Problem-based learning (PBL) has been described as an educational method that enhances clinical reasoning skills. The purpose of this study was to determine the effects of an intensive, problem-based course on the development of clinical reasoning skills of undergraduate occupational therapy students. A quasi-experimental pretest-posttest design was used with a convenience sample of 48 undergraduate seniors. All students participated in an intensive 5-week, 30-hour, PBL course scheduled just prior to Level II fieldwork. The Self-Assessment of Clinical Reflection and Reasoning (SACRR) developed by Royeen, Mu, Barrett, and Luebben (2001) was administered on the first and last days of the course. The Wilcoxon Signed Ranks Test revealed statistically significant differences in pre- and posttest scores for 11 of 26 items on the SACRR. In addition, the overall total score increased from 96.88 to 102.55 (p < .01). The results suggest that a short, but intensive PBL course in the senior year of an occupational therapy curriculum can significantly facilitate the development of students' clinical reasoning skills.

Marjorie E. Scaffa, Donna M. Wooster; Effects of Problem-Based Learning on Clinical Reasoning in Occupational Therapy. Am J Occup Ther 2004;58(3):333-336. doi: 10.5014/ajot.58.3.333.

Authors state that the purpose of this study was to examine how U.S. occupational therapy practitioner's access and use clinically relevant evidence based practice research. Authors surveyed clinically practicing occupational therapists who were members of the American Occupational Therapy Association. 58% of the practitioners surveyed responded. The distribution of opinions and self-reported behavior was portrayed by descriptive statistics, and chi-square cross-tabulations and Pearson correlation coefficients were calculated between demographic and evidence-based practice variables.
Authors found that respondents occasionally accessed research information through a variety of resource media. The majority (57%) implemented between one and five new, research-based treatment plans in the past year. Compared with respondents with less experience, a greater proportion of respondents with 15 or more years of clinical experience did not believe that research conclusions usually translated into treatment plans for individual clients (X2 = 20.620, p < .01). Almost three fifths (59%) of respondents reported that time was provided on the job to attend continuing education; however, 45% strongly disagreed that time was available at work to access research information. Other reported barriers to research utilization included lack of time on the job, high continuing education costs, weak research analysis skills, and placing higher value on clinical experience than on research. Authors conclude that these findings suggest that therapists are currently engaging in a modest amount of evidence-based practice. Removing the barriers identified in this study may increase research utilization among clinicians.

Dysart, A., Tomlin, G. (2002). Factors Related to Evidence-Based Practice Among U.S. Occupational Therapy Clinicians. American Journal of Occupational Therapy, 56, 275-284. Retrieved from http://ajot.aota.org/article.aspx?articleid=1869107&resultClick=3

Authors sought to determine the association between minimal depression, upper-extremity (UE) impairment, and UE motor function in a cohort of participants with subacute stroke. Authors conducted a retrospective, secondary analysis of an interventional study. Correlational analyses were performed using the following outcome measures: the UE section of the Fugl-Meyer Assessment (FM), the functional ability section of the Arm Motor Ability Test (AMAT), and the Beck Depression Inventory (BDI-II). Authors found a negative correlation between BDI-II and both the FM (2.120, p 5 .196) and the AMAT (2.110, p 5 .275); however, this correlation was not statistically significant. Women exhibited higher depression scores (8.75 ± 0.78) than men (6.29 ± 0.46; p 5 .008). Authors concluded that low levels of depression are not associated with UE motor impairment and function in people with minimal to moderate UE disability levels. Poststroke depression occurs more frequently in women, warranting additional research on sex-specific differences. Given the proliferation of UE therapies targeting this group, this information is important for effective therapy planning and implementation.
Weaver, L. L., Page, S. J., Sheffler, L., & Chae, J. (2013). Minimal depression: How does it relate to upper-extremity impairment and function in stroke? American Journal of Occupational Therapy, 67, 550-555.

