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assessment education learning physiotherapy

Developing clinical reasoning and critical thinking

“Clinical reasoning is a process in which the therapist, interacting with the patient and significant others (e.g. family and other health-care team members), structures meaning, goals and health management strategies based on clinical data, client choices and professional judgment and knowledge (Higgs & Jones, 2000).

Clinical reasoning is difficult, if not impossible to “teach” (if anything is actually possible to teach [Game & Metcalfe, 2009]) but can be developed indirectly through careful course design. I’m trying to move my teaching from helping students to answer the simple Who, What, Where and When questions, to answering the more complex How and Why questions. Instead of memorising content, which is how most of my students prefer to study, I’m trying to help them see the value in developing a deeper understanding of the topic. To use the content as a framework around which we can use critical thinking to apply our understanding of theory, to practice. In other words, to develop clinical reasoning.

I’ve started to change the types of assignments I give to my students, to try and integrate some form of critical thinking. I’ve uploaded and shared the last assignment handout on Google Docs (unfortunately I only have the PDF…seem to have deleted to ODT version), and would love suggestions or feedback on the process. The feedback from students has been great and the quality of the work they produce has been of a very high standard. I’ve found that the feedback from the drafting process (a requirement of the assignment) really helps to give direction to the students, and although they are initially resistant to the idea (they want to submit work that is perfect), they see the value when they get their scripts back and have the opportunity to refine their arguments.

The research and evidence-based practice component is something that we’re trying to incorporate into all of our modules, but which currently is covered only superficially. Students don’t understand how to extract relevant information from academic publications, probably because they lack the specific academic literacies required in higher education. Once we establish that they need only identify the main conclusion of the study (this is at a second year undergraduate level), and use that conclusion to construct an argument, they manage just fine.

Game, A., & Metcalfe, A. (2009). Dialogue and team teaching. Higher Education Research & Development, 28(1), 45-57. doi: 10.1080/07294360802444354

Higgs, J. & Jones, M. (2000). Clinical reasoning in the health professions. In Clinical Reasoning in the Health Professions, 2nd edition (J. Higgs & M. Jones, eds), pg. 3-14