Student Perceptions and Understanding of Clinical Reasoning in the Inpatient Environment: A Qualitative Study

Purpose/Hypothesis : Acute care physical therapists work in a 21st century health care system that requires professional competence in clinical reasoning and decision making. For doctor of physical therapist (DPT) students, development of confidence in the clinical reasoning and professional skills necessary for contending with the fast pace of the acute care environment can be challenging. The purpose of this research was to describe how exposure, early in the curriculum, to non-traditional, pre-clinical experiences informed DPT students' recognition and understanding of the clinical reasoning exhibited by experienced physical therapists.Number of Subjects : Thirty-three DPT students participating in pre-clinical experiences at 15 unique acute hospital and acute rehabilitative centers.Materials/Methods : Participants were on 6 month pre-clinicals and working 40 hours per week as physical therapy aides with direct, line of sight, physical therapist supervision. During the fourth month, students observed patient evaluations conducted by experienced clinicians. To provide a mechanism for documenting their reflections about the observation, students were divided into 3 communities of practice (CoPs). Communication within the CoPs transpired virtually using online discussion board technology. To focus student observations, the researchers created 4 discussion threads, 1 per week, that were posted on each CoPÕs discussion board. The researchers collected, interpreted, and analyzed the discussion thread transcripts using qualitative research methods.Results : Four themes emerged from the data: environment; communication; evaluation components; and clinical reasoning. The themes informed a conceptual model depicting the factors observed by DPT students that influenced the clinical reasoning process of experienced clinicians. The students characterized the inpatient environment as medically involved, fluctuating, interprofessional, and fast paced. The medical complexity of patients impacted a therapistÕs evaluation and or treatment approach. Excellent communication was critical for establishing trust in the therapeutic relationship. Experienced therapists seamlessly integrated subjective and objective examination measures and intertwined evaluation and treatment elements within a single patient interaction. The students articulated difficulty separating and identifying certain subjective and objective examination elements because they were interconnected. Reflection on clinical decisions allowed the students to recognize the situated nature of evaluation and treatment approaches.Conclusions : Research is needed that examines student perceptions of experienced cliniciansÕ clinical reasoning in inpatient settings. Our data support inclusion of pre-clinical opportunities to expose students to the thinking of inpatient therapists at earlier stages within DPT curricula.Clinical Relevance : Academic and clinical educators must collaborate to create innovative and structured opportunities that foster the development of clinical reasoning in DPT students.

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  • Control #: 2017879
  • Type: Poster
  • Event/Year: CSM2015
  • Authors: Lorna Hayward, Kristin C. Greenwood, Matthew Nippins, Alicia Canali
  • Keywords: acute care environment|integrated clinical education|clinical reasoning and reflection

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