Curricular integration of a 4-year simulation-based education program on clinical reasoning for physiotherapy students: design and implementation

Background Simulation-based education remains underutilized in physiotherapy and is often limited to isolated experiences rather than longitudinal and systematically integrated approaches with a specific curriculum. This restricts its potential to foster clinical reasoning (CR)—a core competence for diagnosis and treatment planning. This study presents the design and development of a four-year, simulation-based education program (SBEP) focused on CR. Methods The SBEP was created through an institutional and methodological plan, utilizing existing instructional design models. A mapping of CR competencies was made across three domains: (1) Subjective interview, (2) physical examination, and (3) treatment. Faculty development, simulation center support, and resource allocation were prioritized to ensure long-term sustainability. The program was embedded into compulsory coursework from 2015 to 2019 and refined over ten academic cycles. An ad hoc questionnaire was used to assess CR self-perception. Results Twenty-seven tailored scenarios, primarily using standardized patients, were developed. 1,441 students have completed the SBEP, and 80% of the physiotherapy faculty have been trained in simulation methodology. Key challenges included limited faculty expertise, time constraints, and scheduling issues. Preliminary outcomes suggested higher awareness of own limitations in CR after the implementation of SBEP. Conclusions A longitudinal, curriculum-integrated SBEP enables the progressive development of CR, as recommended by the literature. Strategic and methodological planning integration is highly recommended. Our approach offers a replicable framework for institutions seeking to integrate simulation into their health professions curricula. Despite challenges such as resource needs and scheduling, SBEPs could enhance student confidence and competence in clinical reasoning.