A Comparison Of Instructional Methods On Clinical Reasoning In Entry Level Physical Therapy Students

Introduction: Developing clinical reasoning in entry-level physical therapy students is of increasing interest to physical therapist education programs in the United States. Despite this, many physical therapist education programs lack tools and pedagogical approaches for developing and assessing clinical reasoning across the continuum of didactic education. There is a need for evidence-based approaches to develop and assess clinical reasoning in entry-level physical therapy students. The primary aim of this study was to provide a comparison of the effects of two commonly used pedagogical approaches (paper-based case studies versus authentic patient experiences) on clinical reasoning and critical thinking of second year entry-level physical therapy students. It was hypothesized that students who received authentic patient experiences would demonstrate improved critical thinking and clinical reasoning when compared with students who received paper-based case studies or students assigned to a control group. The secondary aim of this study was to explore associations between characteristics of physical therapy students and their performance on (1) a standardized measure of critical thinking and (2) their self-reported reflection and clinical reasoning ability. Methods: A total of 23 students in their second year of a Doctor of Physical Therapy degree program at a small, rural university participated in this study. Participants were randomly assigned to a control group or to receive one of two supplemental learning activities (paper-based case studies or authentic patient experiences). Five one-hour sessions were completed over 5 weeks. Outcomes measured pre- and post- intervention included the Health Science Reasoning Test with Numeracy (HSRT-N) and the Self Assessment of Clinical Reasoning and Reflection (SACRR). Total time between pre- and post-testing was 7 weeks. Data analysis included a comparison of effect sizes of change scores between groups and correlational analysis of pre-test scores and student factors. Results: When compared with paper-based case studies, authentic patient experiences demonstrated a moderate to large effect size for improved HSRT-N scores on 5/8 subscales. The addition of 5 hours of authentic case instruction resulted in moderate to large effect size improvements to the HSRT-N scores for 2/8 subscales and improved SACRR scores when compared with the control group. A strong positive correlation existed between grade point average and pre-test HSRT-N scores. Discussion and Conclusion: When compared with paper-based case studies, the use of authentic patient experiences in an entry- level DPT curriculum may be more effective for improving critical thinking and clinical reasoning. Furthermore, the addition of five hours of paper-based case studies did not show benefits using the outcome tools utilized. The selection of pedagogical approaches to improve critical thinking and clinical reasoning based on sound evidence gained from randomized controlled trials is lacking in physical therapy education. The knowledge gained as a result of this study is significant because it provides a scientific premise for the selection of teaching methodologies as they relate to developing clinical reasoning in physical therapy students. Key Words: clinical reasoning, critical thinking, teaching methods, student outcomes, teaching and learning

The use of simulated patients is a developing instructional strategy in physical therapy education (PTE) programs. However, it is unknown if using simulated patients during instruction yields better outcomes than the traditional use of peer role-play. This two-arm randomized, experimental design investigated the effect of type of simulation-based instruction, simulated patients compared to peer role-play, on clinical reasoning and confidence of students enrolled in an entry-level PTE program learning patient transfer skills. Upon the conclusion of two instructional sessions, clinical reasoning was measured by the Think Aloud Standardized Patient Examination (TASPE) during a simulation experience. Student confidence in performing future acute care skills was measured by the Acute Care Confidence Survey (ACCS) following the simulation experience. Two independent-samples t-test demonstrated that there was not a statistically significant difference in the students' TASPE scores or the ACCS scores based on the type of simulation-based instruction. This study provides evidence that peer role-play can be just as effective in improving physical therapist student clinical reasoning and confidence outcomes compared to using simulated patients when instructing patient transfer skills. Although the use of simulated patients may appear to promote deeper learning by portraying a more real scenario for practicing patient care skills, it is no more advantageous than peer role-play in terms of physical therapist students' clinical reasoning and confidence skills when learning patient transfer skills.

Guide to Evidence-Based Physical Therapist Practice, Third Edition provides readers with the information and tools needed to appreciate the philosophy, history, and value of evidence-based practice, understand what constitutes evidence, search efficiently for applicable evidence in the literature, evaluate the findings in the literature, and integrate the evidence with clinical judgment and individual patient preferences and values. This unique handbook marries the best elements of multiple texts into a single accessible guide. Guide to Evidence-Based Physical Therapist Practice, Third Edition is updated and revised, including a vibrant 2-color engaging layout, improved organization, additional statistics coverage, and expanded resources for instructors and students. Its reader-friendly style facilitates learning and presents the knowledge and skills essential for physical therapist students to develop a foundation in research methods and methodologies related to evidence-based medicine. Students will learn how evaluate research designs, appraise evidence, and apply research in clinical practice. This is a comprehensive resource no physical therapist or student should be without. NEW TO THE THIRD EDITION • Features a new two-color design • Includes updated research examples • Presents statistics coverage in two chapters with more manageable content to review Description and Inference • Contains expanded content related to qualitative research designs • Provides qualitative research examples to illustrate the contribution of these designs to a physical therapist’s ability to discern and understand individual patient/client applications • Explores examples of circumstances where biases and limitations have resulted in errors • Offers new instructor and student resources INSTRUCTOR RESOURCES • Sample Syllabus (corresponding with APTA’s Guide to Physical Therapist Practice 3.0 and the 2016 CAPTE Evaluative Criteria) • PowerPoint Presentations for each chapter • New Test Bank with 150 questions • Revised Sample Evidence Appraisal Worksheets • Helpful Resource List with additional references • Answer Key - Sample Answers for End of Chapter Questions STUDENT RESOURCES: Navigate Companion Website, including: Crossword Puzzles, Flashcards, Interactive Glossary, Practice Quizzes, Web Links, Screenshots of electronic databases

