Skip to main content
Log in

Learning to Reason: A Journey of Professional Socialisation

  • Published:
Advances in Health Sciences Education Aims and scope Submit manuscript

Abstract

One of the key attributes that health professional students and new graduates develop during professional socialisation is clinical reasoning ability. Clinical reasoning is a complex skill that is essential for professional practice. There is limited research specifically addressing how physiotherapists learn to reason in the workplace. The research reported in this paper addressed this gap by investigating how experienced physiotherapists learned to reason in daily practice. This learning journey was examined in the context of professional socialisation. A hermeneutic phenomenological research study was conducted using multiple methods of data collection including observation, written reflective exercises and repeated, semi-structured interviews. Data were analysed using phenomenological and hermeneutic strategies involving in-depth, iterative reading and interpretation to identify themes in the data. Twelve physiotherapists with clinical and supervisory experience were recruited from the areas of cardiopulmonary, musculoskeletal and neurological physiotherapy to participate in this study. Participants’ learning journeys were diverse, although certain episodes of learning were common or similar. Role models, mentors and colleagues were found to be influential in the development of reasoning. An important implication for the professional socialisation of physiotherapists and other health professionals and for those involved in practice development is the need to recognise and enhance the role of practice communities in the explicit learning of clinical reasoning skills.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abrandt Dahlgren M., Richardson B., Sjöström B. (2004). Professions as communities of practice. In Higgs J., Richardson B., Abrandt Dahlgren M (eds), Developing practice knowledge for health professionals Edinburgh: Butterworth-Heinemann pp. 71-88

    Google Scholar 

  • Ajjawi R. (2006). Learning to communicate clinical reasoning in physiotherapy practice. Unpublished Doctoral Thesis, The University of Sydney, Australia

    Google Scholar 

  • Bontekoe R. (1996). Dimensions of the hermeneutic circle. Atlantic Highlands, NJ:Humanities Press

    Google Scholar 

  • Boshuizen, H.P. & Schmidt, H.G. (2000). The development of clinical reasoning expertise. In J. Higgs & M.A. Jones (eds.), Clinical reasoning in the health professions, 2nd edn., pp. 15–22. Oxford: Butterworth-Heinemann

  • Brown J.S., Duguid P. (1991). Organizational learning and communities-of-practice: Toward a unified view of working, learning, and innovation. Organization Science 2(1): 40–57

    Article  Google Scholar 

  • Brown J.S., Duguid P. (1996). Stolen knowledge. In McLellan H (eds), Situated learning perspectives Englewood Cliffs, NJ:Educational Technology Publications. pp. 47–56

    Google Scholar 

  • Cant R., Higgs J. (1999). Professional socialisation. In Higgs J., Edwards H (eds), Educating beginning practitioners: Challenges for health professional education Oxford: Butterworth Heinemann. pp. 46–51

    Google Scholar 

  • Charles C., Gafni A., Whelan G. (1999). Decision-making in the physician–patient encounter: Revisiting the shared treatment decision-making model. Social Science and Medicine 49(5): 651–661

    Article  Google Scholar 

  • Charlin B., Tardif J., Boshuizen H.P. (2000). Scripts and medical diagnostic knowledge: Theory and applications for clinical reasoning instruction and research Academic Medicine 75(2): 182–190

    Article  Google Scholar 

  • Clouder L. (2003). Becoming professional: Exploring the complexities of professional socialisation in health and social care. Learning in Health and Social Care 2(4): 213–222

    Article  Google Scholar 

  • Crotty M. (1998). The foundations of social research: Meaning and perspective in the research process. Sydney:Allen & Unwin

    Google Scholar 

  • Denzin, N.K. & Lincoln, Y.S. (2000). Introduction: The discipline and practice of qualitative research. In␣N.K. Denzin & Y.S. Lincoln (eds.), Handbook of Qualitative Research, 2nd edn., pp. 1–29. Thousand Oaks, CA: Sage Publications

  • du Toit D. (1995). A sociological analysis of the extent and influence of professional socialization on the development of a nursing identity among nursing students at two universities in Brisbane, Australia. Journal of Advanced Nursing 21(1): 164–171

    Article  Google Scholar 

  • Edwards C., Titchen A. (2003). Research into patients’ perspectives: Relevance and usefulness of phenomenological sociology. Journal of Advanced Nursing, 44(5): 450–460

    Article  Google Scholar 

  • Edwards I., Jones M., Carr J., Braunack-Mayer A., Jensen G.M. (2004). Clinical reasoning strategies in physical therapy. Physical Therapy 84(4): 312–335

    Google Scholar 

  • Edwards I.C. (2001). Clinical reasoning in three different fields of physiotherapy: A qualitative study. Unpublished Doctoral Thesis, The University of South Australia, Adelaide, Australia

    Google Scholar 

  • Eraut M. (1994). Developing professional knowledge and competence. London:The Falmer Press

    Google Scholar 

  • Eva K.W. (2004). What every teacher needs to know about clinical reasoning Medical Education 39(1): 98–106

