Development of an Innovative Tool to Assess Student Physical Therapists’ Clinical Reasoning Competency

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Abstract

Background and Purpose.

While clinical reasoning has been specified as an educational outcome for graduates of physical therapist education programs, no instrument has been developed for assessing students’ clinical reasoning competency. The goals of this study were to develop such an instrument and to examine its reliability and usefulness.

Method/Model Description and Evaluation.

An examination development panel used an evidence-based and systematic approach to develop the instrument, the Think Aloud Standardized Patient Examination (TASPE), and plan for its implementation. During the TASPE, each student was required to examine a standardized patient and verbalize the cognitive processes for diagnostic and treatment decisions, with the performance scored by an onsite examiner. Twenty-eight students (68%) and all 4 onsite examiners in a Doctor of Physical Therapy program consented to participate in the study. An independent examiner graded the consented students’ examination performance recorded on video. Every participant completed an anonymous feedback form designed to assess the usefulness of the TASPE.

Outcomes.

Based on the percent of judgments in exact agreement and the weighted kappa, the TASPE was shown to have modest interrater reliability at the level of the individual think aloud item scores. The Spearman rho ranged from 0.63 to 0.98 at the level of the total think aloud score in 3 of the 4 pairs of onsite and independent examiners. The ordinal alpha was 0.93, which demonstrated internal consistency of the TASPE. The research participants appeared to support the usefulness of the TASPE and provided insight on improving the tool.

Discussion and Conclusion.

The TASPE provides a feasible means to access and assess student physical therapists’ clinical reasoning competency. Future users should focus on building consensus in grading among all examiners. The study results warrant further investigations of the TASPE for its validity and applicability in different physical therapy specialties and health professional education programs.

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