PHTY612 - Enhancing Clinical Reasoning in Rehabilitation for Physiotherapists

Year

Credit points

Campus offering

Prerequisites

Nil

Incompatible

Teaching organisation

Unit rationale, description and aim

This post graduate unit is for physiotherapists looking to enhance their clinical reasoning within rehabilitation practice. Physiotherapists wishing to advance their rehabilitation practice will need to critically reflect on and apply enhanced knowledge of rehabilitation practice, to optimise holistic outcomes for clients.

Building on current trends in physiotherapy rehabilitation practice, this unit will use collaborative and reflective activities, to critically evaluate and justify clinical decision making for a range of clinical cases in diverse rehabilitation contexts. Students will explore models of clinical reasoning across the health discipline and will be encouraged to critically evaluate personal and professional knowledge, skills and attitudes on holistic patient centred care, with a focus on integrating and applying concepts such as goal setting, self-management and evidence based practice. Students will be encouraged to embrace reflective practice for long-life learning, as well as develop reflective practice in collaboration with colleagues.

This unit aims to guide students in their critical analysis and enhancement of current practice, to optimise the professional management of clients across the continuum of care, within a multicultural society and varied rehabilitation contexts.

Learning outcomes

To successfully complete this unit you will be able to demonstrate you have achieved the learning outcomes (LO) detailed in the below table.

Each outcome is informed by a number of graduate capabilities (GC) to ensure your work in this, and every unit, is part of a larger goal of graduating from ACU with the attributes of insight, empathy, imagination and impact.

Explore the graduate capabilities.

On successful completion of this unit, students should be able to:

LO1 - Demonstrate knowledge of concepts and processes of clinical reasoning models used in evidence based rehabilitation practice 

LO2 - Critically analyse the concepts and processes of clinical reasoning used by physiotherapists that underpin best practice and decision making within evidence based rehabilitation (GA 3,4,5,6) 

LO3 - Critically evaluate the impact of internal and external contexts on clinical reasoning for holistic person-centred management (GA 4,5,6,7,8) 

LO4 - Apply continuous improvement of clinical reasoning in evidence based rehabilitation through appraisal and reflection on the quality of clinical reasoning (GA1,3,4,5,6,7)  

Graduate attributes

GA1 - demonstrate respect for the dignity of each individual and for human diversity 

GA3 - apply ethical perspectives in informed decision making

GA4 - think critically and reflectively 

GA5 - demonstrate values, knowledge, skills and attitudes appropriate to the discipline and/or profession 

GA6 - solve problems in a variety of settings taking local and international perspectives into account

GA7 - work both autonomously and collaboratively 

GA8 - locate, organise, analyse, synthesise and evaluate information 

Content

Topics will include: 

Models of clinical reasoning 

• Clinical reasoning models used by novices vs. experts related to different presenting patients/conditions/setting (e.g. Hypothetico-deductive; pattern recognition; narrative reasoning; collaborative) 

• Decision making frameworks in rehabilitation practice  

• Reflective practice and its importance in the development of clinical reasoning, quality improvement and clinical expertise for physiotherapists and other health professios  
• Communication of clinical reasoning  
• Strategies to enhance reflective practice and clinical practice  
• Risk reduction and rehabilitation – person-centred approach to risk 

Internal and external contexts influencing clinical reasoning including the triad of the patient, the Healthcare professional and the environment that underpins rehabilitation practice  

• Consumers 
• Disease specific  
• Contextual factors 
• Personal 
• Culture 
• Support  
• Environment 

• Healthcare professionals 
• Personal and professional knowledge, skills, values and attitudes 

• Societal Environment 
• Health sector – structure, changes 
• Legislation and regulation 
• Work / practice settings 
• Internal and external stakeholders 
• Funding models 

Person centred care 

• Clinical assessment and diagnostic reasoning 

Evidence based practice 

• Clinical application of evidence based practice  

Integration and application of self-management 

• Behaviour change – facilitators and barriers including risk management 
• Self-management principles and strategies 
• Motivational interviewing techniques and collaborative goal setting  
• Assisting people to make informed decisions, patient involvement in decision making 

Learning and teaching strategy and rationale

This unit is offered through multi-mode and online delivery for specific on and off shore cohorts. Both modes aim to facilitate learner centred activities and workplace application of learning in relation to selected themes.  Learning and teaching strategies for this post graduate level unit are based on a blend of constructivism, social constructivism, and experiential learning. These strategies focus on active participation and developing a community of inquiry.  Content and types of activities that are the same or similar for all participants regardless of the mode of delivery have been identified. This has led to the development of purposefully designed learning activities that are transferable and work well across both delivery mediums whilst maintaining the flexibility to create and deliver mode specific activities focusing on inquiry based learning principles aimed at encouraging critical thinking, application of knowledge and skills, evidence for practice, collaborative peer learning, and critical self-reflection.  

