Clinical Reasoning Deficits
Dr. Traci O’Connor
Dr. Lisa Tekell
Characteristics of Deficits
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Students may have difficulties:
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Synthesizing, retrieving, and
sorting information
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Clarifying
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Selecting relevant details
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Using knowledge to make
decisions
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Ways to Improve Deficits
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Help students identify pieces of
information they are not
considering
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Review content and rethink cases
with different perspectives
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Group knowledge together to
increase:
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Predictive reasoning
Forward-thinking
Scope of clinical expertise
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Analyzing Cases
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Ask students why questions
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Consider how each of these impact
occupational roles of clients:
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Diagnosis (most recent and past relevant
problems)
Expected outcomes for this diagnosis
Context for OT service (out-patient, acute care,
SNF, school, etc.)
Age, gender, education, and resources (family,
financial, environmental)
Behaviors
Relevant medical history and prior level of
function
Current medications and side effects
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How to Use This Information
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Analyze and synthesize with evaluation
and treatment session data collection
Draw conclusions based on knowledge
and experience
Identify step in this process when
supervisors’ and students’ thinking
differed
Activities to Improve Clinical
Reasoning

Ask students to:
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Identify professional resources
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Search literature for evidence about the effectiveness of an
intervention and create annotated reference list
Make one-page diagnostic summary of disease/condition
Compare/contrast 2-3 different assessment tools to learn tool
selection; review and provide written summary
Identify frame of reference appropriate in the situation
Recognize key goals; determine objectives and treatment
activities to meet these goals
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Write activities prior to session and match to clients’ objectives
Specify grading of each activity and how to increase/decrease
difficulty level
Activities to Improve Clinical
Reasoning

Ask students to:
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Demonstrate sound rationalization for goals/treatments
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Identify obstacles to goal achievement
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Identify the important aspects of the case
Provide rationale for choosing interventions based on data gathered
Articulate rationale or research to determine reasoning
Develop list of possible courses of action in case of emergency
Determine 3 possible solutions to a problem and each solution’s pros and
cons
Take interest in self-directed learning and establish means for
goal attainment using objectives related to clinical reasoning
Activities to Improve Clinical
Reasoning

Ask students to:
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Develop teaching techniques to ensure completion and
generalization
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Watch videotapes of patient assessments/treatments, analyze, and write
brief summary of decisions made and other possibilities
Observe other therapists modeling the reasoning process with some talking
aloud
Review patient charts and identify decision making by other therapists;
document details that influenced decisions
Redesign treatment plans based on hypothetical changes to familiar cases
(age, gender, recovery phase, context for OT services, roles, interests,
etc.)
References
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Costa, D. (2004) The essential guide to
occupational therapy fieldwork
education. Bethesda, MD: American
Occupational Therapy Association