Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. 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

Date Presented 04/21/21 Evidence-based approaches to upper extremity motor recovery emphasize the use of repetitive-task practice strategies incorporating motor learning principles. These approaches, however, are not consistently implemented in practice. Understanding factors related to the practitioner, the client, the practice setting, and the therapeutic interaction that influence a practitioners' clinical decision making reveals strategies that may help decrease this research-to-practice gap. Primary Author and Speaker: Shannon L. Scott Additional Authors and Speakers: Morgan Sanei Contributing Authors: Leora Comis, Rafael Jimenez Silva, and Smita Jha

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Simulation as a Level I fieldwork (FW) has not been widely studied in OT. This presentation will portray student satisfaction outcomes from a 1-week Level I FW using the Simucase™ platform. This descriptive study investigated students' satisfaction with simulated case-based learning and their perception of clinical reasoning skill development compared with paper case scenarios. Students showed a statistically significant change in debrief and reflection, clinical reasoning, and clinical learning (p < .05). Primary Author and Speaker: Amy Mattila Additional Authors and Speakers: Elizabeth Dwyer DeIuliis Contributing Authors: Retta Martin, Emily Casile

OBJECTIVE. The purpose of this study was to describe current occupational therapy practices in the usage and prescription of and clinical reasoning process supporting home exercise programs (HEPs) for clients with neurological injuries (CWNIs). METHOD. A survey was distributed via mail to 2,000 members of the American Occupational Therapy Association. The survey questions concerned basic demographics, current HEP practices, and attitudes toward using HEPs with CWNIs. RESULTS. In the 360 returned surveys, occupational therapists reported numerous benefits of using HEPs and were able to clearly articulate their clinical reasoning. Commonly reported HEP activities were preparatory in nature, and the most frequently prescribed dosage was 16–30 min daily. Most therapists relied on the same clinical reasoning process but varied in implementation methods. CONCLUSION. This study’s results highlight the gaps between evidence and practice. The active ingredients in HEPs for CWNIs need to be more clearly defined and described.

OBJECTIVE. We describe an educational intervention that involved simulation scenarios of medically complex patients to teach transfer training and promote clinical reasoning. METHOD. Scenarios were developed with practitioner input that described (1) a patient who was acutely ill, (2) a critical medical management event that occurred during a bed-to-wheelchair transfer of the patient, and (3) an occupational need. Transfer training, using the scenarios, occurred in a high-technology laboratory with SimMan^® and a mock hospital suite. Evaluation was based on student performance and perceptions of simulation effectiveness. RESULTS. On average, students completed 66%–88% of the transfer items correctly. Student performance suggested that the simulation scenarios were more difficult than practitioners rated them. Students rated the simulation scenarios as effective teaching tools. CONCLUSION. Scenario use in simulations for transfer training makes a positive curricular contribution to teaching procedural skills and clinical reasoning simultaneously.

OBJECTIVE. A national study explored the use of simulated learning experiences in U.S. occupational therapy and occupational therapy assistant entry-level academic programs. METHOD. Program faculty at 245 of 310 occupational therapy assistant and occupational therapy entry-level programs completed a self-reported 23-question online survey on the use of simulation and its challenges and benefits. Data were analyzed using frequency, percentage, and thematic coding. RESULTS. Of 245 programs, 175 (71%) reported using simulation, with the most common teaching methods incorporating human actors and students and video cases. Simulated scenarios were primarily presented in intervention courses (90%). Faculty provided feedback that benefits of the simulated experience were increased critical reasoning, problem solving and decision making, and communication among students. Challenges were time, cost, and scheduling. CONCLUSION. Findings were similar to those in the literature in terms of simulated learning’s uses, benefits, and challenges. Further research on student learning outcomes and pedagogy in occupational therapy is recommended.

This study used mixed methods to compare four different styles of case presentation in a course designed to develop the clinical reasoning skills of master’s level occupational therapy students. Modalities used to present cases were printed text, videotape, live interview, and CD-ROM movies delivered on an Internet platform. The researchers sought to determine the relative merits and limitations of each modality from both pedagogical and practical standpoints. Results indicate that the choice of modality does not compromise the ability of students to meet learning objectives related to clinical reasoning; however, several advantages and disadvantages with respect to practical aspects of presentation and learning were identified from instructor and student perspectives. The strength of the overall instructional format, and decisions concerning the amount and type of information provided in the cases were found to be more relevant to the quality of the learning experience than the modality of presentation. Recommendations are provided for structuring clinical reasoning learning experiences that combine the best features from the case modalities examined in this study.

