Introduction: Increasingly, novice occupational therapists are working in private practice. It is important to understand how to build clinical experience in complex practice areas. Upper limb hypertonicity management is a complex practice area requiring advanced workplace training. This study aimed to identify the teaching and learning processes that assist occupational therapists to acquire this expertise. Methods: Five hospital occupational therapists received 1.5-3 years of apprentice-style training in a specialist hypertonicity clinic. In-depth semi-structured interviews explored their experience. Qualitative Description was used to analyse the data. Results: Participants found that knowledge needed to be applied to practice and then revisited in a cyclical way to deepen their understanding and build their clinical skills. They benefited from having responsibilities graded and repeated opportunities for hands-on learning of embodied knowledge. Producing comprehensive progress notes and teaching colleagues and students were useful learning tools. Learning with a group of colleagues involved observation of the expert, intensive correction and guidance, and group discussion, reflection and questioning to build expertise. Conclusion: Workplaces need to intentionally support novice clinicians to gain expertise in complex practice areas using pedagogically sound training techniques. Continuous workplace training is needed to promote expertise in the face of changing healthcare funding policies.

Participants perceived that there is a dynamic relationship between knowledge and skills. They also believed that competent hypertonicity practice requires a client-centred approach and individualisation of interventions. Future training needs to focus on the development of therapists' clinical reasoning, which was required to individualise interventions and promote positive client outcomes. Implications for Rehabilitation Training in upper limb hypertonicity management in a clinical setting can assist therapists to understand the factors contributing to the complexity of this practice area. Training in a clinical setting is required to allow development of the range of skills needed for competent practice as it provides consistent exposure to clients over time. Practicing in a client-centred manner and making individualised intervention decisions should be emphasized as an overarching framework for developing relevant knowledge and skills in this area of practice. Future research needs to focus on identifying training techniques that will promote therapists' competence in decision making when working in upper limb hypertonicity practice.