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.

What methods are being used to teach clinical reasoning in physical therapy education and are they effective? A systematic review of literature

“…of the 12 articles selected for this review, 10 were quantitative studies [9][10][11][12][13][14][15][16][17][18] and 2 were qualitative studies [19,20]. The quantitative studies included 1 randomised controlled trial, 5 pretest/posttest design studies with control, and 4 posttest design studies with no controls.…”

“…Eleven of the studies assessed only PT students, while 1 study assessed PT along with students from other allied health professions including medicine, pharmacy, occupational therapy and physician assistant [9]. Four of the studies involved 'pre-clinical' PT students [9,12,14,18]; 1 study involved 'pre-clinical' MPT students [10]; 3 studies involved final year dPT/PT students [11,15,20] [17,19]; 1 study involved 2 nd year physiotherapy students [16]; and 1 study involved dPT students in an undefined year in the academic program [13].…”

“…Results of the Critical Review Form: Qualitative Studies (version 2.0) demonstrated overall quality in all 7 assessment criteria, with a few minor exceptions for the two qualitative studies. Sampling methods for both were not done until redundancy, and the study by LaRosa and dinsmore [20] did not use inductive analysis or show evidence of transferability (Table 3).…”

“…Montpetit-Tourangeau et al [16], assessed clinical reasoning performance based on faculty evaluation of student problem-solving using a pretest and 2-phase posttest design and Ladyshewsky [11] created an 8 question post-encounter questionnaire to assess students' abilities in the area of diagnosis, management, history and physical exam features. The two qualitative studies [19,20] assessed strategies used in the process of clinical reasoning. one of the two qualitative studies compared the number of ideas in CR categories [19], while the other used the think aloud methodology with concurrent verbal data collection and counting the number of hypotheses generated [20].…”

“…The two qualitative studies [19,20] assessed strategies used in the process of clinical reasoning. one of the two qualitative studies compared the number of ideas in CR categories [19], while the other used the think aloud methodology with concurrent verbal data collection and counting the number of hypotheses generated [20].…”