Clinical reasoning in intensive care: Insights from novice and expert physiotherapists.
Hudaa Kariem, Liezel Ennion, Farhana Karachi and 2 others
Novices in ICU described constant alarms, unfamiliar ventilators, and fear of end-of-life patients as making it hard to think clearly.
Both groups started from patient records and charts, but experts described more automatic pattern recognition. Novices said clinician prompts and repeated exposure helped them reason.
Key findings
1Both novices and experts described starting their ICU reasoning with patient medical records, nursing notes, vital sign trends, and checking for contraindications before assessing. Clinicians described more automatic, pattern-recognition-based reasoning, while novices described a more deliberate, stepwise process of working through the doctor's file, nursing notes, charts, and then the patient.
2Novices identified three categories of constraints on their ICU reasoning: environmental (constant alarms disrupting focus, unfamiliar ventilators), curricular (online learning during COVID-19 meant previously learned techniques had to be refreshed and the classroom felt very different from the ICU), and personal (fear of critically ill patients, anxiety about life-or-death situations, and a sense of having underperformed even after completing assessments and treatments).
3Novices reported that clinician prompts and feedback helped them connect theoretical knowledge to the specific patient in front of them, and that working with ICU patients daily helped them move from generic, diagnosis-focused thinking toward more patient-specific reasoning.
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What it does not show
Small sample: four clinicians and seven students from one university and one hospital in the Western Cape, South Africa. Findings may not transfer to other settings or countries. Novices were not explicitly asked about their use of clinical reasoning frameworks such as the ICF, so the study cannot say whether or how they used them. The primary researcher had her own ICU physiotherapy experience, which may have shaped how she interpreted students' accounts of anxiety and uncertainty. The study was conducted during and after the COVID-19 pandemic, when much of the students' earlier training was delivered online. Their reports of difficulty transferring classroom learning to ICU may reflect this specific disruption rather than a general feature of physiotherapy education. All data are self-reported. The study did not observe actual clinical performance in the ICU.
Declared interests
No specific grant from any funding agency in the public, commercial, or not-for-profit sectors. No conflicts of interest declared.
The easy way to misread this
Do not read the novices' self-reported difficulties as evidence that ICU physiotherapy education is failing. Seven students from one South African university described their own experiences during a period when much of their earlier training was delivered online. Their accounts are one perspective, not a measured outcome, and the study did not observe actual clinical performance.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →