Clinical Reasoning in Musculoskeletal Practice: Students' Conceptualizations

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.