Exploration of Physical Therapist Students’ Affective Behaviors Influencing Clinical Reasoning

Clinical reasoning (CR) includes thinking and decision making in clinical practice; it is "the critical thought process and judgment behind one's action." CR begins with review of medical records, observation of patients while moving and at rest, and patient interviews, and continues while performing tests and measures. CR requires cognitive, affective, and psychomotor behaviors. Throughout the process, physical therapists (PTs) interpret data and make hypotheses or recognize patterns and illness scripts that drive their decisions. In PT, ideal CR includes collaboration with the patient and the health care team and leads to a plan to improve movement and maximize function. The Commission on Accreditation of Physical Therapy Education requires PT education programs to develop and assess CR. Most literature on CR focuses on its cognitive aspects with less attention paid to the affective behaviors that influence CR, such as effective communication to conduct patient examinations and explain results to patients and families in language they understand; empathy; comfort with ambiguity; and the ability to manage uncertainty. Additionally, clinical and academic faculty address concerns in the affective domain less often than in other domains; problems not addressed are likely to continue. The purpose of this qualitative research study will be to explore PT students' affective behaviors that influence development of effective CR; the response of faculty to the behaviors; and factors that influenced faculty's responses. Our research questions are: 1. What are PT students' exemplary and problematic affective behaviors that influence CR? 2. How do faculty address these behaviors? 3. What factors fostered or hindered the ability of faculty to address students' behaviors? The specific aims of the study are: 1. To describe exemplary and problematic student behaviors influencing clinical reasoning and the context in which the behaviors occurred. 2. To describe how faculty addressed the behaviors. 3. To describe factors that fostered the ability of faculty to address the behaviors. 4. To describe factors that hindered the ability of faculty to address the behaviors.