Abstract
This mixed-methods study aimed to identify the Level II fieldwork learning activities that OT assistant (OTA) students (N = 57) found contributed to the development of their clinical reasoning skills. The data produced six themes that affected the development of OTA students' clinical reasoning skills. These themes explore the components of the students' fieldwork experience that the students perceived to have the biggest impact on the development of their clinical reasoning.
Primary Author and Speaker: Eden Rothacker
Additional Authors and Speakers: Marie-Christine Potvin, Jeanne Coviello, LaRonda Keene, and Taryn Pettigrew
Contributing Authors: Caitlin Taylor, Mary-Beth Thomas
The purpose of Level II Fieldwork (FW) is to develop competent, entry-level occupational therapy practitioners (American Occupational Therapy Association [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 gather information, develop an understanding of clients' needs, and then plan, perform, and reflect on client care (Cornin & Graebe, 2018; Schell & Schell, 2008). Developing clinical reasoning skills is a critical component of the training of occupational therapy assistant (OTA) students in the classroom and in fieldwork. Unfortunately, little is known about the learning experiences in which OTA students engage during their Level II FW, nor which of these experiences have the most value to students' clinical reasoning development. A mixed method study was conducted to: (1) ascertain the type of learning activities that OTA students experience during their Level II FW; (2) determine the frequency of occurrence of these learning activities during the OTA students fieldwork placement; and to (3) explored the OTA students' perceptions of which of these learning experiences had the most value to the development of their clinical reasoning during fieldwork. A convenience sample of participants (n = 57) were recruited from four successive cohorts of OTA students enrolled in a program located in the North Eastern United States. All OTA students (n = 88) in these four cohorts who were registered to complete a Level II FW were eligible to participate. Quantitative data was collected through a structured questionnaire comprised of close ended questions (8 questions and 37 subquestions) analyzed through descriptive statistics. The qualitative data was obtained from focus groups and analyzed through an iterative process with the development of a coding key, and repeated coding of the verbatim transcripts of the focus groups. Inter-coder reliability was established and a multiple-coder process was used. The participants were representative in terms of gender and ethnicity of the population it was drawn from. Eight-one percent of participants were female. They represented a mix of ethnicity with 71.9% of participants identifying as white whereas 24.5% of participants identified as being of color (e.g., American Indian, Alaskan Native, Asian, Black, African American, Hispanic, Latino, Spanish Origin of any race, Native Hawaiian or other Pacific Islander). The participants reported engaging in 12 of 14 learning activities listed in the structured questionnaire to varying degrees. From the qualitative analysis, six major themes emerged reflecting the participants' impressions of experiences which promoted the development of their clinical reasoning skills: (1) ‘Hands on'- Independent OT services Delivery, (2) Thinking on your Feet, (3) Unique Value of Community Based Placements, (4) Fieldwork Educator Supervision Approach, (5) Searching for Clinical Information, and the (6) Unique Value of Interprofessional Interactions. Overall, students described settings that promoted their independence in their clinical fieldwork, with a supportive supervisor/fieldwork educator facilitated the development of their clinical reasoning skills.
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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.