Developing Clinical Reasoning

Clinical reasoning

Expert clinical reasoning and decision-making skills can be developed by the regular practice of intricate reflection backed up by continuous learning and deliberate practice strategies. Physiotherapy clinical practice is a propositional knowledge-informed art crafted with regularly updated-upgraded multimodal skills, knowledge, and experience. However, clinical reasoning is often subconscious and, therefore, a challenging skill to develop (1).

Reflective practice

Kinsella, 2009 (5), has synthesized 5 epistemological underpinnings of a reflective practice informed by the works of Donald Schon (6) : (1) a broad critique of technical rationality; (2) professional practice knowledge as artistry; (3) constructivist assumptions in the theory; (4) the significance of tacit knowledge for professional practice knowledge; and (5) overcoming mind-body dualism to recognize the knowledge revealed in intelligent action. The reflective practice based on these underpinnings has the potential to enhance the evidence-based practice through knowledge, research, and evidence transformation into action.

Everyday reflection of daily practice is the basis of clinical reasoning. The hunger for better performance automatically drives to clinical reasoning. Reviewing patients’ progress on a regular basis with the current treatment regimen raises further questions, no matter the level of experience or knowledge the clinician already has. So, whether clinicians follow pattern recognition or deductive reasoning, there is always more to learn and improve.

Deliberate practice

Deliberate practice is the practice where the practice starts with the strong motivation to improve, the practice is then focused, goals oriented, guided by expert knowledge and techniques, incorporated immediate feedback, practiced outside one’s comfort zone, and become able to produce a strong mental representation of a particular context (7).

Deliberate practice is seen as a common theme in several papers that discuss clinical reasoning in physical therapy. As discussed by Ericsson in 2008 (2) deliberate practice involves immediate feedback, time for problem-solving and evaluation, and opportunities for repeated performance to refine behavior.

Mentorship/case discussion

Clinical mentorship is a cornerstone of post-professional training programs and is intended to develop advanced clinical reasoning skills (1). Case discussion with co-workers is another strong strategy to develop clinical reasoning skills. This not only improves clinical reasoning skills but is also the fastest way to knowledge and skill development.

Deductive reasoning

Understanding and appreciating each individual’s context throughout the patient care to designing an individualized treatment program is another important element of clinical reasoning. This continuously challenges inductive reasoning and asks clinicians to do deductive reasoning to find what could be done better for a better outcome in this particular context?

SCRIPT

The use of a tool such as the SCRIPT may facilitate developing clinical reasoning skills by providing a systematic approach to data gathering and making clinical judgments to bring clinical reasoning to the conscious level, facilitate self-reflection, and make a mentored physical therapist’s thought processes explicit to his or her clinical mentor (1).

References

1. https://pubmed.ncbi.nlm.nih.gov/27470978/
2. https://pubmed.ncbi.nlm.nih.gov/18778378/
3. https://pubmed.ncbi.nlm.nih.gov/30496522/
4. https://pubmed.ncbi.nlm.nih.gov/28371873/
5. https://pubmed.ncbi.nlm.nih.gov/20017878/
6. https://psycnet.apa.org/record/1987-97655-000
7. Ericsson, A., & Pool, R. (2016). Peak: Secrets from the new science of expertise. Houghton Mifflin Harcourt: New York