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Remediating deficits in student skills
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 The
University of South Alabama
Department of Occupational Therapy
Clinical Reasoning
Deficits
When a student is having difficulties with clinical reasoning, they are having trouble synthesizing information. This means
they cannot sort through all the information, select relevant details,
and use their knowledge to guide them in making an appropriate decision.
The breakdown could be in any of these components.
Most often, these deficits can be improved when the student can
identify what pieces of information they are not considering in the
process. A review of that content can often help the student go back and
rethink the case with a different perspective. Fieldwork
supervisors should ask the student many why
questions about a case. Think about how you would logically analyze the
information provided. What factors guided you in your reasoning process?
We often must simultaneously consider the following information:
-
client’s
diagnosis ( most recent and past relevant problems)
-
expected
outcomes for this diagnosis
-
client’s
age, gender, education, and resources (family, financial, and
environmental)
-
current
context for OT service (out-patient, acute care, SNF, school, etc..)
-
relevant
past medical history
-
prior
level of function
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current
medications and side effects
-
behaviors
demonstrated by the client
We then attempt to analyze this information and synthesize it
with the observation and data collection from an evaluation process or
treatment session. This leads us to draw conclusions based on knowledge
and experience. When we must make choices, there are questions we ask
ourselves in the process. If you can identify the step in the process
when your thinking diverged from the student’s thinking, this will
help guide the student to review some specific content.
Activities to help improve clinical reasoning include
asking the student to:
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Search the literature to find evidence about effectiveness of a
specific intervention(s) and outcomes. Create an annotated reference
list with this information.
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Make a one page diagnostic summary of the disease or condition.
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Write out treatment activities prior to a therapy session and
match which objectives from the client’s chart are addressed by each
activity. Specify how to grade each step to make it easier and harder.
FW Supervisors can review this before treatment to make suggestions or
ask questions. This should help the treatment session go more smoothly.
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Ask the student to
give a rationale for choosing certain interventions. Can the student clearly articulate
their rationale? If not, ask them to look up supporting information to
discuss the next day.
-
If students have trouble selecting appropriate assessment tools,
ask students to compare and contrast two or three different tools. They
will need time to look at and review the tools. You can ask them to
provide a written typed summary format for this compare/contrast task.
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Develop a list of possible courses of action in an emergency
situation.
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Have the
student monitor and direct their own learning using learning objectives
written related to clinical reasoning.
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Allow the student to watch a videotape of a patient assessment or
treatment and ask them to analyze the procedure and write a brief
summary of decisions made during the process and other possibilities to
consider
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Arrange for student
to observe another therapist who can provide some role modeling of the
reasoning process with some talking aloud to help student follow the
process
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Ask
the student to
review patient charts and identify decision making of other therapists
and document clues or specific details that influenced the decision
-
Given a potential
problem determine three possible solutions and pros and cons for each
solution
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Utilize a case the student is familiar with. Now make some
hypothetical changes in the case-(age, gender, phase of recovery,
context for delivery of OT services, roles and previous leisure
interests, etc) and ask the student to redesign components of the
treatment plan with this new information. Can he/she shift their
thinking process to include this new information and come out with a
reasonable plan?
 
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