Examining the Influence of Cognitive Load and Self-Efficacy on the Development of Clinical Reasoning in the First Clinical Education Experience of First Year Physical Therapy Students

Authors

• Andrew S. Bartlett, California State University NorthridgeFollow
• Brittney Gunterstockman, Lincoln Memorial UniversityFollow

Abstract

Purpose: Clinical reasoning is critical for effective decision-making and patient outcomes in physical therapy. Although self-efficacy, cognitive load, and clinical reasoning have been studied individually, limited research has examined these constructs holistically. This study explored the influence of cognitive load and self-efficacy on the development of clinical reasoning during the first clinical education experience of first-year Doctor of Physical Therapy students using a think-aloud protocol. Methods: All participants completed measures of self-efficacy (New General Self-Efficacy [NGSE], Physical Therapist Self-Efficacy [PTSE]) and cognitive load (intrinsic, extraneous, germane) before and after their first clinical education experience. Think-aloud protocols were conducted at both timepoints. Quantitative data were analyzed using nonparametric tests, and qualitative transcripts were coded for reasoning strategies and stumbling blocks. Results: Six first-year DPT students from two institutions. NGSE and PTSE scores improved significantly (p=.04), while cognitive load scores did not change significantly (p>.05). Qualitative analysis revealed a reduction in stumbling blocks and more sophisticated clinical reasoning strategies after the clinical experience, including greater use of rule-in/rule-out, pattern recognition, and hypothetico-deductive strategies. Conclusion: First-year DPT students demonstrated improved clinical reasoning strategies after their first clinical education experience despite minimal changes in self-efficacy and cognitive load. Recommendations: Think-aloud protocols provide faculty with valuable insights into students’ reasoning processes and may inform curricular approaches to enhance self-efficacy and manage cognitive load.

Author Bio(s)

Andrew S. Bartlett, PT, PhD, MPA is an Associate Professor in the Department of Physical Therapy at California State University Northridge in Northridge, CA. He is also a licensed physical therapist in the state of California.

Brittney Mazzone Gunterstockman, PT, DPT, EdD is Department Chair and Assistant Professor in the Doctor of Physical Therapy Program at Lincoln Memorial University in Knoxville, TN. She is also a licensed physical therapist in the state of Tennessee.

Acknowledgements

The authors would like to thank the students at California State University Northridge, Lincoln Memorial University, and Nazareth University for their participation in this research.

Recommended Citation

Bartlett AS, Gunterstockman B. Examining the Influence of Cognitive Load and Self-Efficacy on the Development of Clinical Reasoning in the First Clinical Education Experience of First Year Physical Therapy Students. The Internet Journal of Allied Health Sciences and Practice. 2026 Sep 01;24(3), Article 6.