Australian Occupational Therapy Journal (2015) 62, 68–71
doi: 10.1111/1440-1630.12157
Viewpoint
The critical occupational therapy practitioner: How to define expertise? David Robertson,1 Fiona Warrender2 and Sue Barnard1 1
School of Health Sciences, Faculty of Health and Social Care, Robert Gordon University, Aberdeen, UK and 2Independent Occupational Therapist, Aberdeen, UK
KEY WORDS clinical reasoning, critical thinking, expert practitioner.
Introduction Barnett (1997), a pedagogical researcher and theorist, argued that in order to function successfully in the contemporary world, higher education students are required to become ‘critical beings’ (1997, p. 63). Translation of Barnett’s theory from education into professional practice permits the conceptualisation of a critical occupational therapy practitioner, an individual equipped, through the adoption of a critical stance, to succeed in supercomplex environments such as that existent in contemporary health and social care.
The Critical Practitioner The term ‘critical’ as employed in this paper refers to open, conscious, reflective, balanced, evaluation and judgement of situations, opinions, incidents and contexts, rather than the lay understanding of the term which has a broadly negative connotation of unhelpful nit-picking. Barnett (1997) conceptualised the critical being as an individual incorporating three forms of criticality; critical reason, critical self-reflection and critical action. Translated into the domain of practice (Figure 1), these three forms of criticality are reflected in the makeup of the critical occupational therapy practitioner, i.e. an individual who is evidence informed, critically
David Robertson PhD, MSc, DipCOT; Lecturer in Occupational Therapy. Fiona Warrender DipCOT, PgCert; Independent Occupational Therapist. Sue Barnard PhD, MSc, MCSP; Senior Lecturer and Research Co-Ordinator. Correspondece: David Robertson, School of Health Sciences, Faculty of Health and Social Care, Robert Gordon University, Aberdeen AB10 7QG, UK. Email: [email protected] Accepted for publication 4 August 2014. © 2014 Occupational Therapy Australia
reflective and engages reflexively in professional occupations. Using Barnett’s terminology, critical reason is a form of criticality that is concerned predominantly with critique of knowledge that has been generated systematically, for example, evidence from research. Critical self-reflection is a form of criticality concerned with critique of oneself, one’s internal dialogue, performance, cognitive biases and development. Critical action is analogous at some levels (1–3) with clinical reasoning and at others (4) with transformational, macro-level interventions, for example, public health initiatives (Table 1). It should always be borne in mind that this conscious thinking and reasoning occurs alongside a huge well of intuitive thinking and reasoning (Evans, 2003) which guides the bulk of a therapist’s day-to-day actions. As Chaffey, Unsworth and Fossey (2010) recently evidenced, although intuition is integral to practice, it is difficult to define and intuitive thinking difficult to articulate. Where Chaffey et al might be questioned is in their characterisation of intuition as being embedded within a larger clinical reasoning framework. Empirically evidenced contemporary models of thinking (Evans, 2003; Kahneman, 2011) might, in contrast, suggest a clinical reasoning framework either sitting alongside or superimposed on and, in both instances, dwarfed by the much more significant and more frequently utilised intuitive thought. Table 1 is adapted from Barnett (1997) and reflects his illustration of how criticality can be noted on two axes, firstly by levels of criticality (1–4), at the lowest level denoted by straightforward operational skills and at the highest by a transformatory critique. The second axis consists of the three domains of criticality; knowledge (interrogated by Barnett’s form of criticality named critical reason), self (by critical self-reflection) and the world (by critical action) The material in italics illustrates how Barnett’s levels, domains and forms of criticality can be distinguished in the characteristics of the critical occupational therapy practitioner. The comments within parentheses and in italics in Table 1 are for illustrative purposes only and should not be considered definitive.
69
REVISION 2 OF: THE CRITICAL OCCUPATIONAL THERAPY PRACTITIONER
Critical person
Critical action
Critical self reflection
Professionally engaged
Critically self reflective
Critical reason
Critical occupational therapy practitioner
Informed by evidence
FIGURE 1: Critical being as the integration of the three forms of criticality (Barnett, 1997, p. 105; fig. 8.1) translated into practice. Barnett (1997) – reproduced with permission etc.
