Core components of communication of clinical reasoning: a qualitative study with experienced Australian physiotherapists

Communication is an important area in health professional education curricula,however it has been dealt with as discrete skills that can be learned and taught separate tothe underlying thinking. Communication of clinical reasoning is a phenomenon that haslargely been ignored in the literature. This research sought to examine how experiencedphysiotherapists communicate their clinical reasoning and to identify the core processes ofthis communication. A hermeneutic phenomenological research study was conducted usingmultiple methods of text construction including repeated semi-structured interviews,observation and written exercises. Hermeneutic analysis of texts involved iterative readingand interpretation of texts with the development of themes and sub-themes. Communicationof clinical reasoning was perceived to be complex, dynamic and largely automatic.A key finding was that articulating reasoning (particularly during research) does notcompletely represent actual reasoning processes but represents a (re)construction of themore complex, rapid and multi-layered processes that operate in practice. These communicationsare constructed in ways that are perceived as being most relevant to theaudience, context and purpose of the communication. Five core components of communicatingclinical reasoning were identified: active listening, framing and presenting themessage, matching the co-communicator, metacognitive aspects of communication andclinical reasoning abilities. We propose that communication of clinical reasoning is both aninherent part of reasoning as well as an essential and complementary skill based on thecontextual demands of the task and situation. In this way clinical reasoning and its communicationare intertwined, providing evidence for the argument that they should belearned (and explicitly taught) in synergy and in context.