Problem Representation in Occupational Therapy

Abstract

Clinical reasoning is a fundamental component of occupational therapy practice. Educators, researchers and clinicians are faced with the challenge of understanding and fostering the acquisition of clinical reasoning skills. The aim of this study was to examine the internal problem representations held by students and clinicians in respect of clients they had been treating for a period of time. Such representations form the basis on which treatment is formulated so are highly influential in the clinical reasoning process. The ultimate purpose of the study was to identify educational strategies that could be used to assist students to develop clinical reasoning skills. Understandings gained from the literature and from observation, indicated that there would be differences between novices and experts and that the work setting would affect problem representation. Thus the influence of experience and location was the primary focus of the study. To place the study within the context of the occupational therapy literature, the beliefs underlying problem representation were also explored to determine whether or not these were consistent with the philosophical assumptions identified in the literature. The method of investigation was an interview with pre-determined questions. The interview was consistent with the theory base of the study (ie. information processing), but the analysis also included the investigation of qualitative aspects. To ensure a developmental perspective was gained, respondents included students on two different levels of an occupational therapy course and clinicians who were currently practicing. The total number of respondents was 67 ie. 14 stage II students, 31 stage III students (ie. in their final year) and 22 clinicians. The study illustrated that the environmental context affects problem representation in respect of both the amount of data to be considered and the nature of that data. Differences between students' and clinicians' representation of the problem were related to qualitative aspects rather than identification of the elements relevant to treatment planning. In particular, clinicians were more able to elaborate on the data, justify their responses and provide a humanistic perspective beyond the more technical aspects of knowing the clients concerns. The beliefs governing thinking about treatment, demonstrated consistency with the occupational therapy literature (apart from one assumption). A major finding of this study is that the development of schemata related to practice areas is the basis of sound reasoning and justification of treatment planning decisions. Both domain specific knowledge and an understanding of the environmental context are important to the forming of these schemata. The implication for teaching is that the wealth of experiential knowledge that is gained by students while on clinical practice should be tapped to enable them to make links with academic knowledge and thus develop a comprehensive problem representation.