Strategies for Developing Clinical Reasoners: Facilitating Learning in Didactic, Clinical, and Residency Education


To explore teaching strategies for facilitation of clinical reasoning in learners in two dimensions: their stage of professional education and their level of learner proficiency.

Methods and/or Description of Project

This educational session will focus on the analysis of three exemplar cases of teaching and learning for developing physical therapists. Each case is framed in their educational journey, which includes didactic, early and late clinical education experiences, and residency education. The case discussions will connect educational theory and strategies to facilitation of clinical reasoning in didactic and patient care settings for an average learner, an exceptional learner, and a learner requiring remediation along the way.


The session will provide participants with examples of common clinical reasoning developmental patterns in classroom and patient care settings. Additionally, the session will provide strategies for educators that can be applied to the individual learner in each educational context.

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

The achievement of excellence in physical therapist practice at any level of professional development is dependent upon the quality of clinical reasoning within which all clinical decisions are grounded. The development of clinical reasoning abilities should be viewed as a continuous process of development—with progressive growth of the foundational skills learned in the classroom setting facilitated during clinical experiences and further expanded during residency education. Variations in instructional facilitation strategies should occur when the learner is progressing less than optimally (remedial) or at a rate faster than expected (exceptional learner).


Artino AR, Durning SJ, Waechter DM, Leary KL, Gilliland WR. Broadening our understanding of clinical quality: from attribution error to situated cognition. Clinical Pharmacology & Therapeutics 2012; 91(2): 167-169.

Christensen N, Black L, Jensen GM. Physiotherapy clinical placements and learning to reason. In J. Higgs, D. Sheehan, J. Baldry Currens, W. Letts & G. Jensen (Eds.) Realising exemplary practice-based education. Rotterdam, The Netherlands: Sense Publications 2013;135-142.

Christensen N, Nordstrom T. Facilitating the teaching and learning of clinical reasoning. In: Jensen GM, Mostrom E. Handbook of Teaching and Learning for Physical Therapists, 3rd ed. St. Louis, MO: Elsevier Butterworth Heinemann. 2012; 183-199.

Delany C, Golding C. Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators. BMC Medical Education 2014;14:20.

Durning SJ, Artino AR, Pangaro L, van der Vleuten C, Schuwirth L. Context and clinical reasoning: understanding the perspective of the expert’s voice. Medical Education 2011;45:927-938.

Furze J, Black L, Hoffman J, Barr J, Cochran T, Jensen G. Exploration of students’ clinical reasoning development in professional physical therapy education. Journal of Physical Therapy Education 2015; 29(3):22-33.

Furze J, Gale J, Black L, Cochran T, Jensen G, Clinical Reasoning: Development of a Grading Rubric for Student Assessment. Journal of Physical Therapy Education 2015; 29 (3): 34-45.

Irby DM. Excellence in clinical teaching: knowledge transformation and development required. Medical Education 2014;48:776-784.

Jensen GM, Purtilo R. Learning For Practice, Chapter 5 in Higgs J, Sheehan D, Baldry Currens J, Letts W, Jensen GM (eds). Realising Exemplary Practice-based Education. Rotterdam, Netherlands: Sense Publications 2013; 69-80.

Lang VJ, Schuwirth L, Durning SJ, Rencic JJ. Assessment of clinical reasoning. In: Trowbridge RL, Rencic JJ, Durning SJ (eds). Teaching Clinical Reasoning. Philadelphia, PA: American College of Physicians 2015;117-154.

Ratcliffe TA, Durning SJ. Theoretical concepts to consider in providing clinical reasoning instruction. In: Trowbridge RL, Rencic JJ, Durning SJ (eds). Teaching Clinical Reasoning. Philadelphia, PA: American College of Physicians. 2015;13-30.

Schumacher DJ, Englander R, Carraccio C. Developing the master learner: applying learning theory to the learner, the teacher, and the learning environment. Academic Medicine 2013; 88(11):1635-1645.

Young JQ, Van Merrienboer J, Durning S, Ten Cate O. Cognitive load theory: implications for medical education: AMEE Guide No. 86. Medical Teacher 2014;36:371-384.

Course Objectives

At the completion of this session, participants will be able to:
1. Apply contemporary educational theory and research to developing strategies for facilitating clinical reasoning development at different educational stages.
2. Discuss a framework to make an educational diagnosis of common issues in the development of clinical reasoning.
3. Describe techniques/strategies for optimal facilitation of clinical reasoning at selected stages of professional education as well as for various levels of learner proficiency.

Instructional Methods

Presentation, Large Group Discussion

Tentative Outline/Schedule

5 minutes
I. Introduction

15 minutes
II. Exploring the practical use of key foundational educational theory concepts that are applicable to facilitation of clinical reasoning

15 minutes
III. How to apply this theory to guide teaching strategies and facilitation of learning in two dimensions:
A. Various educational settings/contexts
B. Various stages of learner development

45 minutes
IV. Case presentations across didactic, clinical and residency educational settings
A. Average learner: managing the status quo
B. Exceptional learner: balancing challenge and engagement
C. Struggling learner: finding a way up

10 minutes
V. Group discussion/Q and A

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  • Control #: 2526329
  • Type: Educational Session
  • Event/Year: ELC2016
  • Authors: Dr. Nicole Christensen, Lisa Black, Judith Gale, Gail Jensen
  • Keywords:

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