Educational and Experiential Factors Associated With Physical Therapists' Diagnostic Reasoning

Abstract

Introduction. The influence of education level, post-professional training, and experience on physical therapists' (PTs) diagnostic reasoning is unknown. The purpose of this study was to examine the influence of education, training, and experience on PTs' diagnostic reasoning through a series of musculoskeletal case-based surveys. While literature supports quality of care's influence on health care costs, the factors influencing PTs' quality of care are unclear. Literature suggests that surgeons with post-professional training and more experienced Emergency Room physicians demonstrate better patient outcomes, diagnostic accuracy, and efficiency. Methods. Five hundred and twenty-nine licensed PTs participated in this study. A series of 5 case-based electronic surveys assessed participants' diagnostic reasoning in orthopedic presentations. Response rates ranged from 55% to 40%. Accuracy, efficiency, and hypothesis-generation strategies were analyzed to examine diagnostic reasoning. Strength of associations, diagnostic accuracy, and hypothesis-generation strategies were examined via odds ratios; efficiency of determining the accurate diagnosis was examined via t tests. Results. Hypothetico-deductive reasoning by systematically eliminating competing diagnoses (funneling) demonstrated significant correlation with accuracy in 4 of the 5 cases (odds ratio [OR] 2.46 [1.19–5.10] to 13.9 [6.12–31.5]). Physical therapists with any American Board of Physical Therapy Specialities (ABPTS) certification demonstrated significantly greater diagnostic accuracy (OR 2.1 [1.41–3.807] to 3.00 [1.22–7.36]) and efficiency (P < .05) in 3 of the 5 cases compared to those without ABPTS certification. Board-Certified Orthopedic Clinical Specialists (OCS) demonstrated significantly greater diagnostic accuracy (OR 1.90 [1.08–3.34] to 3.42 [1.42–8.40]) and efficiency (P < .05) compared to those without ABPTS OCS certification. Residency-trained PTs demonstrated significantly greater diagnostic accuracy (OR 2.02 [1.03–3.96] to 2.84 [1.38–5.82]) and efficiency (P < .05) compared to those without residency training. Degree level, experience, and fellowship training were not related to accuracy, efficiency, or funneling hypotheses (P > .05). Discussion and Conclusion. American Board of Physical Therapy Specialities certification and American Board of Physical Therapy Residency and Fellowship Education training's significant association with both diagnostic accuracy and efficiency suggests the importance of PTs' pursuit of ABPTS certification and/or formal post-professional training in developing diagnostic reasoning and expertise. These post-professional endeavors may lead to appropriate care more quickly, improving patient outcomes, and decreasing health care costs.

Virtual Reality Instructional Design in Orthopedic Physical Therapy Education: A Randomized Controlled Trial

“…Diagnostic efficiency was assessed by assigning a score based on 1) the selection of the correct diagnosis, 2) when the correct diagnosis was selected (after how many segments of the objective examination), and 3) if a subject deviated from the correct diagnosis after its selection. 33…”

“…Diagnostic efficiency was assessed by assigning a score based on 1) the selection of the correct diagnosis, 2) when the correct diagnosis was selected (after how many segments of the objective examination), and 3) if a subject deviated from the correct diagnosis after its selection. 33 Engagement. After the allocated instructional experience, students completed a self-reported measure of engagement, as described by Fuller et al 34 is 6-item, 5-point Likert scale instrument, which combines features of the Schools Engagement Measure, the Engagement versus Disaffection with Learning questionnaire, and the Motivated Strategies for Learning Questionnaire, has demonstrated good reliability with Cronbach's alpha of 0.79.…”

Factors Influencing Entry-Level Physical Therapy Graduates' Decisions to Participate in Residency Education

“…5 Pursuing an American Board of Physical erapy Specialties certification or formal postprofessional training, such as a residency, may significantly improve diagnostic reasoning and efficiency. 6 In a study by Souter et al, 6 residencyeducated PTs were compared with nonresidency-educated PTs by examining their performance on 5 case-based surveys. ey found residency-educated PTs performed significantly better on the surveys, demonstrating higher performance on diagnostic accuracy and efficiency.…”

“…5 Pursuing an American Board of Physical Therapy Specialties certification or formal postprofessional training, such as a residency, may significantly improve diagnostic reasoning and efficiency. 6…”

“…In a study by Souter et al, 6 residency-educated PTs were compared with non–residency-educated PTs by examining their performance on 5 case-based surveys. They found residency-educated PTs performed significantly better on the surveys, demonstrating higher performance on diagnostic accuracy and efficiency.…”