Date of Award

Summer 2021

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Bonnie L. Van Lunen

Committee Member

Julie M. Cavallario

Committee Member

Luzita I. Vela


Clinical reasoning (CR) is defined as a complex multi-factorial metacognitive process for diagnosis formulation. Clinical reasoning begins as a student and develops over a career. Students are typically taught an analytical approach defined as hypothetico-deductive reasoning (HDR). Expert clinicians use a non-analytical approach defined as the Knowledge Based Model (KBM) of CR. It is accepted that clinicians use the KBM with cases that they have more experience to streamline the evaluation process. Unfortunately, because of the nuance of CR there have been limited investigations within athletic training to evaluate CR outside of the student population.

The overarching purpose of this dissertation was to investigate CR in athletic training preceptors. To achieve this purpose, three interrelated projects were conducted. The first project involved a systematic review to investigate the use of the Diagnostic Thinking Inventory (DTI). The second project assessed clinical reasoning using the Diagnostic Thinking Inventory for Athletic Trainers (DTI-AT) in athletic training preceptors. The second project was guided by the Longitudinal Framework for Fostering Critical Thinking and Diagnostic Reasoning to establish appropriate demographic questions associated with CR development. The final project explored preceptors’ perceptions of CR in athletic training.

The systematic review confirmed that the DTI was a valid, reliable, and widely used instrument to assess CR in healthcare professions. The instrument was used in medicine, physiotherapy, and athletic training. Project II indicated that the athletic training preceptors studied scored higher on the DTI than the averages of all other professions assessed in the literature, however, all other professions included both students and professionals. Professional sociability was found to be the only demographic factor related to higher scores on the DTI-AT. This finding contrasted with the Longitudinal Framework for Fostering Critical Thinking and Diagnostic Reasoning. Project III identified that CR processes in athletic training are highly variable between individual clinicians based on their experiences, confidence, patients, and external factors. Findings from these three projects indicate the importance of continued CR assessment of athletic training professionals, inclusion of soft skills in athletic training education, and encouraging professional sociability both inter- and intraprofessionally.