Validated Tools to Evaluate Clinical Reasoning in Simulation-Based Learning: A Systematic Review for Physical Therapist Education

BACKGROUND AND PURPOSE: Effective clinical reasoning (CR) skills are essential for Doctor of Physical Therapy (DPT) students to manage complex patient scenarios and deliver quality patient-centered care and are often the focus of simulation-based learning experiences (SBLEs) within physical therapist education. Despite this increasing emphasis on CR, validated assessment tools for SBLEs remains limited. This systematic review aimed to identify and assess tools measuring CR, clinical decision making (CDM), and critical thinking (CT) in SBLEs within DPT programs. METHODS: Guided by the PRISMA framework, this review included peer-reviewed articles published post-2017, detailing psychometric assessments of CR/CDM/CT tools applicable to physical therapist education. PubMed, CINAHL, ERIC, and Web of Science databases were searched for published studies that contained 1 or more tools assessment CR/CDM/CT. This search yielded 2084 studies, 23 of which were ultimately included in the review. Tool quality was assessed using the Modified Medical Education Research Study Quality Instrument (MMERSQI). RESULTS: Included studies primarily featured single-group, cross-sectional designs with limited sample sizes, resulting in a mean MMERSQI score of 61.7 (range 36.5-75.5). Most tools demonstrated internal consistency and content validity, but concurrent validity and reliability were infrequently reported. Tools typically were used to assess self-reported skills or applied knowledge in formative, low-stakes contexts. Tools predominantly assessed diagnostic and procedural reasoning; interactive, predictive, ethical, collaborative, and narrative reasoning were less common. DISCUSSION AND CONCLUSION: This systematic review identified several reliable and valid tools for assessing CR/CDM/CT. However, methodological shortcomings, including limited diversity in reasoning strategies assessed and inadequate multi-institutional validation, were also revealed. These gaps underscore the need for more comprehensive assessment tools and comparative research between simulation-based and traditional teaching methods to determine the most effective means of developing CR skills in physical therapy education. Future research should enhance methodological rigor to optimize CR skill development.