Understanding of clinical reasoning by undergraduate students and clinical educators in health and rehabilitation sciences at a South African University: The implications for teaching practice

Abstract

Background. Clinical reasoning (CR) is a skill acquired by students under supervision of clinical educators (CEs) when transitioning from classroom to clinical practice to optimise patient care. However, intra- and inter-professional differences in the definition and facilitation of CR have been reported. At the University of Cape Town, a teaching development grant was obtained and used for a staff development initiative aimed at improving the CR skills of undergraduate health and rehabilitation students.

Objectives. To gain insight into the understanding of CR among CEs and a cohort of third-year students across 4 professional programmes, using an interpretive approach.
Methods. The CEs responsible for third-year supervision (n=45) were invited to take part in a self-developed electronic survey and an initial workshop that explored their understanding of CR. The qualitative survey data, as well as workshop feedback and discussion, were analysed. Students’ understanding was explored during focus group discussions.

Results. There were areas of commonality and differences among CEs. They agreed on a cyclical step-like process to CR and the need to cue students to develop this expertise in clinical settings. The approach of CEs in occupational therapy was client focused; physiotherapy CEs described a higher- order thinking; and audiology and speech and language pathology CEs described a structured procedure informed by evidence. Students were unable to conceptualise a complete picture to reasoning and decision-making.

Conclusion. The difference between students’ understanding of CR and their poor awareness of strategies employed by CEs to facilitate reasoning could account for difficulties in transitioning from classroom to practice. This scenario suggests that divisions need to look at creating more purposeful strategies to teach students about the CR process and how the facilitation may occur within the clinical setting.