Applied Clinical Reasoning within a Tiered Learning Model


To describe a unique way to develop clinical reasoning and enhance clinical decision making confidence in DPT students grouped across co-hort years.


This hybrid course included 6 students and 2 faculty and was delivered via a course management system (CMS) platform. Two teams, comprised of 1 student from each cohort, were formed. The active team (AT) provided the patient case and evidence, the observer team (OT) participated in course elements and discussion without actively providing clinical or research information. The AT DPT year 3 student provided a clinical case using the ICF model and shared via the CMS site. All students (AT & OT) reviewed this case then completed a patient management plan. The AT DPT year 1 and 2 team members completed an annotated bibliography focused on the type of content covered in the curriculum and uploaded to the CMS.

All students were involved in a discussion held 2 weeks after the initial case presentation. Each AT member reviewed their information(15min) with the remainder of the session (45min) focused on discussing the intersection of science, patient factors and clinical decisions for achieving optimal patient outcomes. After the web session, students completed a survey where they reflected on the intersection of clinical knowledge, research evidence and patient factors and how well the actual decisions matched those presented in the evidence.The process was repeated with the AT becoming the OT and reverse.


Student's from all 3 cohort years showed improved feelings of confidence related to the clinical reasoning process with the.takeaway experience differing for students by program year. DPT year 3 students reported improved confidence due to reinforcement of knowledge through “teaching” about their case. DPT year 2 students verbalized improved confidence with applying classroom skills to the patient specific clinical environment, particularly when faced with an atypical case presentation. DPT year 1 students appreciated seeing the “roadmap” of applying foudational knowledge to acquisition of PT specific skills in the second year to the synthesis and application of skills and knowledge in the cllinic during the 3rd year. The DPT 1 and 2 year students also verbalized a deeper appreciation and understanding for the challenge of reconciling the “best practice” elements of evidence, patient needs and clinical skills. All 6 students rated this as a very-good to excellent course that enhanced their understanding of clinical reasoning within the clinical context.

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

This pilot used a unique model to aid development of clinical reasoning across co-hort years. The response of students was favorable with each projecting the positive impact this had/ would have on confidence with clinical decision-making. As this pilot allowed students to learn from their peers, with the faculty role to guide the discussion, it empowers both group and individual learning.


Forneris SG, Neal DO, Tiffany J et. al. Enhancing Clinical Reasoning Through Simulation Debriefing: A Multi-site Study. Nursing Ed Perspec. 2015;36(5):305-310.

Gilliland S. Clinical reasoning in the first- and third-year physical therapist students. J Phys Ther Ed. 2014;28(3):64-80.

Martina EJM, Dason EE, Geke AB. What is a clinical skill? searching for order in chaos through a modified delphi process. Medical Teacher. 2012;34(8).

Noreen CF, Facione PA. Critical Thinking and Clinical Judgment, from Critical Thinking (pg. 1-13) in Clinical Reasoning in the Health Sciences: A Teaching Anthology, 2008. Insight Assessment / The California Academic Press: Millbrae CA.

Resnik L, Jensen GM. Using clinical outcomes to explore the theory of expert practice in physical therapy. Phys Ther. 2003;83:1090-l 106.

Wagner KD. An inquiry into the use of case method instruction to support nursing students' learning transfer from classroom instruction to clinical practice. ProQuest Dissertation and Theses Ann Arbor MI. 2006. University of Kentucky.

BACK to Abstract Results

  • Control #: 2513376
  • Type: Platforms
  • Event/Year: ELC2016
  • Authors: Dr. Patricia Nelson, R. Joseph Palmer
  • Keywords:

BACK to Abstract Results