Previous clinical experience is required to use inductive reasoning and use of this process decreases the amount of time the clinician needs to determine the patient’s primary issue. A clinical instructor could provide a blank ICF framework for the student and ask him or her to fill in the boxes to demonstrate his or her reasoning process. If this is too challenging for the student, the clinical instructor could complete part of the ICF framework and ask the student to complete the remaining areas. Figure 3: Deductive Reasoning Strategies: Use of the ICF Framework
Table 3: Types of Clinical Reasoning Type of Reasoning Definition
Primary User
Hypothetico- deductive (deductive reasoning)
Generation of a hypothesis based upon results of tests and measures, followed by testing this hypothesis.
Frequently used by novices in all situations and by experts during challenging or unfamiliar cases. Used by experts when pattern recognition isn’t working. Frequently used by experts during familiar situations as they recognize patterns or “scripts” that they have previously heard or experienced.
Pattern recognition (inductive reasoning)
Quick retrieval of information from well structured knowledge based upon previous clinical experience.
Note . From Christensen, 2017 Inductive reasoning, on the other hand, uses quick retrieval of information from a well-structured knowledge base derived from previous clinical experience. Experts frequently use inductive reasoning in familiar situations as they recognize patterns, or scripts, that they have previously heard or experienced. When the learner is more advanced in his or her knowledge, skills, and abilities, inductive reasoning strategies including pattern recognition and open-ended questions are helpful in facilitating the clinical reasoning process. Teaching and learning strategies in the clinical setting In an effort to facilitate clinical reasoning skills, clinical educators can use specific teaching and learning strategies developed in the clinical setting such as the “One Minute Clinical Instructor,” the SNAPPS (Summarize, Narrow, Analyze, Probes, Plans, and Selects) Model, and reflective questions (Neher, Gordon, Meyer, & Stevens, 1992; Wainwright et al., 2010; Wolpaw, Wolpaw, & Papp, 2003). These strategies and specific examples are One teaching strategy that may be helpful to use in the clinical setting is the “One Minute Manager” technique or the “One Minute Clinical Instructor (CI)” (APTA, 2012; Neher et al., 1992). This teaching and learning process is taught in the American Physical Therapy Association’s Credentialed Clinical Instructor Course and Advanced Credentialed Clinical Instructor Course series (APTA, 2012). This can be used with an early learner in the clinical education setting to facilitate clinical reasoning skills. Concepts from the “One Minute Manager” have been adapted for the CI and help to provide learners with clinically pertinent information and feedback in a timely, concise manner. Within the “One Minute CI,” the CI highlights appropriate teaching moments and requires the learner to make decisions and develop clinical reasoning skills related to a specific patient, all in approximately one minute. In reality, it may actually take approximately 3 to 5 minutes to complete this process, which is still a relatively short period of time. In this model, the CI is able to relate the patient’s issues in the context of patient care in an effective and efficient manner to improve learning. The “One Minute CI” technique includes the following steps: ● Step 1 : The CI asks the learner to state an opinion about the issues presented in the clinical case. ● Step 2 : The CI asks the learner for evidence to support this opinion. ● Step 3 : The CI provides the learner with information that can be directly applied to the clinical problem at hand. ● Step 4 : The CI reinforces the learner’s correct assumptions and actions and addresses any mistakes or misconceptions. (Neher et al., 1992) described in more detail below. One-minute clinical instructor
Note . From WHO, 2001.
The following example will illustrate how a CI and student can use the “One Minute CI” technique to facilitate learning: A 55-year-old male with a history of low back pain is referred to outpatient physical therapy. The student begins the patient history and ascertains that this “achy” pain has been present for 3 years. It is mostly centralized to the lower back, in the spine, and does not radiate down either leg. The patient rates his pain as 7/10 on the visual analog scale when bending over and 4/10 when sleeping. The patient is a carpenter and works 50 hours per week bending, picking up heavy objects, and hammering. He has a wife and three children to provide for and he is unwilling to take time off from work. After the student has finished with the patient history, the CI asks the learner: Step 1 : Based upon the patient history, what might be causing the patient’s low back pain? The student replies that based upon the length of time the patient has had this pain, it is likely now a chronic injury, but since the patient does not have any pain radiating below his knee, it is NOT likely to be impinging upon any nervous structures. The CI agrees with the student’s general assessment and asks the student what he would like to do next. The student replies that he wants to perform tests and measures to see if the pain is being caused by a problem with joint mobility or muscle recruitment, a lack of core strength, or some other problem. After performing various tests and measures, the student reports back to the CI that trunk flexion activities significantly increase the patient’s pain and trunk extension helps to alleviate the pain, that the patient has very little movement at L1/L2 and L3/L4, and that most of the patient’s lumbar movement is occurring at L4/L5. In addition, the patient has difficulty recruiting important core muscles including transverse abdominus. Step 2 : The CI asks the student, “Now that you have the test results, what do you think is causing the patient’s low back pain?” The student responds that the pain seems to be mechanical in nature due to the hyper- and hypomobility of different segments of the spine and that core muscle weakness and
Page 19
Book Code: PTCA2622B
EliteLearning.com/ Physical-Therapy
Powered by FlippingBook