Expert practice in physical therapy.

BACKGROUND AND PURPOSE The purpose of this qualitative study was to identify the dimensions of clinical expertise in physical therapy practice across 4 clinical specialty areas: geriatrics, neurology, orthopedics, and pediatrics. SUBJECTS Subjects were 12 peer-designated expert physical therapists nominated by the leaders of the American Physical Therapy Association sections for geriatrics, neurology, orthopedics, and pediatrics. METHODS Guided by a grounded theory approach, a multiple case study research design was used with each of the 4 investigators studying 3 therapists working in one clinical area. Data were obtained through nonparticipant observation, interviews, review of documents, and analysis of structured tasks. Videotapes made during selected therapist-patient treatment sessions were used as a stimulus for the expert therapist interviews. Data were transcribed, coded, and analyzed through the development of 12 case reports and 4 composite case studies, one for each specialty area. RESULTS A theoretical model of expert practice in physical therapy was developed that included 4 dimensions: (1) a dynamic, multidimensional knowledge base that is patient-centered and evolves through therapist reflection, (2) a clinical reasoning process that is embedded in a collaborative, problem-solving venture with the patient, (3) a central focus on movement assessment linked to patient function, and (4) consistent virtues seen in caring and commitment to patients. CONCLUSION AND DISCUSSION These findings build on previous research in physical therapy on expertise. The dimensions of expert practice in physical therapy have implications for physical therapy practice, education, and continued research.

[1]  Joy Higgs,et al.  The Nature, Generation and Verification of Knowledge , 1995 .

[2]  K. Shepard,et al.  Attribute dimensions that distinguish master and novice physical therapy clinicians in orthopedic settings. , 1992, Physical therapy.

[3]  P. Taylor.  Clinical Decision Making: From Theory to Practice , 1996 .

[4]  R. Yin.  Case Study Research: Design and Methods , 1984 .

[5]  C. Winstein,et al.  Movement science and its relevance to physical therapy. , 1990, Physical therapy.

[6]  M. Day,et al.  The road to excellence [human resource management] , 1999 .

[7]  Linda S. Lotto.  Qualitative Data Analysis: A Sourcebook of New Methods , 1986 .

[8]  P. Benner.  From novice to expert. , 1984, The American journal of nursing.

[9]  David C. Thomasma,et al.  The virtues in medical practice , 1993 .

[10]  J. K. Dennis,et al.  Expert decision making in physical therapy--a survey of practitioners. , 1991, Physical therapy.

[11]  A. Strauss,et al.  Basics of qualitative research: Grounded theory procedures and techniques. , 1992 .

[12]  Donald A. Schön.  The reflective practitioner : how professionals think in action , 1986 .

[13]  P. Benner,et al.  The Primacy of Caring: Stress and Coping in Health and Illness , 1989 .

[14]  R. Purtilo.  Ethical dimensions in the health professions , 1981 .

[15]  H. Hislop.  Tenth Mary McMillan lecture. The not-so-impossible dream. , 1975, Physical therapy.

[16]  Allen Newell,et al.  Human Problem Solving. , 1973 .

[17]  O. Payton.  Clinical reasoning process in physical therapy. , 1985, Physical therapy.

[18]  O. White,et al.  Clinical decision making by experienced and inexperienced pediatric physical therapists for children with diplegic cerebral palsy. , 1996, Physical therapy.

[19]  Janice M. Morse,et al.  Qualitative Nursing Research: A Contemporary Dialogue , 1990 .

[20]  D. Schoen,et al.  The Reflective Practitioner: How Professionals Think in Action , 1985 .

[21]  V. Robertson.  Research and the cumulation of knowledge in Physical Therapy. , 1995, Physical therapy.

[22]  G. Jensen.  Qualitative methods in physical therapy research: a form of disciplined inquiry. , 1989, Physical therapy.

[23]  J. Higgs,et al.  Clinical Reasoning in the Health Professions , 2000 .

[24]  L. Robrecht.  Grounded Theory: Evolving Methods , 1995 .

[25]  N. Denzin,et al.  Handbook of Qualitative Research , 1994 .

[26]  Arthur S. Elstein,et al.  Medical Problem Solving , 1990 .

[27]  K. Shepard,et al.  The novice versus the experienced clinician: insights into the work of the physical therapist. , 1990, Physical therapy.

[28]  V R Neufeld,et al.  Clinical problem‐solving by medical students: a cross‐sectional and longitudinal analysis , 1981, Medical education.

[29]  K. Holyoak.  Symbolic connectionism: Toward third-generation theories of expertise. , 1991 .

[30]  Pathokinesiology--a name for our times? , 1986, Physical therapy.

[31]  D. Rivett,et al.  Hypothesis Generation in the Clinical Reasoning Behavior of Manual Therapists , 1997 .

[32]  M. Eraut.  Developing professional knowledge and competence , 1994 .

[33]  S. Ian Robertson,et al.  Problem-solving , 2001, Human Thinking.

[34]  K. Shepard,et al.  Describing Expert Practice in Physical Therapy , 1999, Qualitative health research.

[35]  H. Schmidt,et al.  A Cognitive Perspective on Medical Expertise: Theory and Implications , 1990 .

[36]  L. Curry,et al.  Challenge and Vision for Professional Schools in Higher Education@@@Educating Professionals: Responding to New Expectations for Competence and Accountability , 1994 .

[37]  A. Strauss,et al.  Grounded theory methodology: An overview. , 1994 .

[38]  M. Brockett.  Ethics, Moral Reasoning and Professional Virtue in Occupational Therapy Education , 1996 .

[39]  Joseph A. Horvath,et al.  A Prototype View of Expert Teaching , 1995 .

[40]  J. Morse.  Critical Issues in Qualitative Research Methods , 1993 .

[41]  L. Shulman,et al.  Medical Problem Solving: An Analysis of Clinical Reasoning , 1978 .

[42]  R. Tamblyn,et al.  Problem-based learning : an approach to medical education , 1980 .