He now has severe cerebellar ataxia. Terry, W. (1993). These researchers studied the clinical reasoning of expert physical therapists in multiple practice contexts (orthopaedic, neurologic, and home health settings) and proposed a model to depict and make explicit … Use of thrust joint manipulation by student physical therapists in the United States during clinical education experiences. Background and purpose: Clinical reasoning is essential to physical therapist practice. This course begins the development of critical thinking and reasoning strategies through clinical presentations and management. Exploration of Students' Clinical Reasoning Development in Professional Physical Therapy Education. Please enable it to take advantage of the complete set of features! Mezirow And then, at the end, I think we haven't covered shopping or we haven't covered toileting or pressure care or whatever the gaps are. 2020 Dec;28(5):266-274. doi: 10.1080/10669817.2020.1720948. Clinical Reasoning Symposium, July 24, 2017, Creighton University. Bob: Oh bitter? J: Mmmm. Thick description is an anthropological term56 referring to an in-depth description of particular and multiple characteristics of a case (ie, a particular therapist's clinical practice) in order to induct the reader into an experience of the situation. Using clinical outcomes to explore the theory of expert practice in physical therapy. Arocha , Quirk M, Sullivan M. May , Guba EG. Movement, as a procedure, includes several subcategories: touch, handling, palpation, massage, mobilization, manipulation, stretching, and guided exercise. N The grounded theory approach and case study work are both methods that seek to understand human behavior within a natural context and from the participants' point of view.38,39,46 The phenomenon studied is clinical decision making, and the context is the clinical practice in which this decision making takes place. So I guess I have got that sort of internal list, and I work out what hasn't been covered at the end. . (Denise, domiciliary care therapist), I actually think their information is more important than your own sometimes because that's the most powerful part of the relationship with them … and with subjectives [subjective examinations], I'll never write them up afterwards because it's just … it's so much information you're getting, and it's such valuable stuff. P Wife: I wouldn't want to know [pointing to her husband]. Our objective was to generate further theory concerning clinical reasoning in physical therapy. For example, randomized controlled trials are carried out within this paradigm of research. There's none of this, “Do this because I say so.” People say “no” to you more often in this setting than they ever would, even in your rooms or as an outpatient in the hospital; definitely as an inpatient in the hospital. JM The research approach we used follows that of Jensen et al.18 Using a grounded theory, case study approach within an interpretive research paradigm (explained in the “Method” section), Jensen and colleagues were the first researchers to systematically study the clinical work of physical therapists in order to differentiate novice practitioners from their expert counterparts. Individual case studies for each area were combined with the coded material from the interviews of the secondary sample of physical therapist experts to form 3 composite case studies. Mr G's daughter had been present and acting as interpreter. , Patel VL, Patel YC. The purpose of this qualitative study was to examine the clinical reasoning of expert physical therapists in 3 different fields of physical therapy: orthopedic (manual) physical therapy, neurological physical therapy, and domiciliary care (home health) physical therapy. However, the terms “hypothetico-deductive” and “narrative,” in emanating from the clinical reasoning literature, have traditionally been applied to the process of “inquiry” or diagnosis in clinical practice.10,29 The terms “instrumental” and “communicative,” in emanating from the literature of adult learning, are here applied to a range of learning and action tasks and are therefore, we believe, more appropriately applied to the diversity of clinical management strategies. Reasoning about teaching is thinking directed to the content, method, and amount of teaching in clinical practice, which is then assessed as to whether it has been effectively understood. The 6 physical therapists were selected by a purposive50 or critical case sampling method.47. Perhaps the same therapists use different combinations of clinical reasoning skills at different times and occasions according to the particular patient or client and the context of care. Impressions from the field notes were added to these data sources. Dussart C, Pommier P, Siranyan V, Grelaud G, Dussart S. J Eval Clin Pract. strategies [5]. C Phys Ther. . Koch This meant that when listening to the audiotapes later, there was a written commentary supplying both contextual information and a workable “index” to material on the audiotapes—an important factor for coding and the later construction of case studies. Phys Ther. A model of clinical reasoning in physical therapy characterized by the notion of "clinical reasoning strategies" is proposed by the authors. Bob: h-uh. Prediction as a task in clinical practice was found to vary among settings. Prediction included such decisions as when athletes could return to their sport or when injured workers could return to their jobs. Rivett One of their early explanations (or conceptual frameworks) of the differences among orthopedic physical therapists in outpatient settings was that expert clinicians exhibited clinical qualities that differed from those of their novice counterparts. The therapists were told that this was not meant to be a curriculum vitae but rather a personal reflection on those influences, which could include people and events outside the profession. . Other models of clinical reasoning from this same cognitive science (empirico-analytical) perspective have focused less on the processes and more on the organization and accessibility of knowledge stored in the clinician's memory. Early studies and models of clinical reasoning in physical therapy provided explanations of clinical reasoning that were similar to those of physicians and were mainly concerned with “diagnosis.”4–9 The common factor was support of the hypothetico-deductive model of reasoning. 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