This study aims to improve the Clinical Decision Making (CDM) skills of a group of Myanmar physical therapists by series of educational workshops that will introduce them to and guide them through the decision making process by using the CDM workbook. Participants will be separated into two groups, CDM workshop group and CDM workbook group. There will be three time assessments; one pre-workshop/ workbook and two post-workshop/workbook assessments by using Clinical Decision Making (CDM) assessment worksheet.

This study aims to improve the clinical decision making skills of a group of Myanmar Physical therapists by series of educational workshops that will introduce them to and guide them through the decision making process. The hypothesis of the study is the independent variable of CDM education workshop will affect the dependent variable of CDM skills of participants and the direction will be one-tailed.

Regarding my study design with pre-test-post-test for the same subjects design, samples would need 27 samples to see average change in knowledge (CDM knowledge) from pre-test to post-test with the alpha 0.05, power 0.08 and medium effect size of 0.5. However, Researcher will recruit 34 participants to cover 20% of drop out for each group. Altogether 68 participants will be needed.

Participants will be separated into two groups, one workshop and one workbook group. Among all registrants (by initial online announcement of CDM workshop and onsite invitation of CDM workshop -snow ball recruitment ), participants will be randomly assigned to two different group first then principle investigator will inform again them about their group with information sheet and informed consent form to have agreement to join the study from one group. Intervention group will have Clinical Decision Making (CDM) workshop while workbook group will be provided by the Clinical Decision Making (CDM) workbook without attending workshop and onsite interaction.

To conduct the study "Effectiveness of Clinical Decision Making (CDM) workshop in group of Myanmar Physical Therapists" , three preliminary studies have to be done before conducting the main study. Three preliminary studies are 1) Development of Clinical Decision Making (CDM) assessment worksheet, Qualitative Approach (in-depth interview) with 18 physical therapists form Yangon, 2) Validity and Reliability study of Clinical Decision Making (CDM) assessment worksheet and 3) Development of series of Clinical Decision Making (CDM) workshop based on the emerged themes and developed categories to represent the CDM knowledge in Myanmar physical therapists. Study 1 and 3 were done in order to able to develop the protocol of the main study.

Study 4: Effectiveness of Clinical Decision Making (CDM) workshop in group of Myanmar Physical Therapists

Intervention group:

• Clinical Decision Making (CDM) workshops will be presented on four weekdays and will be held in University of Medical Technology, Yangon, Myanmar in 2017.
• Participants will sign an informed consent form describing the benefits and risks of the workshops.
• Participants will be assigned a number. They will put the number on the top of the worksheet to protect their identity.
• A demographic sheet will be given during the workshop registration. This will ask participants their age, gender, years of practice, school attended, places they have practiced, area of practice specialty i.e. Pediatrics, Musculoskeletal etc.
• The workshop will begin with the first assessment approximately 30 minutes.
• During the educational workshop the CDM workbook will be presented and followed by participants as they actively sequence through a typical patient case they have chosen.
• A workbook will be used throughout the workshop which integrates the two clinical practice models: the ICF and Therapeutic Process (TP).
• The workshop will encourage and require group and individual participation and also assist the participants in reflection on their decisions.
• Participants will be assigned into small groups to introduce each other and then introduce to large group.
• Participant will choose a recent patient case and will be guided through the CDM process during the workshop using that case as their example.
• Then discussion will follow guiding the participants through the Therapeutic Process, the ICF and reflecting on choices they made or could make with the patient. During the last half hour of the last session the participants will retake the assessment worksheet.
• The CDM assessment worksheet will be administered one month at the conclusion of the workshop.
• At the time of one month post-CDM workshop assessment, participants will also be asked to reveal the number of patient cases they used CDM workbook to guide their CDM process in their practice to see usefulness of CDM workbook and opportunity to use workbook.

Workbook group:

• Participants will receive Clinical Decision Making (CDM) workbook which will be used to teach the CDM process in the four days CDM workshop.
• Participants will sign an informed consent form describing the benefits and risks of the study.
• Participants will be assigned a number. They will put the number on the top of the worksheet to protect the identity.
• Before receiving CDM workbook, participants will take the first CDM assessment it will take approximately 30 mins.
• A demographic sheet will be given before taking the first CDM assessment. This will ask participants their age, gender, years of practice, school attended, places they have practiced, area of practice specialty i.e. Pediatrics, Musculoskeletal etc.
• After one week, participants will take the second CDM assessment worksheet which is the same time with the immediate post-CDM workshop assessment of the intervention group.
• Then the CDM assessment worksheet will be administered at one month later which is the same time with the one month post-CDM workshop assessment of the intervention group.
• At the time of taking CDM assessment for the last time, participants will be asked to reveal the number of patient cases they used CDM workbook to guide their CDM process in their practice to see usefulness of CDM workbook and opportunity to use workbook.

Inclusion Criteria:

• Currently practicing physical therapists with at least two years of clinical experiences.
• Participants have to be available to join all the 4 days of CDM workshop which will be held at the University of Medical Technology (UMT), Yangon, Myanmar.

Exclusion Criteria:

• Physical therapists with less than 2 years of clinical experiences.
• Physical therapists who were not educated in Myanmar.
• Physical therapists who are not available to join all 4 days of CDM workshop.