Reflective Narratives by Physical Therapist Students on Their Early Clinical Experiences: A Deductive and Inductive Approach

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Abstract

Background and Purpose.

Clinical experiences are essential for a physical therapist (PT) student to develop practical knowledge and critical thinking in the context of the uncertainty and unpredictability of clinical practice. The written narrative provides a method to reflect on experiences and develop practical knowledge. The aims of this study were 2-fold: (1) Apply a framework, developed by Hatton and Smith, to evaluate the highest level of reflection attained in written narratives, and (2) use a process of phenomenological analysis to explore themes and subthemes embedded in the narratives.

Methods.

A retrospective analysis examined PT student experiences encountered during initial clinical experiences. The first step of analysis used a deductive process to identify the presence and level of reflection in the initial sample of 47 narratives. Written narratives absent of reflection were excluded, leaving 30 narratives for the second and final step of phenomenological analysis.

Results.

The retrospective inductive analysis identified 6 themes: patient-centered care, ethical conflict, confidence, professional identity, student-clinical instructor communication, and classroom to clinic integration. Of the initial sample of narratives, 68% met Hatton and Smith's criteria for reflective writing. Of those that did meet the inclusionary criteria (n = 30), 80% fell below the critical and critical/dialogic reflection levels.

Discussion and Conclusion.

The themes were similar to those found in previous studies of novice PT or student therapist early clinical experiences. Although some students possessed reflective abilities, based on the results of this study, we recommend that the principles and skills of writing reflective narratives be implemented and integrated in physical therapy educational programs and residency programs.

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