Does clinical decision making vary between novice and experienced residency trained orthopedic physical therapists?

Purpose/Hypothesis : Physical therapists who complete residency training obtain a substantial foundation in clinical decision making which is thought to further develop with clinical practice. The degree to which this clinical decision making develops with continued practice has not been explored. The purpose of this study was to identify if differences in clinical decision making existed between novice and experienced residency-trained physical therapists.Number of Subjects : Seventy subjects completed the study.Materials/Methods : An electronic survey was distributed to all physical therapists who had completed an American Physical Therapy Association accredited orthopedic residency. The survey consisted of 12 clinical vignettes and a 25 question musculoskeletal competency exam related to orthopedic practice; both the vignettes and the competency exam had been validated and used in previous research studies. The study subjects were divided into two groups; those with two years of clinical experience or less and those with greater than two years of experience.Results : An estimated one thousand clinicians were invited to participate and seventy successfully completed surveys. Novice clinicians (n=17) had on average 18 months (SD = 5.5 mo) of clinical experience, while experienced clinicians (n=53) had an average of 72 months (SD = 41.0 mo) experience. For the clinical competency questions, novice therapists averaged 69% correct answers while experienced clinicians averaged 66%, but there was no significant difference between the groups (p <0.05). For all multiple choice vignettes in which therapists were asked to keep, refer, or both, both groups correctly managed patients 82% of the time. In critical medical cases, experienced clinicians correctly referred the patient more often (71%) than novice clinicians (65%). Interestingly, 9 out of 17 (53%) novice clinicians correctly managed all 4 non-critical medical cases compared to 22 out of 53 (42%) experienced clinicians. On average when both tools were combined, novice clinicians scored 73% while experienced clinicians scored 70%, but the difference between groups was not statistically significant (p <0.05).Conclusions : Novice and experienced residency-trained physical therapists made similar clinical decisions with competency questions and keep/refer vignettes. This suggests that residency training adequately prepares novice therapists to make complex clinical decisions, with similar accuracy as experienced therapists. However, this conclusion must be viewed with caution due to low response rate to the survey (7%), which may be attributed to difficulty and length of the survey.Clinical Relevance : The results from this study highlight that both novice and experienced physical therapists who are residency-trained demonstrate similar orthopedic competency and make similar clinical decisions with keep/refer cases, regardless of amount of clinical experience.

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  • Control #: 2026088
  • Type: Poster
  • Event/Year: CSM2015
  • Authors: Chelsea Savage, Matthew Barton, Ryan Cotton, Emily J. Slaven
  • Keywords: clinical decision making|direct access|physical therapy residency

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