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Clinical Reasoning in Musculoskeletal Practice: Students’ Conceptualizations

P Hendrick, BSc(Hons), GradDipPhty, PGDMPhty, MMPhty, MNZSP, is Professional Practice Fellow, Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, PO Box 56, Dunedin, New Zealand.
C Bond, PhD, MCSP, is Academic Director, Student Learning Centre, and Senior Lecturer, The Higher Education Development Centre, University of Otago.
E Duncan, PhD, BSc(Hons), is Research Assistant, School of Physiotherapy, University of Otago.
L Hale, PhD, MSc(Physio), BSc(Physio), FNZCP, is Senior Lecturer, Centre for Physiotherapy Research, School of Physiotherapy, University of Otago.

Address all correspondence to Mr Hendrick at: paul.hendrick{at}otago.ac.nz or Paul-Sinead{at}xtra.co.nz

Background: Qualitative research on physical therapist students’ conceptualizations of clinical reasoning (CR) is sparse.

Objectives: The purpose of this study was to explore CR from students’ perspectives.

Design: For this study, a qualitative, cross-sectional design was used.

Methods: Thirty-one students were randomly selected from years 2, 3, and 4 of an undergraduate physical therapist program in New Zealand. Students were interviewed about their understanding of CR and how they used it in practice in a recent musculoskeletal placement. Interviews were recorded and transcribed verbatim. A 3-stage analysis included the categorization of students’ conceptualizations on the basis of the meaning and the structure of each experience and the identification of cross-category themes.

Results: Five qualitatively different categories were identified: A—applying knowledge and experience to the problem, patient, or situation; B—analyzing and reanalyzing to deduce the problem and treatment; C—rationalizing or justifying what and why; D—combining knowledge to reach a conclusion; and E—problem solving and pattern building. Cross-category analysis revealed 5 general themes: forms of CR, spatiotemporal aspects, the degree of focus on the patient, attributions of confidence, and the role of clinical experience.

Conclusions: Categories formed a continuum of CR from less to more sophistication and complexity. Students were distributed evenly across categories, except for category E, which included only students from years 3 and 4. Each category comprised a logical, coherent experiential field. The general themes as critical dimensions suggest a new way of exploring CR and suggest a possible pathway of development, but further research is required. These findings have implications for teaching and the development of physical therapy curricula.

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