    Article  Google Scholar 

  • Eva K.W., Regehr G. (2005). Self-assessment in the health professions: A reformulation and research agenda. Academic Medicine 80(10 supplement): S46–54

    Article  Google Scholar 

  • Higgs J. (1993). Physiotherapy, professionalism and self-directed learning. Journal of Singapore Physiotherapy Association 14(1): 8–11

    Google Scholar 

  • Higgs J., Jones M. (2000). Clinical reasoning in the health professions. In: Higgs J., Jones M (eds), Clinical reasoning in the health professions. Oxford:Butterworth-Heinemann. pp. 3–14

    Google Scholar 

  • Jensen G.M., Gwyer J., Shepard K.F., Hack L.M. (2000). Expert practice in physical therapy. Physical Therapy 80(1): 28–43

    Google Scholar 

  • Koch T. (1996). Implementation of a hermeneutic inquiry in nursing: Philosophy, rigour and representation. Journal of Advanced Nursing 24(1): 174–184

    Article  Google Scholar 

  • Lave J., Wenger E. (1991). Situated learning: Legitimate peripheral participation. Cambridge:Cambridge University Press

    Google Scholar 

  • Lingard L., Haber R.J. (1999). Teaching and learning communication in medicine: A rhetorical approach. Academic Medicine 74(5): 507–510

    Article  Google Scholar 

  • Llewellyn G., Sullivan G., Minichiello V. (1999). Designing health research: Sampling in qualitative research. In: Minichiello V., Sullivan G., Greenwood K., Axford R (eds), Handbook for research methods in health sciences. Sydney:Addison-Wesley. pp. 174–199

    Google Scholar 

  • McArdle K., Coutis N. (2003). A strong core of qualities – a model of the professional educator that moves beyond reflection. Studies in Continuing Education, 25(2): 225–237

    Article  Google Scholar 

  • Minichiello V., Aroni R., Timewell E., Alexander L. (1995). In-depth interviewing (2nd ed). Melbourne:Longman

    Google Scholar 

  • Minichiello , V., Madison, J., Hays, T., Courtney, M. & St John, W. (1999). Collecting and evaluating evidence: Qualitative interviews. In V. Minichiello, G. Sullivan, K. Greenwood & R. Axford (eds.), Handbook for research methods in health sciences, pp. 396–418. Sydney: Addison Wesley

  • Moran D. (2000). Introduction to phenomenology. New York:Routledge

    Google Scholar 

  • Norman G. (2005). Research in clinical reasoning: Past history and current trends. Medical Education 39(4): 418–427

    Article  Google Scholar 

  • Patel V.L., Glaser R., Arocha J.F. (2000). Cognition and expertise: Acquisition of medical competence. Clinical and Investigative Medicine 23(4): 256–260

    Google Scholar 

  • Refshauge, K. & Higgs, J. (2000). Teaching clinical reasoning. In J. Higgs & M. Jones (eds.), Clinical reasoning in the health professions, 2nd edn., pp. 141–147 Oxford:Butterworth-Heinemann

  • Richardson B. (1999a). Professional development: Professional socialisation and professionalisation. Physiotherapy 85(9): 461–467

    Article  Google Scholar 

  • Richardson B. (1999b). Professional development: Professional knowledge and situated learning in the workplace. Physiotherapy 85(9): 467–474

    Article  Google Scholar 

  • Smith D. (1997). Phenomenology: Methodology and method. In Higgs J (eds), Qualitative research: Discourse on methodologies. Sydney: Hampden Press. pp. 75–80

    Google Scholar 

  • Solomon N. (1999). Culture and difference in workplace learning. In Boud D., Garrick J (eds), Understanding learning at work. London: Routledge. pp. 119–131

    Google Scholar 

  • Thompson J.L. (1990). Hermeneutic inquiry. In: Moody L.E (eds), Advancing nursing science through research. Newbury, CA: Sage Publications. Vol. 2, pp. 223–280

    Google Scholar 

  • Titchen A. (2000). Professional craft knowledge in patient-centred nursing and the facilitation of its development. Oxford:Ashdale Press

    Google Scholar 

  • Titchen, A. & McIntyre, D. (1993). A phenomenological approach to qualitative data analysis in nursing research. In A. Titchen (ed.), Changing nursing practice through action research, (Report no. 6, pp. 29–48). Oxford: National Institute for Nursing, Centre for Practice Development and Research

  • van Manen M. (1997). Researching lived experience: Human science for an action sensitive pedagogy (2nd ed). Ontario:Althouse Press

    Google Scholar 

  • Wenger E. (1998). Communities of practice: learning, meaning, and identity. Cambridge: Cambridge University Press

    Google Scholar 

Download references

Acknowledgements

The authors gratefully acknowledge funding from the Australian Postgraduate Award and ANZAME: The Association for Health Professional Education

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rola Ajjawi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ajjawi, R., Higgs, J. Learning to Reason: A Journey of Professional Socialisation. Adv in Health Sci Educ 13, 133–150 (2008). https://doi.org/10.1007/s10459-006-9032-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10459-006-9032-4

Keywords

Navigation