Teaching Strategies for the Development of Clinical Reasoning

Neistadt, Maureen E.

doi:10.5014/ajot.50.8.676

Cited by 54 publications

(66 citation statements)

References 19 publications

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“…Cognitive Processing (ranked 1 st ) is relevant during the cognitive learning stage and includes critical thinking, decision-making, and problem-solving. One could surmise the value of reflective processes [32][33][34][35] to OMPT education and skill development 34 , based on their importance in hypothesis testing 32,36,37 and management strategy development 38 . Adaptation (ranked 2 nd ) characterizes the associative psychomotor learning stage.…”

Section: Motivationmentioning

confidence: 99%

Intrinsic and Extrinsic Factors Important to Manual Therapy Competency Development: A Delphi Investigation

Sizer

Sawyer²,

Felstehausen³

et al. 2008

Journal of Manual & Manipulative Therapy

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A learner's development of orthopaedic manual physical therapy (OMPT) psychomotor skills may be influenced by selected intrinsic and extrinsic factors. The purposes of this study were to identify the factors that influence learners' development of manual physical therapy competencies and to define each factor as intrinsic or extrinsic. A 3-round Delphi method survey and a retrospective review of the data were used to develop composite scores and rankings. Eighty manual physical therapy educators participated in the 3 rounds. Thirty-six factor descriptor statements associated with manual physical therapy competency were established and further categorized as intrinsic (19 total), extrinsic (10 total), or conceptual outliers (7 total). Cognitive Processing ranked as the most important factor influencing manual physical therapy competency development. Adaptation ranked second, followed by Science Knowledge. This study is the first to establish manual physical therapy educational factors associated with attainment of competency. The majority of the factors distill into the theory of extrinsic and intrinsic factors identified by Schmidt and Lee. The outcomes of this study identify the factors to which OMPT educators should give particular attention when developing and executing the learning experiences for their learners. Keywords:Competency-Based Education, Curriculum, Delphi Technique, Factors, Motor Learning, Musculoskeletal Manipulations, Psychomotor Performance. S pecific manual and/or movement-based competencies are emphasized by physical therapy educators during learners' development of psychomotor skills. Psychomotor skill acquisition is a product of psychomotor learning, which is a set of processes associated with practice or experience leading to relatively permanent changes in the capability for responding to stimuli 1 . As a consequence of psychomotor learning, individuals gain greater movement efficiency, develop more complex movement control strategies, optimize movement behaviors, and develop movement expertise 2 . Schmidt and Lee identified five extrinsic and four intrinsic factors that influence psychomotor learning factors are 1) practice, 2) feedback, 3) task classification, 4) instruction format, and 5) movement context. Factors such as practice, which involves cognitive processing 3,4 , accentuate learned abilities through the processing of sensory information 5 . The use of quantitative feedback and concurrent feedback in manual physical therapy learning has provided both favorable [6][7][8] and unfavorable results 9 . Visual instructional formats incorporate observation to facilitate psychomotor skill acquisition 10 , while kinesthetic instruction uses the learner's sensory system by physically moving the learner through the task 11 . Finally, movement context appears to influence psychomotor skill acquisition 12 . The intrinsic factors include 1) attention, 2) memory, 3) motivation, and 4) psychomotor learning stage 13 . These factors are less tangible and more difficult to measure t...

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Section: Motivationmentioning

confidence: 99%

Intrinsic and Extrinsic Factors Important to Manual Therapy Competency Development: A Delphi Investigation

Sizer

Sawyer²,

Felstehausen³

et al. 2008

Journal of Manual & Manipulative Therapy

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“…The process of clinical reasoning is multifarious and clinicians of all levels of ability and experience look to develop the cognitive elements of decision-making to enhance practice and improve patient-care (Benner 1984;Higgs 1992;Neistadt 1996). This synthesising process involves considering many facets of patient data, clinician experience, clinician knowledge, and the literature (Higgs and Jones 2008;Simmons 2010).…”

Section: Introductionmentioning

confidence: 99%

The role of clinician emotion in clinical reasoning: Balancing the analytical process

2016

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TitleThe role of clinician emotion in clinical reasoning: balancing the analytical process.Key words: Physiotherapy; reasoning; emotion. Authors DiscussionIt is proposed that clinicians should consider the emotions associated with decision-making, especially when there is concern surrounding a presentation. Reflecting on practice in the clinical environment and subsequently applying this to a patient presentation should involve some acknowledgement of clinicians' physical responses, emotions and how they may play a part in any decision made. Presenting intuition and gut-feeling as separate reasoning methods and how these processes co-exist with other more accepted reasoning such as hypotheticodeductive is also discussed. ConclusionMusculoskeletal physiotherapy should consider the elements of feelings, emotions and physical responses when applying reflective practice principles. Furthermore, clinicians dealing with difficult and challenging presentations should look at the emotional as well as the analytical experience when justifying decisions and learning from practice.

