The Effect of Case Presentation on Student Physical Therapists' Clinical Reasoning Hypotheses

Abstract

Purpose: Clinical reasoning is an essential skill for Physical Therapists to develop for making sound decisions regarding patient care. Case-method teaching is an instructional strategy commonly implemented in physical therapy professional education programs for facilitating clinical reasoning skill acquisition. One advantage of case-method teaching is the various ways cases can be portrayed. The purpose of this study was to identify how a case is portrayed effects student thinking and their subsequent clinical decision making. Method: Third-year student physical therapists (n = 14) working in dyads clinically reasoned through a hypothetical musculoskeletal case presented via written case study or simulated patient experience. Talk aloud methodology via concurrent reports was implemented for data collection. Mann-Whitney U-tests followed by manual calculations of effect sizes were conducted for comparing hypothesis category generation between groups. Results: A total of 14 hypothesis categories were generated by the student dyads during the problem-solving sessions. Specifically, students generated more ideas regarding health condition, and contextual factors when thinking through a written case study whereas significantly more thoughts regarding symptom characteristics, client perspectives, and minimizing reasoning errors were generated during simulated patient experiences. Conclusion: When implementing case-method teaching, physical therapy academic educators need to be aware that the manner a case is portrayed affects the clinical judgements students generate and their learning of clinical reasoning. Future research should continue to investigate these effects and how they ultimately impact clinical practice.