The path to bricolage: an approach to facilitating epistemological reflexive practice on a pre-qualifying physiotherapy doctorate

Clinical reasoning is based on principles of patient-centred care and evidence-based practice. When clinical reasoning is complex and ambiguous, these two approaches may appear at odds. Practitioners may be challenged in reconciling their professional’s values, knowledge and worldviews (epistemic stance); knowledge derived through research, and the humanistic approach needed for patient-centred care. For practice to develop and provide patients with the best care, it is important that practitioners develop criticality of their epistemic stance and how this impacts on decision making. In the absence of a single, dominant practice epistemology, there is a need for a pluralistic epistemology, such as bricolage, to inform practice. Using the ‘epistemic cognition’ framework, the aim of this paper is to discuss teaching and learning strategies for employing epistemic stance as a critical lens to enhance reflexive practice in a pre-qualifying doctoral healthcare learners. Facilitating an ethos of safe uncertainty is discussed as a pedagogic approach to support learners in their journey through liminality towards bricolage.