Clinical reasoning skills of speech and language therapy students

Hoben, Kirsty, Varley, Rosemary and Cox, Richard (2007) Clinical reasoning skills of speech and language therapy students. International Journal of Language and Communication Disorders, 42 (S1). pp. 123-135. ISSN 1368-2822

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Abstract

Difficulties experienced by novices in clinical reasoning have been well documented in many professions, especially medicine (Boshuizen and Schmidt 1992, 2000; Elstein, Shulman and Sprafka 1978; Patel and Groen 1986; Rikers, Loyens and Schmidt 2004). These studies have shown that novice clinicians have difficulties with both knowledge and strategy in clinical reasoning tasks. Speech and language therapy students must also learn to reason clinically, yet to date there is little evidence of how they learn to do so. Aims: In this paper, we report the clinical reasoning difficulties of a group of speech and language therapy students. We make a comparison of a subgroup of these with experienced speech and language therapists, who were not part of the project team, also completed an assessment of one of these cases under the same conditions. Screen capture was used to record all on screen activity within PATSy web pages (i.e. mouse pointer position, hyperlink and button presses, page scrolling, browser navigation interactions and data entered); Verbal comments made by participants were analysed via a seven-level coding scheme that aimed to describe the events that occur in the process of diagnostic reasoning. Outcomes & Results: Students displayed a range of competence in making an accurate diagnosis. Diagnostically accurate students showed use of specific professional vocabulary, and a greater use of firm diagnostic statements. For the diagnostically inaccurate students, typical difficulties were a failure to interpret test results and video observations, difficulty in carrying out a sequence of tests consistent with a diagnostic reasoning path, and problems in recalling and using theoretical knowledge. Conclusions and Implications: We discuss how identification of student diagnostic reasoning difficulties can inform the design of learning materials intended to address these problems.

Item Type: Article
Additional Information: Originality: This is original research on reasoning in a complex task (clinicaldiagnosis). It is one of very few studies of student clinicians'diagnostic reasoning performance using real patients i.e. a study conducted under conditions of high ecological validity (as opposed to artificial tasks and settings). The clinical reasoning difficulties of a group of speech and language therapy students are reported. The performance of student subgroups is compared with that of independent experts (experienced speech and language therapists). Rigour: Students diagnosed previously unseen patient cases. These were made available to them via PATSy (www.patsy.ac.uk), a nationally used large-scale interactive database of virtual patient cases (developed under direction of Cox). Dynamic video computer screen capture was used to record all on-screen activity. Verbal comments made by participants were analysed via protocol analysis. An original protocol (seven-level 'clinical reasoning event' coding scheme) was developed too as part of the research. Diagnostically accurate students showed use of specific professional vocabulary, and a greater use of firm diagnostic statements. Diagnostically inaccurate students typically failed to correctly interpret test results and video observations, and, inter alia, had difficulty in carrying out a sequence of tests consistent with a diagnostic reasoning path.Significance/Impact: Results have wide implications for the design of effective training programmes for pre-service and in-service clinicians. Also for reasoning more generally eg in general medicine and in broader complex cognitive task contexts eg electronic troubleshooting.
Schools and Departments: School of Engineering and Informatics > Informatics
Depositing User: Richard Cox
Date Deposited: 06 Feb 2012 20:24
Last Modified: 27 Mar 2012 09:09
URI: http://sro.sussex.ac.uk/id/eprint/25813
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