Date Presented 04/05/19
In this mixed-methods study, we explored the extent to which an experiential learning course improved professional reasoning, using self-determination theory (SDT) as a frame of reference. Quantitative results indicated a statistically significant increase in professional reasoning. Findings from reflective journals indicate a pathway to professional reasoning through SDT. OT educators can utilize the results of this study to better facilitate student development of professional reasoning.
Primary Author and Speaker: Tiffany Bolton
Additional Authors and Speakers: Evan Dean
PURPOSE: Occupational therapy (OT) education frequently utilizes experiential learning as an effective instructional method to develop professional reasoning in OT students. However, little is known about how professional reasoning develops (Unsworth & Baker, 2016). This study used a mixed-methods research design to determine the extent to which an experiential learning course was effective in increasing professional reasoning.
DESIGN: We utilized a mixed-methods design to investigate 1) the extent to which professional reasoning developed during the experiential learning experience and 2) the process through which professional reasoning was developed. We used a retrospective convenience sample of 36 occupational therapy graduate students enrolled in an experiential learning course as part of their didactic curriculum. The students completed pre and post measure of clinical reasoning on the first and sixteenth weeks of class. The students also completed reflective journal assignments on the first, eighth, and sixteenth weeks of class. The journal assignments were designed to understand the clinical reasoning process. All students were engaged in direct client contact in a variety of settings. Students were 88.9% female (n=32) and 11.1% male (n=4). 22.2% had previous college degrees prior to starting the OT program (n=8). The mean age of the students was 23, with a range from 22-28 years of age.
METHOD: To measure clinical reasoning, we used the SACRR is a 26-item self-assessment, each question has a five-point scale. The tool is designed to assess self-perception of learning related to clinical reasoning and reflection (Johnson et al., 2017). The SACRR shows acceptable psychometric properties with Cronbach’s alpha of .87 for pretest and .92 for posttest, and the Spearman rank order correlation coefficient of test-retest reliability with a score of .60 (Royeen et al., 2001). We analyzed differences in pre and post scores on the SACRR using MANOVA.
For the qualitative portion of the study, the researchers examined the results of three separate reflective journal entries completed by each student. First, the lead researcher used holistic coding by reading overall reflective journal passages for themes. The researchers then used deductive coding using codes developed from Self-Determination Theory (SDT) (i.e. competence, relatedness, and autonomy).
RESULTS: MANOVA revealed that students made significant growth in professional reasoning based on SACRR data (f=3.657; p=.018). Post-hoc testing revealed that the significant differences were due to 21/26 items on the SACRR. Content analysis of the reflective journals revealed themes related to self-determination theory. As students developed professional reasoning, student journal responses showed a progression from a focus on competence to relatedness and autonomy.
CONCLUSION: Self-determination theory informs us that most adults require competence, relatedness, and autonomy in order to make self-regulated and intrinsically motivated decisions (Orsini et al., 2016). The results of this study indicate that the same tenets of SDT can apply to the development of professional reasoning in OT students. In order to proficiently utilize professional reasoning, an OT must be competent in their skills, relate to their client, and make autonomous decisions. These concepts also assist OT educators in developing assignments and experiences that satisfy OT students’ needs for competence and relatedness while encouraging autonomy. This study builds upon previous literature both internal and external to OT. We gain insight by combining self-determination theory with professional reasoning, which allows OT educators to better understand and foster its development in students.
References
Orsini, C., Binnie, V.I., & Wilson, S.L. (2016). Determinants and outcomes of motivation in health professions education: A systematic review based on self-determination theory. Journal of Educational Evaluation for Health Professions, 13(19). https://dx.doi.org/10.3352/jeehp.2016.13.19.
Royeen, C., Mu, K., Barrett, K., & Luebben, A.J. (2001). Pilot investigation: Evaluation of clinical reflection and reasoning before and after workshop intervention. In P. Crist (Ed.), Innovations in occupational therapy education (pp. 107-114). Bethesda, MD: American Occupational Therapy Association.
Seif, G., Coker-Bolt, P., Kraft, S., Gonsalves, W., Simpson, K., & Johnson, E. (2014). The development of clinical reasoning and interprofessional behaviors: Service learning at a student-run free clinic. Journal of Interprofessional Care, 28(6), 559-564. https://dx.doi.org/10.3109/13561820.2014.921899.
Unsworth, C., & Baker, A. (2016). A systematic review of professional reasoning literature in occupational therapy. British Journal of Occupational Therapy, 79(1), 5-16. https://dx.doi.org/10.1177/0308022615599994.
