Novice and experienced physical therapist clinicians: A comparison of how reflection is used to inform the clinical decision-making process

Abstract

Background. Prior experience informs clinical decision making and shapes how reflection is used by novice and experienced physical therapist clinicians. Objectives. The aims of this research were: (1) to determine the types and extent of reflection that informs the clinical decision-making process and (2) to compare the use of reflection to direct and assess clinical decisions made by novice and experienced physical therapists. Design. Qualitative research methods using grounded theory were used to gain insight into how physical therapists use reflection to inform clinical decision making. Methods. Three participant pairs (each pair consisting of one novice and one experienced physical therapist) were purposively selected from 3 inpatient rehabilitation settings. Case summaries of each participant provided the basis for within- and across-case analysis. Credibility of these results was established through member check of the case summaries, presentation of low-inference data, and triangulation across multiple data sources and within and across the participant groups. Results. Although all participants engaged in reflection-on-action, the experienced participants did so with greater frequency. The experienced participants were distinguished by their use of reflection-in-action and self-assessment during therapist-patient interactions. An intermediate effect beyond novice practice was observed. Conclusions. The results of this study may be used by educators and employers to develop and structure learning experiences and mentoring opportunities to facilitate clinical decision-making abilities and the development of the skills necessary for reflection in students and novice practitioners. © 2010 American Physical Therapy Association.