OT Practitioner Students’ Perspectives of Clinical Reasoning Development During Level II Fieldwork

The purpose of Level II Fieldwork (FW) is to develop competent entry-level occupational therapy practitioners (American Occupational Therapy Association [AOTA], 2011). A large component of becoming clinically competent is the development of clinical reasoning which is the process whereby practitioners gather information, develop an understanding of clients’ needs, and then plan, perform, and reflect on client care (Cornin & Graebe, 2018; Liu, Chan, & Hui-Chan, 2000). Currently, there is limited evidence regarding the types of learning experiences that promote the development of clinical reasoning skills during Level II FW for OTA and OT students, and there is no research investigating the similarities or differences between these two groups (Coviello et al., 2019). The present study addresses this gap by using a mixed method design to: (1) ascertain the type and frequency of learning activities that OTA and OT students experience during their Level II FW; and (2) explore the students’ perceptions regarding which learning activities have the most value for the development of clinical reasoning.

A convenience sample was recruited from successive cohorts of OTA and OT students enrolled in programs located in the Northeastern United States. All students who registered to complete their first Level II Fieldwork experiences were eligible to participate. Quantitative data was collected through the Learning Experience Questionnaire. Qualitative data was obtained through focus groups and triangulated through analysis of fieldwork journals. Descriptive and inferential statistics (t-test and Mann-Whitney U test) were used to summarize and analyze the quantitative data. An iterative process was used for the qualitative data analysis using a multi-coder approach and inter-coder reliability was established.

The study identified 15 different types of learning experiences in which OTA students (n=38) participated to varying degrees during their Level II FW. Of these, OTA students identified four learning experiences that had the most impact on the development of their own clinical reasoning skills: meeting weekly with their fieldwork educator to receive feedback (87.5%), daily interactions with their fieldwork educator (62.5%), their fieldwork educator engaging in story-telling (62.5%), and their fieldwork educator providing information in small chunks (62.5%). This data was further substantiated by the qualitative analysis which found eight major themes reflecting the participants’ impressions of experiences which promoted the development of their clinical reasoning skills: on-boarding process, knowing expectations, feedback, fieldwork educators’ characteristics, collaboration, hands-on learning, consistent caseloads, and self-reflection. Although self-reflection was perceived as important by OTA students, only 26% of them reported being asked to engage in written self-reflection during their Level II FW. The presentation of information in small chunks is another experience which OTA students felt impacted their clinical reasoning development yet only 6.7% of Phase 1 and 2 participants and 37.5% of Phase 3 participants reported their fieldwork educator doing so consistently throughout their fieldwork experience. Data collection and analysis are underway with the OT students.

OTA students experience a variety of learning activities during their Level II FW which they perceive contribute to the development of their clinical reasoning skills. However, there is a discrepancy between activities experienced and most valued activities. The findings of the present study provide valuable information on how to best advance the development of clinical reasoning skills during Level II FW, contributing to greater clinical competence in OT practitioners.

References

American Occupational Therapy Association (2011). Accreditation Council for Occupational Therapy Education (ACOTE) standards. American Journal of Occupational Therapy, 66(6, Suppl.), S6-S74.

Coviello, J. M., Potvin, M. C., & Lockhart-Keene, L. (2019). Occupational Therapy Assistant Students’ Perspectives About the Development of Clinical Reasoning. The Open Journal of Occupational Therapy, 7(2). https://doi.org/10.15453/2168-6408.1533

Cronin, A., & Graebe, G. (2018). Clinical reasoning in occupational therapy. Bethesda, Maryland: AOTA Press.

Liu, K. P. Y., Chan, C. C. H., & Hui-Chan, C. W. Y. (2000). Clinical reasoning and the occupational therapy curriculum. Occupational Therapy International, 7(3), 173-183. 10.1002/oti.118