), 500-507. doi:10.2519/jospt.2014.4935

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  • Control #: 2507054
  • Type: Platforms
  • Event/Year: ELC2016
  • Authors: Mrs. Tricia Prokop
  • Keywords:

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