Clinical reasoning is an essential non-negotiable element for all health professionals. The ability of the health professional to demonstrate professional competence, compassion, and accountability depend on a foundation of sound clinical reasoning. The clinical reasoning process needs to bring together knowledge, experience, and understanding of people, the environment, and organizations along with a strong moral compass in making sound decisions and taking necessary actions. While clinical reasoning and the role of mentors has been a focus of the continued growth and development of residency programs in physical therapy, there is a critical need to have a broader, in-depth look at how educators across academic and clinical settings intentionally facilitate the development of clinical reasoning skills across one’s career. Clinical Reasoning and Decision Making in Physical Therapy: Facilitation, Assessment, and Implementation fills this need by providing a comprehensive and in-depth focus on development of the patient-client management skills of clinical reasoning and clinical decision-making. It takes into account teaching and learning strategies, assessment, and technological applications across the continuum from novice to residents/fellows-in-training, along with academic and clinical faculty for both entry-level and specialist practice. Drs. Gina Maria Musolino and Gail Jensen have designed this comprehensive resource with contributions from professional colleagues. The text centers on life-long learning by encouraging the development of clinical reasoning abilities from professional education through residency education. The aim and scope of the text is directed for physical therapy education, to enhance clinical reasoning and clinical decision-making for developing professionals and post-professionals in both clinical and academic realms, and for the development of clinical and academic faculty. Clinical Reasoning and Decision Making in Physical Therapy uniquely offers both evidence-based approaches and pragmatic consultation from award-winning authors with direct practice experiences developing and implementing clinical reasoning/clinical decision-making in practice applications for teaching students, residents, patients, and clinical/academic faculty in classrooms, clinics, and through simulation and telehealth. Clinical Reasoning and Decision Making in Physical Therapy is the first of its kind to address this foundational element for practice that is key for real-world practice and continuing competence as a health care professional. Physical therapy and physical therapist assistant students, faculty, and clinicians will find this to be an invaluable resource to enhance their clinical reasoning and decision making abilities.

Clinical reasoning is the foundation of professional clinical practice. Totally revised and updated, this book continues to provide the essential text on the theoretical basis of clinical reasoning in the health professions and examines strategies for assisting learners, scholars and clinicians develop their reasoning expertise. key chapters revised and updated nature of clinical reasoning sections have been expanded increase in emphasis on collaborative reasoning core model of clinical reasoning has been revised and updated

The leading scholarly and theoretical approach to clinical reasoning in occupational therapy, Schell & Schell’s Clinical and Professional Reasoning in Occupational Therapy, 3rd Edition, continues a successful tradition of not only teaching occupational therapy students how practitioners think in practice, but detailing the why and how to develop effective reasoning in all phases of their careers. More practical and approachable than ever, this updated 3rd Edition incorporates a new emphasis on application and reflects the personal insights of an international team of contributors, giving emerging occupational therapists a professional advantage as they transition to professional practice.

Clinical reasoning is a key skill underpinning clinical expertise. Clinical Reasoning in Musculoskeletal Practice is essential reading for the musculoskeletal practitioner to gain the contemporary knowledge and thinking capacity necessary to advance their reasoning skills. Now in its 2nd edition, it is the only all-in-one volume of up-to-date clinical reasoning knowledge with real-world case examples illustrating expert clinical reasoning. This new edition includes: • Comprehensively updated material and brand new chapters on pain science, psychosocial factors, and clinical prediction rules. • The latest clinical reasoning theory and practical strategies for learning and facilitating clinical reasoning skills. • Cutting-edge pain research and relevant psychosocial clinical considerations made accessible for the musculoskeletal practitioner. • The role of clinical prediction rules in musculoskeletal clinical reasoning. • 25 all new real-world, clinical cases by internationally renowned expert clinicians allowing you to compare your reasoning to that of the best.

This book is open access under a CC BY 4.0 license. This volume describes and explains the educational method of Case-Based Clinical Reasoning (CBCR) used successfully in medical schools to prepare students to think like doctors before they enter the clinical arena and become engaged in patient care. Although this approach poses the paradoxical problem of a lack of clinical experience that is so essential for building proficiency in clinical reasoning, CBCR is built on the premise that solving clinical problems involves the ability to reason about disease processes. This requires knowledge of anatomy and the working and pathology of organ systems, as well as the ability to regard patient problems as patterns and compare them with instances of illness scripts of patients the clinician has seen in the past and stored in memory. CBCR stimulates the development of early, rudimentary illness scripts through elaboration and systematic discussion of the courses of action from the initial presentation of the patient to the final steps of clinical management. The book combines general backgrounds of clinical reasoning education and assessment with a detailed elaboration of the CBCR method for application in any medical curriculum, either as a mandatory or as an elective course. It consists of three parts: a general introduction to clinical reasoning education, application of the CBCR method, and cases that can used by educators to try out this method.

An Australian text designed to address the key area of clinical reasoning in nursing practice. Using a series of authentic scenarios, Clinical Reasoning guides students through the clinical reasoning process while challenging them to think critically about the nursing care they provide. With scenarios adapted from real clinical situations that occurred in healthcare and community settings, this edition continues to address the core principles for the provision of quality care and the prevention of adverse patient outcomes.