Impact of Case-Based Learning and Reflection on Clinical Reasoning and Reflection Abilities in Physical Therapist Students

Introduction. Clinical reasoning and reflection are vital skills for physical therapists (PTs) to become autonomous practitioners of choice for movement disorders. This study addresses the impact of the combination of case-based learning (CBL) and external reflective articulation on the development of clinical reasoning and reflective abilities in physical therapist students. Review of Literature. The current CBL literature in health care education is mixed regarding its effectiveness in promoting clinical reasoning, with less literature that specifically relates to physical therapist education. The literature also recommends use of reflection to increase clinical reasoning; however its direct impact on promoting clinical reasoning and reflective abilities in PT students is unknown. It is also unknown if the combination of CBL and use of explicit reflection using a technique labeled external reflective articulation increases clinical reasoning over use in isolation. Participants. Participants were secondyear PT students (N = 27) participating in a course on the strategies used by PTs in the examination, evaluation, and treatment of a variety of neuromuscular disorders. Methods. The intervention was the use of written external reflective articulation assignments with the Physical Therapy Clinical Reasoning and Reflection Tool as well as posed questions relating to clinical reflection on CBL activities. Five CBL activities were completed before the addition of external reflective articulation. Participants completed the Diagnostic Thinking Inventory (DTI) and the Self-Assessment of Clinical Reasoning and Reflection (SACRR) 3 times during the course: at the beginning of the course, before implementation of the intervention, and at the conclusion of the course. Results. Seventeen participants (63.0%) were women and 10 (37.0%) were men, with a mean age of 24.63 years (SD = 2.53 years) and a grade point average of 3.52 (SD = 0.24). There were no significant differences in DTI and SACRR scores with respect to sex, age, and grade point average. The main effect of SACRR scores was significant (P < .001). There were significant differences across the 3 SACRR and DTI scores, with no statistically significant differences (P > .05) before the reflection was implemented (from time 1 to time 2) and statistically significant increases in SACRR (P = .001) and DTI (P = .01) scores after the reflection was implemented (from time 2 to time 3). Discussion and Conclusion. The results of this study support the addition of external reflective articulation to CBL activities for PT students to increase clinical reasoning and reflection abilities. Purposeful use of CBL and reflection promoted improvement in clinical reasoning skills, a critical factor in clinical decision-making. The results provide useful information to guide educators and administrators in selecting learning activities that improve reflection and clinical reasoning abilities in PT students.