Evidence map›Paper›PMID 38698376›Full record

ArticleBMC medical education2024

Use of the International IFOMPT Cervical Framework to inform clinical reasoning in postgraduate level physiotherapy students: a qualitative study using think aloud methodology.

Katie L Kowalski, Heather Gillis, Katherine Henning, Paul Parikh, Jackie Sadi, Alison Rushton

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Article in BMC medical education, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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2citing papers in PubMed
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2 citing papers in PubMed.

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5 · Who and what money

Authors and funding

6 authors.

Katie L KowalskiSchool of Physical Therapy, Western University, London, Ontario, Canada. kkowals7@uwo.ca.
Heather GillisSchool of Physical Therapy, Western University, London, Ontario, Canada.
Katherine HenningSchool of Physical Therapy, Western University, London, Ontario, Canada.
Paul ParikhSchool of Physical Therapy, Western University, London, Ontario, Canada.
Jackie SadiSchool of Physical Therapy, Western University, London, Ontario, Canada.
Alison RushtonSchool of Physical Therapy, Western University, London, Ontario, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundVascular pathologies of the head and neck are rare but can present as musculoskeletal problems. The International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) Cervical Framework (Framework) aims to assist evidence-based clinical reasoning for safe assessment and management of the cervical spine considering potential for vascular pathology. Clinical reasoning is critical to physiotherapy, and developing high-level clinical reasoning is a priority for postgraduate (post-licensure) educational programs.

objectiveTo explore the influence of the Framework on clinical reasoning processes in postgraduate physiotherapy students.

methodsQualitative case study design using think aloud methodology and interpretive description, informed by COnsolidated criteria for REporting Qualitative research. Participants were postgraduate musculoskeletal physiotherapy students who learned about the Framework through standardized delivery. Two cervical spine cases explored clinical reasoning processes. Coding and analysis of transcripts were guided by Elstein's diagnostic reasoning components and the Postgraduate Musculoskeletal Physiotherapy Practice model. Data were analyzed using thematic analysis (inductive and deductive) for individuals and then across participants, enabling analysis of key steps in clinical reasoning processes and use of the Framework. Trustworthiness was enhanced with multiple strategies (e.g., second researcher challenged codes).

resultsFor all participants (n = 8), the Framework supported clinical reasoning using primarily hypothetico-deductive processes. It informed vascular hypothesis generation in the patient history and testing the vascular hypothesis through patient history questions and selection of physical examination tests, to inform clarity and support for diagnosis and management. Most participant's clinical reasoning processes were characterized by high-level features (e.g., prioritization), however there was a continuum of proficiency. Clinical reasoning processes were informed by deep knowledge of the Framework integrated with a breadth of wider knowledge and supported by a range of personal characteristics (e.g., reflection).

conclusionsFindings support use of the Framework as an educational resource in postgraduate physiotherapy programs to inform clinical reasoning processes for safe and effective assessment and management of cervical spine presentations considering potential for vascular pathology. Individualized approaches may be required to support students, owing to a continuum of clinical reasoning proficiency. Future research is required to explore use of the Framework to inform clinical reasoning processes in learners at different levels.

Indexed as

Clinical ReasoningQualitative ResearchCervical VertebraeClinical CompetenceEducation, GraduateFemaleHumansMalePhysical TherapistsPhysical Therapy ModalitiesPhysical Therapy SpecialtyClinical reasoningEducational researchInternational IFOMPT Cervical FrameworkPhysiotherapyPostgraduate studentsQualitative researchThink aloud methodology

Identifiers

PMID38698376
PMCPMC11064242

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.