Authors aimed to determine whether a difference in productivity exists between clinicians supervising and not supervising a Level II occupational therapy student and whether factors including clinician years of experience, practice setting, and clinician productivity without a student could predict clinician productivity while supervising a student. Authors used a paired-sample t tests to examine clinician productivity with and without a student in 109 clinician-student encounters and regression analysis to determine factors predictive of clinician productivity with a student. Results indicated no difference in clinician productivity with or without a student. Clinician years of experience, practice area, and productivity without a student were significant predictors of clinician productivity while supervising a student. Study results contradict the belief that supervising Level II fieldwork students lowers clinicians' productivity. Findings suggest that practice area and productivity without a student are important factors influencing the productivity of clinicians supervising a fieldwork student.

Ozelie, R., Janow, J., Krewtz, C., Murly, K., Penkala, A. (2014). Supervision of Occupational Therapy Level II Fieldwork Students: Impact on and Predictors of Clinician Productivity. American Journal of Occupational Therapy, 69(01). Retrieved from http://ajot.aota.org/article.aspx?articleid=2087155&resultClick=3

Authors suggest that healthcare reform has brought about significant changes to the definition and practice of professionalism. Authors go on to say that occupational therapy practitioners must continually strive to provide excellent patient care, delivering positive patient outcomes while responding effectively to the increasing financial and administrative constraints. Fourteen occupational therapy practitioners participated in this study. Each participant was interviewed over 12 month period. Each participant was interviewed three times and was asked to keep a monthly diary of critical incidents. A process of narrative analysis was developed to analyze these data. Authors found that the changes that have occurred throughout healthcare reform have affected professional values, expertise, status, and accountability.

Mackey, H. (2013). Living tensions: Reconstructing notions of professionalism in occupational therapy. Australian Journal of Occupational Therapy, 61(3), 168-176.

Authors conducted this study to determined occupational therapy practitioners perceptions of the following aspects of intervention planning: economics, ethics, independent professional judgment, and evidence-based practice. 142 occupational therapy practitioners participated in a cross-sectional survey for this study. Authors found that occupational therapists fell into one of four clusters, with the largest cluster having positive perceptions about ethics and independent professional judgment but negative perceptions about economic issues. Smaller clusters of occupational therapists were more positive about economic issues or less positive about ethics and independent professional judgment. Negative perceptions about the ability to implement evidence-based practice spanned all clusters. Authors concluded that most occupational therapists exercise independent professional judgment but perceive economic limitations when developing intervention plans. Practicing occupational therapists need additional research to support evidence-based practice and help in accessing and using research.

Lopez, A., Vanner, E., Cowan, A., Samuel, A., Sheperd, D. (2008). Intervention Planning Facets - Four Facets of Occupational Therapy Intervention Planning: Economics, Professional Judgment, and Evidence Based Practice. American Journal of Occupational Therapy, 62, 87-96. Retrieved from http://ajot.aota.org/article.aspx?articleid=1867034&resultClick=3

Authors suggest that the performance of novice and expert occupational therapy practitioners are largely due to their ability to clinically reason. This study was conducted to gain further understanding of the ways novice and expert occupational therapists use clinical reasoning in practice and ultimately how novice practitioners can begin to clinically reason like experts. Five occupational therapists participated in this mixed methods study. Three expert and two novice occupational therapists working in rehabilitation settings wore head-mounted video cameras while completing three therapy sessions (assessment, treatment, and discharge planning). Therapist then reviewed the videos and reported on their clinical reasoning. The verbal reports were then transcribed and analyzed by the authors. Authors concluded that novice therapists could benefit from spending more time reflecting on the therapy process, and discussing their therapy with expert colleagues.

Unsworth, C. (2001). The Clinical Reasoning of Novice and Expert Occupational Therapists. Scaninavian Journal of Occupational Therapy, 8(4), 163-173. Retrieved from http://informahealthcare.com/doi/pdf/10.1080/110381201317166522