Teaching and Assessing Clinical Reasoning: A Survey of Physical Therapy Clinical Instructors
Purpose/Hypothesis: Clinical reasoning (CR) is the process by which healthcare clinicians “collect cues, process the information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the process” (Trowbridge). CR is a multi-faceted skill that is developed over time, and needed to facilitate maximum improvement in patients. Despite its importance, there is limited understanding of how CR is taught in the clinical setting or how clinical instructors (CI)--herein defined as clinician-to-student supervisor and mentor-- set expectations for students in this area. CR requires a “substantial amount of practice with realistic patients to develop.” (Huhn, 2018). To better understand how CIs teach and assess CR for physical therapy (PT) students, Huhn surveyed CIs identified from the American Physical Therapy Association (APTA) database of credentialed CIs. The survey results for 749 CIs are described in Huhn’s study and establish that CIs understand the importance of CR, but did not expect students to be able to achieve entry-level CR skills in their time in training. In our study, we adapted Huhn’s survey instrument to assess strategies and perceptions of CIs to test two hypotheses: 1. There is a difference in the responses of CIs in Appalachia relative to national responses. 2. There is a difference between the responses of CIs who are and who are not APTA credentialed clinical instructors. Number of Subjects: We administered an adapted version of Huhn’s survey to CIs in the Appalachian region. Using a database available and managed by East Tennessee State University (ETSU), we invited 400+ CIs working regionally with ETSU physical therapy students and asked them to forward the survey to other ETSU CIs (snowball sample). As an incentive, ten respondents were randomly selected for a $50 gift card. Materials and Methods: In this project, we adapted Huhn’s 18-item questionnaire with permission from the author. We received 170 responses (169 complete). The survey was self-administered through the Qualtrics platform and data were analyzed using SPSS. Results: While we did not find that completion of the APTA CI Credentialing course was a statistically significant predictor of confidence in teaching CR, we did find the following factors to be statistically significant in increasing confidence: if a CI has completed a residency or fellowship; if they are ABPTS Board Certified Specialists; if they supervise more students; and their time in clinical practice. Like Huhn, we found that the CIs in our sample expected students to be advanced intermediate (49.1%) or entry-level (43.2%) in their CR skills by their third and final year of training. Conclusions: The survey results indicate that CIs are generally confident in their ability to teach and assess CR and that they hold high expectations for the students’ development of CR over their three years in DPT training. If programs are seeking to work with CIs that are confident in their CR teaching abilities, one strategy is to identify CIs who are board-certified specialists and/or are residency or fellowship trained. Clinical Relevance: First, in better understanding how CR is defined, taught, and assessed by CIs mentoring physical therapy students, we can enhance a DPT program’s ability to shape student learning, enhance the ability of our students to utilize CR upon graduation by explicit teaching strategies, and we can increase the ability to effectively educate CIs. Second, the data collected through this survey will advance the limited, but emerging literature currently available on teaching CR.