Clinical Reasoning in Athletic Training Education: Modeling Expert Thinking

Abstract

Objective: To address the need for a more definitive approach to critical thinking during athletic training educational experiences by introducing the clinical reasoning model for critical thinking. Background: Educators are aware of the need to teach students how to think critically. The multiple domains of athletic training are comprehensive and complex. Thinking is the fundamental connection between didactic and experiential components. Therefore, clinical thinking must be viewed as a critical part of experiential education in athletic training. Description: Research from educational journals in medicine, physical therapy and athletic training, as well as relevant texts, were searched to investigate the theoretical and practical underpinnings of clinical thinking models. Definitions, applications, and the historical underpinnings of the clinical thinking processes in allied health were reviewed and presented to highlight the need for athletic training educators to better appreciate the thinking processes of students and practitioners. Practical suggestions for the implementation of clinical reasoning in athletic training are presented. Application: Athletic training requires clinically based decision-making and problem solving skills. Medical educators recognize differences between the thinking of novice and expert practitioners, and have investigated the nature of clinical cognition as part of their formal curriculum. As AT's professional scope and credibility expand, the process of teaching, fostering, and evaluating clinical reasoning is paramount for AT educators.

Commentary: The Use of Case-based Learning and Concept Mapping to Teach Students Clinical Reasoning

“…The challenge presented to classroom instructors and clinical preceptors is how to teach clinical reasoning processes in a manner that best prepares learners for clinical practice. In 2009, Geisler and Lazenby 4 advanced the discussion in athletic training education of the importance of helping ATSs think by presenting two types of clinical reasoning: hypothetico-deductive reasoning (HDR) and case pattern recognition (CPR).…”

“…Geisler and Lazenby refer to this as a miseducative experience. 4 Returning to the example above, the ATS followed CPR, albeit without the necessary knowledge and experience to do so. Her failure was because she was not adequately prepared to use HDR and CPR.…”

Challenges Facing New Educators: Expanding Teaching Strategies for Clinical Reasoning and Evidence-Based Medicine

“…Clinical experience assists with decision making and reasoning. 4,5 Without practice experience new faculty members in healthcare professions can easily become overwhelmed. In an editorial, Turocy 6 highlighted the differences between those who are experts in a specific content area and those who are expert teachers.…”

Evaluating Evidence-Informed Clinical Reasoning Proficiency in Oral Practical Examinations

“…Central to this cognitive mechanism is the ability to consider and rule out relevant and competing differential diagnoses in order to act upon subsequent management decisions, and to develop safe and effective plans of care for patients. 1 Athletic training is no different than its medical and health care contemporaries-both students and practitioners need to develop and display effective clinical reasoning skills in the assessment of injury and illness in order to provide evidence-based functional outcomes. In clinical practice, a sound and accurate diagnosis (Dx) is indeed the first step towards developing favorable and efficient outcomes; thus, the thinking process that initiates each and every patient encounter must be sound and sophisticated.…”

“…Whereas novice clinicians favor the more intuitive, hypothetico-deductive approach to reasoning that's characterized by the formation of multiple hypotheses followed by prolonged, unorganized, and time-intensive evaluation procedures, more experienced practitioners display more streamlined and accurate thinking by using case pattern presentation (CPP) as their primary mode of thinking through complex patient problems. 1 It is central to the ability to formulate, store, and recall specific CPPs that the capable clinician be able to readily identify key features (KFs) that fit within a known and experienced pattern, while equally recognizing features that don't fit known or previously experienced patterns-which lead to new case patterns, in a cyclical fashion. Akin to an experienced criminal detective, an experienced clinician is able to quickly and adeptly discern relevant from irrelevant data points, and, better yet, accurately connect the dots between various features (signs, symptoms, mechanism of injury, physical exam results, etc) presented before him or her.…”