Date Presented 04/05/19
This quantitative study examined clinical reasoning development achieved through case-based learning during one year of an entry-level OT curriculum. Self-Assessment of Clinical Reflection and Reasoning identified statistically significant changes in clinical reasoning skills in total score and 10 individual items based on this instructional method. Results were supported by student feedback regarding the benefits of case formats that promoted reasoning and enriched the learning experience.
Primary Author and Speaker: Lynne Murphy
Additional Authors and Speakers: Jennifer Radloff
PURPOSE: Although clinical reasoning is a critical skill of a competent occupational therapist, there is limited evidence about how instructional methods contribute to the acquisition of these skills. Although case studies are often used in OT education, outcomes related to clinical reasoning have not been fully explored. This study examined clinical reasoning development resulting from case-based learning experiences throughout one year of an entry-level occupational therapy curriculum. Specifically, it addressed the following research questions: 1) how does case-based learning contribute to the development of clinical reasoning skills, and 2) what are student perceptions of various forms of case-based learning?
DESIGN: This quantitative quasi-experimental research utilized a one group pre-test post-test design. Data was collected using the Self-Assessment of Clinical Reflection and Reasoning (SACRR) to measure students’ perceptions of clinical reasoning skills and actions. To enrich understanding of SACRR results and facilitate improved learning experiences, student perceptions of various case formats was explored.
METHOD: The SACRR pre-test was given in the first week of the fall 2017 semester to 26 students entering the second year of a 2.5 year MSOT program. During both fall 2017 and spring 2018 courses, a variety of case-based learning methods were used in several classes, including text case studies, video case studies, role-playing client cases, observations of actual clients, and simulated patient cases, with associated assignments. In the last week of the spring 2018 semester, students completed the SACRR post-test and answered open-ended questions regarding their perceptions of the case formats. The SACRR asks students to rate 26 clinical reasoning skills on a 5-point Likert scale regarding how they use that skill. Repeated measures t-tests were used it identify changes in perceived clinical reasoning between pre-test and post-test, and open-ended data was reviewed by researchers.
RESULTS: There was a statistically significant change in clinical reasoning skills for the total SACRR score (t=-4.60, p<.01), as well as 10 individual items, which were primarily focused on use of frames of reference or theory, understanding client deficits and facilitation of intervention planning and implementation, and seeking to understand client outcomes.
Student comments identified that the majority of students (57.7%) reported a preference for a combination of different case formats. Video cases were preferred by 26.9%, no preference was identified by 11.5% and 3.8% preferred simulated patients. Learners described benefits of each case format as follows: text cases provided detailed client information, videos provided authenticity and ability to develop observation skills with real clients, and simulated patients provided the ability to utilize student hands-on skills and interactive reasoning.
Student comments described how case-based learning increased readiness for fieldwork and clinical practice through intentional use of applied clinical reasoning skills.
CONCLUSION: This study provided additional evidence, consistent with the limited existing research and perceptions reported in literature, that case-based learning has a positive influence on clinical reasoning development necessary for clinical practice.
IMPACT STATEMENT: This research provides guidelines for using various case formats as outcomes support the use of combined case formats as an ideal instructional method to facilitate clinical reasoning in occupational therapy education.
References
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