Differences in the clinical reasoning process of expert and novice cardiorespiratory physiotherapists

Through the process of clinical reasoning, physiotherapy practitioners critically evaluate their interventions in the management of patients. This qualitative investigation focused upon the thought processes of two groups of physiotherapists as they engaged in the consideration of a presented respiratory paper case scenario; identifying problems, possible diagnoses, and finally proposing a treatment plan. One group of 15 physiotherapists were designated ‘expert’ in their practice, whereas the second group of 15 were relatively inexperienced junior physiotherapists. The aim of the study was to investigate the differences in the clinical reasoning process of the novice versus the expert group.

After considering the presented paper case scenario, each therapist completed an open questionnaire. A corroborated content thematic analysis of the presenting data was performed. Through this analysis common themes were identified across the data, and differences presenting between novice and expert practitioners were explored.

A number of differences in the clinical reasoning process were identified between the novice and expert groups. It is postulated that the mechanisms for storage and retrieval of knowledge are more refined in the expert group. This in turn impacts upon practitioner problem-solving ability and hence clinical judgement. These findings support those of previous studies, which have not, however, included a consideration of the clinical reasoning process in the field of cardiorespiratory physiotherapy.

Clinically the results provide information on the different thought processes of novice and expert practitioners in the field of respiratory physiotherapy. This has implications for day-to-day management of physiotherapy staff and for the continuing professional development of practitioners.