Believing, Thinking, and Doing: Physical Therapist Students’ Clinical Reasoning and Characterizations of Practice
This dissertation study examined how physical therapist (PT) students from two entry-level physical therapist educational programs characterized practice and engaged in clinical reasoning. The theoretical frame for this study identified four capacities, a well-organized knowledge base, the ability to effectively interact with patients, the ability to manage decision making in a context of uncertainty, and a patient-centered, biopsychosocial orientation to practice, required for effective clinical reasoning. This study addressed four primary research questions: How do PT students characterize physical therapy practice? During an encounter with a patient, what clinical decisions do PT students make, and what clinical reasoning strategies underlie their decisions? What is the relationship between PT students’ characterizations of practice and their clinical decisions? Do PT students’ clinical decisions and reasoning strategies vary across educational programs? This qualitative study drew on PT students’ responses to interview questions concerning their conceptualizations of practice and PT students’ performance on and explanations of a standardized patient case. Although all students were at the same stage of their education, some characterized physical therapy with a focus on patient education and emotional support consistent with expert practice, while others described a focus on technical and biomechanical issues more characteristic of novice practice. Students’ abilities to organize their knowledge impacted their clinical decision-making. Further, students’ actions during the clinical encounter ranged from typical novice practice focused on diagnosing the pathology to more advanced practice focused on assessing and addressing the patient’s emotional and behavioral needs. The problems students framed and decisions they made during the patient encounter paralleled their characterizations of practice. Each of the four capacities played a crucial role in their clinical reasoning. The differences in the perspectives and clinical reasoning of the students from the two programs suggest that program level factors impacted their development of clinical reasoning. The findings from this study support a model of clinical reasoning that demonstrates the influence of students’ perspectives on practice on their use of content specific reasoning and interactional skills for clinical reasoning. Further, this study has highlighted the importance of reflection both in- and on-action for students’ clinical decision-making and professional development.