Entry-level physical therapist students cannot perform clinical reasoning: What? So What? Now What?
What: Academic faculty assume that students acquire clinical reasoning (CR) skills osmotically through their encounters in the classroom, however if recent trends in the rise of clinical reasoning literature are to be believed, this is not true.
Clinical reasoning is a critical skill1 required of PTs, however little is known contextually or developmentally about this skill. Teaching CR is challenging to academic faculty as they may lack the requisite knowledge, skills and resources required for structuring and evaluating student performance in CR.2
So What: Teaching CR is reliant upon access to patient care and clinical cases, thus is assumed to take place during clinical rotations3, 4 but cannot be left solely to the clinic. It behooves the academy to initiate clinical reasoning strategies across curricula. The purpose of this session is to demonstrate strategies used in one academic program.
Now What: Marymount University (Arlington, VA) is engaged in a comprehensive, multifactorial implementation of clinical reasoning teaching using cases for building context, patterns for presentation of concepts, empowerment of students to build self-efficacy and clinical reasoning specific-teaching for clinical faculty across the curriculum.
This session will walk participants across the curriculum to experience these strategies in order to begin their unique program dialog for advancing clinical reasoning into entry-level practice.
Methods and/or Description of Project
Program Evaluation and Project Motivation aka Methods
The program faculty used a grounded theory approach for analysis of data from end-of-year faculty meetings from 2011 to present triangulated with data collected from clinical performance instruments across fulltime clinical rotations, and student-self-report data to identify clinical reasoning as a curriculum concern. Literature from medicine, primarily, was used to structure interventions currently employed for teaching and developing clinical reasoning.
Adoption of, and implementation of clinical reasoning strategies across the curriculum:
Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education
Clinical reasoning is a developmental construct that is best addressed with integrated strategies that increase in complexity across an entry-level curriculum in a manner that complements physical therapist student professional identity formation as entry-level practitoners, and translates into lifelong, self-referrant professional development.
1. Higgs J, ed. Clinical Reasoning in the Health Professions. 3. ed., repr. Amsterdam: Elsevier [u.a.]; 2011.
2. Furze J, Kenyon LK, Jensen GM. Connecting Classroom, Clinic, and Context: Clinical Reasoning Strategies for Clinical Instructors and Academic Faculty. Pediatr Phys Ther. 2015;27(4):368-375. doi:10.1097/PEP.0000000000000185.
3. Bowen JL. Educational Strategies to Promote Diagnostic Reasoning. N Engl J Med. 2006;355:2217-2225.
4. Schmidt HG, Mamede S. How to improve the teaching of clinical reasoning: a narrative review and a proposal. Med Educ. 2015;49(10):961-973. doi:10.1111/medu.12775.
1. Differentiate clinical reasoning from critical thinking.
2. Explain the role of reflection in clinical reasoning.
3. Discuss the role of clinical cases for teaching clinical reasoning.
4. Re-Define the role of clinical education as a unique contributor to clinical reasoning development of physical therapist students that began in the classroom.
5. Differentiate clinical reasoning between novice and expert clinical practitioners.
A practical session based on the evolving curriculum at Marymount University.
Discussion and demonstration of integrated clinical reasoning strategies across the curriculum:
1. Definitions and role of, and strategies for student/faculty reflection
2. Patient cases and tutorial strategies
1. Introduction to pattern recognition
2. Decision strategy frameworks
3. Clinical reflections from part-time clinic assignments
4. Partnership between academic and clinical faculty
1. Student-directed reflection
2. Models for decision-making and models for dissemination: Advancing students thinking and reasoning
3. Capstone case report
4. Withdrawal of resources for facilitation clinical reasoning in an international community engagement activity