Cultivating Competency in Clinical Reasoning Across the Continuum: Classroom to Clinic to Residency


The purpose of this presentation is to illustrate a model for cultivating clinical reasoning competency utilizing strategies progressing from classroom to clinic to residency.

Methods and/or Description of Project

With the complexity of today’s dynamic healthcare environment and the professions' increasing expectation for autonomy and direct access, physical therapists are required to possess strong clinical reasoning skills. Graduates are expected to enter the workforce with highly developed clinical reasoning skills. Therefore, academic faculty must intentionally incorporate specific clinical reasoning strategies within curricula to ensure student growth and development in this area. The presenters will define clinical reasoning as it relates to critical thinking and current theory to support acquisition of necessary skills for physical therapists. The panelists will then present model strategies implemented in the classroom, clinical experiences and residency programs to foster clinical reasoning as well as methods used to assess this growth and mastery of clinical reasoning skills.
The presenters will first describe elements built into the classroom curriculum and early integrated clinical experiences to build a foundation for clinical reasoning skills. Strategies such as case studies, patient simulation labs, student-led physical therapy grand rounds and professional behavior self-assessments will be explored.
Strategies connecting classroom clinical reasoning skills to full time clinical experiences will be described. Student clinical placement process will be discussed as an intentional strategy to create an optimal learning environment to promote continuous and staged development of clinical reasoning skills. Students are also challenged during their clinical experiences with specific assignments designed for reflection on patient care and their clinical reasoning skills in order to advance to entry level by the end of the terminal internship experiences.
For individuals who are accepted into the post-graduate residency program, there is a continued expectation for clinical reasoning growth. Components of the residency program will be described to foster on-going acquisition of advanced clinical reasoning skills through structured mentoring sessions and patient-related mind mapping assignments.
By assessing the different stages of professional development, from classroom to clinic to residency, a suggested framework will be proposed examining how to implement strategies and assess clinical reasoning skills.


The results and outcomes of this presentation will provide tangible “take away” strategies for immediate application in other entry-level or residency programs. In addition, shared discussions will provide meaningful insight on how to build a culture of excellence of clinical reasoning skills. These discussions will include strategies for success in the classroom assessed through formal course evaluations, peer evaluations and professional behaviors self-assessment data to aid in the understanding of how to track and monitor clinical reasoning growth throughout an academic program.
Clinical outcome tools such as Physical Therapist Clinical Performance Instrument (PT-CPI) will be discussed and results shared to demonstrate excellence in clinical reasoning skills of program graduates. Through classroom to clinic and into residency education, clinical reasoning outcomes are assessed through NPTE pass rates. On average over the past five years, Bellarmine University physical therapy graduates have an average pass rate of 97.0%. The Bellarmine University/Norton Healthcare Neurologic Residency Program graduates have achieved a 100% ABPTS pass-rate over the past five years. Understanding and utilizing patient outcomes is also a critical way to explore clinical reasoning by student physical therapists and post-graduate residents. Results from patient-related mind mapping activities will also be shared.

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

With the complexity of how to define, develop and assess clinical reasoning skills, educators may be unsure how to best foster this skill set. The model presented may provide useful pedagogical strategies to cultivate clinical reasoning within existing entry-level and residency programs.
This discussion will provide a framework to allow participants to identify successes of one particular program whose intentional strategies were designed to foster clinical reasoning and assess student growth from classroom to clinic to residency. Participants will be encouraged to reflect on their existing entry-level or residency program clinical reasoning strategies and how these session "take away" strategies may be useful for immediate curricular implementation.


American Physical Therapy Association: Physical Therapist Clinical Performance Instrument for Students. Alexandria, VA: American Physical Therapy Association; 2006.

APTA: Minimum Required Skills of Physical Therapist Graduates at Entry-Level 2009. Available at:

D’Antoni A, Pinto Zipp G, Olson V and Cahill T: Does the mind map learning strategy facilitate information retrieval and critical thinking in medical students? BMC Med Educ. 2010; 10:61-72.

Resnik L, Jensen GM: Using clinical outcomes to explore the theory of expert practice in physical therapy. Phys Ther. 2003; 83(12):1090-1106.

Furze J, Black L, Hoffman J, Barr JB, Cochran TM, Jensen GM: Exploration of Reasoning Development in Professional Physical Therapy Education. J Phys Ther Educ. 2015; 29(3):22-33.

Hakim EW, Moffat M, Becker E, Bell KA, Manal TJ, Schmitt LA, Ciolek C: Application of Educational Theory and Evidence in Support of an Integrated Model of Clinical Education. J Phys Ther Educ. 2014; 28:13-21.

May W, Kontney L, Iglarsh A: Professional Behavior Assessment. Physical Therapy Program Marquette University, Milwaukee, WI: 2010. Available at:

Zipp G, Maher C: Prevalence of mind mapping as a teaching and learning strategy in physical therapy curricula. J Scholar Teach Learn. 2013; 13:21-32.

Atkinson HL, Nixon-Cave K: A Tool for Clinical Reasoning and Reflection Using the International Classification of Functioning, Disability and Health (ICF) Framework and Patient Management Model. Phys Ther. 2011; 91(3):416-430.

Thistlethwaite JE, Davies D, Ekeocha S, Kidd JM, MacDougall C, Matthews P, Purkis J and Clay D: The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME guide no. 23. Med Teach. 2012; 34:e421-e444.

Course Objectives

Describe and build curricular strategies incorporating case studies and early integrated clinical experiences to promote development of clinical reasoning skills in physical therapist students.
Describe methods used in student-site placements, student preparation and course assignments to create positive opportunities for clinical reasoning growth during full-time clinical experiences.
Understand and apply current resources to measure progress and success in clinical reasoning skills within a physical therapy residency program.

Instructional Methods

Instructional methods will include lecture format with power point slides, panel discussion, audience participation and polling, and question and answer session.

Tentative Outline/Schedule

15 min. Introduction/purpose/objectives of presentation
10 min. Overview of strategies for implementation in all areas
15 min. Classroom clinical reasoning strategies and assessment
15 min. Clinical reasoning strategies and assessment during clinical experiences
15 min. Clinical reasoning strategies and assessment throughout the residency
10 min. Challenges/Barriers to Success
10 min. Questions/Answers

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  • Control #: 2508979
  • Type: Educational Session
  • Event/Year: ELC2016
  • Authors: Dr. Catherine Crandell, Carrie Hawkins, Sarah Quinn, Elizabeth Ulanowski
  • Keywords:

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