Critical thinking and clinical reasoning in new graduate occupational therapists: a phenomenological study.
Robertson, David M.
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The aim of this study was to examine, understand and conceptualise the critical thinking and clinical reasoning adopted by new graduate occupational therapists as they enter the workforce to become newly autonomous practitioners. The study obtained the perspectives of new graduates, their supervisors and service managers on the means by which critical thinking and clinical reasoning develop to meet the expectations of employers. Factors which impeded the transition between new graduate and autonomous practitioner were identified and explored. Ethical approval was obtained to conduct the study. The study adopted a qualitative phenomenological research approach; Interpretative Phenomenological Analysis (IPA), which informed framing, data gathering and analysis. Semi-structured interviews were conducted with new graduates (n=6), supervisors (n=7) and managers (n=7) from multiple sites within one National Health Service Board. Interviews were transcribed verbatim from audio-recordings. The findings indicate that new graduates are expected to develop critical thinking and clinical reasoning in a manner that might challenge traditional conceptualisations of the transitioning process. A phenomenon, historically named the “shock of practice”, was reflected on by therapists in each phase of the study and adaptive and mal-adaptive responses to this in the thinking and behaviour of new graduates was identified. The clinical supervisor-supervisee relationship appeared to be the key source of support, and the supervisor the most significant knowledge resource, for new graduates. This relationship was supplemented by both peer support and Preceptorship. Discharge planning was a significant source of anxiety and development of an algorithm to support this process is proposed. Recommendations for further research and theoretical implications for practice and undergraduate education are discussed.