Clinical Reasoning in Physical Therapy Diagnosis: Translation to Learning

Purpose/Hypothesis : Clinical reasoning (CR) reflects the thinking processes and application of knowledge utilized in patient diagnosis and management, leading to clinical decisions. Experienced Physical Therapists (PTs) rely on CR strategies that integrate their formal and procedural knowledge. Novice PTs depend primarily on formal knowledge when analyzing patient problems. Despite the known differences in CR strategies used among experienced and novice PTs, there is limited understanding of how to translate this knowledge to actual CR skill development. Novice PTs, including student PTs, generally develop their CR skills through accumulated clinical experiences. Little is known about how to specifically facilitate the organization and application of knowledge to patient problems in the educational environment. Therefore our aim is to investigate how experienced orthopedic PTs apply their knowledge to patient problems, and how their thinking processes may provide insight into CR skill development among student PTs.Number of Subjects : Convenience sample of PT examiners with orthopedic certified specialty (n=2, mean practice years=5). Convenience sample of two patients with low back pain.Materials/Methods : Each examiner was videotaped examining each patient. Structured interviews with PTs were conducted following the examination. Interviews were audio-taped and transcribed. Transcriptions were coded based on operational definitions: formal knowledge, procedural knowledge, patient problem, explanations, and clinical decisions. Themes emerged through group consensus based on relationships between codes.Results : Three themes emerged including 1) Experienced PTs rely heavily on procedural knowledge when engaging in diagnostic. 2) Explanations of clinical findings are focused on relevant information when considering the relationship between the patientÕs symptoms, impairments, and function. 3) Experienced PTs engage in clinical reasoning within the context of the whole patient.Conclusions : In the current study, PTÕs explanations of their thinking processes through the patient examination were used to provide insight on CR. The results of our study are consistent with the existing literature on CR. Experienced PTs gain procedural knowledge through direct patient care experiences. Procedural knowledge allows PTs to process information more efficiently, and contributes strongly to clinical decision-making. This contrasts to less efficient CR approaches that rely more on the application of formal knowledge to patient problems. Experienced PTs are also better able to consider contextual information in patient diagnosis. Since student PTs rely predominantly on formal knowledge in solving patient problems, the challenge in CR skill development is helping them bridge the gap between formal and procedural knowledge. Encouraging the use of explanations, particularly when interpreting clinical data, may facilitate CR skill development.Clinical Relevance : Encouraging students to explain their thinking processes during clinical education experiences may facilitate more efficient acquisition of CR skills.

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  • Control #: 1726538
  • Type: Poster
  • Event/Year: CSM2014
  • Authors: Marcia A. Miller Spoto, Jessica Goodrich, Leslie Gale, Adam Sterns, Rachel Waugh
  • Keywords: Clinical Reasoning|Diagnosis|Knowledge translation

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