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Purpose: The recognition of pathological processes, which are not appropriate for physiotherapy, is a crucial part of the clinical reasoning process. Over recent years, there have been several research efforts investigating qualified physiotherapists and doctoral students’ capability in making precise clinical decisions on whether a patient’s condition is suitable for physiotherapy intervention (keep), or rather requires medical check-up (refer). No study so far has examined the keep/refer decision making abilities of final year undergraduate physiotherapy students within Europe. Materials and methods: A survey containing 12 validated vignettes was distributed among 2238 final year undergraduate physiotherapy students from 15 different member countries of the European Network of Physiotherapy in Higher Education (ENPHE). Results: Seventy-three respondents were included in the final analysis. Only slightly more than half (mean: 53%; median: 67%) of the medical critical vignettes were answered correctly. Just eight respondents (11%) correctly identified all three medical critical vignettes. Conclusion: European final year undergraduate physiotherapy students are not sufficiently equipped with enough knowledge and skills to make very precise keep/refer decisions (based on clinical vignettes) and, most importantly, seem insufficiently trained to accurately identify more critical medical conditions which need a timely referral to another health care professional.

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