Clinical narratives in residency education: Exploration of the learning process.

Background: Post-professional residency educational programs aim to advance the knowledge and skills of therapists in a clinical specialty area, however, little is known about the process, outcomes, or effectiveness of residency education. Purpose: The purpose of this study was to use narrative as a teaching and learning tool to gain insight into the progressive development of the residents' learning process. Design: Qualitative methods including a retrospective analysis of residents' narratives were used to explore the professional development and thought process of residents. Methods: Six physical therapy residents wrote reflective narratives across 4 time placements during their one-year residency. Qualitative content analysis was used to analyze the data for types of reflection across time frames and to construct themes based on meaning statements. Results: Four main themes evolved from the residents' clinical narratives: 1) developing clinical reasoning skills; 2) developing professional formation and identity; 3) moral agency; and 4) emerging characteristics of expertise Conclusions: In this study, clinical narratives served as a pedagogical tool to enhance aspects of clinical expertise. The utilization of clinical narrative may be used as one tool to help to create reflective practitioners with improved skills foundational to clinical practice.

Longitudinal gait analysis of a person with a transfemoral amputation using three different prosthetic knee/foot pairs.

Using gait analysis, we documented kinetic and temporospatial changes over a 7-year period in a single healthy individual with a transfemoral amputation walking with three different knees and matched foot components. The knee/foot pairs in chronological order were Four Bar Endolite knee/Endolite Dynamic Response foot; Ossur Total Knee 2000/Pathfinder I foot; and C-Leg knee/IC40 C-walk foot. The design of the suspension and socket were unchanged across the three prostheses. We found an increase in the braking component of A-P ground reaction force on the intact limb while using the C-Leg compared to the other two prosthetic fabrications. There was progressive change across the three component combinations, which included increased step length, increased walking velocity, and decreased double limb support time. The subject ranked the C-Leg system as the most stable. The final gait pattern with the C-Leg was faster, less cautious, and more stable than with the other prosthetic components.