Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students.
Maria Elvén, Jacek Hochwälder, Elizabeth Dean and 1 others
PMID 30869789WHAT IT FOUND
Students from programs with behavioral medicine content scored higher on behavior-change reasoning.
Curriculum orientation accounted for only 3% of the variation in input from client scores and 4% of the variation in functional behavioral analysis scores.
Key findings
01Students from programs with behavioral medicine competencies had higher scores on input from client, functional behavioral analysis, and strategies for behavior change.
02For input from client, higher self-rated cognition, metacognition, and positive attitudes were associated with higher scores, while knowledge and self-efficacy did not contribute significantly.
03Curriculum orientation was the only independent variable associated with strategies for behavior change scores.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The cross-sectional design cannot show cause and effect. Only 151 of 369 invited students participated, and the response rate was 41%. Six predictors were self-assessed, which may reflect social desirability bias. The outcomes were limited to reasoning focused on behavior change, not clinical reasoning overall. The models left much variance unexplained, especially for functional behavioral analysis and strategies for behavior change. The sample was slightly younger than the national population of graduated students. The web-based instrument may not fully capture interactive and contextual dimensions of clinical reasoning. Conclusions are about clinical reasoning skills, not competence in clinical practice.
The easy way to misread this
Do not conclude that a physical therapist curriculum with behavioral medicine content causes better clinical reasoning. The study was cross-sectional, response rate was 41%, and curriculum orientation explained only 3% of variance in input from client and 4% in functional behavioral analysis.