Moving back to Figure 1 it can be seen that in practice, a critical occupational therapy practitioner might be characterised by the ability to apply the appropriate form of criticality at the appropriate level, in each of the three domains. Given its high profile as a graduate attribute and professional characteristic numerous studies have been undertaken into isolated components of critical thinking such as critical self-reflection (Morley, Smith & Petty, 2011) and critical reason (Bennett, Tooth, McKenna, Rodger, Strong & Ziviani, 2003). If the proposition that clinical reasoning is analogous with certain levels of critical action is accepted, it can be recognised that there has been a longstanding interest in that form of criticality within the profession. Few authors have investigated the integration of the forms of criticality. Bannigan and Moores (2009) developed a model of professional thinking incorporating reflective practice
and evidence based practice. It is somewhat unclear from their paper how they conceptualise clinical reasoning as fitting in to this model. They initially state that clinical reasoning is ‘closely aligned’ to professional thinking but then go on to say that they will use the term professional thinking ‘in preference to clinical reasoning’. A paragraph later they list the components of professional thinking as ‘a combination of deliberation, rational thinking, clinical reasoning, professional knowing and expertise gained from previous knowledge’ (Bannigan & Moores, 2009, p. 343). They then go back to suggest that, in establishing the validity of their model, researchers should employ methodologies employed for studying clinical reasoning. Bannigan and Moores (2009) should be applauded for recognising the value in integrating components of, what they term, professional thinking rather than compartmentalising each. They support the contention that
TABLE 1: The critical occupational therapy practitioner (adapted from Barnett, 1997, p. 103 table 8.1: Levels, domains and forms of critical being) (Barnett’s concepts in bold) Domains Levels of criticality
Knowledge
Self
World
4. Transformatory critique
Knowledge construction and reconstruction. (publication, peer reviewing) Critical thought (systematic review and evidence evaluation)
Reconstruction of self (leadership, professional influence, mentorship) Development of self within traditions (continuous professional development) Self-reflection (reflection on one’s own practice and performance) Self-monitoring to given standards and norms (ethics, professional standards)
Critique-in-action (collective reconstruction of world, macro-level intervention) Mutual understanding and development of traditions (evidence implementation and re-evaluation) Reflective practice (metacompetence, adaptability, flexibility: capability) Problem-solving (means-end instrumentalism: competence – skills and knowledge)
Critical self-reflection
Critical action
3. Refashioning of traditions 2. Reflexivity
Critical thinking (reflection on understanding and implications)
1. Critical skills
Discipline-specific critical thinking skills (critique of evidence, ideas, norms, memes, practices) Critical reason
Forms of criticality
© 2014 Occupational Therapy Australia
70 integration of the forms of criticality is essential in equipping the occupational therapy practitioner for contemporary practice.
Critical action/Clinical reasoning Understanding and articulation of clinical reasoning is desirable for a multitude of reasons, for example to enhance communication with patients and clients and to work towards improving efficacy of treatment, to aid decision-making, to facilitate the training of students and new graduates and to communicate and share knowledge. Perhaps one of the most important reasons for articulating clinical reasoning is that challenges to our cognitive biases, assumptions and social norms are then permitted. Research into clinical reasoning (Kuipers & Grice, 2009b) has primarily revealed differences in the reasoning of ‘novices’ and ‘experts’, and has proposed a variety of forms of clinical reasoning. Careful examination might suggest that the forms of clinical reasoning identified in the occupational therapy literature are dependent to some extent on the context (cultural, historical, geographical, socio-economic, etc.), within which the underpinning research was undertaken and the background of the researchers. The body of research that has identified differences in clinical reasoning between ‘novices’ and ‘experts’ is compromised by the absence of agreed criteria on what constitutes each, although it has been demonstrated that clinical reasoning in ‘novices’ can be improved in specific situations, particularly by permitting access to the reasoning of ‘experts’, whether expert practitioners (Harries & Gilhooly, 2011) or expert systems (Kuipers & Grice, 2009b). The authors concur with Rassafiani, Ziviani, Rodger & Dalgleish (2009) that traditional methods of identifying expertise may be misleading. Evidence from studies of clinical reasoning is frequently compromised by a lack of consistency and validity in identification of participants as either expert or novice.
