Physical Therapy Students’ Application of a Clinical Decision-Making Model

Purpose: Most educational programs in the health sciences present their students with a clinical decision-making model (CDMM) to help them define and treat client problems with a client-centered approach. However, little is known about how well students apply such a model in a clinical setting. The purpose of this study was to determine whether physical therapy students used a CDMM to make clinical decisions, and how well they used it. Method: Fifty-four physical therapy students in their first full-time clinical placement were asked to write up one of their client cases explaining how they made their clinical decisions and evaluating the success of these decisions. Three faculty members used a standardized form to assess each student’s use of various components of the CDMM. Results: Students were generally better at following the CDMM for obtaining information (history and assessment) and determining a diagnosis, than they were for planning goals and methods of treatment. Most students emphasized impairment rather than activity or participation, and did not consider the client’s specific concerns. Although few students defined measurable outcomes for their clients, they still felt that their decisions were well founded and that the clients got better. Conclusions: Physical therapy students in their first major clinical placement believe that they are using the CDMM “automatically” and are making appropriate clinical decisions for their clients. However, students need assistance to effectively use all the steps in the CDMM to design client-centered, outcome-oriented treatment.