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“…The aim of each is to better prepare student practitioners for the diverse challenges of reasoning within routine clinical practice. A review of the literature found use of multimedia (audio, video and/or text) delivered asynchronously online using chat rooms and message boards, and live simulations with students functioning in the role of therapist and/or client in a classroom environment as methods to teach clinical reasoning (Hedge, Pickens, & Neville, 2015;Lysaght & Bent, 2005;Neistadt, 1996;Scaffa & Wooster, 2004). Additional instructional activities designed to promote clinical reasoning in students include interviewing and occupational profile assignments, treatment planning assignments, ethical case studies, evidence-based decision-making assignments, and student reflection and journaling assignments (Coker, 2010;Mattingly & Fleming, 1994;Neistadt, Wight, & Mulligan, 1998;Peloquin & Davidson, 1993;Tickle-Degnen, 2000).…”

Section: Narrative Reasoningmentioning

confidence: 99%

“…Narrative reasoning emerges during the clinical process as the therapist and the client collaborate on intervention goals, strategies, and solutions (Mattingly & Fleming, 1994;Neistadt, 1996).…”

Section: Narrative Reasoningmentioning

confidence: 99%

“…Clinical reasoning has been defined as the thought process that is used by occupational therapists during evaluation and intervention as part of a therapeutic plan of care (Neistadt, 1996). For occupational therapy students who are learning how to address sensory processing deficits in pediatric clients, clinical reasoning is especially important, and can be challenging for educators to teach.…”

Section: Introductionmentioning

confidence: 99%

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First Year Occupational Therapy Students’ Clinical Reasoning Approach to Addressing Challenging Behaviors Related to Sensory Processing Using a Simulated Case Study

Gee¹,

Thompson²,

Strickland³

et al. 2017

JOTE

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Occupational therapy students must be prepared to use clinical reasoning to select appropriate interventions for children with sensory processing disorders (SPDs). Although these interventions are typically taught in entry-level occupational therapy programs, there is little information regarding the method by which occupational therapy students are taught a clinical reasoning process to determine which sensory processing intervention to use with pediatric clients. A problem-solving framework called A SECRET was used to teach students clinical reasoning for children with SPDs, via an online, module-based course. Following the module, the students were tested with an online assessment tool regarding their ability to discriminate between appropriate and inappropriate intervention strategies, and to articulate their rationale to demonstrate how they clinically reasoned through a complex client case. Eight students participated in a focus group to provide their perceptions of the online delivery of the content and the A SECRET reasoning process. Five descriptive representations emerged from the qualitative data analysis: the A SECRET Process, Self-Regulation, the Occupational Therapy Practice Framework, Participation, and Safety/Security. The findings suggest an inherent value for online learning to assist occupational therapy students in their program's first year to learn the A SECRET process and then clinically reason through a simulated case study. ABSTRACTOccupational therapy students must be prepared to use clinical reasoning to select appropriate interventions for children with sensory processing disorders (SPDs). Although these interventions are typically taught in entry-level occupational therapy programs, there is little information regarding the method by which occupational therapy students are taught a clinical reasoning process to determine which sensory processing intervention to use with pediatric clients. A problem-solving framework called A SECRET was used to teach students clinical reasoning for children with SPDs, via an online, module-based course. Following the module, the students were tested with an online assessment tool regarding their ability to discriminate between appropriate and inappropriate intervention strategies, and to articulate their rationale to demonstrate how they clinically reasoned through a complex client case. Eight students participated in a focus group to provide their perceptions of the online delivery of the content and the A SECRET reasoning process. Five descriptive representations emerged from the qualitative data analysis: the A SECRET Process, Self-Regulation, the Occupational Therapy Practice Framework, Participation, and Safety/Security. The findings suggest an inherent value for online learning to assist occupational therapy students in their program's first year to learn the A SECRET process and then clinically reason through a simulated case study.

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Teaching Strategies for the Development of Clinical Reasoning

Cited by 54 publications

References 19 publications

Intrinsic and Extrinsic Factors Important to Manual Therapy Competency Development: A Delphi Investigation

Intrinsic and Extrinsic Factors Important to Manual Therapy Competency Development: A Delphi Investigation

The role of clinician emotion in clinical reasoning: Balancing the analytical process

First Year Occupational Therapy Students’ Clinical Reasoning Approach to Addressing Challenging Behaviors Related to Sensory Processing Using a Simulated Case Study

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