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Author ORCID Identifier

Arvie Vitente: https://orcid.org/0000-0001-7177-7704

Pamela Taylor: https://orcid.org/0000-0002-8486-9541

Christopher Dela Rosa: https://orcid.org/0009-0000-2393-4568

 Arthur Lubinski: https://orcid.org/0009-0002-2575-9163

Abstract

Introduction. Physical therapist learners may accurately recall anatomy yet struggle to translate it into testable hypotheses, recognize discordant findings, select proportionate actions, and communicate uncertainty within scope. Existing frameworks address clinical reasoning or structured communication, but limited guidance connects anatomy-based hypothesis testing directly to patient-centered referral communication when findings do not fit. This theory piece pairs Anatomy-to-Decision (A2D) with SCOPE-D to address that curricular gap.

Methods. Integrative conceptual design drew on literature concerning physical therapist clinical reasoning, illness scripts, cognitive load, dual-process reasoning, hypothesis-oriented patient management, safety screening, and communication of diagnostic uncertainty. These foundations were translated into features intended to organize knowledge, require analytic checking, manage avoidable cognitive load, and externalize scope-aware communication.

Results. A2D organizes reasoning into BUILD, TEST, and ACT. BUILD constructs a provisional anatomical model situated within patient goals and context; TEST distinguishes concordance, independent convergence, and discordance; and ACT selects continue, modify, monitor, refer, or escalate. Safety may interrupt any phase. SCOPE-D translates the evidence boundary into patient-facing, interprofessional, and documentary communication: State the mismatch, Connect the concern, Own your scope, Plan the next step, Ease concern, and Document.

Discussion. The proposed contribution is the coupling of an evidence-to-action reasoning scaffold with an uncertainty-to-communication scaffold. Together, they may bridge anatomy, contextualized clinical decisions, and scope-aware referral communication. They are educational scaffolds, not diagnostic rules or substitutes for practice guidelines, consultation, medical evaluation, or local law. Content validation, response-process studies, reliability testing, comparative educational trials, and transfer studies are needed before effectiveness claims can be made.

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