A model for the development of clinical reasoning in occupational therapy

Abstract

In this rapidly changing health care environment, practitioners and educators need to be flexible thinkers and skilled in clinical reasoning. They need to develop divergent approaches to solutions to complex, ill structured problems. Ill-structured problems in health care are problems that are not clearly delineated in that the nature of the problem, intermediate steps and goals are often unknown at the referral and initial interview stages of intervention. The clinical reasoning used to understand and solve this type of problems requires more than just guessing, ignoring, appealing to authority, or using rote protocols (Facione & Facione, 1996). Students need to develop these skills of reasoning, establish the connection between theory and practice, and apply these skills in client intervention. My interest in the development of clinical reasoning and reflective practice grew out of a particular concern for discovering how we can facilitate students to develop these skills beyond the technical rational approach that has been adopted in the past. Thus the purpose of this qualitative research is to explore the clinical reasoning and thinking of occupational therapists and students in Hong Kong within the context of the local culture. I used an action research approach informed by grounded theory. This involved a dynamic interaction between my research, teaching, and reflection in constructing and generating propositions, thus I incorporate insights about clinical reasoning development into my teaching and my teaching informs my research development. I incorporate the literature to substantiate and expand my understanding of clinical reasoning development and constructivist approaches to learning. I refer to clinical reasoning strategies that correlate with my study and suggest relationships. I discuss methods I have developed for promoting the learning of these clinical reasoning skills by our occupational therapy students. The teaching and learning strategies reflect an understanding of the Hong Kong education system and the learning style of Hong Kong university students. These have been viewed in the context of defined clinical reasoning skills in experienced Hong Kong practitioners. The conclusion of my study suggests ways in which the development of Hong Kong students'clinical reasoning skills can be encouraged taking into account the culturally influenced learning style of students. Clinical reasoning does not occur in isolation and is associated with the development of professional practice skills and understanding. An outcome of this study is the Sinclair Matrix of Clinical Reasoning 2002, which illuminates the developmental continuum from novice to expert of facets of clinical reasoning in occupational therapy. The Matrix may be extrapolated with modifications to other healthcare professions. The importance of generalizability of the matrix is in breaking the reasoning process into various facets relevant to a specific profession and a special domain, which will then provide a format for stage development and assessment of competence.