OBJECTIVE. The purpose of this study was to explore current conceptualizations of clinical reasoning in occupational therapy. METHOD. Using a head-mounted video camera and debriefing interviews following therapy sessions, clinical reasoning data were collected from 13 experienced occupational therapists working in physical rehabilitation. The data were collected and analyzed within a focused ethnographic framework. FINDINGS. Mattingly and Fleming's (1994) classification of clinical reasoning encompassed most of the thinking processes revealed in the therapists’ debriefing interviews. Therapists also used aspects of pragmatic reasoning (Schell & Cervero, 1993). Additionally, within the forms of procedural, interactive, conditional, and pragmatic reasoning, a new form of “generalization reasoning” is proposed in which therapists draw on past experience or knowledge to assist them in making sense of a current situation or client circumstance. CONCLUSION. This research builds upon previous classification systems to support the categories of narrative, procedural, interactive, conditional, pragmatic (practice context), and generalization reasoning to explain how occupational therapists think in action. Further research is required to explore this emerging description of clinical reasoning.

OBJECTIVE. Problem-based learning (PBL) has been described as an educational method that enhances clinical reasoning skills. The purpose of this study was to determine the effects of an intensive, problem-based course on the development of clinical reasoning skills of undergraduate occupational therapy students. METHOD. A quasi-experimental pretest–posttest design was used with a convenience sample of 48 undergraduate seniors. All students participated in an intensive 5-week, 30-hour, PBL course scheduled just prior to Level II fieldwork. The Self-Assessment of Clinical Reflection and Reasoning (SACRR) developed by Royeen, Mu, Barrett, and Luebben (2001) was administered on the first and last days of the course. RESULTS. The Wilcoxon Signed Ranks Test revealed statistically significant differences in pre- and posttest scores for 11 of 26 items on the SACRR. In addition, the overall total score increased from 96.88 to 102.55 (p < .01). CONCLUSION. The results suggest that a short, but intensive PBL course in the senior year of an occupational therapy curriculum can significantly facilitate the development of students’ clinical reasoning skills.

OBJECTIVE. The purpose of this paper is to examine the clinical reasoning of an occupational therapist in group practice in mental health. It emerged from a larger phenomenological study of expert occupational therapy practitioners in community mental health. METHOD. Data were gathered through intensive, semi-structured interviews with 1 day of participant observation. Analysis was an iterative process in which emerging themes were identified for reflection and interpretation. Previously established categories of clinical reasoning were used as a structure for describing the results. RESULTS. A rich description of clinical reasoning in psychosocial task groups is presented using interactive, narrative, conditional, and pragmatic reasoning. The gestalt of community practice is illustrated, as the therapist describes the multiple levels of consciousness used in her consideration of, and response to, clients within the context of the larger environment. CONCLUSION. This study suggests that an examination of occupational therapy with psychosocial groups is a rich area for research to extend our understanding of clinical reasoning in occupational therapy.

A 3-year project of curricular renaissance undertaken by the faculty of an entry-level master’s degree program is described. This project culminated in a thoroughly redesigned program of study centered around the construct of occupation and built on a foundation of knowledge in occupational science. Described herein are three developmental and highly iterative domains of activity that we re crucial to the project’s success: (a) environmental scanning and analysis, (b) creation of a compelling future vision of occupational therapy, and (c) curriculum planning. Also detailed are especially salient assumptions and beliefs about graduate education as well as seven themes that encompass the program’s academic content and illustrate its defining emphases. These themes are (a) occupation, (b) the human as an occupational being, (c) occupation as a medium of change, (d) clinical reasoning , (e) ethical reasoning, (f) investigative reasoning, and (g) occupational therapists as scholars and change agents in systems. The article concludes with reflections on innovation in graduate education in occupational therapy today.

Objectives. Problem-based learning (PBL) is increasingly being used within health care professional educational programs to develop critical thinking skills via a learner-centered approach. However, few studies have evaluated the effect of participation in a PBL-centered curriculum on occupational therapy knowledge and skill development over time from the perspective of the students involved. This study examined student evaluations of the first three class cohorts participating in a PBL-based curriculum. Method. A participatory action design study involving qualitative, student-led focus groups was conducted with 154 students across 2 years of the education program. Fourteen focus groups were audiotaped, and those audiotapes were transcribed by an outside expert, followed by two levels of analysis by program faculty members and a member check by student participants. Results. Themes that emerged from the data analysis related to (a) defining elements of PBL, (b) the role of students and faculty members, (c) learning strategies used by students in a PBL versus traditional education program, (d) the challenges of a PBL approach, and (e) PBL’s relationship to clinical reasoning and occupational therapy practice. Conclusions. Students perceived that a PBL approach adopted consistently across the curriculum contributed to the development of information management, critical reasoning, communication, and team-building skills; however, identified challenges were time and role management, information access, instructor versus PBL expectations and practices, and coping with the ambiguity of knowledge and reasoning.

