Paper Type

Doctoral Dissertation


College of Education and Human Services

Degree Name

Doctor of Education in Educational Leadership (EdD)


Leadership, School Counseling & Sport Management

NACO controlled Corporate Body

University of North Florida. Department of Leadership, School Counseling & Sports Management

First Advisor

Dr. Daniel Dinsmore

Second Advisor

Dr. Beven Livingston

Rights Statement

Third Advisor

Dr. Brian Zoellner

Fourth Advisor

Dr. Matthew Ohlson

Department Chair

Dr. Elizabeth Gregg

College Dean

Dr. Diane Yendol-Hoppey


This mixed-methods study investigated the effects of case method presentation on the clinical reasoning hypotheses generated, strategies implemented, and errors made by physical therapy students working through a musculoskeletal clinical problem. The study was framed by Marton and Säljö’s levels of processing, McCrudden’s et al. goal-focusing model, Cognitive Load Theory, and the Model of Domain Learning. Verbatim transcriptions for each problem-solving session was created and coded. Cohen’s kappa was κ = .75 indicating substantial inter-rater reliability for the finalized coding schemes. Quantitative analysis included mean and standard deviation calculations followed by Mann Whitney-U comparisons which detected several significant differences between groups regarding clinical reasoning hypotheses generated, reasoning strategies implemented, and errors made during the problem-solving sessions. Moderate-to-large effect sizes, ranging from r2 = .64–.78, indicated that differences in clinical reasoning between groups was mostly attributed to the case presentation method. Additionally, a qualitative profile enriched the data set by identifying differences in type of knowledge regulation each group exhibited and timing of treatment considerations. Specifically, participants in the simulated patient group were found to regulate more psychomotor skill knowledge compared to the written case study group who exhibited more regulation of propositional knowledge. This research project has already impacted the educational experiences physical therapy students receive in their professional education program. Future research should include multi-institutional investigations with a larger number of participants allowing for better representation of physical therapy students across professional education programs before generalizing any findings.