Perspectives and Practice: Physical Therapist Students' Clinical Reasoning

2020 ◽  
Vol 34 (2) ◽  
pp. 150-159 ◽  
Author(s):  
Sarah Gilliland ◽  
Susan Flannery Wainwright
Keyword(s):  
Clinical Reasoning ◽  
Physical Therapist ◽  
Physical Therapist Students

scholarly journals Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students

2019 ◽  
Vol 99 (8) ◽  
pp. 964-976 ◽  
Author(s):  
Maria Elvén ◽  
Jacek Hochwälder ◽  
Elizabeth Dean ◽  
Anne Söderlund
Keyword(s):  
Behavior Change ◽  
Behavioral Medicine ◽  
Clinical Reasoning ◽  
Psychological Factors ◽  
Physical Therapist ◽  
Cross Sectional ◽  
Independent Variables ◽  
Curriculum Orientation ◽  
Dependent Variables ◽  
Physical Therapist Students

AbstractBackgroundAlthough physical therapist students must be well prepared to integrate biopsychosocial and behavioral perspectives into their clinical reasoning, there is a lack of knowledge regarding factors that influence such competence.ObjectiveThis study explored the associations among the independent variables—knowledge, cognition, metacognition, psychological factors, contextual factors, and curriculum orientation vis-à-vis behavioral medicine competencies—and the dependent variables—outcomes of input from client (IC), functional behavioral analysis (FBA), and strategies for behavior change (SBC) as levels in physical therapist students’ clinical reasoning processes.DesignThis study used an exploratory cross-sectional design.MethodsThe Reasoning 4 Change instrument was completed by 151 final-semester physical therapist students. Hierarchical multiple regression analyses for IC, FBA, and SBC were conducted. In the first step, curriculum orientation was inserted into the model; in the second step, self-rated knowledge, cognition, and metacognition; and in the third step, psychological factors.ResultsAll independent variables except contextual factors explained 37% of the variance in the outcome of IC. Curriculum orientation explained 3%, cognitive and metacognitive factors an additional 22%, and attitudes another 15%. Variance in the outcomes of FBA and SBC were explained by curriculum orientation only (FBA change in R2 = 0.04; SBC change in R2 = 0.05). Higher scores of the dependent variables were associated with a curriculum having behavioral medicine competencies.LimitationsThe limitations of this study are that it was cross-sectional.ConclusionsCognitive and metacognitive capabilities and skills and positive attitudes are important predictors of physical therapist students’ clinical reasoning focused on behavior change at the IC level. Curricula with behavioral medicine competencies are associated with positive outcomes at all clinical reasoning levels.

scholarly journals Patterns of Clinical Reasoning in Physical Therapist Students

2017 ◽  
Vol 97 (5) ◽  
pp. 499-511 ◽  
Author(s):  
Sarah Gilliland ◽  
Susan Flannery Wainwright
Keyword(s):  
Clinical Reasoning ◽  
Physical Therapist ◽  
Physical Therapist Students

scholarly journals The Hypothesis-Oriented Pediatric Focused Algorithm: A Framework for Clinical Reasoning in Pediatric Physical Therapist Practice

2013 ◽  
Vol 93 (3) ◽  
pp. 413-420 ◽  
Author(s):  
Lisa K. Kenyon
Keyword(s):  
Clinical Reasoning ◽  
Clinical Education ◽  
Physical Therapist ◽  
Management Process ◽  
Pediatric Practice ◽  
Reasoning Process ◽  
Physical Therapist Students ◽  
Therapeutic Philosophy ◽  
Client Management

Pediatric physical therapist practice presents unique challenges to the clinical reasoning processes of novice clinicians and physical therapist students. The purpose of this article is to present the Hypothesis-Oriented Pediatric Focused Algorithm (HOP-FA), a clinical framework designed to guide the clinical reasoning process in pediatric physical therapist practice. The HOP-FA provides a systematic, stepwise guide to the patient/client management process wherein the therapist is asked to consider various factors and issues that may affect the clinical reasoning process for a particular child and family. The framework provided by the HOP-FA is not built upon a specific therapeutic philosophy and may be useful as a tool in clinical education, in the classroom, and for clinicians who are new to or re-entering pediatric practice.

