Nature of feedback by supervisors based on comments in the Work Habits Report

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Identification of the problem

From the previous argument it is clear that clinical reasoning is one of the core professional behaviours to be mastered by occupational therapy students and that interpersonal communication between supervisor and student underpins the successful fieldwork education required for this. Even though various studies on the supervision of occupational therapy students during their fieldwork education was internationally and nationally investigated (Bonello, 2001; Hummell, 1997; Kumbuzi, Chinhengo, & Kagseke, 2009) no published research could be found on how the supervisors’ interpersonal communication patterns impact on the clinical reasoning ability of occupational therapy students. In the South African context with its cross-cultural paradigms, diverse value systems and backgrounds fieldwork education of final year occupational therapy students often poses a challenge to those involved. In view of this it seemed necessary to investigate how the interpersonal communication patterns of supervisors in the South African context enhance the ability of their occupational therapy students to apply clinical reasoning skills during their fieldwork education.

Delimitations

Student participants for the study were limited only to those from one university in South Africa where occupational therapy training is offered. Supervisor participants were limited to those supervising these students in both public and private hospital settings in the physical field. Only Caucasian students’ findings and results were included in the data analyses, the reason being twofold: First of all, in the planning of the research study, there were only three African students which is not a representative sample on which to base meaningful findings and results. Secondly, because including another cultural group would bring in a variable that would be difficult to quantify in terms of its effect on the study. This hypothesis is in line with Teffo and Roux’s notion that “In Western philosophy the starting-point for an account of personhood is usually epistemological and psychological. Knowledge is the possession of a particular individual … how the individual sees him/herself from the inside”, but “in African thinking the starting-point is social relations – selfhood is seen and accounted for from this relational perspective” (Teffo & Roux, 1998, p. 145). The research study was conducted during each one of the three physical fieldwork education blocks as timetabled by the Department of Occupational Therapy only for the year 2007 (Table 1-1)

Clinical reasoning: The concept

Joan Rogers describes clinical reasoning as “the thought process that guides practice” in which therapists employ their clinical reasoning skills to first assess their patients’ health status, i.e. establish what are the patients’ impairments and what their strengths are, and following that (in collaboration with the patients themselves) deciding upon desirable intervention strategies (Law & Baptiste, 2002; Rogers J. C., 1983, p. 336). Based upon these decisions the quality of life of the patient can be significantly improved. Mattingly and Fleming are of the opinion though that clinical reasoning is not merely “matching condition to therapy of choice” (scientific reasoning), but a complex practical reasoning process in which the individual needs of the patients, including their experience of their illness, are considered (Mattingly & Fleming, 1994, p. 13). Neistadt, Wight & Mulligan (1998, p. 125) add that clinical reasoning is the thought process used by clinicians to “individualize treatment”. Royeen et al. also define clinical reasoning in the same vein, but qualify “thought process” as a “reflective thought process” which therapists “undergo to integrate client evaluation information in order to develop and implement intervention plans” (Royeen, Mu, Barrett, & Luebben, 2001, p. 108). Unsworth (2011) on the other hand maintains that when authors in general define clinical reasoning as “many modes of thinking that guide clinical practice” this concept is indistinct and much research would be required to explore and examine the phenomenon. Although authors differ in their view of the concept it would seem that the notion of Rogers’ (1983), i.e. data collection about the patient’s problems and strengths, analysis and interpretation of such data, and the implementation of intervention strategies, still form the core components of the concept (Kuipers & Grice, 2009; Mendez & Neufeld, 2003).

Interactive reasoning

With interactive reasoning (Mattingly & Fleming, 1994) the approach of the therapist is client-centred with the intention of understanding the patient as a person and how he/she perceives his/her world (Hagedorn R. , 1995). In order to do so the therapist focuses on the core therapeutic skills of empathy, unconditional positive regard and congruence (Du Toit, Grobler, & Schenk, 1998). Furthermore therapists collaborate with patients, if appropriate, about their own treatment, thus fostering a feeling of control (Goodman, Hurst, & Locke, 2009). In this respect Du Toit (2009, p. 17) maintains that the clinician cannot apply treatment procedures to or do anything for the patient, but is obliged to “wait for the patient in his totality to do with her”. The Nigerian Association of Occupational Therapy (World Federation of Occupational Therapists, 2003, p. 27) believes in this regard that the therapist should work with the client “towards promoting freedom from dependence on others and to attract respect and not pity”. The client-centred approach described by Fleming (1991) seems to be based on Carl Rogers’ series of 19 propositions of human behaviour and his person-centred approach (Rogers C. R., 1951). Central to this approach is the notion that the therapist tries to understand how the patient or client sees him/herself. Rogers (1951, p. 30) states in this regard that “the therapist must lay aside his preoccupation with diagnosis and his diagnostic shrewdness … must give up the temptation subtly to guide the individual … and must concentrate on one purpose only; that of providing deep understanding and acceptance of the attitudes consciously held at this moment by the client…”. Mattingly and Fleming (1994) also maintain that improvement occurs within the scope of an interpersonal relationship.

