The Clinical Reasoning of Novice and Expert Occupational Therapists

Abstract

Carolyn A. Unsworth. The clinical reasoning of no×ice and expert occupational therapists. Scand J Occup Ther 2001; 8: 163-173.Over the past 15 years, research in health sciences has consistently shown that differences in the performance of novice and expert clinicians are predominantly due to their clinical reasoning abilities. Furthering our knowledge of the ways expert and novice occupational therapists reason can help us to explicate the complexities of practice and ultimately assist novices to think like experts. This paper presents the ndings of a study which investigated qualitatively and quantitatively the clinical reasoning of novice and expert occupational therapists. Three expert and two novice occupational therapists working in rehabilitation settings wore head-mounted video cameras while completing three therapy sessions (assessment, treatment, discharge planning). Therapists then viewed the videos and reported back on their reasoning. These verbal reports were transcribed and analysed. While the quantitative results indicated several differences in both the amounts and types of clinical reasoning used by novices and experts, the qualitative analyses were more useful in revealing differences in the ways these two groups presented their clinical reasoning. The ndings suggest that novice therapists could bene t from spending more time re ecting on the therapy process, and discussing their therapy with expert colleagues. Key words : qualitati×e method, quantitati×e method, retrospecti×e ×erbal report, ×ideo-assisted recall. NOVICE EXPERT DIFFERENCESResearchers investigating the diagnostic and problem solving decision making of physicians and nurses have consistently found ve main differences between novices and experts [1]. Experts appear to possess a better knowledge base than novices which enables them to compare a current problem to their recollections of past cases. Experts also use less irrelevant information when making decisions, and seem to recall critical cues better than their novice counterparts. In addition, experts seem to employ more discon rmatory hypotheses than novices. Novice clinicians tend to con rm their hypotheses by collecting supporting information rather than testing a hypothesis through use of an appropriate discon rming hypothesis. Experts solve clinical problems faster than novices, and nally, experts have been found to have better general problem solving and clinical reasoning skills than novices [1]. This last difference is of most signi cance to occupational therapists. Occupational therapists are concerned with problem solving with their clients around occupational performance dif culties and ways to overcome them. Thus, rather than diagnosing the client's problem, the way therapists think in action and reason has been consistently identi ed as the key difference between novice and expert occupational therapists [2 -6].

A qualitative grounded theory study of the conceptions of clinical practice in osteopathy – A continuum from technical rationality to professional artistry

“…This finding is consistent with findings from research investigating the clinical reasoning of musculoskeletal physiotherapists (Noll et al, 2001;Thornquist, 2006;Cruz et al, 2012). Practice akin to technical rationality has been considered an attribute of novice healthcare practitioners (Jensen et al, 1990(Jensen et al, , 1992Unsworth, 2001;Smith et al, 2008, Smith et al, 2010, where practice is characterised as being practitioner-centred, emphasising the application of specific factual knowledge and technical skills in a routine predictable manner. In this current study, no relationship between participants' years of clinical experience and their conception of practice was found.…”

Barriers of Occupation-based Intervention

“…An expert, as defined in this study, is a person who holds a senior position at work (Kuipers & Grice, 2009) and was nominated by peers to have pertinent expertiseness in certain areas of professional specialty (Jensen, Gwyer, & Shepard, 2000). Additionally, Unsworth (2001) differentiated the novice and expert occupational therapist by years of experience, where the experts were described as having at least five years' experience in the occupational therapy field. Therefore, the inclusion was set as: (i) occupational therapy practitioners and educators who are holding a senior position; (ii) qualified at least with a bachelor's degree in occupational therapy; and (3) have at least 5 years' experience in the field of occupational therapy practice.…”

Identifying Instructional Methods for Development of Clinical Reasoning in Entry-Level Occupational Therapy Education: A Mixed Methods Design

“…Mattingly (1991) reported that clinical reasoning in occupational therapy is not only articulating knowledge but is a skill that is translated "…through our hands and our eyes…" (p. 979). The development of clinical reasoning in occupational therapy follows a continuum of five stages and is a skill that is developed over time (Furze et al, 2015;Neistadt, 1996;Unsworth, 2001). The five stages include novice, advanced beginner, competent, proficient, and expert, with each stage marked by a variety of characteristics (Neistadt, 1996;Unsworth, 2001).…”

“…The development of clinical reasoning in occupational therapy follows a continuum of five stages and is a skill that is developed over time (Furze et al, 2015;Neistadt, 1996;Unsworth, 2001). The five stages include novice, advanced beginner, competent, proficient, and expert, with each stage marked by a variety of characteristics (Neistadt, 1996;Unsworth, 2001). Because years of clinical practice and continuing education are required to achieve or maintain the competent, proficient, and expert levels of clinical reasoning, it is unreasonable to expect occupational therapy students or entry-level practitioners to provide services at these stages (Neistadt, 1996).…”