Students’ Perceptions of Clinical Use of Differential Diagnosis Based on Discussion Board Responses: What Can We Learn?
To identify situations in which students used differential diagnosis and the reasoning process used to draw a conclusion, as shared in their discussion board postings.
Subjects: Entry-level Doctor of Physical Therapy students who graduated in 2013 (n=22), 2014 (n=25), and 2015 (n = 28) who had completed 3 weeks of clinical education prior to this rotation. Procedures: A qualitative analysis was used to analyze individual discussion board responses to the following question: “Share an experience you have had with an evaluation where you had difficulty pinpointing exactly what the problem was (differential diagnosis). What was the key question or assessment technique that helped you reach your final diagnosis?” Data Analysis: QDA Miner 4.0, a qualitative software program, was used to analyze individual discussion board responses. Each response was entered into the program individually. Keywords were identified by the researchers and entered for each theme. The program's keyword retrieval function was used to highlight each code within the responses. Each highlighted item was manually coded with the correct theme. Program analysis revealed frequency and percentage of coded responses.
A total of 75 students responded to this question. Commonly reported methods used for differential diagnosis included: 1) special tests (57%) or general tests (29%); 2) listening to the patient (31%); 3) researching and reassessing (24%); and 4) previous medical history (20%). Surprisingly, 45% of students reported they were not using differential diagnosis, but in these cases, the student was in the inpatient setting and providing physical therapy for medically diagnosed problem such as hip or knee replacement, abdominal surgery, myocardial infarct or stroke.
Conclusions/Relevance to the conference theme: Through the Looking Glass: Transforming Physical Therapy Education
The tools student’s used for differential diagnosis are all things that students are taught in their physical therapy curriculum. The presence of these themes in student’s posts on differential diagnosis may be encouraging to both educators and clinical instructors. Students mentioned using tests, either specific or general, more than any other process and many noted the value of listening to the patient. Students stating they were not using differential diagnosis or not using it very often justified this response by saying it was due to their setting, or a doctor already giving the patient a medical diagnosis. CLINICAL RELEVANCE: Students may need encouragement to value all aspects of the evaluation process in their differential diagnosis and not just the use of objective tests. Educators and clinical instructors should guide students to continue to evaluate the patient properly regardless of setting and even if the patient already has a medical diagnosis from a doctor.
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