Abstract
Developing clinical reasoning skills is a mandatory component of training OT assistant students. The results of this qualitative study present empirical evidence addressing the preparation of OTA students’ perceptions of Level II learning experiences, which promoted the development of their clinical reasoning skills.
Primary Author and Speaker: Jeanne Coviello
Additional Authors and Speakers: LaRonda Lockhart-Keene
Contributing Authors: Marie Christine Potvin
The purpose of Level II Fieldwork (FW) is to develop competent, entry-level occupational therapy practitioners (American Occupational Therapy Association [AOTA], 2011). Level II FW requires students to apply academic knowledge and skills in clinical practice settings and to demonstrate clinical competence (AOTA, 2011). A large component of becoming clinically competent is the development of clinical reasoning skills (Liu, Chan, & Hui-Chan, 2000). Clinical reasoning is described as the process by which practitioners collect information, develop an understanding of clients’ needs, and then plan, direct, perform, and reflect on client care (Cornin & Graebe, 2018; Schell & Schell, 2008). Developing clinical reasoning skills is a mandatory component of training Occupational Therapy Assistant (OTA) students.
Due to the lack of empirical data on this topic, the first known qualitative exploratory study was conducted to examine Level II OTA students’ perceptions of what constitutes clinical reasoning, their perceptions of fieldwork learning experiences which contributed to the development of clinical reasoning skills, and their perceptions about the number and frequency of different learning experiences which promoted their development of clinical reasoning skills. Pilot-year data was collected, analyzed, and the second phase of data collection and analysis is continuing in order to acquire an in depth first-person account of OTA students’ perspectives about clinical reasoning and what learning experiences contribute to their development of clinical reasoning skills during Level II fieldwork.
Participants were from a convenience sample recruited from a cohort of sixteen OTA students enrolled in an OTA program located in the North Eastern United States. All OTA students who were registered to complete a Level II FW during fall 2017 were eligible to participate. Twelve of sixteen eligible students consented to participate during the initial phase. Qualitative data sources for this study included a total of 46 fieldwork journals, two focus groups, and 10 questionnaires.
Ten of the 12 students (83%) who consented to participate in the pilot phase completed questionnaires. Two focus groups were conducted, following the participants’ completion of their first Level II FW. Based on a review of the literature, a questionnaire was developed. To avoid priming participants, the questionnaires were distributed once the focus groups were concluded. The questionnaire consisted of fourteen 5-point Likert Scale questions. Data analysis began with coding of participants’ fieldwork journals, followed by coding of the focus group transcripts using a step-by-step, multiple-coder process.
Upon completion of Level II FW, participants had a clear sense of what constitutes clinical reasoning. Participants also provided examples of five types of clinical reasoning: ethical, interactive, pragmatic, scientific, and procedural reasoning. Eight major themes emerged in the data reflecting the participants’ impressions of experiences which promoted the development of their clinical reasoning skills which included: on-boarding process, knowing expectations, feedback, fieldwork educators’ characteristics, collaboration, hands-on learning, consistency in caseload, and self-reflection. Questionnaire results reflect the participants reported engaging in 12 of 14 learning experiences, to varying degrees and OTA students perceived modeling of best practice and receipt of consistent feedback as learning experiences which most significantly contributed to clinical reasoning skill development. This information is important to the profession, as the development of clinical reasoning skills by Level II OTA students is a requirement for entry-level competence.
American Occupational Therapy Association. (2011). Accreditation Council for Occupational Therapy Education (ACOTE) standards. American Journal of Occupational Therapy, 66(6, Suppl.), S6-S74.
Cronin, A., & Graebe, G. (2018). Clinical reasoning in occupational therapy. Bethesda, Maryland: AOTA Press.
Liu, K. P. Y., Chan, C. C. H., & Hui-Chan, C. W. Y. (2000). Clinical reasoning and the occupational therapy curriculum. Occupational Therapy International, 7(3), 173-183. 10.1002/oti.118
Schell, B. A. B., & Schell, J. W. (2008). Clinical and professional reasoning in occupational therapy. Lippincott Williams & Wilkins.