Multi-mode delivery requires participation in a workshop providing underpinning knowledge and skills that are enhanced throughout the unit. Where possible, workshop activities are designed as reusable learning content able to be provided online or modified slightly as required to take into account current information and communication technologies for online delivery. As required, for example in different time zones, learning and teaching strategies will be adapted for online delivery to specific cohorts. In addition, students in both delivery modes, will participate in individual and small group activities, based on analysis of current practice, assimilation and application of enhanced knowledge aimed at facilitating the translation of learning into personal clinical practice. 

Assessment strategy and rationale

PHTY6XX assessments have been purposefully designed to replicate authentic reflection on reasoning, thinking and problem solving within personal clinical practice. The assessments incorporate a broad range of tasks aligned to andragogic principles of adult learning, facilitating choice and self-direction for the post graduate student. Unit assessments tools have been designed from an “Assessment for Learning” approach in order to not only provide evidence for judgement of learning, but also to reinforce, facilitate and support learning and application of learning.   

In the first assessment task students will be asked using a case study example from their clinical practice to identify and reflect on the factors influencing collaborative clinical reasoning and clinical decision making within their teams and workplace. In assessment task 2 students will video record their treatment of a client and provide a written critique of their application of clinical reasoning, critical thinking, clinical judgement, and evidence to practice when making the clinical decisions relevant for the client and treatment. Assessment tasks 3 seeks students to reflect on their personal and collaborative clinical reasoning practice and communicate these reflections relevant to their work setting using evidence based reasoning and decision making, to management and peers.  

The broad range of assessment activities encourages application of clinical reasoning, critical thinking, clinical judgement, and evidence to practice when solving simple to complex problems and making clinical decisions. These assessments have been specifically timed to provide optimal enhancement for learning. Assessment has been aligned to the emerging complexities as students learn, assimilate and apply progressively advanced levels of professional and theoretical knowledge and enhanced critical analysis skills with the aim of optimising each student’s ability to personally and professionally reflect, analyse and appraise clinical practice. Scheduling of assessments will be equitable for both modes of delivery. Assessment tasks may be delivered and assessed locally with moderation according to University Policies and Procedures. All assessments will be submitted electronically. 

Overview of assessments

Representative texts and references

Atkinson, H. L., & Nixon-Cave, K. (2011). A tool for clinical reasoning and reflection using the international classification of functioning, disability and health (ICF) framework and patient management model. Physical Therapy, 91(3), 416-30 

Higgs J, Jones M, Christensen N, Loftus S. (2018) Clinical reasoning in the health professions (4th ed.) New York, NY. Elsevier/Butterworth Heinemann. 610 CLI  

Hoffman T, Bennett, S., Del Mar C. (2017) Evidence based practice across the health professions. 3rd edition. Chatswood, NSWL Elsevier. 616HOF 

Kinsella, E. A. (2010). The art of reflective practice in health and social care: Reflections on the legacy of Donald Schön. Reflective Practice, 11(4), 565-575 

McKivett A, Paul D, Hudson N (2018) Healing conversations: developing a practical framework for clinical communication between aboriginal communities and healthcare practitioners. Journal of Immigrant and Minority Health. doi-org.ezproxy2.acu.edu.au/10.1007/s10903-018-0793-7 

National Stroke Foundation (2017). Stroke Clinical Guidelines. Melbourne, Australia. National Stroke Foundation (2010). Stroke Clinical Guidelines. Melbourne, Australia.  

Oakland T and Mpofy E (2009) Rehabilitation and Health Assessment: Applying the ICF Guidelines New York: Springer Publishing Company LLC  

Rose A, Rosewilliam S, Soundy A. (2017) Shared decition making within goal setting in rehabilitation settings: A systematic review. Patient Education and Counseling 100:65-75.  

Siegert RJ, Levack WMM (2015) Rehabilitation Goal Setting: Therapy, Practice and Evidence. Chapman and Hall, CRC.  

World Health Organization. International Classification of Functioning, Disability and Health (ICF) (2015) Geneva. WHO