The Journal of Korean Physical Therapy

The Korean Society of Physical Therapy (대한물리치료학회)
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Clinical Decision Making Development of Clinical Physical Therapists under the Fee for Service and the Prescription of Physician

  • Lee, In-Hee (Department of Physical Medicine and Rehabilitation, Keimyung University) ;
  • Lee, Hye Young (Department of Rehabilitation Science, Graduate School, Daegu University)
  • Received : 2012.04.16
  • Accepted : 2012.06.03
  • Published : 2012.06.26
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Abstract

Purpose: The purpose of this study was to investigate the clinical decision making (CDM) development process throughout the comparison between novice and expert physical therapist as well as develop a CDM model for physical therapists under the fee-for-service (FFS) and physicians' prescriptions. Methods: Purposive sampling techniques were used to select 10 clinical physical therapists paired into five groups (each pair consisted of 1 novice and 1 expert physical therapist). The coding schemes were extracted from interviews and through within- and across-case analyses, cases were summarized. The reliability of coding schemes was confirmed by checking of case summaries by the participants. Results: Novice and expert physical therapists were influenced by two themes, internalized theme and external forces or information. Novice clinicians depended more on external forces or information. Although clinicians should care patients under the FFS and physician's prescription, expert clinicians were more likely to rely on internalized knowledge. Conclusion: The findings of the present study may be used by educators or association officials enhance CDM abilities and knowledge pools of student or novices as well as develop a guide to suitable novices or students under the specific context limiting the development of their CDM.

Keywords

References

  1. Payton OD. Clinical reasoning process in physical therapy. Phys Ther. 1985;65(6):924-8. https://doi.org/10.1093/ptj/65.6.924
  2. Jensen GM, Shepard KF, Hack LM. The novice versus the experienced clinician: insights into the work of the physical therapist. Phys Ther. 1990;70(5):314-23. https://doi.org/10.1093/ptj/70.5.314
  3. Jensen GM, Shepard KF, Gwyer J et al. Attribute dimensions that distinguish master and novice physical therapy clinicians in orthopedic settings. Phys Ther. 1992;72(10):711-22. https://doi.org/10.1093/ptj/72.10.711
  4. Wainwright SF, Shepard KF, Harman LB et al. Factors that influence the clinical decision making of novice and experienced physical therapists. Phys Ther. 2011;91(1):87-101. https://doi.org/10.2522/ptj.20100161
  5. Riolo L. Skill differences in novice and expert clinicians in neurologic physical therapy. Neurol Rep. 1996;20:60-3.
  6. Harvighurst CC. The changing locus of decision making in the health care sector. J Health Pol, Pol'y & Law 1986;11(4):697-735. https://doi.org/10.1215/03616878-11-4-697
  7. Koo HM, Lee IH. A study on the relationship between subjective quality of life and job stress among physical and occupational therapists. J Korean Soc Phy Ther. 2010;22(2):69-76.
  8. Lee IH, Shin AM, Son CS et al. Understanding the behavior of physical therapists and occupational therapists in protecting patient's medical information: An application of the theory of planned behavior. J Korean Soc Phy Ther. 2010;22(2):55-60.
  9. Chenitz WC, Swanson JM. From practice to grounded theory. Menlo Park, Addison-Wesley Publishing Co Inc., 1986.
  10. Morse JM, Field PA. Qualitative research methods for health professionals. Thousand Oaks, Sage Publications Inc., 1995:125-149.
  11. Wainwright SF, Shepard KF, Harman LB et al. Novice and experienced physical therapist clinicians: a comparison of howreflection is used to inform the clinical decision-making process. Phys Ther. 2010;90(1):75-88. https://doi.org/10.2522/ptj.20090077
  12. Strauss AL, Corbin JM. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 2nd ed. Thousand Oaks, Sage Publications Inc., 1998.
  13. Jensen GM, Gwyer J, Shepard KF. Expert practice in physical therapy. Phys Ther. 2000;80(1):28-43.
  14. Wessel J, Williams R, Cole B. Physical therapy student's application of a clinical decision-making model. The internet journal of allied Health Sciences and Practice. 2006;4(3):1-11.
  15. Schmidt HG, Norman GR, Boshuizen HP. A cognitive perspective on medical expertise: theory and implication. Acad Med. 1990;65(10):611-21. https://doi.org/10.1097/00001888-199010000-00001
  16. Patel VL, Groen GJ. Developmental accounts of the transition from medical student to doctor: some problems and suggestions. Med Educ. 1991;25(6):527-35. https://doi.org/10.1111/j.1365-2923.1991.tb00106.x
  17. West AF, West RR. Clinical decision-making: coping with uncertainty. Postgrad Med J. 2002;78(920):319-21. https://doi.org/10.1136/pmj.78.920.319
  18. Portney LG, Watkins MP. Foundations of clinical research: Applications to Practice. 3rd ed. Norwalk, Prentice Hall, 2008.
  19. Morse JM. Critical Issues in Qualitative Research. Thousand Oaks, Sage Publication, 1994.
  20. McGinnis PQ, Hack LM, Nixon-Cave K et al. Factors that influence the clinical decision making of physical therapists in choosing a balance assessment approach. Phys Ther. 2009;89(3):233-47. https://doi.org/10.2522/ptj.20080131
  21. Resnik L, Jensen GM. Using clinical outcomes to explore the theory of expert practice in physical therapy. Phys Ther. 2003;83(12):1090-106.
  22. Schön D. Educating the reflective practitioner. San Fransico, Jossey-Bass Inc Publishers, 1987.
  23. Masley PM, Havrilko CL, Mahnensmith MR, et al. Physical therapist practice in the acute care setting: a qualitative study. Phys Ther. 2011;91(6):906-19. https://doi.org/10.2522/ptj.20100296
  24. Ryu YU, Park JS. Medical and narrative use of physical therapy knowledge in clinical reasoning by Korean physical therapists. J Phys Ther Sci. 2011;23:251-254. https://doi.org/10.1589/jpts.23.251