Pragmatic reasoning

Schell and Cevero added pragmatic reasoning as another mode of reasoning to Mattingly and Fleming’s framework of clinical reasoning in occupational therapy (Schell & Cervero, 1993). According to these authors pragmatic reasoning consists of both the practice and the personal aspect of therapy. As indicated by them it only makes sense to include contextual factors that facilitate or enhance treatment as part of the clinical reasoning process. These factors from a practice point of view include hospital policy, available funding, equipment, space, treatment protocols, time schedules (Schell B. A., 2003) and the therapists’ personal abilities such as their repertoire of therapeutic and interpersonal communication skills and their value systems (Schell & Cervero, 1993). Unsworth (2004) on the other hand questions the inclusion of pragmatic reasoning as a separate mode of clinical reasoning in occupational therapy, based on the findings of her research on 13 occupational therapists’ clinical reasoning applied to 13 patients from three physical rehabilitation centres. Data were collected from a focused ethnographic framework. The findings indicated that pragmatic reasoning was related to the practice context only.

Table of Contents :

• 1. INTRODUCTION
  • 1.1 Identification of the problem
  • 1.2 Research question
  • 1.3 Purpose of the study
  • 1.4 Significance of the study
    • 1.4.1 Development of students’ professional behaviour
    • 1.4.2 Supervision
    • 1.4.3 Health care
    • 1.4.4 Contribution to the scientific body of knowledge
  • 1.5 Dissemination of research results
  • 1.6 Delimitations
  • 1.7 Assumptions
  • 1.8 Definition of key terms
  • 1.9 Abbreviations and acronyms
  • 1.10 Chapter overviews
• 2. LITERATURE REVIEW
  • 2.1 Introduction
  • 2.2 Clinical reasoning
    • 2.2.1 Introduction
    • 2.2.2 Clinical reasoning: The concept
    • 2.2.3 Clinical reasoning: The content
      • 2.2.3.1 Scientific clinical reasoning
      • 2.2.3.2 Interactive reasoning
      • 2.2.3.3 Conditional reasoning
      • 2.2.3.4 Narrative reasoning
      • 2.2.3.5 Pragmatic reasoning
      • 2.2.3.6 Ethical reasoning
    • 2.2.4 Clinical reasoning: The process
    • 2.2.5 Clinical reasoning: Teaching strategies
      • 2.2.5.1 Paper cases
      • 2.2.5.2 Video cases
      • 2.2.5.3 Narratives or story telling
      • 2.2.5.4 The classroom as clinic
      • 2.2.5.5 Fieldwork education
    • 2.2.6 Therapists’ level of clinical reasoning competency
  • 2.3 Physical fieldwork education
    • 2.3.1 Introduction
    • 2.3.2 The purpose of fieldwork education
    • 2.3.3 Expected outcomes of physical fieldwork education
    • 2.3.4 Development models in fieldwork education
    • 2.3.5 Teaching approaches in fieldwork education
    • 2.3.6 Assessment of and feedback to the student in fieldwork education
  • 2.4 Interpersonal communication in the context of fieldwork education
    • 2.4.1 Introduction
    • 2.4.2 The General Systems Theory
    • 2.4.3 The Humanistic Approach
    • 2.4.4 Interactional Pattern Analysis Theory and Interpersonal Variables
    • 2.4.5 The fieldwork educator (supervisor) in the relationship
    • 2.4.6 The student in the relationship
  • 2.5 Assessment of clinical reasoning skills in the practical exam
    • 2.5.1 The purpose
    • 2.5.2 The role of the examiner
  • 2.6 Conclusion
• 3. THE INVESTIGATION
  • 3.1 Research design
    • 3.1.1 Purpose statement
    • 3.1.2 Research questions
    • 3.1.3 Mixed methods research design
    • 3.1.4 Rationale for mixed methods research design
      • 3.1.4.1 Triangulation
      • 3.1.4.2 Complementarity
      • 3.1.4.3 Development
      • 3.1.4.4 Expansion
      • 3.1.4.5 Initiation
    • 3.1.5 Types of mixed methods strategies
      • 3.1.5.1 Phase I – Data generation
      • 3.1.5.2 Phase II – Data analysis
      • 3.1.5.3 Phase III – Data interpretation
    • 3.1.6 Techniques
      • 3.1.6.1 Sampling
      • 3.1.6.2 Data generation
    • 3.1.7 Recording data
    • 3.1.8 Transcribing data
