Utilization of the Clinical Reasoning Assessment Tool Across a Physical Therapy Curriculum: Application for Teaching, Learning, and Assessment

Abstract

Introduction. Clinical reasoning is a multifaceted skill set crucial to optimal patient care. The ability to assess development of clinical reasoning skills in entry-level physical therapist students continues to be challenging. The Clinical Reasoning Assessment Tool (CRAT) was developed in order to assess students' progress in the essential link between clinical reasoning and the development of knowledge. Based on a previously published tool (Clinical Reasoning Grading Rubric), the CRAT considers 3 domains representing clinical reasoning and knowledge development (content knowledge, procedural knowledge and psychomotor skills, and conceptual reasoning). The purpose of this study was to determine whether the use of the CRAT would reliably reflect student progress in acquisition and application of clinical reasoning skills across didactic and clinical components of physical therapist education and to determine whether case context impacts performance. Methods. A cross-sectional study was performed using the CRAT to assess student performance at 4 specific time points across 2 years of a physical therapy curriculum. Fifty-five students from 2 consecutive class cohorts were assessed using the CRAT. Eleven assessors scored 172 completed tools using a visual analog scale representing a learner continuum (beginner, intermediate, competent, and proficient). Analysis of variance (ANOVA) was used to determine whether time and case context were predictors of performance in each of the 3 clinical reasoning domains. Results. Mean scores in each of the 3 domains steadily increased at each performance assessment point, and results of the ANOVA showed that each specified time point was significantly predictive of performance in each of the 3 domains of interest (P < .0001 for each). In addition, case context is predictive of procedural knowledge (P = .007) and conceptual reasoning (P = .0297). Discussion and Conclusions. The results of this study, and observations related to use of the tool, demonstrate the utility of the CRAT in measuring the performance of physical therapy students.