Clinical reasoning (CR) is a multifaceted skill set crucial to optimal patient care. The ability to teach, learn and assess the development of CR skills in an entry-level doctor of physical therapy program (DPT) continues to be challenging due to the complexity of this necessary skill (e.g., thinking, decision-making). The clinical reasoning assessment tool (CRAT) is a patient-centered tool containing 3 domains (content knowledge, procedural knowledge and conceptual reasoning) which was developed to assess studentsÕ progress in the development of CR. The purpose of this qualitative study was to explore how DPT program faculty and clinical instructors (CIs) define and assess studentsÕ CR using the CRAT in multiple didactic and clinical settings of a DPT program.
Fourteen DPT program faculty and CIs with experience using the CRAT were purposively sampled to understand their perspectives and experiences regarding CR assessment in DPT students. To achieve the study purpose, a guide was used to collect qualitative data in three audio recorded focus groups (80±5 min). Thematic saturation was obtained and transcripts were analyzed in a team-based approach using a framework analysis to identify emergent themes.
Faculty and CIs from didactic and clinical settings similarly defined CR as the process of interpreting data from a clinical encounter, integrating best evidence, knowledge and past experience while providing a strong rationale for patient focused decision making. The CRAT provided a common language and framework for assessment including meaningful dialogue and structured feedback. Additionally, three main themes emerged as being central to the assessment of studentsÕ CR using the CRAT. The CRAT: 1) guided studentsÕ self-reflection and expectations of the CR process 2) assisted faculty with organization and structured discussion relevant to CR assessment 3) facilitated benchmarking of CR development in the learner. Overall, faculty and CIs described the CRAT as being a helpful tool to facilitating critical discussions surrounding studentsÕ CR abilities which ultimately drive patient care decisions. Additionally, faculty and CIs described these critical discussions as an essential component to the assessment and development of CR.
Conclusions/Relevance to the conference theme:
Study findings suggest that CR is a multifaceted skillset that requires student reflection and faculty/student dialogue, all necessary for assessment of student CR. The CRAT may be a useful learning and assessment tool that provides a common language and framework for students and faculty in order to facilitate CR development. Additionally, the CRAT may be used to structure questions that facilitate studentsÕ reflection, rationale, and justification for decisions, ultimately informing assessment and overall development of CR.