Objective. Clinical reasoning concepts can be viewed as descriptions of mental operations or as a thinking frame—a structure to organize and support clinical thinking. This study examined an approach for teaching clinical reasoning as a thinking frame to occupational therapy students. Method. A quasi-experimental, pretest-posttest design was used with a convenience sample of 10 undergraduate occupational therapy seniors. All participants (a) acquired the thinking frame of clinical reasoning concepts through explicit instruction and (b) practiced that thinking frame with an external aid—the Clinical Reasoning Case Study Format. The accuracy of participants' definitions of clinical reasoning concepts before and after this learning experience were examined to assess their acquisition of the thinking frame. The content of clinical reasoning case studies were examined to assess students' application of the thinking frame to clinical situations. Results. Wilcoxon signed rank tests done on presemester and postsemester definitions ratings indicated that the latter were rated significantly higher than the former for (a) narrative reasoning (p = .008), (b) procedural reasoning (p =.005), (c) interactive reasoning (p =.006), (d) pragmatic reasoning (p = .008), and (e) conditional reasoning (p =. 01). The content of participants' clinical reasoning case studies indicated that they were able to apply clinical reasoning concepts. Conclusion. The results suggest that using a clinical reasoning thinking frame to organize clinical observations is an effective way to help entry-level occupational therapy students learn and apply clinical reasoning concepts.

Objective. Students are taught how to apply clinical reasoning methods through a variety of teaching methods, including the use of case studies. Various types of case studies have been described in the literature: paper cases, videotape cases, simulated client cases, and real client cases. This study examined the effectiveness of a new type of paper case study—the clinical reasoning case study—in teaching the clinical reasoning process to occupational therapy students. Method. Four seniors in an undergraduate occupational therapy program completed intervention plans in response to both traditional medical model and clinical reasoning paper case studies. Qualitative methods were used to analyze intervention plans and videotaped discussion about this learning experience. Results. Themes discovered in the data sources suggest that compared with traditional case studies, the clinical reasoning case studies increased the quality of participants’ intervention plans, participants’ confidence levels about their plans, and participants’ understanding of the clinical reasoning process. Participants also reported preferring clinical reasoning case studies over traditional paper case studies. Conclusion. The clinical reasoning case studies are effective teaching tools because they provide students with a holistic picture of the client and his or her occupational therapy treatment. In addition, these case studies model the clinical reasoning process by organizing client information according to the types of clinical reasoning that would be used to gather that information. Occupational therapy educators may find this type of paper case study useful in introducing students to the intervention planning process.

Within occupational therapy education, there has been increased attention to curricula and courses that emphasize problem solving, clinical reasoning, and synthesis of information across traditional discipline-specific boundaries. This article describes the development, implementation, and outcomes of a problem-based learning course entitled Selected Cases in Occupational Therapy. The course was designed to help students to integrate the various elements of a specific occupational therapy curriculum and to enhance their abilities to respond to an ever-changing health care environment. An evaluation of the course by the first 11 students who completed it revealed both strengths and weaknesses. Students responded that the course enhanced their professional behavior, including interpersonal communication skills, team work, and follow-through with professional responsibilities; helped them to integrate the various elements of the total occupational therapy academic program; enhanced their clinical reasoning skills by providing a structure for thinking through clinical issues; and provided personal gain or benefit (i.e., students perceived the course to be a valuable, realistic, and motivating experience). The students also identified several specific course elements that contributed to its integrating function, including content, class session format, and students’ role. Identified course weaknesses included the methods of evaluating student performance and the format and content of specific cases.

This single-case study explored what internal beliefs or commitments one therapist holds about the nature of reality and how those beliefs influence her delivery of occupational therapy services. Data were collected through three in-depth interviews and through observation of the therapist conducting treatment sessions. Results suggest that the therapist’s view of reality can be categorized into four areas: (a) what she believes about ultimate reality; (b) what she believes about life, death, and eternity; (c) what she believes about human nature; and (d) what she believes about the nature of knowing. The findings also suggest that this core worldview informs how the therapist fames clinical practice and how she delivers occupational therapy services. Further, both the therapist’s view of reality and her clinical practice are deeply rooted in her sociocultural experiences. This case study provides a rich description of the interrelatedness of sociocultural context, worldview, and clinical reasoning.