Background;
With the recognition of the impact of lifestyle-related behaviours on health and illness there is a need to advance the clinical reasoning of health professionals in general and physiotherapy students in specific. Enabling such advancements requires robust assessments and knowledge regarding factors associated with physiotherapy students’ clinical reasoning outcomes. The aim of this project was to develop a web-based clinical reasoning instrument to assess physiotherapy students’ clinical reasoning and investigate individual- and curriculum level predictors of their clinical reasoning outcomes.
Summary of work;
A new clinical reasoning instrument was developed based on theory, evidence and expert opinions. Reliability and validity of the instrument were evaluated including physiotherapy students and physiotherapists. 151 physiotherapy students in their final semester at the eight entry-level programmes in Sweden responded the instrument and data were analysed with multiple regression analysis.
Summary of results;
The web-based instrument, named Reasoning 4 Change (R4C), comprise four domains related to 1) physiotherapists’ capabilities, skills, attitudes and beliefs 2) history-taking and examination, 3) analysis and 4) treatment strategies to support behaviour change. The instrument is built up of several case scenarios and incorporates a holistic, client-centred and behavioural focused clinical reasoning process. The instrument demonstrated satisfactory reliability and validity. Cognitions, attitudes and curricula content were significantly associated with students’ clinical reasoning outcomes in the end of their education.
Discussion and Conclusions; The R4C instrument fills a gap in education and can support investigations and evaluations of students’ clinical reasoning focused on clients’ behaviour change. To develop students’ clinical reasoning competence, cognitive, metacognitive capabilities and skills, positive attitudes, and behavioural medicine content in curricula need to be targeted.
Take-home Messages: The web-based R4C instrument is ready to be used in physiotherapy education evaluation. With some modifications the instrument may be used in other health professional educations as well. To improve physiotherapy students’ clinical reasoning for the benefit of clients’ health-related behaviour change, education interventions should focus on developing students’ analytical and reflective capabilities and skills. Also, a learning environment that support positive attitudes towards the integration of biopsychosocial and behavioural considerations in clinical reasoning should be encouraged.
2019. p. 883-883