Fieldwork Educators’ Communication of Clinical Reasoning to Their Students

Occupational therapy (OT) fieldwork provides an opportunity for students to practice in-context clinical reasoning under the supervision of a clinical fieldwork (FW) educator. A qualitative descriptive design was used to explore, from the perspective of FW educators, how FW educators develop and experience their process of clinical reasoning, and to examine the ways in which the FW educators communicate their clinical reasoning to OT students when making decisions within their OT process. Individual interviews were conducted with five clinical FW educators with recent experience as a FW educator. Email recruitment was via the sponsoring institution’s clinical educator list. Participants first received a written pre-interview reflection guide containing both operational definitions of clinical reasoning terms and prompts designed to facilitate self-reflection regarding use of clinical reasoning and communication. A corresponding interview guide was used to facilitate the face-to-face and telephone interviews. Thematic analysis highlighted participants’ valuation of mentorship through modeling of more advanced skills, which they shared with students through articulation of their own procedural and interactive reasoning with patients. Sharing reflections on clinical actions was the most often described approach for communicating clinical reasonings to students, with FW educators reporting use of multiple strategies including prompting reflection and allowing trial and error to facilitate students’ engagement in the clinical reasoning process. Notably, participants did not articulate their own meta-cognitive process of clinical reasoning, such as articulation of the types of tactic information that is prioritized and why, and how such information is linked to other knowledge. FW educators have needs for targeted support in developing meta-cognitive understanding of their own clinical reasonings used, which OT educational programs can develop for their FW educators.

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