Date of Award

May 2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Teaching & Learning

First Advisor

Bonni Gourneau

Second Advisor

Bonni Gourneau

Abstract

Clinical Reasoning (CR) integrates thinking and decision-making in clinical practice (Huhn et al., 2019). CR is an established area of research in Doctor of Physical Therapy (DPT) education (Musolino & Jensen, 2019; Jensen & Mostrom, 2012) and has been acknowledged as a core competency of physical therapist residency education (APTA Residency Competency Work Group, 2020). Despite the established research, the assessment of CR has emerged as a topic of importance due to the need for standardized assessment of CR in DPT education that can lead to high-quality research and implementation of evidence-informed teaching and learning (Reilly et al. 2021; Furze et al., 2022; Christensen et al., 2017). Simulation-Based Learning (SBL) is an area of recent focus amongst DPT educators that has demonstrated the ability to improve student clinical decision-making, CR, and critical thinking in the health professions (Macauley et al., 2017). SBL is “a technique that creates a situation or environment to allow persons to experience a representation of a real event for the purpose of practice, learning, evaluation, testing, or to gain understanding of systems of human actions” (Lioce et al., 2020, p. 44). SBL promotes active learning and emotional engagement of the learner and has been integrated into DPT education (LeBlanc & Posner, 2022). Need for the Current Research Despite the recognized benefits of SBL, the effects of Simulation-Based Learning Experiences (SBLE) on DPT student CR have yet to be investigated. Additionally, limited tools are available to assess student CR in DPT education. One recently developed assessment tool is the Clinical Reasoning Assessment Tool (CRAT), which can be used to evaluate CR in both didactic and clinical settings. The CRAT assesses three domains of CR by rating a student’s foundational knowledge, psychomotor skills, and conceptual reasoning on a 0 to 16 Likert scale (McDevitt et al., 2019). The CRAT is designed to track student CR assessment and development longitudinally over time (Furze et al., 2015; McDevitt et al., 2019), but the reliability psychometrics of the CRAT have not been established. This three-article dissertation investigated CR development in DPT students following a SBLE. The results of this dissertation will inform subsequent research. The combination of the three articles provides needed insight into the development of CR in DPT students following a SBLE in a DPT education program. The three articles include the following: 1. Assess the reliability of the CRAT. 2. Perform a systematic literature review on the effects of high-fidelity SBL on DPT student learning and performance. 3. Assess the effect of a high-fidelity SBLE on DPT student CR as measured by the CRAT.

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