Physiotherapy students’ experiences with clinical reasoning during clinical placements: a qualitative study

Background: Clinical reasoning skills are considered to be among the key competencies a physiotherapist should possess. Yet, we know little about how physiotherapy students actually learn these skills in the workplace. A better understanding will benefit physiotherapy education. Objectives: To explore how undergraduate physiotherapy students learn clinical reasoning skills during placements. Design: A qualitative research design using focus groups and semi-structured interviews. Setting: European School of Physiotherapy, Amsterdam, the Netherlands. Participants: Twenty-two undergraduate physiotherapy students and eight clinical teachers participated in this study. Main outcome measures: Thematic analysis of focus groups and semi-structured interviews. Results: Three overarching factors appeared to influence the process of learning clinical reasoning skills: the learning environment, the clinical teacher and the student. Preclinical training failed to adequately prepare students for clinical practice, which expected them to integrate physiotherapeutic knowledge and skills into a cyclic reasoning process. Students’ basic knowledge and assessment structure therefore required further development during the placements. Clinical teachers expected a holistic, multifactorial problem-solving approach from their students. Both students and teachers considered feedback and reflection essential to clinical learning. Barriers to learning experienced by students included time constraints, limited patient exposure and patient communication. Conclusions: Undergraduate physiotherapy students develop clinical reasoning skills through comparison of and reflection on different reasoning approaches observed in professional therapists. Over time, students learn to synthesise these different approaches into their own individual approach. Physiotherapy programme developers should aim to include a wide variety of multidisciplinary settings and patient categories in their clinical placements