Modelling diagnosis in physical therapy: a blackboard framework and models of experts and novices

Abstract

The primary objective of this study was to explore clinical reasoning in physical therapy and to highlight the similarities and differences by modelling the diagnostic phase of clinical reasoning. An experimental design comparing expert and novice physical therapists was utilized. Concurrent verbal protocols detailing the clinical reasoning about standardized case material were elicited. A framework for modelling diagnosis was specified and provided the parameters for analysis. The diagnostic utterances were classified as cues or hypotheses and the knowledge utilized was identified. The experts recruited significantly more knowledge than the novices (p = 0.01) and used more cues (p < 0.01). Their diagnoses were more accurate when compared to the original diagnosis. This difference between the experts and novices was reflected in the differences shown in the models (p < 0.01). The differences between these subjects focused upon the knowledge recruitment, which impacted on the accuracy of the diagnosis. The novices' inaccurate or non-existent diagnoses led to poor quality of treatment prescription. Modelling proved to be a useful way of representing these differences.

A reusable e-learning tool for paediatric physio-therapy education: a preliminary report

“…Physiotherapists assess and diagnose in order to identify appropriate therapeutic interventions, which in the main involve exercise and mobilisations with various levels of movement advice. This extra 'movement' dimension is an organic process in physiotherapy practice 2 and is a distinguishing feature of physiotherapists in comparison to other healthcare practitioners. 3,4 In this complex area on-going problem solving and clinical reasoning development should be at the core of any educational program.…”

Physical Therapist Students’ Development of Diagnostic Reasoning: A Longitudinal Study

“…24 This study builds on a cross-sectional analysis of clinical reasoning in first-and third-year PT students that includes a full explanation of the rationale for the method. 25 For the student population in this study, the verbal exchange approach to patient simulation used by James 24 was preferable to a patient simulation approach in which the student actually performs the manual tests on an actor 26 , because the initial data collection was being performed before the students had been introduced to handson clinical skills. Additionally, the information-focused format allowed for assessment of the students' problem-solving approaches without confounding by their limited technical skills.…”

Toward an Integrated Model of Expertise Redevelopment and its Implications for HRD

“…With a few exceptions (e.g., Chermack, 2003;Swanson, 2003) the exploration of expertise in relation to HRD is limited. Studies of expertise conducted outside of HRD has tended to be domain-specific (Daley, 1999;Yielder, 2005), has compared experts to novices (e.g., Hmelo-Silver & Pfeffer, 2004;Hsu, 2006;James, 2007), or like de Groot's (1978) study of chess players, has focused primarily on cognitive processes and decision-making, largely to the exclusion of the experiential, contextual, and affective dimensions of practice.…”