Use of the Dual-Processing Theory to Develop Expert Clinical Reasoning in Physical Therapy Students

Abstract

Background and Purpose. Cognitive error as a result of poor judgment accounts for a significant percentage of diagnostic errors in medicine. Use of judgment in the clinical setting can be described as clinical reasoning. Therefore, if educators of PT students intend to cultivate safe and effective practitioners, it is imperative to assist students in the development of effective judgment in addition to requisite knowledge and skills. Despite the importance, there are currently many limitations in clinical reasoning research in the field of physical therapy education. The purposes of this article are to introduce dual-processing theory as a means of conceptualizing clinical reasoning in physical therapy education and to provide recommendations for development of clinical reasoning. Position and Rationale. Clinical reasoning in physical therapy education lacks a unified theoretical framework from which to base instructional methods. It is the opinion of this author that in conjunction with an understanding of the development of expertise and expert performance, the dual-processing theory of reasoning provides an optimal foundation for clinical reasoning instruction and assessment. The dual-processing theory is underused despite being the prevailing theory to describe reasoning in health care providers. The dual-processing theory describes clinical reasoning as a balance between type I, intuitive, and type II, analytical processing. The final decision made is the result of the interaction between the two types of processing rather than sole reliance on analytical or intuitive thinking alone. This balance is how health care providers make decisions during the evaluation, examination, and treatment of patients. A key component in the ability to accurately manage the use of both types of processing is the awareness of the accuracy of thought processes. This awareness is also referred to as metacognition and is the necessary component of accurate clinical reasoning. Discussion and Conclusion. This position paper addresses one of the current limitations in clinical reasoning research in physical therapy by providing a theoretical rationale for use of the dual-processing theory in conceptualizing the components of clinical reasoning. PT students must cultivate an awareness of the accuracy of their thought processes in addition to acquiring deep-structure disciplinary knowledge. In accordance with the dual-processing theory as the theoretical framework for clinical reasoning, explicit teaching of accurate metacognitive self-monitoring in physical therapy education is integral to effective clinical reasoning.