scholarly journals Validation of the Revised Physical Therapist Clinical Performance Instrument (PT CPI): Version 2006

2012 ◽  
Vol 92 (3) ◽  
pp. 416-428 ◽  
Author(s):  
Kathryn E. Roach ◽  
Jody S. Frost ◽  
Nora J. Francis ◽  
Scott Giles ◽  
Jon T. Nordrum ◽  
...  
Keyword(s):  
United States ◽  
Student Performance ◽  
Physical Therapist ◽  
Clinical Performance ◽  
The United States ◽  
Final Evaluation ◽  
Convenience Sample ◽  
Evaluation Data ◽  
Physical Therapist Students ◽  
Clinical Performance Instrument

Background Based on changes in core physical therapy documents and problems with the earlier version, the Physical Therapist Clinical Performance Instrument (PT CPI): Version 1997 was revised to create the PT CPI: Version 2006. Objective The purpose of this study was to validate the PT CPI: Version 2006 for use with physical therapist students as a measure of clinical performance. Design This was a combined cross-sectional and prospective study. Methods A convenience sample of physical therapist students from the United States and Canada participated in this study. The PT CPI: Version 2006 was used to collect CPI item–level data from the clinical instructor about student performance at midterm and final evaluation periods in the clinical internship. Midterm evaluation data were collected from 196 students, and final evaluation data were collected from 171 students. The students who participated in the study had a mean age of 24.8 years (SD=2.3, range=21–41). Sixty-seven percent of the participants were from programs in the United States, and 33% were from Canada. Results The PT CPI: Version 2006 demonstrated good internal consistency, and factor analysis with varimax rotation produced a 3-factor solution explaining 94% of the variance. Construct validity was supported by differences in CPI item scores between students on early compared with final clinical experiences. Validity also was supported by significant score changes from midterm to final evaluations for students on both early and final internships and by fair to moderate correlations between prior clinical experience and remaining course work. Limitations This study did not examine rater reliability. Conclusion The results support the PT CPI: Version 2006 as a valid measure of physical therapist student clinical performance.

scholarly journals Creating Significant Learning Experiences for Clinical Reasoning by Physical Therapist Students

2019 ◽  
Author(s):  
Lois Stickley
Keyword(s):  
Decision Making ◽  
Clinical Reasoning ◽  
Curriculum Design ◽  
Clinical Decision Making ◽  
Physical Therapist ◽  
Learning Experiences ◽  
First Year ◽  
Clinical Decisions ◽  
First Year Students ◽  
Significant Difference

Background: Clinical reasoning skills are embedded in all aspects of practice. There is a lack of consensus and standards for curriculum design and teaching methods of clinical reasoning in entry-level education of health professionals. Purpose: The purpose was to describe a process of designing one comprehensive, planned sequence of four courses to create significant learning experiences for clinical reasoning for Doctor of Physical Therapy students. Method: Fink’s design process was used to develop four clinical decision-making courses to ensure a close alignment of learning goals, feedback and assessment, and learning activities to engage students in practicing components of clinical reasoning. Student outcomes were measured by self-efficacy ratings for clinical reasoning in a practical exam for first-year students and by ratings of performance by clinical instructors for third-year students. Results: 41 first-year students ranked their confidence in making clinical decisions both before and after a midterm practical. A paired t-test found a significant difference (.05t40 = -6.66, ρ=0.00) in the mean ratings of students from the pre-practical assessment to the post-practical assessment about confidence in making clinical decisions. Third-year students received ratings that met or exceeded expectations on five audited skills from the Physical Therapist manual for the Assessment of Clinical Skills (PT MACS), both at midterm and at the final assessment. No significant differences between midterm and final ratings on any of the selected skills were found using a Chi-Square Test of Independence (α=.05). Conclusion: The four-course sequence was designed using four themes: patient-centered care, models of practice, and evidence-based practice, and ethics/legal issues. This paper offers specific details about how one method of teaching clinical reasoning meets the current trends in education and health care for accountability and meaningful outcomes. Students gained practical knowledge and skills in the components of clinical reasoning and decision-making by participating in active and engaging significant learning experiences.

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