Date Presented 3/31/2017
This complementary mixed-methods study explored the impact of text or video cases on clinical reasoning of occupational therapy students. Significantly higher inductive reasoning and complex understanding of clinical reasoning was facilitated by video case studies and can impact learning activities in occupational therapy education.
Primary Author and Speaker: Lynne Murphy
PURPOSE: Skilled clinical reasoning, a necessary precursor to occupational therapy (OT) practice, is not easily taught in the classroom. Although case-based reasoning is often used in OT education, there is a lack of evidence linking instructional methods to clinical reasoning. This research study examined the differences in clinical reasoning and perceptions of learning experience of students who completed text-based case activities with students who completed comprehensive video case studies and associated learning activities targeting clinical reasoning.
DESIGN: This complementary mixed-methods study examined 60 entry-level OT students enrolled in a mid-Atlantic university. Either video or text cases were included as part of a physical rehabilitation course over 2 yr as part of the curriculum, and students were given the choice of participation in the research.
METHOD: Participants completed the Health Science Reasoning Test to measure clinical reasoning and the Self-Assessment of Clinical Reflection and Reasoning to examine student perceptions of reasoning as a pretest and posttest. Thirty students completed three text-based cases with targeted questions; 30 students completed three cases from an online video library paired with a targeted clinical reasoning activity. At the conclusion of the semester, eight students were interviewed to explore their learning experiences. Paired t tests examined the differences in reasoning scores from pretest to posttest in each group. Covariates of age, grade point average, and prior experience in physical rehabilitation were controlled using analysis of covariance to compare posttest scores of the text and video groups. Next, phenomenological analysis of the interview data explored student engagement and supported understanding of the influence of instructional methods on clinical reasoning.
RESULTS: Quantitative analysis indicated that students using video cases demonstrated statistically significant improvements in reasoning in overall score, percentile, deduction, analysis, inference, and evaluation. The video case group also demonstrated significantly higher induction skills than the text case group. Qualitative analysis identified consistent student satisfaction with both the text and video groups for the use of case-based reasoning and relevance to clinical practice. Students in the text-based group favored the ease of understanding the client identified in the text; students in the video group favored the authenticity of the videos. Students in the video case group were able to explain a more detailed and integrated understanding of clinical reasoning than students in the text case group.
CONCLUSION: Students identified high satisfaction with case-based learning, supported by the literature. However, there were distinct advantages to each type of case-based instructional methods, consistent with investigation in other disciplines. While text cases provided a more structured learning experience, the authenticity of the video cases promoted statistically significant improvements in inductive reasoning and higher student reports of clinical readiness.
IMPACT STATEMENT: This study provided evidence that case-based reasoning using video cases and instructional activities targeting clinical reasoning should be included in didactic education as they facilitate inductive reasoning. Additionally, they provide OT educators with techniques to structure cases to promote student learning and engagement. As educational technologies and opportunities continue to emerge, it is important to use this evidence that specific instructional strategies can positively influence clinical reasoning and readiness for practice.
