Clinical Reasoning in First- and Third-Year Physical Therapist Students

Background and Purpose. The development of clinical reasoning skills is a crucial component of professional physical therapist education. Prior research has described reasoning patterns in novice and expert practitioners, yet little is known about how professional physical therapist (PT) students develop clinical reasoning skills. The purpose of this study was to explore how first-year PT students perform clinical reasoning in comparison to third-year PT students in their final semester. Subjects. A simple random sample of 6 first-year (mean age 23.1 years) and 6 third-year (mean age 27 years) Doctor of Physical Therapy students were recruited. Methods. Participants completed an evaluation and treatment plan for a simulated patient case while performing a think-aloud. Participant strategies were identified based on patterns of examination data collected and hypotheses formed. Participant hypotheses and final assessments were coded for dimensions of the International Classification of Functioning, Disability and Health (ICF). Results. Qualitative differences were found between first- and third-year students in categories of hypotheses formed, assessments made, and treatments selected. Six reasoning strategies were identified. Third-year students demonstrated use of the 3 more sophisticated strategies, while first-year students used only the 3 simplest strategies. First-year students demonstrated 3 faulty patterns of reasoning that were not present in the work of the third-year students. Discussion and Conclusion. This study provides a preliminary description of clinical reasoning strategies used by first-and third-year physical therapist students. Third-year students demonstrated reasoning strategies previously described in studies of novice practitioners, while first-year students demonstrated reasoning errors not previously described in the literature. These findings may inform curricular design to promote effective development of clinical reasoning.