Perspectives and Practice: Physical Therapist Students' Clinical Reasoning

Abstract

Introduction. Entry-level physical therapist (PT) educational programs need to prepare practitioners who engage in patient-centered clinical reasoning. Many factors, including health care practitioners' beliefs and values, influence how clinicians engage in clinical reasoning. Variations in students' characterizations of physical therapy practice may explain some of the differences observed in previous studies of clinical reasoning. This paper examines the relationship between PT students' characterizations of practice and their clinical reasoning during an encounter with a patient. Methods. This paper used a qualitative, descriptive case study method with thematic analysis. Eight entry-level doctor of physical therapy students from 2 programs participated in semistructured conceptual interviews and standardized patient encounters with retrospective think-aloud for this paper. Qualitative thematic analysis was used to examine the students' perspectives on practice and clinical reasoning strategies. The students' perspectives on the purpose and the patient's role in the physical therapy encounter were then analyzed for their relationship with the students' clinical decision-making processes during a standardized patient encounter. Results. The students demonstrated a spectrum of qualitative differences in both their perspectives and their reasoning. The students' clinical decision-making processes paralleled their views on practice. A negative case example illustrates the complexity of the relationship between perspective and practice. Discussion and Conclusion. Physical therapist students' approaches to a patient encounter parallel their perspectives on practice; however, students must also have the appropriate clinical skills to enact their characterization of practice. Entry-level PT educational programs should include learning opportunities that support students in developing patient-centered perspectives as well as the skills to carry out that practice.