(How) Can We Understand the Development of Clinical Reasoning?

Abstract

Clinical reasoning is a topic that has received significant attention over the last decade, within both the academic and clinical communities. The numerous and varied publications in the Journal of Physical Therapy Education (JOPTE) reflect the profession's interest in studying clinical reasoning in physical therapy education and practice.In this issue, 4 papers address the topic of clinical reasoning. Drs Huhn and Parrott present a research report exploring the use of the Health Sciences Reasoning Test (HSRT) and academic measures (GPA and GRE scores) at the time of admission to predict physical therapist (PT) student success on the NPTE.1 This paper builds on Dr Huhn's prior work examining the utility of the HSRT in demonstrating development of critical thinking skills across PT education programs.2 Drs Venskus and Craig have developed and validated a tool to measure the degree of self-efficacy with respect to the development of clinical reasoning skills reported by PT students. This paper adds to the growing body of literature about the development of clinical reasoning, specifically addressing the student's capability to reason.3The other 2 papers in this issue are research reports that explore the development of clinical reasoning abilities. Dr. Gilliland has applied qualitative research methods to explore the development of diagnostic reasoning in PT students. She employed think aloud processes using a musculoskeletal paper case at 2 points in the students entry-level PT education to identify evolution of diagnostic reasoning.4 Drs Trommelen, Karpinski, and Chauvin studied the effectiveness of a novel instructional activity to promote reflection in a case-based delivery model for neuromuscular physical therapy.5 Like Drs Huhn and Parrott, these authors used standardized measures (the Diagnostic Thinking inventory and the Self-Assessment of Clinical Reasoning Tool) to demonstrate improvement in the student's clinical reasoning and reflective abilities. One of the challenges in conducting and applying this research is the varied methods and assessment tools that are used in studying clinical reasoning.Study of clinical reasoning in PT students has demonstrated that clinical reasoning abilities develop over time within PT curricula.6,7 Research on expertise has demonstrated the continued development of these clinical reasoning abilities beyond formal entry-level education. For example, a study of promising novices over a 2-year period as they entered practice indicated ongoing development and subsequent expansion and refinement of formal and informal learning, clinical skills, and collaboration.8 Findings such as these indicate the importance of creating opportunities to develop clinical reasoning skills as a student and novice practitioner.Another area of study in clinical reasoning has been the development of rubrics to assess clinical reasoning during practical assessment of student's clinical knowledge and skill performance. Two such assessment tools have been reported in JOPTE. The Think Aloud Standardized Patient Examination (TASPE)9 was developed to assess clinical reasoning competency in novice physical therapy students during standardized musculoskeletal patient encounters. Using the TASPE, students are assessed on their ability to synthesize data to inform think-aloud sessions across the hypothetico-deductive reasoning process: hypothesis generation, hypothesis evaluation, and intervention. A second tool, the Clinical Reasoning Grading Rubric, 10 has 2 intended purposes: (1) assess the clinical reasoning skills of PT students, and (2) evaluate readiness to progress to full-time clinical education. This tool incorporates assessment across cognitive, psychomotor, and affective domains with criteria from low to high performance of knowledge, skills, and attitudes.Another category of study is the development of skills that are components of clinical reasoning. Several studies exploring the development of critical thinking have been published in JOPTE over that past few years. …