The Novice Versus the Experienced Clinician: Insights into the Work of the Physical Therapist

Abstract

The purpose of this study was to develop a conceptual framework and a data-collection tool to begin a systematic analysis of the work of the physical therapist. The primary method of data collection was nonparticipant observation of physical therapist-patient treatment sessions. A team of two researchers performed each of the observations. Eight physical therapists, representing three levels of experience, were observed in four different adult outpatient orthopedic settings. Field notes constructed from the observations and transcribed data were used to develop coding categories. These categories were the basis for the development of five themes that describe some aspects of the therapeutic intervention: 1) how treatment time is allocated, 2) the types and uses of information gathered from the patient, 3) the impact of the therapeutic environment, 4) the degree of responsive therapeutic interaction, and 5) the therapist integration of nontherapeutic interaction with therapeutic interaction. These findings are a beginning for understanding the practice of physical therapy.

A qualitative grounded theory study of the conceptions of clinical practice in osteopathy – A continuum from technical rationality to professional artistry

“…This finding is consistent with findings from research investigating the clinical reasoning of musculoskeletal physiotherapists (Noll et al, 2001;Thornquist, 2006;Cruz et al, 2012). Practice akin to technical rationality has been considered an attribute of novice healthcare practitioners (Jensen et al, 1990(Jensen et al, , 1992Unsworth, 2001;Smith et al, 2008, Smith et al, 2010, where practice is characterised as being practitioner-centred, emphasising the application of specific factual knowledge and technical skills in a routine predictable manner. In this current study, no relationship between participants' years of clinical experience and their conception of practice was found.…”

Manipulating practices: A critical physiotherapy reader

“…The language used in this approach reflected objectivity and precision and often included short, closed questions from the therapist with similarly short responses from the patient. This communicative approach has also been found in other authors' descriptions of the communicative and cognitive processes of clinical reasoning (Jensen, Shepard & Hack, 1990;Talvitie & Reunanen, 2002).…”

Reconsidering the patient-centeredness of osteopathy

“…35 Interestingly, these researchers claimed that the experienced practitioners appeared to 'enter the lives' of their patients with a two-way dialogue eliciting and providing information pertaining to the treatment. 36 During the same period, researchers in other health professions, such as occupational therapy were recognising that their practitioners went beyond only reasoning towards a diagnosis, but they took a 'patient-centred' and individualised approach to patient treatment and management. 37,38 Occupational therapists tailored their treatment approach to suit the individuality of the patient.…”