Using Case-Based Learning to Facilitate Clinical Reasoning Across Practice Courses in an Occupational Therapy Curriculum

Although occupational therapy educators have historically used cases as a means to prepare students for clinical practice, there is little evidence that this instructional method actually facilitates clinical reasoning. This convergent, parallel mixed methods study examined how the use of varied case formats, built on the tenets of case-based learning, facilitated specific components of clinical reasoning, and explored how the cases contributed to readiness for professional practice. Case formats included text, video, role-playing, simulated patients, and a client. Case-based learning activities included application of models and frames of reference, conducting assessments, planning and implementing interventions, clinical documentation, and identification of reasoning used. All cases included the opportunity for instructors to provide direct and appropriate feedback, and facilitation of student reflection on their performance. The Self-Assessment of Clinical Reflection and Reasoning (SACRR) was used for quantitative data analysis and detected statistically significant changes in the use of theory and frames of reference to inform practice and in student reasoning about interventions, following case-based learning. Student surveys allowed for pragmatic qualitative analysis, and identified the themes of self-awareness, confidence, and developing competence related to readiness for fieldwork and clinical practice. Student preferences for case format and benefits of varied types of cases were identified. Case-based learning used different case formats, and contributed to the occupational therapy student transition from a clinical reasoning novice to an advanced beginner. Knowledge of this process is useful to occupational therapy educators in structuring case-based learning activities to influencing reasoning.