Clinical Reasoning Deficits

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/Image/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/UNC220/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/therapyspecialist.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