L'évaluation du raisonnement clinique en physiothérapie

Major changes have occurred in the last few decades in teaching the health sciences at the university level in professional training programs. One of these major changes is that most professional training programs have now adopted a competency-based approach. At the same time that this change in training paradigm was occurring, health professions were increasingly considering clinical reasoning as being at the core of clinician competency and were granting it increasing importance in their programs. These two changes in health-science training put into question the methods for assessing clinical reasoning in a competency-based approach. One of the responses to this questioning was the emergence of tests to assess clinical reasoning in the field of medicine. Indeed, over the last 20 years, instruments such as the script concordance test (SCT) and clinical reasoning problems (CRPs) were developed and have been studied primarily in the various medical specialties. While physiotherapy and medicine share a number of characteristics, they also have several differences. As a result, the appropriateness of using these tools in the specific context of physiotherapy is an issue that should be explored.  In an attempt to gather data, versions of these tests were developed using a table of specifications for a course in the physiotherapy program at the Université de Sherbrooke and were administered to 93 volunteer students from the second, third, and fourth year of the program. In accordance with the scoring procedure for these tests, a panel of experts in the field (n = 19) also responded to the items.  The results obtained indicate that the SCT revealed significant differences between novice students (second year) and graduating students (fourth year) in the physiotherapy program with a significant effect size (Cohen d = 0.85). In contrast, there were no significant differences between the average score for third-year students and the other two cohorts. Significant differences were noted between the scores of the panel of experts and those of the students from the three cohorts. With respect to CRPs, the scores do not allow us to distinguish the level of clinical-reasoning development of physiotherapy students in the three years of training studied. On the other hand, as with the SCT, there were significant differences between the scores of the panel of experts and those of the students from the three cohorts. Moreover, we analyzed and categorized the 183 rotation forms of the students who participated in the study. These forms were categorized according to level of clinical reasoning based on the observations of rotation supervisors. The results of this part of the study suggest that the CRP scores were discriminating in terms of rotation results for the various categories of results. As for the SCT, the students who encountered difficulties with clinical reasoning during rotations also had the lowest SCT scores. Consequently, these tools may also be able to screen for students who have problems with clinical reasoning and could benefit from remedial assistance at this level. On the other hand, while these results are encouraging, the population sample of students with clinical-reasoning difficulties during rotations in this research was small. Therefore, the role of any possible screening requires confirmation through a broader study.

Keyphrases: Assessment, Physiotherapy teaching, Script concordance test, Clinical reasoning problem, Clinical placement