Design and evaluation of an e-learning environment to support the development and refinement of clinical reasoning and decision-making

Justin Newton Scanlan
Faculty of Health Sciences
University of Sydney

Catherine McLoughlin
SIMERR, ACT
Australian Catholic University

Nicola Hancock
Faculty of Health Sciences
University of Sydney

Emerging paradigms of clinical reasoning skills are tending to veer away from linear and clinical competencies towards generic professional skills and decision making processes.  In the present study, occupational therapy students have previously complained that they do not receive enough support from the university or their peers during fieldwork placements, when they are expected to demonstrate clinical reasoning skills. Supervisors have observed that occupational therapy students, as novices, have difficulty in demonstrating strong clinical reasoning skills in the fieldwork setting. In this situation, the end-user (i.e. the patient or client) may not receive the optimal level of care and it is therefore imperative to scaffold students’ reasoning skills to prepare them as working professionals. This paper will explore the design and evaluation of a moderated online forum to support the development and refinement of clinical reasoning (a form of critical thinking) skills in occupational therapy students undergoing fieldwork placements. An innovative analytic content-based instrument derived from current models of clinical reasoning is applied to a corpus of data to measure students’ skills, and on the basis of results obtained, to suggest ways of enhancing the online environment to support emerging decision-making skills among novice practitioners.

Keywords: online asynchronous discussion; clinical reasoning; critical thinking; occupational therapy; health professional education; instrument development