The Fieldwork Case Study: Writing for Clinical Reasoning

Occupational Therapy in Health Care, 2004

Fieldwork has been described as an educational method that enhances clinical reasoning skills. The purpose of this study was to determine the effects of Level II fieldwork on the development of clinical reasoning skills of undergraduate occupational therapy students. Method. A quasi-experimental pretest-posttest design was used with a convenience sample of 48 undergraduate seniors. All students participated in two 12-week, full-time rotations of Level II fieldwork. The Self-Assessment of Clinical Reflection and Reasoning (SACRR) developed by Royeen, Mu, was administered the week before the students left for fieldwork and the first day after they returned from fieldwork. Results. Paired t-tests revealed statistically significant differences in pretest and posttest scores for 13 of 26 items on the SACRR. In addition, the overall total score increased from 102.55 to 108.41 (p < .01).

African Journal of Health Professions Education, 2021

Transitioning from classroom to clinical setting presents multiple challenges for health science students. These challenges range from a lack of generic skills and professional behaviours to difficulties translating the taught skills and theory into patient management, raising further concerns about the existence of a 'theory-practice gap' . Even under the supervision of clinical educators (CEs), students struggle with the complexity of the clinical situations they encounter. CEs are also challenged when facilitating students' learning in these complex clinical contexts, while providing effective service to patients. Skill in clinical reasoning (CR) is necessary to guide students and educators in assessing, assimilating, retrieving and/or discarding components of information that affect patient care. Failure to develop CR is considered one of the key reasons for students' lack of confidence and effectiveness in the clinical area, ultimately influencing their academic success. While the explicit development of CR is a foundation requirement of entry-level practice education, it cannot be assumed to develop in the absence of specific educational strategies. Therefore, CEs need to create learning opportunities that explain the multidimensional nature of CR to students to support them in developing these capabilities and scaffold the development as they progress through their clinical years. 'Until well into the 17th century, academic medicine was almost exclusively a theoretical affair. Reasoning played an important role, but it was exclusively employed to defend theses or to construct logical arguments, rather than to arrive at diagnoses or to select therapies. ' Over the years, there were many attempts to integrate theoretical knowledge with clinical experience, and thus the value of teaching CR to students became more evident. However, CR is not taught explicitly in all health profession educational programmes. Another challenge is the existence of different interchangeable terminologies, definitions and concepts for CR. Differences among healthcare professionals regarding the CR processes were also noted. While medical professionals focus on a cognitive psychology perspective, nursing or physiotherapy professionals adopt an interpretive and sociocultural lens that goes beyond the cognition. These discrepancies possibly contributed to a potential mismatch between CEs' and students' understanding of CR, and how learning and teaching may be facilitated. It could also account for the lack of student awareness of the cues being provided by the CEs, which ultimately results in a lack of development in the area. Therefore, it seems that educators and students would benefit from attempts to develop a common understanding of the concept of CR and its terms. Understanding the CR process is challenging. In the broadest and most general sense, it 'can be summarised as the thinking and decision making of a health care provider in clinical practice, ' leading to clinical decisionmaking. CR was also defined as 'an inferential process used by practitioners Background. Clinical reasoning (CR) is a skill acquired by students under supervision of clinical educators (CEs) when transitioning from classroom to clinical practice to optimise patient care. However, intra-and inter-professional differences in the definition and facilitation of CR have been reported. At the University of Cape Town, a teaching development grant was obtained and used for a staff development initiative aimed at improving the CR skills of undergraduate health and rehabilitation students. Objectives. To gain insight into the understanding of CR among CEs and a cohort of third-year students across 4 professional programmes, using an interpretive approach. Methods. The CEs responsible for third-year supervision (n=45) were invited to take part in a self-developed electronic survey and an initial workshop that explored their understanding of CR. The qualitative survey data, as well as workshop feedback and discussion, were analysed. Students' understanding was explored during focus group discussions. Results. There were areas of commonality and differences among CEs. They agreed on a cyclical step-like process to CR and the need to cue students to develop this expertise in clinical settings. The approach of CEs in occupational therapy was client focused; physiotherapy CEs described a higherorder thinking; and audiology and speech and language pathology CEs described a structured procedure informed by evidence. Students were unable to conceptualise a complete picture to reasoning and decision-making. The difference between students' understanding of CR and their poor awareness of strategies employed by CEs to facilitate reasoning could account for difficulties in transitioning from classroom to practice. This scenario suggests that divisions need to look at creating more purposeful strategies to teach students about the CR process and how the facilitation may occur within the clinical setting.

