Teaching clinical reasoning as a thinking frame.

OBJECTIVE Clinical reasoning concepts can be viewed as descriptions of mental operations or as a thinking frame--a structure to organize and support clinical thinking. This study examined an approach for teaching clinical reasoning as a thinking frame to occupational therapy students. METHOD A quasi-experimental, pretest-posttest design was used with a convenience sample of 10 undergraduate occupational therapy seniors. All participants (a) acquired the thinking frame of clinical reasoning concepts through explicit instruction and (b) practiced that thinking frame with an external aid--the Clinical Reasoning Case Study Format. The accuracy of participants' definitions of clinical reasoning concepts before and after this learning experience were examined to assess their acquisition of the thinking frame. The content of clinical reasoning case studies were examined to assess students' application of the thinking frame to clinical situations. RESULTS Wilcoxon signed rank tests done on presemester and postsemester definitions ratings indicated that the latter were rated significantly higher than the former for (a) narrative reasoning (p = .008), (b) procedural reasoning (p = .005), (c) interactive reasoning (p = .006), (d) pragmatic reasoning (p = .008), and (e) conditional reasoning (p = .01). The content of participants' clinical reasoning case studies indicated that they were able to apply clinical reasoning concepts. CONCLUSION The results suggest that using a clinical reasoning thinking frame to organize clinical observations is an effective way to help entry-level occupational therapy students learn and apply clinical reasoning concepts.