What students think is best practice when teaching them clinical reasoning in practice education Dr Caroline Hills1, Professor Tracy Levett-Jones2, Professor, Helen Warren-Forward3 and Dr. Samuel Lapkin4

Clinical reasoning in Occupational Therapy Clinical reasoning is the clinical judgement and practice decision that is almost invisible to the practising therapist. It is a habituated expertise that allows the therapist to pay attention to relevant cues and unconsciously shift therapeutic responses in response to them (Mattingly & Hayes Fleming, 1994).

In occupational therapy In a recent systematic review of clinical reasoning it was concluded that little is known about the best educational approaches to facilitate the development of clinical reasoning in occupational therapy (Unsworth & Baker, 2016).

Aim of the study This mixed method study aimed to investigate the teaching and learning preferences of occupational therapy students in practice education. Ethical Approval One subtheme identified related to clinical reasoning

Method Using a qualitative descriptive method 22 semi structures face to face, telephone and Skype interviews with 3rd and 4th year OT students in Australian University. These were analysed thematically

Theme One: Talk through your reasoning and decision making (I need to hear your thinking) Take the time to talk it through Break it down and be at my level Talk about alternatives and options too

“both my supervisors set aside time to go over the day, to go over what had happened, what they were thinking, why they were did it a particular way, what channel they went down and it was really important for me to work out ok, this is why we are doing it this way and this is why we got this result. Because it’s the unseen that we really need to learn going out into practice”. Cassie

Theme Two: How to develop my reasoning : Guide me through my analysis Encourage me to think out loud Encourage me to apply theory Ask me questions that make me think

“The one who talked with me yeah, she asked me a lot of questions and that made me think about things as opposed to speaking at me. I can easily regurgitate what someone has told me but if they ask me to think for myself its different so, and she also gave me time to think about it and then we’d talk about, I know it only had to be a few minutes but silence in a conversation is really interesting.One of my supervisors would talk at me, we talked a lot, but I don’t think, upon reflection, I don’t really think she gave me as much as the other supervisor did”. Kate 2

Theme Three: Preferred teaching and learning approaches for clinical reasoning (Have clinical reasoning two way conversations) Make it a two way discussion Don't put me on the spot and feel like an exam Give me time to reflect

“I feel like I’m a bit of a reflector, in the style that I learn, if I think about it afterwards kind of things will hit me and I’ll go oh yeah that’s how that happened um so yeah that was really helpful just talking it out in a real casual setting as well, there was no pressure, she wasn’t asking me questions continuously it was kind of a flowed conversation which was nice, yeah”. Veronica

Conclusion Develop a clinical reasoning discussions as essential to education of students in practice Grade this and provide expectations to students from day one that they will be expected to demonstrate their thinking and practice decision making Need to develop a clinical reasoning template for students to start to ‘listen’ and ‘hear’ key messages 21/11/2018

For example What decision was made? What other options were available? What was the basis of this decision (pragmatic, scientific, evidence based, based on experience, client centred, scope of practice)? List the factors the key factors that influenced this decision Risk, cost, time, patient outcomes, service available, diagnosis, prognosis, best practice standards, clients preferences, environmental, etc What would be a good alternative decision, and why? 21/11/2018

Thoughts How do we prepare educators to have these conversations and facilitate competence? Do we assess clinical reasoning conversations when considering the quality of placements? Further research is indicated to analyse the most effective conversations so that frameworks can be developed

Next Steps

References Ajawi, R., Loftus, S., Schmidt, H. G., & Mamede, S. (2009). Clinical reasoning: the nuts and bolts of clinical education. In C.Delaney & E.Molloy (Eds.), Clinical education in the Health Professions (pp. 109-127). Sydney, Australia: Elsevier. Mattingly, C., & Hayes Fleming, M. (1994). Clinical reasoning. Forms of inquiry in a therapeutic practice. Philadelphia, PA: FA Davis. Rochmawati, E., & Wiechula, R. (2010). Education strategies to foster health professional students' clinical reasoning skills. Nursing & Health Sciences, 12(2), 244-250. doi: 10.1111/j.1442-2018.2009.00512.x Sefton, A., Gordon, J., & Field, M. (2000). Teaching clinical reasoning to medical students. In J. Higgs & M.Jones (Eds.), Clinical reasoning in the health professions (pp. 184-190). Oxford, UK: Butterworth-Heinemann. Unsworth, C. A., & Baker, A. (2016). A systematic review of professional reasoning literature in occupational therapy. British Journal of Occupational Therapy, 79(1), 5-6. doi: 10.1177/0308022615599994