American Journal of Occupational Therapy, 1991

Narrative reasoning is a central mode of clinical reasoning in occupational therapy. Therapists reason narratively when they are concerned with disability as an illness experience, that is, with how a physiological condition is affecting a person’s life. In this paper, narrative reasoning is contrasted with propositional reasoning, and two kinds of narrative thinking are examined. The first is the use of narrative as a mode of speech that can be contrasted with biomedical discourse, in which disability is framed as physical pathology. The second involves the creation rather than the telling of stories. Therapists try to “emplot” therapeutic encounters with patients, that is, to help create a therapeutic story that becomes a meaningful short story in the larger life story of the patient.

Journal of Occupational Therapy Education, 2021

Occupational therapy academic programs are tasked with preparing occupational therapy assistant (OTA) students to develop and use clinical and professional reasoning in practice. A component of this academic education, Level II fieldwork (FW), develops clinical and professional reasoning by allowing students to practice this skill. Although numerous studies have investigated this topic in occupational therapy students, only one small study has previously investigated this in OTA students during Level II FW. Thus, we designed a mixed methods study of OTA students during Level II FW (n = 58) to confirm and expand our knowledge of learning experiences that develop clinical and professional reasoning skills. Six major aspects of Level II FW were identified by participants as contributing to the development of their clinical and professional reasoning skills: “hands-on experience,” “thinking on your feet,” “the value of community-based placements,” “the supervision approach of the FW edu...

The American Journal of Occupational Therapy, 2001

This qualitative case study focused on the clinical reasoning of a certified occupational therapy assistant who had 16 years of practice experience. Observation and interview methods were used to collect data. Transcripts and field notes were coded using a priori codes of the forms of clinical reasoning of occupational therapists identified in published research. The study participant demonstrated the use of pragmatic, procedural, interactive, conditional, and narrative reasoning. We encourage further research to support these findings and to increase the understanding of the forms of clinical reasoning used by occupational therapy assistants.

Australian Occupational Therapy Journal, 2015

Background/aim: Feedback on clinical reasoning skills during fieldwork education is regarded as vital in occupational therapy students' professional development. The nature of supervisors' feedback however, could be confirmative and/or corrective and corrective feedback could be with or without suggestions on how to improve. The aim of the study was to evaluate the impact of supervisors' feedback on final-year occupational therapy students' clinical reasoning skills through comparing the nature of feedback with the students' subsequent clinical reasoning ability. Method: A mixed-method approach with a convergent parallel design was used combining the collection and analysis of qualitative and quantitative data. From focus groups and interviews with students, data were collected and analysed qualitatively to determine how the students experienced the feedback they received from their supervisors. By quantitatively comparing the final practical exam grades with the nature of the feedback, their fieldwork End-of-Term grades and average academic performance it became possible to merge the results for comparison and interpretation. Results: Students' clinical reasoning skills seem to be improved through corrective feedback if accompanied by suggestions on how to improve, irrespective of their average academic performance. Supervisors were inclined to underrate high performing students and overrate lower performing students. Conclusions: Students who obtained higher grades in the final practical examinations received more corrective feedback with suggestions on how to improve from their supervisors. Confirmative feedback alone may not be sufficient for improving the clinical reasoning skills of students.

2018

Clinical reasoning is at the heart of clinical work; it is affected by different field factors. A clear understanding of the reasoning process could solve practitioners' problems on how to make their underlying theories, assumptions and values more explicit. The aim of this research is to understand how clinical reasoning process is formed in the context of occupational therapists working in different clinical settings in Iran. Methods: A purposeful and theoretical sampling of 15 occupational therapists working in clinical settings was performed through semi-structured interviews. All the data were recorded, transcribed, and analyzed using Strauss and Corbin's (2008) grounded theory approach and constant comparative analyses. Results: Conceptual model was developed to explain the relationships among the main categories extracted through the grounded theory. Achieve an observable change emerged as the core category. Other important categories linked to the core category were, performing the continuum of clinical reasoning, context of clinical reasoning, and effective factors in clinical reasoning. Discussion: Findings showed that achieving an observable change in the client was the main consequence of the action/interaction strategies. Some facilitating factors related to the therapist, helped to process reasoning with a holistic and client-centered view, while also helping to develop the self-belief and professional identity. The dominance of medical views and a lack of health insurance were two intervening factors that constrained the dynamics of clinical reasoning within the context of practice.

Trends Med, 2019

Introduction: At the present time, four tests including key features, clinical reasoning, puzzle, and scenario writing are among the most well-known tests frequently used in training and assessing medical students. Medical Students who are spending their internship are the main targets of the clinical reasoning tests. Research has shown that, in terms of expertise level, the mental scripts of this group of students are categorized as intermediate (compared to two levels of students and residents). That is, different forms of tasks could activate different aspects of their mental scripts. The purpose of this study is to investigate the script-based reasoning of the intermediate group when facing different clinical reasoning tests and compare it with the reasoning of the expert and novice groups.

2014

Section 2 Background...