An investigation into the clinical reasoning of cardiorespiratory physiotherapists using a simulated patient and simulated high dependency unit

• Main Author: Thackray, Debbie
• Other Authors: Fuller, Alison ; Roberts, Lisa ; Nind, Melanie
• Published: University of Southampton 2014
• Subjects: 370; RD Surgery
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.628701

The ability of physiotherapists to make clinical decisions is understood to be a vital component of achieving expertise and is part of being an autonomous practitioner, yet this complex phenomenon has been under-researched in cardiorespiratory physiotherapy. Educators in this field need to understand what method of clinical reasoning clinicians are using, so that educational strategies can be designed to facilitate the development of clinical reasoning by undergraduate physiotherapy students prior to them going on clinical placement. This study explored the clinical reasoning of eight expert cardiorespiratory physiotherapists by observing their actions and behaviour whilst they assessed a simulated patient with respiratory complications in a simulated environment. The assessments were video-recorded. The physiotherapists were encouraged to think-aloud to verbalise their thought processes and had a debrief interview afterwards. The videos and the verbal transcripts from the assessment were analysed using a framework analysis and compared to other models of clinical reasoning. The study has confirmed that clinical reasoning is a complex, multi-dimensional phenomenon and the model produced shares some similarities with other models of clinical reasoning. Four key concepts have been identified as requirements for clinical reasoning development: knowledge acquisition; knowledge storage and retrieval; information processing and cognitive skill development; and metacognition and reflection. These concepts have been incorporated into a new conceptual model of clinical reasoning and embedded into a simulation learning strategy to facilitate clinical reasoning across all three years of the undergraduate physiotherapy programme.