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Fieldwork - Remediation Ideas - Clinical Reasoning
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When a student is having difficulties with clinical reasoning, they are having trouble synthesizing information. This means they cannot sort through all the information, select relevant details, and use their knowledge to guide them in making an appropriate decision. The breakdown could be in any of these components. Most often, these deficits can be improved when the student can identify what pieces of information they are not considering in the process. A review of that content can often help the student go back and rethink the case with a different perspective. Fieldwork supervisors should ask the student many why questions about a case. Think about how you would logically analyze the information provided. What factors guided you in your reasoning process? We often must simultaneously consider the following information:
We then attempt to analyze this information and synthesize it with the observation and data collection from an evaluation process or treatment session. This leads us to draw conclusions based on knowledge and experience. When we must make choices, there are questions we ask ourselves in the process. If you can identify the step in the process when your thinking diverged from the student’s thinking, this will help guide the student to review some specific content.

Activities to help improve clinical reasoning include asking the student to:
  1. Search the literature to find evidence about effectiveness of a specific intervention(s) and outcomes. Create an annotated reference list with this information.

  2. Make a one page diagnostic summary of the disease or condition.
  3. Write out treatment activities prior to a therapy session and match which objectives from the client’s chart are addressed by each activity. Specify how to grade each step to make it easier and harder. FW Supervisors can review this before treatment to make suggestions or ask questions. This should help the treatment session go more smoothly.
  4. Ask the student to give a rationale for choosing certain interventions. Can the student clearly articulate their rationale? If not, ask them to look up supporting information to discuss the next day.
  5. If students have trouble selecting appropriate assessment tools, ask students to compare and contrast two or three different tools. They will need time to look at and review the tools. You can ask them to provide a written typed summary format for this compare/contrast task.
  6. Develop a list of possible courses of action in an emergency situation.
  7. Have the student monitor and direct their own learning using learning objectives written related to clinical reasoning.
  8. Allow the student to watch a videotape of a patient assessment or treatment and ask them to analyze the procedure and write a brief summary of decisions made during the process and other possibilities to consider
  9. Arrange for student to observe another therapist who can provide some role modeling of the reasoning process with some talking aloud to help student follow the process
  10. Ask the student to review patient charts and identify decision making of other therapists and document clues or specific details that influenced the decision
  11. Given a potential problem determine three possible solutions and pros and cons for each solution
  12. Utilize a case the student is familiar with. Now make some hypothetical changes in the case-(age, gender, phase of recovery, context for delivery of OT services, roles and previous leisure interests, etc) and ask the student to redesign components of the treatment plan with this new information. Can he/she shift their thinking process to include this new information and come out with a reasonable plan?
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