Summerfield-Mann, Lynn; (2010) Exploring the development and assessment of clinical reasoning in a problem-based graduate entry occupational therapy curriculum. Doctoral thesis , Institute of Education, University of London.

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Abstract

Clinical reasoning is central to the practice of occupational therapy and can be viewed as one of three components which comprise clinical competence; the other components being relevant knowledge and relevant skills. These three components are highly inter-related, influenced by attitudinal factors and related to prior knowledge and experience; this makes the assessment of clinical reasoning challenging. Problem-based learning (PBL) is an educational strategy well suited to preparing graduates for life-long learning and the evolving practice environments within which they will work. One of the key objectives of a problem-based curriculum is to create a learning environment within which learners can develop clinical reasoning skills alongside self-direction. There is limited research evidence within occupational therapy to suggest how effective PBL is in facilitating the development of clinical reasoning. This study aims to explore student acquisition of clinical reasoning within the PBL curriculum through the use of a case study assessment. This mixed-methods study explores the assessment of clinical reasoning in graduate entry occupational therapy students who have completed an accelerated 2-year PBL curriculum. A Clinical Reasoning Instrument (CRI) was developed to rate clinical reasoning ability in completed case study assessments, the main assessment method of the curriculum. Exploratory Factor Analysis was used to explore the underlying dimensions of clinical reasoning. Student reflections on learning from clinical experiences associated with the case study assessment were analysed using qualitative content analysis. The study concludes that students demonstrate variation in use of clinical reasoning and self-direction which are strongly influenced by practice placements and learning approach. The study recommends that the development of clinical reasoning in occupational therapy needs to account more fully for the complex and situated nature of learning that takes place within clinical environments and that assessment in PBL needs to be more aligned with the goals of capability and life-long learning.

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