Clinical Reasoning during Community Health Home Visits: Expert and Novice Differences

Abstract

Very little is known about the differences between novice and expert clinical reasoning in community health practice. This article presents the findings of a study of the clinical reasoning of five expert and five novice community health occupational therapists (CHOTs) during the conducting of home visits. A head-mounted video camera was used to record the visits, followed by the participants reporting their clinical reasoning verbally using a video-assisted debriefing method. The transcripts from these verbal reports were analysed quantitatively and qualitatively. The quantitative results demonstrated many differences between experts and novices in terms of the amounts and types of clinical reasoning used. For example, the novices used more procedural reasoning whereas the experts used more conditional reasoning and mixes of different reasoning types. The qualitative results demonstrated that the experts used a free-flowing conversational approach when reasoning during home visits whereas the novices depended on external structures such as assessment forms to guide the process. Given their experience and familiarity with the process, the experts were confident and clear in their reasoning whereas the novices were more awkward and self-conscious. The experts handled sensitive issues whereas the novices seemed to avoid them. The study findings may provide insights for student and novice therapists concerning expert CHOTs' practice and promote reflection in general on the attainment of expertise in clinical practice.

Discharge Planning for the Elderly in Acute Care: The Perceptions of Experienced Occupational Therapists

“…Discharge planning must be combined with developed clinical reasoning skills to meet the needs of each client, and comprehensive discharge planning decisions have been found to be linked to therapist's clinical experience (Crennan & MacRae, 2010;Jette et al, 2003;Mitchell & Unsworth, 2005;Unsworth, 2001). Current research does not address the perspective of the experienced occupational therapist, which could result in valuable insights and a deeper understanding of the process of formulating, developing, and prioritizing discharge recommendations for elderly clients.…”

Is length of experience an appropriate criterion to identify level of expertise?

“…The findings of these studies and studies with other professionals such as physical therapists [for example, 32,35], physicians (36), and ergonomists (37) illustrated that length of experience may not be an appropriate predictor of level of expertise. In contrast, Mitchell and Unsworth (29) found many differences when comparing experts with more than five years of experience to novices with less than two years of experience. For example, while the experts used conditional reasoning and a mixes of different reasoning types, the novices used more procedural reasoning.…”

Gaining Insights to the Clinical Reasoning that Supports an on-Road Driver Assessment

“…Better results are usually obtained using video-prompted recall (Mattingly & Fleming, 1994;Unsworth, 2008). While a static video camera can be used, drawing on the work of researchers in fields such as orienteering (Omodei & McLennan, 1994), the author has successfully used head-mounted video camera to capture therapy sessions and prompt the clinical reasoning of occupational therapists working in physical dysfunction (Unsworth, 2001(Unsworth, , 2004(Unsworth, , 2005 and the community (Mitchell & Unsworth, 2005). It is possible that this approach may also be useful in shedding light on the thinking patterns and reasoning of occupational therapy driver assessors.…”