Student and educator perspectives on clinical reasoning: a qualitative study

Abstract

When students and educators understand a skill like clinical reasoning (CR) differently, attempting to develop it becomes challenging. Miscommunication in how different stakeholders understand this essential skill can potentially harm patients. Our study explores how physiotherapy students and educators (both lecturers and clinical educators [CEs]) in a physiotherapy department understand CR. The research aimed to identify any potential gaps in the stakeholders’ understanding of CR and explore strategies for better alignment. A qualitative exploratory descriptive design was employed. In-depth interviews were conducted with 27 undergraduate physiotherapy students, 10 physiotherapy lecturers, and 8 CEs. Thematic analysis revealed three key themes: cognitive process, evidence-based practice, and clinical approach. Significant differences emerged between experts (lecturers and CEs) and novices (students) in conceptualising CR. The experts demonstrated a more holistic understanding, focusing on hypothesis generation and interconnected reasoning. In contrast, students focus on information collecting and justification of actions. The findings highlight a gap in CR understanding that could potentially impede reaching expected learning outcomes. Our study recommends seeking alignment of students’ and educators’ perspectives through structured dialogue and intentionally designed educational strategies. This includes developing holistic assessment rubrics that acknowledge both foundational and advanced CR skills and implementing case-based learning approaches. And creating opportunities for educators to make their reasoning processes explicit and visible to students.