Promoting Clinical Reasoning in Undergraduate Physical Therapy Education: A Review of Strategies and Approaches

Background: Clinical reasoning (CR) also referred to as “critical thinking” or “decision making” is being recognized as a core competency of the physical therapy professional at various levels of practice. However, it is difficult to teach in view of its invisible and tacit nature. Phenomenal changes in the profession, including the role as a diagnostician have witnessed aggressive thinking in this area. This has resulted in diverse methods and strategies to transfer reasoning skills effectively to students. Awareness about recommended pedagogical techniques to enhance clinical reasoning skills can significantly influence the educator’s choice of methods within and beyond the classroom teaching. It is imperative that physical therapy educators utilize innovative pedagogical methods to facilitate learning of reasoning skills in students.

Purpose: The review is an attempt to highlight and discuss selected pedagogical strategies and approaches to enhance clinical reasoning skills in undergraduate physical therapy education. It also emphasizes the approaches utilized by clinical instructors and students themselves to facilitate the reasoning process.

Methods: A literature search was conducted using the key words “clinical reasoning”, “critical thinking“, “decision making“, “teaching clinical reasoning”, “promoting clinical reasoning” and “reflective practice”. The databases PUBMED, CINAHL, PEDro, ERIC were used and direct search through google scholar was also performed for popular literature on the subject. English literature relevant to the teaching and promotion of clinical reasoning in education programs was shortlisted for the review. References of pertinent literature were scanned to identify further relevant citations.


Results: The review provides a detailed insight into the interwoven nature of pedagogical techniques to promote clinical reasoning being used by different physical therapy curricula. Under the broad paradigm of Problem Based Learning (PBL), which is being viewed as the key shift in educations in the last few years, many other models have been proposed. Strategies such as case based teaching, blended learning, co-operative learning, interactive learning, blogging and clinical practise with guided thinking are some of the important recommended pedagogical methods to enhance reasoning skills. The review also suggests that there is a huge scope of customization of these techniques to match different curricula and contexts.

Conclusion(s): To enhance hypothetico-deduction and the pattern recognition skills in physical therapy students, focused teaching methods and strategies need to be emphasized and adopted by academicians, clinical educators and of course students. It is also of utmost importance that evaluation systems of physical therapy programs are introspected for inclusion of clinical reasoning skills.