Abstract
This research is in line with the conclusions of Lagniaux (2013) and Jeulin (2014) on the need to produce specific expert knowledge in physiotherapy on the one hand, and on the other hand to rely on specialists in the field of humanities for teaching and research on clinical reasoning. The conceptualisation in action as a theoretical framework of professional didactics proposed by Pastré (2011) allows the identification of expert knowledge. The research question was to identify the conceptual structure of the triage situation by clinical reasoning in direct access for a physiotherapist. Based on five self-confrontation interviews following a standardised non-instrumental high-fidelity simulated session, we mobilised the content analysis advocated by Bardin (1977) taking into account the cognitive load theory in the selection of outcomes (Tricot and Sweller, 2016). The thesis identified the expert knowledge of the physiotherapist during triage by clinical reasoning in a direct access situation. This expert knowledge is the key element of the clinical reasoning triage decision. The expert knowledge is constituted by the pragmatic concepts of the situation of triage by clinical reasoning of the patient in direct access. This includes the history and clinical examination of the pain function, the indicators and variables related to this knowledge. This expert knowledge also includes the moment of decision making for triage, which is essentially carried out during the categorisation stage, combining the history and physical examination. Finally, this expert knowledge shows that the most experienced physiotherapists preferentially use non-analytical cognitive processes, i.e. non-analytical clinical reasoning (system 1), combined with interactive processes. These research results allow the process of didactic transposition initially described by Chevallard (1985) and developed by Perrenoud (1998), thanks to data from real activity to be used as a pedagogical tool and to be associated with active pedagogical methods in the learning of the macro-capacity of clinical reasoning, and of the capacity of triage by clinical reasoning in both initial and continuing education. Furthermore, dilemmas inherent to this situation of triage by clinical reasoning in direct access are highlighted in the continuity of the work of Balas (2012): "to care for the patient" or "to care for the pathology", "to collaborate with other care professionals" or "to stick to one's guns", and "kinetic well-being" or "kinetic care". These identified conflicts are to be explored through methodologies allowing access to the transpersonal dimension of the profession (Clot, 2000) of physiotherapist in order to build and assert the identity logic of medical profession with defined competences produced by Roquet, Gatto and Vincent (2015).