1. Clinical Reasoning Deficits Dr. Traci O’Connor Dr. Lisa Tekell

2. Characteristics of Deficits Students may have difficulties: Synthesizing, retrieving, and sorting information Clarifying Selecting relevant details Using knowledge to make decisions http://www.damsafety.org/media/Documents/Im age/ClipArt/Information.jpg

3. Ways to Improve Deficits Help students identify pieces of information they are not considering Review content and rethink cases with different perspectives Group knowledge together to increase: Predictive reasoning Forward-thinking Scope of clinical expertise http://www.fotosearch.com/bthumb/UNC/UNC 220/u12455180.jpg

4. Analyzing Cases Ask students why questions Consider how each of these impact occupational roles of clients: Diagnosis (most recent and past relevant problems) Expected outcomes for this diagnosis Context for OT service (out-patient, acute care, SNF, school, etc.) Age, gender, education, and resources (family, financial, environmental) Behaviors Relevant medical history and prior level of function Current medications and side effects http://www.therapy- dynamics.com/images/therapyspecial ist.jpg

5. How to Use This Information Analyze and synthesize with evaluation and treatment session data collection Draw conclusions based on knowledge and experience Identify step in this process when supervisors’ and students’ thinking differed

6. Activities to Improve Clinical Reasoning Ask students to: Identify professional resources Search literature for evidence about the effectiveness of an intervention and create annotated reference list Make one-page diagnostic summary of disease/condition Compare/contrast 2-3 different assessment tools to learn tool selection; review and provide written summary Identify frame of reference appropriate in the situation Recognize key goals; determine objectives and treatment activities to meet these goals Write activities prior to session and match to clients’ objectives Specify grading of each activity and how to increase/decrease difficulty level

7. Activities to Improve Clinical Reasoning Ask students to: Demonstrate sound rationalization for goals/treatments Identify the important aspects of the case Provide rationale for choosing interventions based on data gathered Articulate rationale or research to determine reasoning Identify obstacles to goal achievement Develop list of possible courses of action in case of emergency Determine 3 possible solutions to a problem and each solution’s pros and cons Take interest in self-directed learning and establish means for goal attainment using objectives related to clinical reasoning

8. Activities to Improve Clinical Reasoning Ask students to: Develop teaching techniques to ensure completion and generalization Watch videotapes of patient assessments/treatments, analyze, and write brief summary of decisions made and other possibilities Observe other therapists modeling the reasoning process with some talking aloud Review patient charts and identify decision making by other therapists; document details that influenced decisions Redesign treatment plans based on hypothetical changes to familiar cases (age, gender, recovery phase, context for OT services, roles, interests, etc.)

9. References Costa, D. (2004) The essential guide to occupational therapy fieldwork education. Bethesda, MD: American Occupational Therapy Association