An evaluation of the development of clinical reasoning skills in a cohort of occupational therapy students in Hong Kong: implications of curriculum design

The aim of the study was to evaluate how Hong Kong Occupational Therapy students develop their clinical reasoning abilities and progress through the stages of their undergraduate curriculum. The study examines a range of factors that may affect their development of clinical reasoning. The student cohort was composed of a class of 80 BSc (Honours) occupational therapy students at the Hong Kong Polytechnic University. The study was predominantly quantitative; however, focus group interviews were included among a range of methodologies. Validated test instruments were administered during the four instances of pre- and post-clinical education intervention. The Study Process Questionnaire (Biggs, 1987c) assessed approaches to learning. The Moore & Fitch Inventory of Learning Preferences (cited in Woods, 1994) was administered to determine whether or not changes in students’ learning preferences and attitudes affected clinical reasoning skills. The Self-Assessment of Clinical Reflection and Reasoning (Royeen et al, 1994) was administered as a pre- and post-clinical education intervention to evaluate students’ level of clinical reflection and reasoning skills. A focus group interview was designed to probe students’ understanding and application of clinical reasoning processes. The study’s findings enhance our understanding of the progressive development of students’ clinical reasoning skills through novice to expert continuum. Extrapolating into the undergraduate domain, this study highlighted the difficulties students face when trying to reason through, integrate and synthesize their theoretical learning in both academic and clinical education settings. An outcome of this study identified that clinical reasoning is multifaceted and complex in its application.The major conclusions suggest ways in which the development of Hong Kong students’ clinical reasoning skills could be enhanced by taking account of their culturally influenced learning styles. As clinical reasoning does not occur in isolation, students need to develop these skills, establish the connection between theory and practice, and apply these skills in client intervention.