Date Presented 3/30/2017
This study operationalizes theories of clinical and professional reasoning and outcomes-oriented, evidence-informed practice and develops a two-dimension, probabilistically equal-interval, self-report measure of the habits of mind and practice that comprise these constructs in therapeutic practice.
Primary Author and Speaker: Mark Johnston
Additional Authors and Speakers: Angela Benfield
BACKGROUND AND PURPOSE: Clinical professionals need to develop habits of mind and recurrent behaviors that enable them to become competent and even expert clinical reasoners and evidence-informed practitioners. This study aimed to develop and test a practical, self-report measure of habits of mind and recurrent behaviors that constitute various levels of clinical and professional reasoning and evidence-informed practices. In doing so, it also aimed to clarify the realistic, observable basis of these theories.
DESIGN AND METHOD: An online survey of 158 items was developed from previous theory, publications, and review by an expert panel and given to 107 respondents in 33 states and four Canadian provinces. Rasch analysis was used to identify items that had properties of a probabilistically equal-interval measure. Principle components of residuals was employed to guide decisions about dimensionality of measurement solution. Estimates of person level of clinical thinking practices and evidence-informed practices were correlated to the criterion items on adoption of new interventions.
RESULTS: Many items did not fit any distinct measurement structure and hence were eliminated. After numerous analyses, a two-dimensional solution with 32 items emerged. This solution was chosen because it had better measurement properties and was more interpretable than alternatives. The first dimension had an item separation of 8.49 (.99 reliability) and comprised items on clinical and professional reasoning or thinking. The second dimension had an item separation of 6.19 (.97 reliability) and comprised related habits of mind and recurrent behaviors on evidence-informed practices. The two dimensions were correlated (r = .778, p < .001). High levels of evidence-based practice habits and critical clinical reasoning were uncommon in the sample even though 50.3% had greater than 15 yr of clinical experience. The criterion analysis found moderate correlations (r = .206–.554) between person measures on the two subscales and 13 criterion items.
CONCLUSIONS: We named the scale as a whole the Evidence-Informed Professional Reasoning (EIPT). It comprises two related but separable dimensions: Critical Clinical Reasoning and Evidence-Informed Practices. Behaviors composing these habits of mind and practice can be quantified in equal-interval measures that identify levels of competency and expertise in these critical clinical practices. The EIPT can and should be used as a tool to improve clinical education, expertise, and practices in occupational therapy and related fields, thus advancing the field as whole, enhancing provision of effective treatments, and improving clients’ outcomes.
References
Bannigan, K., & Moores, A. (2009). A model of professional thinking: Integrating reflective practice and evidence-based practice. Canadian Journal of Occupational Therapy, 76, 342–350.
Benfield, A. M. (2015). Developing a measure of evidence-informed professional thinking. Doctoral dissertation, University of Wisconsin–Milwaukee.
Dysart, A. M., & Tomlin, G. S. (2002). Factors related to evidence-based practice among U.S. occupational therapy clinicians. American Journal of Occupational Therapy, 56, 275–284. https://doi.org/10.5014/ajot.56.3.275
Linacre, J. M. (2006). A user’s guide to Winsteps Ministep Rasch-model computer programs. Chicago: Winsteps.com.
Salls, J., Dolhi, C., Silverman, L., & Hansen, M. (2009). The use of evidence-based practice by occupational therapists. Occupational Therapy in Health Care, 23, 134–145. https://doi.org/10.1080/07380570902773305
