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

Background and Purpose. Clinical reasoning is a complex problem-solving process that is necessary for effective clinical practice in physical therapy. Within the process of clinical reasoning, a physical therapist’s diagnostic reasoning should address the patient’s functional movement abilities and the impact of the patient’s condition on his or her ability to participate in life activities. This longitudinal study examined the development of entry-level physical therapist students’ diagnostic reasoning processes across time in their doctor of physical therapy education. Methods. Qualitative methods were used to analyze participants’ diagnostic reasoning during a simulated patient case scenario. Six physical therapist students completed a think-aloud patient case scenario at 3 points during their entrylevel education (first-year, second-year, and postclinical). Low-inference data (verbatim transcripts) from the students’ think-aloud work on the patient cases and postcase interviews were analyzed using a 2-stage process of thematic analysis. Structural coding was followed by pattern coding to categorize students’ diagnostic reasoning processes. Results. Students’ hypotheses focused on anatomical structures during their first year and shifted to medical diagnoses and biomechanical contributing factors during the second year and following clinical affiliation. Students consistently focused on the anatomical and biomechanical (impairment level) aspects of the patient’s condition and gave minimal attention the patient’s life context (participation level). Discussion and Conclusion. Students demonstrated consistent development toward the movement and biomechanical elements of the specific physical therapist diagnostic process, yet they demonstrated no consistent patterns of development toward identifying or addressing the impact of the patient’s life context on his or her level of disability. Further research should examine the curricular factors that influence students’ patterns of development in diagnostic reasoning