Clinical decision-making is an important process involving critical thinking and problem solving. Clinical decision-making is essential to effective patient care and professional autonomy in physical therapy. Despite the importance of developing sound clinical decision-making skills for physical therapy practice, no validated clinical decision-making tool exists in physical therapy. The purpose of this presentation is to describe the development process used to validate a tool to assess clinical decision-making across the continuum of physical therapy education.
The development and validation of this clinical decision-making tool has taken place over the last five years at one New England physical therapy program. The initial tool consisted of 25 items modified by the researchers from the professional behaviors on the Clinical Performance Instrument. Initially, the items were validated for content and face validity using expert opinion of clinicians and faculty. A pilot study was conducted to compare students’ perceptions of their own clinical decision-making to that of their clinical instructors. The results were positive, so a larger cross-sectional mixed methods study was undertaken. This study looked at the comparison of the students’ perception of their own clinical decision-making skills to those of their clinical instructors and compared the students’ clinical decision-making skills at 4 different points in the curriculum. In addition, qualitative data was gathered via a focus group and an open ended question on the tool.. To further validate the items on the tool, serial Rasch analyses were conducted. Based on these results, the tool was modified at each phase. Finally, to increase the generalizability of the tool, data was collected on students enrolled in another program.
Results of the pilot study and subsequent study showed that students’ perceptions of their own clinical decision-making were consistent with that of their clinical instructors. The tool differentiated students’ clinical decision- making skills appropriately based on their place in the program. The Rasch analysis consistently demonstrated that the tool was not measuring lower or higher level clinical decision-making skills. This analysis also showed a lot of redundancy within the tool. Based on these results, the tool was modified iteratively. The final tool consists of 12 items measured on a 4 point Likert scale.
Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education
Outcome Assessment in Physical Therapy Education: Developing a tool that measures clinical decision-making across the continuum of physical therapy education will better inform those involved in physical therapy education and challenge them to develop programs that develop these skills in physical therapists. Future studies comparing our students to a broader student population, and assessing clinical decision-making skills in physical therapists in residency and fellowship training is planned.
Brudvig T and Macauley K. A clinical decision making tool for DPT students. Academic Exchange. Summer 2015 ISSN 1096-1453 Volume 19, Issue 2.
Brudvig TJ, McCauley K, and Segal N. Measuring clinical decision making and clinical skills in DPT students across a curriculum. J of Allied Health accepted for publication.
Roach KE, Frost JH, Francis NJ, Giles S, Nordrum JT, Delitto A. Validation of revised physical therapy clinical performance instrument (PT CPI): Version 2006. Phys Ther. 2012; 92(3):416-428.