Student and educator perspectives on clinical reasoning: A qualitative study.
Danelle Hess, Jacqueline Hendricks, José Frantz and 1 others
PMID 40470170WHAT IT FOUND
Physiotherapy students focused on justifying their actions, while educators prioritised hypothesis generation.
This mismatch suggests teaching and assessment need to explicitly bridge novice and expert reasoning styles rather than assuming a shared understanding of clinical reasoning.
Key findings
01Students emphasised justifying their actions as central to clinical reasoning, whereas lecturers and clinical educators focused on hypothesis generation.
02Participants described clinical reasoning as a multifaceted process involving cognitive decision-making, integrating theory with practice, and patient-centred care.
03The divergence in perspectives between students and educators may lead to students missing crucial cues or focusing on less relevant aspects of clinical reasoning.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was conducted in a single university department in South Africa, so findings may not transfer to other educational contexts or countries. The authors were insiders (staff and colleagues) in the department, which may have influenced participant responses due to power dynamics, despite mitigation strategies like using a research assistant for some interviews. The sample size was relatively small (n=45), and the focus was on understanding perceptions rather than measuring clinical outcomes or patient care quality. The study did not observe actual clinical reasoning in practice; it relied on participants' self-reported understanding of the concept.
Declared interests
The research was supported by funding from the University of the Western Cape. The authors declared no conflicts of interest, but noted that two authors were staff members in the department where the study took place, which was managed through transparency and supervision.
The easy way to misread this
Do not interpret the difference between students and educators as a deficiency in student ability. The study highlights a gap in shared understanding, not a lack of skill. Students' focus on justification is a normal part of their learning process, and educators' focus on hypothesis generation reflects their experience. The finding is about educational alignment, not clinical competence.