Significant efforts in the past decades to teach evidence-based practice (EBP) implementation has emphasized increasing knowledge of EBP and developing interventions to support adoption to practice. These efforts have resulted in only limited sustained improvements in the daily use of evidence-based interventions in clinical practice in most health professions. Many new interventions with limited evidence of effectiveness are readily adopted each year—indicating openness to change is not the problem. The selection of an intervention is the outcome of an elaborate and complex cognitive process, which is shaped by how they represent the problem in their mind and is mostly invisible processes to others. Therefore, the complex thinking process that support appropriate adoption of interventions should be taught more explicitly. Making the process visible to clinicians increases the acquisition of the skills required to judiciously select one intervention over others. The purpose of this paper is to provide a review of the selection process and the critical analysis that is required to appropriately decide to trial or not trial new intervention strategies with patients.

Background and aimsA number of theories have been proposed on clinical expertise and its development in occupational therapy and allied health professions. Clinical reasoning, outcome measurement and evidence‐based practice are names for leading conceptualisations. The aim of this research was to develop an operational measure of habits of mind and practice that constitute these desirable professional activities amongst professional therapists.MethodsItems were developed on the basis of literature review and feedback from an expert panel. An online self‐report survey was completed by 107 occupational therapists and other allied health clinicians. Rasch analysis was used to identify and calibrate items that fit the criteria for equal‐interval measurement. Residuals from identified equal‐interval dimensions were examined using principal components analysis to identify multidimensionality.ResultsA two‐dimension solution employing 32 items was identified. The first dimension comprised items on Critical Clinical Reasoning and had an item separation of 8.49 (0.99 reliability) and a person separation of 2.93 (0.90 reliability). The second dimension comprised items on Evidence‐Informed Practice behaviours and had an item separation of 6.19 (0.97 reliability) and a person separation of 2.97 (0.90 reliability). These dimensions were positively correlated (r = .778, p < .001). We named the overall scale ‘Evidence‐Informed Professional Thinking’, or EIPT. The EIPT measures correlated significantly with 12 of 13 relevant external criterion items.ConclusionEvidence‐informed professional thinking can be measured in terms of two correlated probabilistically equal‐interval dimensions: Critical Clinical Reasoning and Evidence‐Informed Practice behaviours. The EIPT measure should be useful in research on development and application of clinical expertise, quality and outcomes of care and implementation of improved practices among practicing therapists in clinical treatment settings. Further research is recommended to understand the generalisability, strengths, limitations and correlates of EIPT.

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Date Presented 3/30/2017 This study operationalizes theories of clinical and professional reasoning and outcomes-oriented, evidence-informed practice and develops a two-dimension, probabilistically equal-interval, self-report measure of the habits of mind and practice that comprise these constructs in therapeutic practice. Primary Author and Speaker: Mark Johnston Additional Authors and Speakers: Angela Benfield