Fostering Clinical Reasoning in Athletic Training Education: Insights from Miller’s Pyramid

In athletic training education, Miller’s Pyramid of Clinical Competence (1990) offers valuable insights for nurturing students’ clinical reasoning skills. This pyramid outlines four sequential levels of competence: knows, knows how, shows how, and does. These levels progress from theoretical knowledge to practical application and ultimately to autonomous clinical practice.

Here’s a look at Miller’s Pyramid and how it can be applied in athletic training education:

• Knows (Knowledge): This is the foundation of the pyramid, encompassing the factual knowledge base for understanding mechanisms of injury, diagnostic procedures, and treatment modalities commonly encountered in athletic training practice. For example, knowledge of anatomy, physiology, and biomechanics.
• Knows How (Competence): Here, students develop the ability to apply their knowledge to solve problems. This involves using clinical scenarios, case studies, simulations, and problem-based learning exercises.
• Shows How (Performance): Next, students demonstrate their competence in simulated settings. Learning experiences like practicing techniques in a lab or role-playing patient interactions are appropriate at this stage.
• Does (Action): The pinnacle involves applying knowledge and skills in real-world situations during supervised clinical experiences. Clinical experiences provide students with opportunities to assess, diagnose, and treat injuries under the guidance of preceptors. Students become proficient and autonomous practitioners capable of making sound clinical judgments independently.

Pyramid graphic from Ramani, S., & Leinster, S. (2008). AMEE Guide no. 34: teaching in the clinical environment. Medical Teacher, 30(4), 347–364.

How to use Miller’s Pyramid of Clinical Competence with ATu to foster clinical reasoning:

• Build the “Knows” level through video-based lectures/handouts and assess factual recall through MicroLearning.
• Elevate students to “Knows How” with Case Studies and other problem-solving activities.
• Allow students to “Show” their knowledge through clinical simulations found in MiniSIMS using standardized patients.
• Provide the crucial “Does” experience through MacroSIMS to augment students’ supervised clinical experiences.

By integrating Miller’s Pyramid into athletic training education, educators can create structured learning experiences that gradually build students’ clinical reasoning skills from foundational knowledge (“Knows”) to advanced clinical practice (“Does”). This structured approach fosters a deep understanding of clinical concepts and prepares students to excel as competent and confident athletic trainers.

Ready to transform your classroom? Schedule a meeting with ATu Education Lead, Christopher Schmidt, PhD, ATC.

References:

1. Miller, G. E. (1990). The assessment of clinical skills/competence/performance. Academic Medicine, 65(9 Suppl), S63-67.
2. Ramani, S., & Leinster, S. (2008). AMEE Guide no. 34: teaching in the clinical environment. Medical Teacher, 30(4), 347–364.