    • 3.1.9 Data coding and analysis
      • 3.1.9.1 Thematic content analysis
      • 3.1.9.2 Analysis of coded material
      • 3.1.9.3 Interpersonal Pattern Analysis
    • 3.1.10 Trustworthiness
    • 3.1.11 Ethical considerations
    • 3.1.12 Pre-test
  • 3.2 The method of research implementation
    • 3.2.1 Purpose statement
    • 3.2.2 Research questions
    • 3.2.3 Mixed methods research design
    • 3.2.4 Rationale for mixed methods research design
    • 3.2.5 Type of mixed methods strategies
    • 3.2.6 Techniques
      • 3.2.6.1 Sampling
      • 3.2.6.2 Data generation
    • 3.2.7 Recording data
    • 3.2.8 Transcribing data
    • 3.2.9 Data coding and analysis
      • 3.2.9.1 Thematic content analysis
      • 3.2.9.2 Analysis of coded material
      • 3.2.9.3 Interpersonal Pattern Analysis (IPA)
    • 3.2.10 Trustworthiness
    • 3.2.11 Ethical considerations
    • 3.2.12 Conclusion
• 4. RESULTS AND DISCUSSION
  • 4.1 Introduction
  • 4.2 Demographic profile of the supervisors and students in the sample
    • 4.2.1 Demographic data of supervisors
    • 4.2.2 Demographic data of students
    • 4.2.3 Geographic placement of participants
    • 4.2.4 Demographics summary
  • 4.3 Practical examination of clinical reasoning skills
  • 4.4 Interpersonal Pattern Analysis (IPA) of supervisors
    • 4.4.1 Interpersonal Pattern Analysis of supervisors with high performing students
      • 4.4.2 Interpersonal Pattern Analysis of supervisors with medium performing students
      • 4.4.3 Interpersonal Pattern Analysis of supervisors with low performing students
      • 4.4.4 Summary of the Interpersonal Pattern Analysis of supervisors
  • 4.5 Students’ experience of the nature of their relationship with supervisors
    • 4.5.1 The nature of their relationship with supervisors as experienced by high performing students
    • 4.5.2 The nature of their relationship with supervisors as experienced by medium performing students
    • 4.5.3 The nature of their relationship with supervisors as experienced by low performing students
    • 4.5.4 Summary
  • 4.6 Nature of feedback given by supervisors based on focus groups and one-on-one interviews
  • 4.7 Grades students received for their clinical reasoning skills from their supervisors on the Work Habits Report
  • 4.8 Nature of feedback by supervisors based on comments in the Work Habits Report
  • 4.9 Comparison of students’ practical exam grade with general academic performance
  • 4.10 Triangulating for supervisor’ interpersonal communication profiles
  • 4.10.1 Triangulation for profile of supervisors with high performing students
  • 4.10.2 Triangulation for profile of supervisors with medium performing students
    • 4.10.3 Triangulation for profile of supervisors with low performing students
  • 4.11 Characterisation and discussion of the most effective supervisory profile
    • 4.11.1 Supervisor’s level of competency
    • 4.11.2 Supervisor’s interpersonal communication with student
    • 4.11.3 Supervisor’s impact on student
    • 4.11.4 Summary
  • 4.12 Characterisation and discussion of the least effective supervisor profile
    • 4.12.1 Supervisors’ level of competency
    • 4.12.2 Supervisors’ interpersonal communication with student
    • 4.12.3 Supervisors’ impact on student
    • 4.12.4 Summary
• 5. CONCLUSION
  • 5.1 Findings of the study
  • 5.2 Reflection on the findings of the study
  • 5.3 Reflection on the significance of the study
    • 5.3.1 Development of students’ professional behaviour
    • 5.3.2 Supervision
    • 5.3.3 Health care
    • 5.3.4 Contribution to the scientific body of knowledge
  • 5.4 Reflection on the execution of the study
    • 5.4.1 Participants
    • 5.4.2 Methodology applied
  • 5.5 Limitations of the study
  • 5.6 Recommendation for further research
  • 5.7 Closing remarks

GET THE COMPLETE PROJECT
INTERPERSONAL COMMUNICATION FACTORS IN THE SUPERVISORY RELATIONSHIP THAT PLAY A ROLE IN ENHANCING OCCUPATIONAL THERAPY STUDENTS’ CLINICAL REASONING DURING PHYSICAL FIELDWORK EDUCATION