A comparison of instructional methods on clinical reasoning in entry-level physical therapy students
Authors:   , Kobal Kara L. , Finley Margaret A 
Published: September 2022

Introduction: Developing clinical reasoning in entry-level physical therapy students is of increasing interest to physical therapist education programs in the United States. Despite this, many physical therapist education programs lack tools and pedagogical approaches for developing and assessing clinical reasoning across the continuum of didactic education. There is a need for evidence-based approaches to develop and assess clinical reasoning in entry-level physical therapy students. The primary aim of this study was to provide a comparison of the effects of two commonly used pedagogical approaches (paper-based case studies versus authentic patient experiences) on clinical reasoning and critical thinking of second year entry-level physical therapy students. It was hypothesized that students who received authentic patient experiences would demonstrate improved critical thinking and clinical reasoning when compared with students who received paper-based case studies or students assigned to a control group. The secondary aim of this study was to explore associations between characteristics of physical therapy students and their performance on (1) a standardized measure of critical thinking and (2) their self-reported reflection and clinical reasoning ability. Methods: A total of 23 students in their second year of a Doctor of Physical Therapy degree program at a small, rural university participated in this study. Participants were randomly assigned to a control group or to receive one of two supplemental learning activities (paper-based case studies or authentic patient experiences). Five one-hour sessions were completed over 5 weeks. Outcomes measured pre- and post- intervention included the Health Science Reasoning Test with Numeracy (HSRT-N) and the Self Assessment of Clinical Reasoning and Reflection (SACRR). Total time between pre- and post-testing was 7 weeks. Data analysis included a comparison of effect sizes of change scores between groups and correlational analysis of pre-test scores and student factors. Results: When compared with paper-based case studies, authentic patient experiences demonstrated a moderate to large effect size for improved HSRT-N scores on 5/8 subscales. The addition of 5 hours of authentic case instruction resulted in moderate to large effect size improvements to the HSRT-N scores for 2/8 subscales and improved SACRR scores when compared with the control group. A strong positive correlation existed between grade point average and pre-test HSRT-N scores. Discussion and Conclusion: When compared with paper-based case studies, the use of authentic patient experiences in an entry- level DPT curriculum may be more effective for improving critical thinking and clinical reasoning. Furthermore, the addition of five hours of paper-based case studies did not show benefits using the outcome tools utilized. The selection of pedagogical approaches to improve critical thinking and clinical reasoning based on sound evidence gained from randomized controlled trials is lacking in physical therapy education. The knowledge gained as a result of this study is significant because it provides a scientific premise for the selection of teaching methodologies as they relate to developing clinical reasoning in physical therapy students. Key Words: clinical reasoning, critical thinking, teaching methods, student outcomes, teaching and learning