Curricular integration of a 4-year simulation-based education program on clinical reasoning for physiotherapy students: a descriptive design and implementation report

BACKGROUND: Simulation-based education remains underutilized in physiotherapy and is often limited to isolated experiences rather than longitudinal and systematically integrated approaches with a specific curriculum. This restricts its potential to foster clinical reasoning (CR)-a core competence for diagnosis and treatment planning. This study presents the design and implementation report of a four-year, simulation-based education program (SBEP) focused on CR. METHODS: This study reports the design, implementation and iterative refinement of a four-year SBEP using instructional and quality-improvement approach following the SQUIRE-EDU guidelines. The program was embedded into compulsory coursework from 2015 to 2019 and refined over ten academic cycles. RESULTS: The program resulted in the development of 27 simulation scenarios, integration across four academic years, and faculty development strategies supporting implementation. A total of 1,441 students have completed the SBEP, and 80% of physiotherapy faculty members have been trained in simulation methodology. Over the cycles, the SBEP was progressively refined based on faculty, simulated participants' and students feedback, focusing on scenario fidelity, feasibility, and alignment with intended CR sub-processes (subjective interview, examination, and treatment). CONCLUSIONS: A longitudinal, curriculum-integrated SBEP may support the progressive development of CR-related competencies, as recommended in the literature. The primary contribution of this work is detailed, transferable framework for designing, integrating, and iterative improving a physiotherapy SBEP focused on CR. Strategic and methodological planning integration is highly recommended. Our approach offers a replicable framework for institutions seeking to integrate simulation into their health professions curricula.