CLINICAL REASONING AND DECISION MAKING OF EXPERIENCED CLINICIANS AND ENTRY-LEVEL PHYSICAL THERAPIST STUDENTS. Ellen F. Spake* Physical Therapy Education, Rockhurst University, Kansas City, MO PURPOSE: The purpose of this study was to distinguish the clinical reasoning and decision-making strategies of experienced clinicians and students with varying levels of content knowledge and experiential background, while using a computerized patient management problem (PMP) case study to solve a clinical problem. BACKGROUNDS/SIGNIFICANCE: The clinical reasoning of expert and novice physical therapists has become a focus of investigation in recent years. Current researchers are interested in the study of "real world" experiences, and the creation of an authentic learning environment using an interactive computerized case study provides a mechanism for explicating the reasoning of experienced and novice physical therapists. SUBJECTS: Seventy-two participants comprising a sample of convenience participated in this study. Group 1 consisted of 18 entry-level physical therapist students who had no clinical experience and who had completed only basic science courses applicable to working with patients who exhibit neurological disorders. Group 2 consisted of 12 entry-level physical therapist students who had completed a one-semester course in the physical therapy management of individuals with neurological disorders, basic science courses, and a two-week, full-time clinical experience. Group 3 consisted of 21 entry-level physical therapist students who had completed all course work and 27 additional weeks of full-time clinical experience. Group 4 consisted of 21 experienced acute care physical therapists. METHODS AND MATERIALS: An interactive, web-based computer program that allowed for an on-going record of decision-making as subjects engaged in a computerized patient management case representing a non-complex neurological problem was developed. The automatic recording of every event allowed for tracking through the case including such parameters as time spent on tasks, hypothesis generation, informational cues accessed during the decision-making process, and total time for completion of the case. Following a semi-constrained order while working through the computer program, subjects were instructed to generate hypotheses, identify pathology and etiology, establish physical therapy diagnoses, and determine a prognosis for the patient as efficiently and accurately as possible. At the completion of the case, a report was generated which time-stamped each decision event and provided a chronological record of the order in which subjects accessed information from the medical record, recorded hypotheses, and finalized clinical decisions. ANALYSES: Data were analyzed using SPSS 11.5 for Windows. A one-way analysis of variance (ANOVA) was used to determine differences across groups. RESULTS: The results of this study indicate that experienced clinicians used fewer informational cues when making diagnostic decisions, arrived at physical therapy diagnoses more quickly, and identified a greater number of correct physical therapy diagnoses than did students at any experiential level. However, in general, students tended to generate more hypotheses and in a shorter amount of time than did experienced clinicians. When making diagnostic decisions to confirm pathology, there also appeared to be a clinical experience effect, as experienced clinicians and students who had completed all full-time clinical experiences made diagnostic decisions more quickly than did students who had little or no previous experience. CONCLUSIONS: While issues related to use of informational cures, accuracy of diagnostic decisions, and generation of diagnostic hypotheses have been well documented in the nursing and medical literature, there is a paucity of studies in physical therapy focusing on these parameters. Studies in the continuum of expert-novice decision-making have focused primarily on describing characteristics of the decision maker or the decision-making process. Furthermore, decision-making in physical therapy has been studied primarily from a qualitative paradigm. This study presents quantifiable evidence of differences in the decision-making of experts and novices in physical therapy. The use of a computerized patient management problem for description of clinical decision-making has implications not only for examination of the decision-making process, but for the education of physical therapist students as well. The use of such a program can assist the physical therapist educator in the identification and development of the clinical decision-making skills of students. FUNDING SOURCE: A Title III grant supported the development of the software program. KEYWORDS: Clinical Reasoning, Decision-making, Expert-Novice 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. 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