EARLY CLINICAL REASONING SKILLS IN PHYSICAL THERAPY STUDENTS. Janet Gangaway*; Jeanine Stancanelli Physical Therapy, University of Hartford, West Hartford, CT PURPOSE: Autonomous physical therapist practice requires independent, self-determined professional judgment which includes the ability to use clinical reasoning to guide decisions. The purpose of this study was to identify factors physical therapy students consider the most important when selecting clinical sites as an early indicator of their clinical reasoning skills. This will assist the Academic Coordinator of Clinical Education (ACCE) in guiding the clinical reasoning process early in the students’ academic career. BACKGROUNDS/SIGNIFICANCE: The profession of physical therapy is becoming more autonomous, requiring advanced clinical reasoning skills. The authors sought to identify if physical therapy students are using clinical reasoning in site selection as an early indicator of the development of this critical skill. Through interactions with students, it appeared that they were selecting clinical sites based on a limited number of factors, which did not take into consideration the importance of their personal abilities such as strengths and weaknesses, learning style, supervisory preferences, learning environment, and personality traits. While the students must make decisions in selecting a clinical site, the facility selected may not be the best fit for the student as a result of the students’ failure to use appropriate critical reasoning skills. Understanding the students’ thought process and clinical reasoning skills assists the ACCE in determining the most efficient use of their time and available resources. The ACCE must determine how to foster clinical reasoning skills to enable the student to select sites that are more suited to their personal abilities to promote a positive clinical education experience with a successful outcome. These results may also assist clinicians in better understanding the critical thinking and decision-making process used by physical therapy students in the selection of clinical sites. SUBJECTS: A convenience sample of 74 participants comprised of first and second year physical therapy students was recruited from the University of Hartford. Of the 74 participants, 51 (69%) were female and 23 (31%) were male and 30 (41%) of the 74 students had completed their first full-time Clinical Experience. METHODS AND MATERIALS: A survey was developed by the Clinical Education Coordinators of PT and OT to identify the important factors that influence clinical site selection among PT students. The survey consisted of 9 questions designed to identify factors that may be important to students when selecting clinical sites. Using Likert-like scales students rated the importance of the listed factors from 1 indicating not important to 5 indicating very important. The University of Hartford Human Subjects Review Board approved this study prior to the start of data collection. ANALYSES: Study results were compiled using SPSS software; mean scores for student responses across all three clinical education sessions were calculated and paired sample t-tests were used to determine significant differences in importance level. RESULTS: The most important factor to students was financial considerations, followed by meeting program requirements, type of specialty offered, proximity to home, reputation of the facility, a facility the student might like to work in after graduation, family/friends in area selected, schools’ site availability, personal abilities, and desire to travel. Least important were proximity to school and free/low cost housing provided by the facility. A paired samples t-test was conducted to compare the importance of factors to the student’s perceived importance of personal abilities. Type of specialty offered, financial considerations, meets program requirements, and reputation of the facility were all statistically more important than the student’s personal abilities (p<0.05). Personal abilities was seen as statistically more important than free/low cost housing provided by the facility (p<0.01) A factor that is perceived important by the program’s clinical education coordinators is the student’s personal ability, which plays a large role in the student’s success at a clinical education experience. As can be seen above, personal abilities play a minor role in the student’s decision-making process. A facility providing free/low cost housing was the only factor considered statistically less important than personal abilities, despite financial considerations as the statistically most important factor. As the goal of physical therapy education programs is to graduate competent, entry-level generalist physical therapists, students’ giving importance to type of specialty offered is not in line with the mission of physical therapy education programs. Likewise, a facility may have a great reputation but not be a good match for the student’s learning style, strengths, and weaknesses and as a result not provide the best possible clinical education experience. Meeting program requirements is the responsibility of the ACCE, and should not be a primary concern for students. CONCLUSIONS: Early development of clinical reasoning and critical thinking skills will promote lifelong learning and inquiry. Finding strategies to improve the critical thinking skills to encourage students to consider their own personal strengths and weaknesses during the selection process is vital.This would ensure a matching of their abilities and learning styles with the facilities clinical education program design. The results of this study may help students make better choices in clinical site selection and assist the ACCE and clinicians in better understanding the motivation behind students’ selection of clinical sites. Further research into critical thinking, clinical decision making, and reasoning as it relates to student development of these skills and their future success as competent, entry-level physical therapists is warranted. FUNDING SOURCE: none KEYWORDS: clinical education, clinical reasoning 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.