The impact of fellowship and board-certification on diagnostic clinical reasoning in lumbar spine dysfunction using...

Clinical reasoning (CR) is essential for effective physical therapy (PT) practice but remains inconsistently defined and under-researched, particularly in terms of its development across varying levels of clinical expertise. Diagnostic reasoning (DxR), a key component of CR, involves making decisions under uncertainty and is fundamental to accurate clinical judgment. The Script Concordance Test (SCT), grounded in Cognitive Script Theory, is a validated tool used to assess DxR by comparing examinee responses to those of experienced clinicians. Although SCT has seen broad use in medical education, its application in PT is still emerging.

This study aimed to evaluate CR abilities of physical therapists (PTs) with different educational and clinical training backgrounds using an SCT focused on lumbar spine (LS) disorders. Specifically, it examined whether SCT scores varied significantly among final-year Doctor of Physical Therapy (DPT) students, board-certified Orthopedic Clinical Specialists (OCS), and Fellows of the American Academy of Orthopedic Manual Physical Therapists (FAAOMPT).

Fifty-eight participants were divided into three groups: final-year DPT students (n = 21), OCS-certified clinicians (n = 20), and FAAOMPT-trained reference panel clinicians (n = 17). After informed consent, participants completed a 50-item online SCT focused on LS dysfunction. A one-way between-subjects ANOVA was conducted, followed by Tukey's HSD post-hoc analysis.

FAAOMPT-trained clinicians scored significantly higher than both OCS and student groups (p < .001). There was no statistically significant difference between OCS-certified clinicians and DPT students (p = .102).

This study used the SCT to assess CR among PTs with different training levels. The findings suggest that advanced post-professional training, such as fellowship education, is associated with higher DxR performance. Future research should expand SCT use across anatomical regions and educational stages to further support value-based, expertise-driven physical therapy care.