How do orthopaedic manual physical therapy fellows experience clinical reasoning? A phenomenological study

Clinical reasoning in orthopaedic physical therapy is a complex process requiring integration of diverse cognitive and psychomotor skills. Orthopaedic manual physical therapy fellows are recognized as clinical reasoning experts.

The purpose of this study was to examine how orthopaedic manual physical therapy fellows experience clinical reasoning.

A phenomenological method was used. The eight participants were all fellows in the American Academy of Orthopaedic Manual Physical Therapists and engaged in semi-structured interviews. Interview transcripts were analyzed using Amedeo Giorgi's descriptive phenomenological method. Researchers followed four steps: 1) bracketed biases and read transcripts; 2) segmented meaning units; 3) analyzed units to uncover themes; 4) described the experience's essential structure.

Data analysis revealed four themes: Receptive-Reflective Mind, Patient Presence, Empirical and Iterative Process, and Synthesis. The Receptive-Reflective Mind is a cognitive state that receives the clinical experience without premature decisions, encouraging real-time observation, and reflection. Patient Presence emphasizes that the patient remains central in all aspects of clinical reasoning. Empirical and Iterative Process describes the fellow's method of choosing an iterative course of action based on data. Synthesis integrates the themes into a unified whole.

The essential structure of participant's clinical reasoning experience is a receptive, reflective mind-set attuned to the patient, where data-driven decisions are made per the patient's desires and response. Although patient focus and data-driven processes align with prior research, this study highlights that a Receptive-Reflective Mind-set, marked by unbiased awareness and real-time reflection, underlies the experience of advanced reasoning. Future studies should examine this concept further.