Professional Reasoning

According to the OTPF, practitioners use professional reasoning when choosing occupations as the primary means of intervention throughout the OT process. Practitioners help clients achieve their desired outcomes by facilitating the client’s interactions, their contexts, and the occupations in which they engage. Professional reasoning promotes a client-centered approach and should be utilized throughout the OT process, from evaluation to outcome measures.⁴ 

Professional reasoning is defined as the “Process that practitioners use to plan, direct, perform, and reflect on client care”.⁵ 

1. Context is important in critical reasoning.
2. Use an open-minded attitude towards finding solutions.⁶ 
3. Professional is used instead of clinical to indicate that the process is not limited to use in medical settings.
4. Reasoning is used instead of thinking to denote the complexity of the problem-solving process.⁷ 
   1. Procedural reasoning – the use of specific routines for evaluation and intervention and intended to focus on physical problems.
   2. Interactive reasoning – focuses on the engagement with individuals to understand their perceptions, feelings, and needs.
   3. Conditional reasoning – considers social and temporal (time) contexts and how a disability may affect future life roles.
   4. Scientific reasoning – a logical process of gathering information for the identification of problems, understanding conditions, and recognizing factors that can potentially affect performance and decisions about possible interventions.
   5. Narrative reasoning – understanding the experience of the client and those involved and their various perspectives when planning interventions.
   6. Pragmatic reasoning – incorporates contextual information into the decision-making process and anticipates the impact that various options on the system may have in the process. An example is time constraints or limited budgets.
   7. Ethical reasoning – uses the information gathered from other aspects of critical reasoning to determine the client’s best interest, identify barriers to best practice, and find solutions to allow everyone to feel included.⁷ 
5. Professional reasoning is the method by which genuine client-centered practice is accomplished.⁸ 
6. There are no fixed rules or no standardized approaches for solving clinical problems.⁹ 
7. Students should develop a knowledge base and consider concepts from multiple perspectives.¹⁰ 

Preparation

• Avoid being a “superficial thinker” and try to be a “deep-thinker” by understanding the logic, rationale, or explanation.
• Ask yourself: why? how? how else? what? what else? what if?
• Study the rationales for practice questions, even the ones you got correct. You may have gotten lucky so it is important to understand what the author intended when asking the question.
• Identify your weak areas or topics and move on. Come back to study this later. If you really do not know the answer to the actual exam, do not waste time on it. Flag it and come back to it later.

Reflection Questions that use Scaffolding¹¹ 

1. Are there any possible emotional issues that could be a factor?
2. Is there anything about the context that may be a safety concern?
3. What developmental stage is the client in?
4. What issues do people in this stage face?
5. Are there any other perspectives that would be important to use?
6. Who is the client as a person? Traits, desires?
7. What characteristics of the diagnosis affect their occupations?
8. How can you use targeted outcomes?
9. Are there any standardized assessments you can use?

What the Research Says

• Individuals with less practice in cognitive tasks use more analytical processing, while those with more practice experience use more intuitive strategies.¹² 
• Studies have shown that junior therapists use more science-based reasoning that focuses on physical problems and the routines used for evaluation and treatment.
• Senior occupational therapists spend more time considering the social and temporal contexts, and the effects of the disability on the client’s life roles.^{13 14 15 16} 
  • This means, based on how much experience you have, e.g., whether you worked as a COTA or if you have no OT experience at all, this may influence how you answer questions on the NBCOT® Exam.
  • In other words, the best answer that may be used in practice may not necessarily be the best answer that the NBCOT® exam is looking for. One way to know if you are on the right track is by doing lots of practice questions and seeing how you answer compared to how you should be answering.

Critical Thinking Strategies

1. Identify assumptions vs. facts vs. inferences.
2. Determine the significance of the information.
3. Identify inconsistencies in the information.
4. Identify commonalities and differences; opposites.
5. Identify patterns of the client based on diagnoses, etc.
6. Identify gaps of information. Do not add your own information to the question.
7. Make inferences based on the information provided or not provided (vs. assuming).
8. Identify the actual problem vs. distractions.
9. Establish priorities, e.g., the client’s stated goals.
10. Take specific action that is client-centered, and goal-oriented, e.g., S.M.A.R.T. to solve the problem.
11. Evaluate the outcome – which should be measurable.
12. Reflect on the outcome and reevaluate your answer choice.

1. Velde BP, Wittman PP, Vos P (2006). Development of critical thinking in occupational therapy students. Occupational Therapy International 13 (1): 49–60.[↩]
2. Mattingly C, Fleming MH (1994). Clinical Reasoning: Forms of Inquiry in a Therapeutic Practice. Philadelphia, PA: F.A. Davis.[↩]
3. Schell BB, Schell JW (eds). (2008). Clinical and Professional Reasoning in Occupational Therapy. Philadelphia, PA: Lippincott, Williams, & Wilkins.[↩]
4. American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process
   (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi. org/10.5014/ajot.2020.74S2001[↩]
5. Schell, B. A. B. (2019). Professional reasoning in practice. In B. A. B. Schell & G. Gillen (Eds.), Willard and Spackman’s occupational therapy (13th ed., pp. 482–497). Philadelphia: Wolters Kluwer.[↩]
6. Daly WM (1998). Critical thinking as an outcome of nursing education. What is it? Why is it important to nursing practice? Journal of Advanced Nursing 28 (2): 323–331.[↩]
7. Mitchell, A. W., & Batorski, R. E. (2009). A study of critical reasoning in online learning: Application of the occupational performance process model. Occupational Therapy International, 16(2), 134-153.[↩][↩]
8. Atkins S, Ersser SJ (2000). Education for advanced nursing practice: an evolving framework. International Journal of Nursing Studies 37(6): 523–533.[↩]
9. Maudsley G, Strivens J (2000). ‘Science,’ ‘critical thinking,’ and ‘competence’ for tomorrow’s doctors. A review of terms and concepts. Medical Education 34 (1): 53–60.[↩]
10. Saye JW, Brush T (2002). Scaffolding critical reasoning about the history and social issues in multimedia-supported learning environments. Educational Technology Research and Development 50 (3): 77–96.[↩]
11. Hannafin M, Land S, Oliver K (1999). Open learning environments: foundations, methods, and models. In: Reigeluth C (ed.). Instructional Design Theories and Models (Vol. II) (pp. 115–140). Mahwah, NJ: Erlbaum.[↩]
12. Harries PA, Harries C (2001). Studying clinical reasoning, part 1: Have we been taking the
    wrong ‘track’? British Journal of Occupational Therapy 64 (4): 164–168.[↩]
13. Mattingly C, Fleming MH (1994). Clinical Reasoning: Forms of Inquiry in a Therapeutic Prac-
    tice. Philadelphia, PA: F.A. Davis.[↩]
14. Alnervik A, Svidén G (1996). On clinical reasoning: patterns of reflection on practice. Occupational Therapy Journal of Research 16 (2): 98–110.[↩]
15. Liu KPY (2000). Clinical reasoning and the occupational therapy curriculum. Occupational Therapy International 7 (3): 173–183.[↩]
16. Mitchell R, Unsworth C (2005). Clinical reasoning during community health home visits: expert and novice differences. British Journal of Occupational Therapy 68 (5):
    215–223.[↩]