Influence of residency training on the clinical reasoning development of Kenyan physiotherapists

Abstract

Objective: The purpose of this study was to explore the clinical reasoning development of physical therapists participating in an 18-month orthopaedic residency program in Nairobi, Kenya. Methods: A mixed methods research design was utilized. The participants' clinical reasoning was assessed through a live patient examination prior to entering the residency program and upon graduation. One-on-one interviews were performed with the residents to explore their clinical reasoning during the final examination. Results: Residents (n = 14) demonstrated a statistically significant improvement in their ability to perform an examination of a patient and determine a hypothetical diagnosis. The clinical reasoning process described by the participants included the hypothetical deductive and narrative reasoning models. The residents did not appear to incorporate pattern recognition during the patient assessment. Discussion: Similar to studies on novice and expert practice in physical therapy, residents demonstrated an improvement in cue acquisition, the ability to verify and refute a hypothetical diagnosis, and the ability to match interventions to patients impairments. In addition, the residents utilized a combination of clinical reasoning models during the examination and evaluation of the patient including hypothetical deductive reasoning and narrative reasoning.

Qualitative research in physiotherapy: A systematic mapping review of 20 years literature from sub-Saharan Africa

“…About one third (36/114; 31.6%) of the studies did not discuss the process of ensuring rigour in conducting the qualitative studies, and only 12 studies described all four process (credibility, confirmability, dependability and transferability) of ensuring rigour (Voges and Frantz, 2019;Kambole and Struthers 2009;Narain and Mathye, 2019;Kumurenzi et al, 2015;Joseph et al, 2016;Mathye and Eksteen, 2015;Abdullahi and Isah, 2020;Cunningham et al, 2019;Adandom et al, 2020;Okoh et al, 2020;. Forty-four studies described at least one process of ensuring rigour: credibility (n=32), confirmability (n=8), dependability and transferability (n=2, each), while…”

“…We rated 74 studies as low-quality qualitative studies, 29 as moderate (Adandom et al, 2020;Cunningham et al, 2019;Gona et al, 2013;Louw et al, 2018;Tawiah, Borthwick Authors in the included studies explored these research areas from the perspectives of patients/relatives, healthcare professionals and students, including physiotherapists and physiotherapy students.…”

Narrative analysis to track the development of clinical reasoning during residency

“…2 However, few studies have investigated the influence of residency education on the development of clinical reasoning, which can affect patient outcomes. 3,4 Additionally, educators lack consensus on what constitutes clinical reasoning and vary in their approaches to teaching and developing this skill, 5,6 and there are few mechanisms to track the development of reasoning over the residency year. 3,4,7 Clinical reasoning is described as 'the ability to organize, synthesize, integrate, and apply sound clinical rationale for patient management'.…”

“…3,4 Additionally, educators lack consensus on what constitutes clinical reasoning and vary in their approaches to teaching and developing this skill, 5,6 and there are few mechanisms to track the development of reasoning over the residency year. 3,4,7 Clinical reasoning is described as 'the ability to organize, synthesize, integrate, and apply sound clinical rationale for patient management'. 1 Currently, residency programs use live patient examinations (LPEs) and specialty-specific skills assessments to assess knowledge and clinical reasoning skills.…”

“…2 In a comparison of LPE scores among residents at the beginning and end of residency, examination and diagnosis showed a statistically significant change, while evaluation did not change significantly. 3 While LPEs allow residents to showcase their clinical reasoning skills in action, narrative reflections allow residents to reflect on action and identify areas for development, such as clinical reasoning. Not only are narratives helpful for a resident's personal reflection but they also allow mentors access to residents' thought processes and allow for targeted feedback from mentors.…”