Purpose: Clinical reasoning is a critical skill required to be an effective clinician in today’s dynamic and complex healthcare environment. Reflective ability is considered foundational for building clinical reasoning skills. The purpose of this mixed methods study was to explore the clinical reasoning strategies used by Doctor of Physical Therapy (DPT) students during a computer-based simulation and the relationship between the quality of reflection and clinical reasoning strategies used. Methods: Forty-five first (n=15), second (n=23), and third (n=7) year DPT students enrolled in six professional DPT programs in the United States participated in an asynchronous computer-based simulation designed to facilitate clinical reasoning and decision-making. The written responses to open-ended questions collected during the computer-based simulation and subsequent written self-debrief were analyzed qualitatively and quantitatively. Results: Students demonstrated the use of four main clinical reasoning strategies. More sophisticated reasoning strategies were observed in greater frequency among second and third-year students. The quality of reflection of the written responses to the self-debrief was variable. A correlational analysis using Fisher’s exact test demonstrated there was not a statistically significant relationship between reflection quality and clinical reasoning strategy used during the simulation. Conclusions: Results were consistent with the findings of other studies that observed a progression along class years toward more sophisticated reasoning strategies with increased focus on the factors that contribute to patient impairments. Quality of reflection was not found to be associated with the clinical reasoning strategy used by participants. This highlights the need for additional research to determine the factors that impact clinical reasoning and reflective ability to inform the development of effective methods of instruction and assessment of these skills.

Author Bio(s)

Denise Romano, MPS PT, EdD, CHSE, CSCS is an Assistant Professor in the Decker College of Nursing and Health Sciences at Binghamton University.

Alyson Pasquale, OTD, MS, OTR/L is a Clinical Associate Professor in the Decker College of Nursing and Health Sciences at Binghamton University.



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