Date of Award

Fall 2023

Document Type


Degree Name

Doctor of Education (EdD)


College of Education


Department of Education

Primary Advisor

Dr. Sarah Yates

Second Advisor

Dr. Thomas Gollery

Third Advisor

Dr. Lance Cherry


Clinical reasoning (CR) is a difficult concept to assess and is a leading cause of failure for outpatient clinical experiences for physical therapy (PT) students (Silberman et al., 2018). The purpose of this study was to determine to what degree didactic assessments of CR could predict CR in clinical practice utilizing Miller’s (1990) pyramid as a conceptual framework. Using a retrospective quantitative exploratory observational design, archived data were collected for graduates in the classes of 2022 and 2023 (N = 84) from a hybrid Doctor of Physical Therapy program. Each assessment pertained to the musculoskeletal domain of PT practice and aligned with corresponding tiers of Miller’s (1990) pyramid. Assessments included biomechanics exams, clinical skills practical exams, musculoskeletal Triple Jump scores (tiers 1-3) and Clinical Internship Evaluation Tool scores (tier four). Regression analyses were completed for didactic assessments (tiers 1-3) to determine whether each individually and as a group could predict CR in clinical practice (tier four). No statistically significant results were found for any individual assessment or the group of assessments for prediction of CR in practice; however, follow-up ancillary analysis revealed that clinical experience cohort rotation was a significant predictor of CR in practice. Further research is needed to explore variables not included in this study; however, results of this study indicate that Miller’s (1990) pyramid may not be the best conceptual framework for assessment of CR for PT students. Educational research is warranted for alternative models or frameworks to assess CR during a Doctor of Physical Therapy program.