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Advancing clarity: exploring professional thinking skills in occupational therapy


Background: Reasoning, reflection and evidence-based practice are three interrelated and essential skills for occupational therapy practice. As threshold concepts in the field, they contribute to development of a sense of professional identity. However, these skills are inconsistently defined and differentiated from one another, leading to difficulties in related communication, education, and research. In this dissertation I sought to advance the profession's understanding of consensus conceptualizations of these essential professional thinking skills and how they are taught. Methods: This dissertation comprises five articles reporting results of two broad studies. In the first study, a scoping review, I explored peer-reviewed occupational therapy literature that included a definition of a term related to reasoning and/or reflection. Along with my research team, I extracted data from each paper on definitions of relevant terms, relationships amongst relevant terms, references used to define relevant terms, and descriptive information about each article. In the second study, I used Delphi methodology to explore nine occupational therapy educators' consensus definitions of, conceptualizations of relationships between, and educational strategies for teaching clinical reasoning, professional reasoning, reflective practice, and evidence-based practice. I then conceptually integrated results of both studies to compare findings between the literature and educators. Findings: Both studies indicate that there is some agreement about main characteristics of each of these skills. They also both suggest that clinical/professional reasoning, reflective practice, and evidence-based practice are related to each other in complex, non-linear ways that warrant further exploration. Findings from the Delphi study additionally indicate that there are key educational strategies that may support development of multiple of these professional thinking skills. Conclusion: This dissertation adds to the body of literature clarifying conceptualizations of necessary professional thinking skills in occupational therapy. Continued explicit consideration of conceptualizations of reasoning, reflection, and evidence-based practice within occupational therapy literature and education will advance communication, measurement, and, ideally, uptake of these skills into practice to support an integrated sense of professional identity.


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Embargo expires: 12/29/2025.


evidence-based practice
professional reasoning
reflective practice
occupational therapy education
clinical reasoning
professional thinking


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