Influence of residency training on the clinical reasoning development of Kenyan physiotherapists

ABSTRACT

Objective: The purpose of this study was to explore the clinical reasoning development of physical therapists participating in an 18-month orthopaedic residency program in Nairobi, Kenya.

Methods: A mixed methods research design was utilized. The participants’ clinical reasoning was assessed through a live patient examination prior to entering the residency program and upon graduation. One-on-one interviews were performed with the residents to explore their clinical reasoning during the final examination.

Results: Residents (n = 14) demonstrated a statistically significant improvement in their ability to perform an examination of a patient and determine a hypothetical diagnosis. The clinical reasoning process described by the participants included the hypothetical deductive and narrative reasoning models. The residents did not appear to incorporate pattern recognition during the patient assessment.

Discussion: Similar to studies on novice and expert practice in physical therapy, residents demonstrated an improvement in cue acquisition, the ability to verify and refute a hypothetical diagnosis, and the ability to match interventions to patients impairments. In addition, the residents utilized a combination of clinical reasoning models during the examination and evaluation of the patient including hypothetical deductive reasoning and narrative reasoning.

Level of Evidence: 4

KEYWORDS:

• Clinical reasoning
• residency education
• Kenya
• physical therapy

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by the Waldon College of Health Sciences.

Notes on contributors

Shala Cunningham

Shala Cunningham, PT, DPT, PhD is an assistant professor at Radford University in Roanoke, VA.  She received her Bachelor of Science in Physical Therapy at Indiana University, her transitional Doctor of Physical Therapy from AT Still University and her PhD from Nova Southeastern University.  She has completed a manual therapy residency and fellowship with the Ola Grimsby Institute. Dr. Cunningham’s research agenda and areas of expertise include clinical reasoning development and interprofessional education through human simulation.

Bini Litwin

Bini Litwin, PT, DPT, PhD, MBA is an associate professor at Nova Southeastern University in Fort Lauderdale, FL.  She received her physical therapy degree from State University of New York at Buffalo, her Doctor of Physical Therapy from AT Still University and her PhD from Nova Southeastern University.  Dr. Litwin’s research interests include interprofessional processes, cultural competency, and educational strategies for medically complex patients.

Alicia Fernandez-Fernandez

Alicia Fernandez-Fernandez, PT, DPT, PhD is an associate professor at Nova Southeastern University in Fort Lauderdale, FL.  She received her degree in physical therapy from the University of Oviedo (Spain). She attended Florida International University where she received a Master in Physical Therapy. She received her Doctor of Physical Therapy from Nova Southeastern University and her PhD in Biomedial Engineering at Florida International University. Dr. Fernandez-Fernandez’s research interests include clinical decision making, innovative educational approaches and the development of therapeutic agents for cancer.

Jennifer Canbek

Jennifer Canbek, PT, PhD is an associate professor at Nova Southeastern University in Fort Lauderdale, FL.  She received her Bachelor of Science Degree at Maryville University in 1998 and her PhD from Nova Southeastern University on 2011.  Dr. Canbek’s primary research interests include validation of functional performance- based instruments, developing clinical decision-making skills in physical therapy students and novice clinicians and blended learning to enhance retention in physical therapy education.