Doctor of Physical Therapy Students' Developing Understanding of Physical Therapy Practice: A Longitudinal Study

Abstract

Introduction. Clinical reasoning is a complex real-world practice that requires problem framing prior to problem solving. Clinicians and students demonstrate qualitative differences in their approaches to clinical reasoning that are influenced by their beliefs about practice. The purpose of this study was to examine the development of Doctor of Physical Therapy (DPT) students' perspectives on physical therapy practice throughout their entry-level education. Methods. A total of 44 students completed semistructured interviews that included both general and specific descriptions of their perceptions of physical therapy practice at 3 points during their DPT education: first, third, and eighth semester. The qualitative process of thematic analysis was used to identify patterns in the interview data. Patterns of change at both the group and individual levels within each coding dimension were identified. Results. First-semester students demonstrated a biomedical perspective focused on fixing problems related to specific pathologies while prioritizing the physical therapist's medical knowledge. Eighth semester students demonstrated a broader spectrum of perspectives with some retaining a biomedical view and others recognizing a more collaborative approach to practice with an emphasis on patient education and empowerment. There were high levels of variation in student development that became more pronounced as students moved through the curriculum. Discussion and Conclusions. Students' perspectives become more divergent over the 3 years in the program suggesting that natural development through classroom and clinical learning may not be sufficient for some students to develop comprehensive, patient-centered perspectives. The inconsistencies in development suggest that programs may need to give more explicit attention to students' development of perspectives/understandings in order to foster comprehensive development of patient-centered clinicians.