Katherine F Shepard

Factors That Influence the Clinical Decision Making of Novice and Experienced Physical Therapists

Background The depth and breadth of prior experience informs clinical decision making in novice and experienced physical therapist clinicians. Objectives The aims of this research were to identify differences in clinical decision-making abilities and processes between novice and experienced physical therapist clinicians and to develop a model of the factors that influence clinical decision making. Design Qualitative research methods and grounded theory were used to gain insight into the factors and experiences that inform clinical decision making. Methods Three participant pairs (each pair consisted of 1 novice physical therapist and 1 experienced physical therapist) were purposively selected from 3 inpatient rehabilitation settings. Case summaries from each participant provided the basis for within- and across-case analyses. The credibility of the results was established through checking of the case summaries by the participants, presentation of low-inference data, and triangulation across multiple data sources and within and across participant groups. Results The factors that influenced clinical decision making were categorized as informative or directive. Novice participants relied more on informative factors, whereas experienced participants were more likely to rely on directive factors. An intermediate effect beyond novice practice was observed. Conclusions The results of this study may be used by educators and employers to develop and structure learning experiences and mentoring opportunities for students and novice learners with the aim of facilitating the development of skills and abilities consistent with expert clinical decision making.

Novice and Experienced Physical Therapist Clinicians: A Comparison of How Reflection Is Used to Inform the Clinical Decision-Making Process

Background Prior experience informs clinical decision making and shapes how reflection is used by novice and experienced physical therapist clinicians. Objectives The aims of this research were: (1) to determine the types and extent of reflection that informs the clinical decision-making process and (2) to compare the use of reflection to direct and assess clinical decisions made by novice and experienced physical therapists. Design Qualitative research methods using grounded theory were used to gain insight into how physical therapists use reflection to inform clinical decision making. Methods Three participant pairs (each pair consisting of one novice and one experienced physical therapist) were purposively selected from 3 inpatient rehabilitation settings. Case summaries of each participant provided the basis for within- and across-case analysis. Credibility of these results was established through member check of the case summaries, presentation of low-inference data, and triangulation across multiple data sources and within and across the participant groups. Results Although all participants engaged in reflection-on-action, the experienced participants did so with greater frequency. The experienced participants were distinguished by their use of reflection-in-action and self-assessment during therapist-patient interactions. An intermediate effect beyond novice practice was observed. Conclusions The results of this study may be used by educators and employers to develop and structure learning experiences and mentoring opportunities to facilitate clinical decision-making abilities and the development of the skills necessary for reflection in students and novice practitioners.

Describing Expert Practice in Physical Therapy

In this article, the authors demonstrate how grounded theory may be used to develop models for understanding clinical practice. Through a series of research studies involving novice, experienced, and expert physical therapy practitioners, conceptual frameworks were continually revised based on data obtained from returning to the field and relevant literature available at the time. As concepts and relationships moved to larger themes, a theoretical framework for expertise in clinical practice was proposed. Current work on verifying the theoretical framework continues. Grounded theory is an excellent research approach to bound and help guide a multistage research program involving multiple researchers working in multiple settings.

Are You Waving or Drowning

Dr Shepard has made remarkable contributions to the profession of physical therapy through her accomplishments across all areas of practice, education, research, publication, and service. She was one of the pioneers who introduced qualitative research methods to the profession and, with her colleagues, went on to apply the principles of these methods to study differences between “master” and “novice” clinicians. Her work in this area has been vital as the profession continues to grapple with effective ways to prepare professional students, clinical specialists, interns, and residents in physical therapy. Her scholarly work includes more than 60 papers and book chapters and coauthorship of 3 textbooks. She has been invited to speak at state, national, and international professional meetings and has held visiting professorships in Sweden and South Africa. She was the “first” for several invited lectures, including the Polly Cerasoli Lecture at APTAs Combined Sections Meeting and the Eleanor Branch Lecture at Duke University. Dr Shepards list of awards and honors includes APTAs Dorothy E Baethke-Eleanor J Carlin Award for Excellence in Academic Teaching, Golden Pen Award (now the Jules M Rothstein Golden Pen Award for Scientific Writing), Dorothy Briggs Memorial Scientific Inquiry Award (3 times), and Lucy Blair Service Award. In 1989, Dr Shepard was elected as a Catherine Worthingham Fellow of APTA. She has received awards for outstanding contributions to physical therapy education from Stanford University and Temple University and the APTA Education Sections Leadership Award, and she holds an honorary doctor of science degree from the University of Indianapolis. Thank you, Mr President, Mary McMillan Awardees, physical therapists and physical therapist assistants, guests, and the staff from states and national office who support us so consistently and graciously. Like the Mary McMillan Lecturers before me, I am gratified and humbled to take my place in that long …