DESIGNING A LEARNING EXPERIENCE FOR FIRST YEAR DPT STUDENTS TO INITIATE THE PROCESS OF DEVELOPING CRITICAL THINKING SKILLS. Duane A. Williams*; Ute H. Breese Physical Therapy, East Tennessee State University, Johnson City, TN UNIQUE: Students spend the first year of most entry-level DPT programs obtaining a foundation of basic science knowledge and clinical skills. However, most students seem to have difficulty both organizing this new knowledge and retrieving appropriate information from this new body of knowledge to apply to a clinical problem. Being able to organize, retrieve, and apply appropriate information is a skill developed by physical therapists who are perceived to be experts in their field. Rather than hope that students will develop this skill over time during their years of clinical practice, the idea behind this learning experience is to provide a method to help 1st year DPT students develop the critical thinking skills necessary to organize, retrieve, and use the information in a thoughtful manner. PURPOSE: The purpose of this planned learning activity was twofold: 1)introduce 1st year DPT students to a method for organizing and retrieving vast amounts of information about orthopaedic physical therapy, and 2) provide a learning experience designed to promote the development of critical thinking skills. FOUNDATION: Physical therapists perceived to be experts in their field have learned to combine and use their deductive reasoning (general to specific, i.e. in performing a history and physical examination on a specific patient) and inductive reasoning (specific to general, i.e. recognizing clinical profile patterns). These master clinicians apply their critical thinking skills, particularly in areas of clinical uncertainty, to narrow down both the probable medical and physical therapy diagnosis (primarily movement dysfunction) and to determine a reasonable and patient appropriate evidence-based treatment intervention. So, how do we design educational experiences promoting critical thinking for the entry-level physical therapy student or novice physical therapist? DESCRIPTION: This learning activity took place in the second semester of an entry-level DPT program after students had completed some basic science and basic skills courses. Using a modified version of the Norwegian System of Orthopaedic Manual Therapy (5-5 scheme by Dr. Herbert Frish), students learn key questions for the case history and the 5 major areas of the physical examination: I: Inspection; II: Function (based on Dr. Cyriax's diagnosis of soft-tissue concepts); III: Palpation; IV: Neurological Screening; and V: Special Additional Tests. They then apply this 5-5 scheme to the following: 1) identifying red flags during a musculoskeletal exam, 2) being cognizant of the most likely clinical profile of signs and symptoms that each injured musculoskeletal tissue might present, and 3) learning common clinical profiles (patterns) of common musculoskeletal disorders. Then, using a case study, they begin learning the process of differential diagnosis as they determine potential hypotheses of a patients potential problem(s). The students, in pairs, orally present a case-study to their classmates using the 5-5 scheme. For this initial critical thinking learning experience they are limited to only two potential diagnoses for a given case history and each of the pair presents the key questions they would ask during the case history as well as the key physical examinations (using the 5-5 scheme format) they believe would be necessary to make a differential diagnosis. During this process, students are expected to consider not only the potential cause of the patients problem(s), but also any contributing factors. This exercise requires students to organize and retrieve sorted information in an efficient manner; apply it to a particular uncertain clinical situation; and to reflect on the critical thinking process. OBSERVATIONS: Many students seem to have difficulty applying selected knowledge in an efficient manner as they progress into the clinical sciences from the basic sciences. However, students appear to organize accumulative musculoskeletal information better when using a process or format such as the 5-5 scheme. The students appear to benefit from doing an oral presentation for which they must select key questions and physical examination procedures. The students also report that they use the 5-5 scheme format in the clinic during their clinical education rotations. We often get feedback from the Clinical Instructors for the early clinical education rotations that they are surprised how well many of the students use critical thinking skills in the clinical setting. CONCLUSIONS: The process of designing educational experiences to promote and develop requisite critical thinking skills will continue to evolve as we prepare practitioners of physical therapy to be autonomous health care professionals. The preceding has described one example of a learning experience that theoretically should encourage students to begin developing the critical thinking skills necessary to progress through the professional curriculum and into their professional work. Since the literature about teaching critical thinking to health care professionals, especially physical therapists, is minimal, the opportunities for future research are unlimited. Suggestions for the future would include activities such as: 1) finding meaningful and reliable instruments such as the California Critical Thinking Disposition Inventory (CCTDI) or the California Critical Thinking Skills Test (CCTST) that could be used to measure change in critical thinking ability over time, and 2) comparing and contrasting the APTA clinical performance instrument tool, personality profiles such as the Myers-Brigg, learning styles inventory (LSI), with the CCTDI or CCTST or other measures or indicators of critical thinking ability. FUNDING SOURCE: None KEYWORDS: learning experiences, teaching critical thinking, organizing knowledge, retrieving information Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. Other types of customers who want permission to reprint should contact the APTA Editorial Office, Attn: Physical Therapy.