A term that is used with different meaning in a variety of health care professions and contexts,and is understood differently even among members of the physical therapy profession

In the context of allied health professional literature, is most commonly understood to represent the thinking and associated decusion making of the clinician in practice

An individual process of diagnosis occuring inside of the clinical’s head

process of reflective inquiry, in collaboration with a patieny or family, which seeks to promote a deep and contextually relevant understanding of the clinical problem, in order to provide a sound basis for clinical intervention

A common finding across research that distinguishes characteristics of expert physical therapists practice is their ability to create a collaboratively oriented clinical reasoning exchange with their patients, caregivers and other members of the health care team

Knowledge

Clincial reasoning

Movement

Virtues

Each dimensions also contributed and was influenced by the experts’ knowledge of practice

The physical therapists’ focus was on medical diagnosis

Focused on understanding a patients story

Used clinical reasoning as a tool to fit the patient story within their clinical and experiential knowledge

Practice methods served to facilitate the collaboration that the expert practitioners valued in clinical practice

Focuses more on themselves

More therapist-centered, lacking in collaboration with less focus of understanding of patient as a person in favor of a narrower focus on only the physical aspects of patient presentation

Can be provided strategies to promote their own clinical reasoning development within the context of an explicitly biopsychosocial oriented, patient centered, collaborative approach to PT practice

Strategies used for diagnosing the patient

Used to drive ethical problem solving as it arises in the diagnostic and management phases of patient care

Strategies used throughout the managment components of patient care

Employs development and systematic testing of hypothesis to establish a cause and effect relationship between variables

Does not involve the development or testing of hypotheses, but rather it proceeds from a thorough understanding of the particulars of the case, including the context in which the PT interacts with the patient

Eliciting of data directly from patients, from their perspective, in order to understand that individual’s own perspective or story

Deductive

Inductive

Both inductive and deductive

Required knowledge of what information is needed

Required knowledge of how that information is interpreted

Necessary information and interpretation strategies must be implemented for data from both the patient interview or interation and the physical examination

Requires establishment of and understanding of the person inside the patient

This strategy involves an understanding of the patients’ story, illness experience, context, beliefs and culture

Requires choice in administration of interventions

Uses re examination to help determine progress and outcomes

Requires a means of approach and interaction with the patient

The goal of this interaction is the establishment of rapport

Requires a working relationship with patient

Include a distribution of power in the decision making process

Fosters a consensual approach in interpretation of examination data, setting an prioritization of intervention goals and choice of intervention approach

Requires approaches and strategies for educating patients

Requires therapist to verify that new information has been understood by the patient

Requires focus on the process of develiping a prognosis

Choices about management and the implications of those choices should be explored and considered

Requires the awareness and resolution of both ethical and pragmatic dilemmas in patient practice

The end result should be doing the right thing as dictated by all of the situational variables and constraints

Practitioner knowledge, values and obligations

Patient/carer knowledge, values and perspective

Deductive

Inductive

Means through which experienced PTs link their narrative and principle based reasoning strategies

Instruction in clinical and ethical reasoning as part of a physical therapy curriculum is common

Research revealed that the student participants understood clinical reasoning to be a sequential, linear process of inductive problem solving

Students demonstrated a lack of awareness of the role of collaboration in the clinical reasoning process

Considers the ethical principles and norms of the profession at issue in the situation

Where students personal narratives were evident and formed primarily by the students past histories and their interpretations of their roles as both students and future PTs

Clinical and lay language was used rather than the specific language of bioethics

Critucal aspect of the educatuin of professionals

Not only are students learning to “____” physical therapy, they are learning to “____” a physical therapist

Implies the creation of an identity as a PT and adopting the spirit and ethos of the profession

Adoption of a specific philosophy for the approach to patients integrated through all applicable courses in the curriculum

Biopsychosocial approach

Portifolio that includes the development of a philosophy of practice through the course of matriculation in the program

Student’s personal beliefs about the relationship a physical therapist has with patients

Student’s belief about the moral role of PTs

Standardized patients for practical exams

Rubrics that include student’s use of clinical reasoning strategies in standardized patient encounters

Student’s written critical self-reflection on the clinical reasoning strategies in standardized patient encounters

Clinical faculty development workshops mentoring students’ clinical reasoning capability

Use rubrics on clinical reasoning from the standardized patient encounters in the academic setting for feedback and mentoring during clinical experiences

Ask for student’s criticial self reflection on their clinical reasoning strategies ff patient visits

Faculty development workshops mentoring students’ clinical reasoning capability

Rubrics on clinical reasoning from standardized patient encounters in the academic setting used for feedback and mentoring during clinical experiences

Student’s critical self reflection on their clinical reasoning strategies following patient visit

The justified confidence and ability to interact effectively with other people and tasks in unknown contexts of the future as well as known contexts of today

Described as the integration and effective application of thinking and learning skills to make sense of and learn collaboratively from clinical experiences

Proposes 4 key dimensions of clinical reasoning capability, which are congruent with the descriptions of thinking an learning skills inherent in the clinical reasoning of expert PTs

Clinical reasoning capability

The clinical environment provides an ideal avenue for critical self reflection to foster professional formation

Reveal the students meta cognitive processes

Question their assumptions

Examine their relationships with patients and caregivers

Evaluate their deductive and inductive thinking

How a clinician has decided to describe the parient presentation— what it consists of

Critical examination of the problem solving strategies being used

Questioning the validity of the underlying assumptions that may have guided thinking or actions

Drawing the students’ attention to what they feel they have learned through the process of critical self reflection

what do you think are the cause and effect relationships underlying the presentation?

What is your understanding of the patient’s perspectives on his problem?

How did you empirically validate any cause and effect relationships you have recognized?

How did you determine that you understood your patient’s perspectives or history?

What do you think your assumptions are about the way this type of patient or person this is?

Do you have any assumptions or biases about the type of patient or person this is?

How do you know your assumptions are valid or invalid?

What have you learned from questioning your assumptions?

Should you or should you not revise your own perspectives?

Will you think or do anything differently in the future based on this experience?