Clinical reasoning and reflective practice: Influence of fieldwork activities

Date of Completion

January 1997


Health Sciences, Education|Health Sciences, Rehabilitation and Therapy|Education, Adult and Continuing




With advances in medicine, more people are surviving accidents and illnesses. For this reason, an increased need for rehabilitation services has developed. As the need for rehabilitation grows, the demand grows for highly competent occupational therapists who demonstrate clinical reasoning skills. Occupational therapy students learn to be therapists in both classroom and fieldwork settings. Fieldwork experiences are designed to integrate classroom material with practice so that students develop clinical reasoning skills. The literature indicates, however, that this integration may not be happening. As a result, educators are searching for the answer to the question: How do educators design fieldwork experiences so that occupational therapy students develop clinical reasoning skills?^ Theories and research suggest that learning clinical reasoning skills was related to several factors. To explore the relationships suggested by prior literature, six research questions were developed to examine: (a) the effect of fieldwork on clinical reasoning skill development, (b) participation in clinical reasoning activities during fieldwork, (c) degree of participation in activities on clinical reasoning skills, (d) differences between highest gaining scorers and highest declining scorers on the Clinical Reasoning Case Analysis Test (CRCAT) in their perceptions of clinical reasoning activities, (e) adaptive flexibility before and after fieldwork, and (f) adaptive flexibility and the development of clinical reasoning skills.^ The sample for this study consisted of 70 occupational therapy fieldwork students from a private, New England college. Data were collected using a researcher-developed case analysis test (CRCAT), the Adaptive Style Inventory, a questionnaire, and a structured interview. Paired t tests, ANCOVA, and multiple regressions were used to analyze the quantitative data from the research questions. Analysis of themes and frequency counts were used to analyze the interview data.^ Research results found that fieldwork does improve clinical reasoning skills and reflective dialogue activities were highly reported as effective in helping students think like an occupational therapist. No relationships were found between adaptive flexibility and clinical reasoning. The results of the study support the improvement of fieldwork as a mode of developing clinical reasoning skills in occupational therapy students. ^