Expert: The criteria Much of the understanding of what constitutes an expert is built on the work of Dreyfus and Dreyfus’s (1980) model of skills acquisition via the work of Benner (1982). The major determinant of expertise in the occupational therapy research literature seems to be length of service (Kuipers & Grice, 2009a), although Rassafiani (2009) and others (Weiss, Shanteau & Harries, 2006) have demonstrated no correlation between length of experience and expertise. Dreyfus and Dreyfus’s (1980) model was based on their work with military pilots, a profession where a longstanding perception of expertise related to flight time is existent. While Benner (1982) was quite prescriptive about relating skills acquisition to duration of experience in new graduates, she was © 2014 Occupational Therapy Australia
D. ROBERTSON ET AL.
very careful not to do so when describing experts, stating quite explicitly ‘experience is not the mere passage of time or longevity’ (Benner, 1982, p. 407). Subsequent to Benner’s original work, other authors (cited in Rassafiani, 2009) have, perhaps misguidedly, extrapolated from her work to suggest somewhat arbitrary durations of service concomitant with the term ‘expert’. However, drawing on Benner’s original work and best evidence, duration of service should not be considered as a criterion for judging expertise and, for example, for the purposes of conducting research into the phenomena, the term expert should be associated with characteristics or criteria other than simply length of experience. Returning to the adaptation of the work Barnett above, Table 1 attempts to demonstrate how the critical occupational therapy practitioner might achieve integration of Barnett’s three forms of criticality at various levels. It could be suggested that achievement of levels of development of criticality in each domain might denote expertise in a practitioner with greater validity than simple duration of service.
Conclusion Contemporary occupational therapy practice is both intellectually challenging and stimulating. The bulk of a therapist’s day-to-day thinking and reasoning is intuitive and subconscious. Effective but effortful conscious reasoning and communication of reasoning, for example where a therapist decides to treat or not to treat, requires the therapist to juggle multiple frames of reference, data, theories and self knowledge. In order for thinking to become intuitive in, for example, new practitioners, which it must do due to the fatigue associated with effortful conscious thought, rehearsal and modelling are required (Robertson, 2012). Access to expert practitioners, mentors or systems has been shown to facilitate thinking and reasoning in new practitioners, although this would also be true of learners at all levels. It is therefore essential that the criteria used to recognise or demonstrate expertise are valid. It is the opinion of the authors that the characteristics of the critical occupational therapy practitioner provide criteria that are more valid than duration of service alone. Translation of Barnett’s theory from education into practice permits the conceptualisation of a therapist with well integrated and highly developed conscious thinking skills which can be employed to moderate, or produce a rationale for, decisions that are predominantly made intuitively (Evans, 2003; Kahneman, 2011).
References Bannigan, K. & Moores, A. (2009). A model of professional thinking: Integrating reflective practice and evidence based practice. Canadian Journal of Occupational Therapy, 76, 342–350.
REVISION 2 OF: THE CRITICAL OCCUPATIONAL THERAPY PRACTITIONER
Barnett, R. (1997). Higher education: a critical business. Buckingham: The Society for Research into Higher Education and Open University Press. Benner, P. (1982). From novice to expert. American Journal of Nursing, 82, 402–407. Bennett, S., Tooth, L., McKenna, K., Rodger, S., Strong, J., Ziviani, J. et al. (2003). Perceptions of evidence-based practice: a survey of Australian occupational therapists. Australian Occupational Therapy Journal, 50, 13–22. Chaffey, L., Unsworth, C. & Fossey, E. (2010). A grounded theory of intuition among occupational therapists in mental health practice. British Journal of Occupational Therapy, 73, 300–308. Dreyfus, S. & Dreyfus, H. (1980). A five-stage model of the mental activities involved in directed skill acquisition. Retrieved 1 October, 2013, from http://www.dtic.mil/ cgi-bin/GetTRDoc?AD=ADA084551&Location=U2&doc= GetTRDoc.pdf Evans, J. (2003). In two minds: Dual-process accounts of reasoning. Trends in Cognitive Sciences, 7, 454–459. Harries, P. & Gilhooly, K. (2011). Training novices to make expert, occupationally focused, community mental health referral decisions. British Journal of Occupational Therapy, 74, 58–65. Kahneman, D. (2011). Thinking, fast and slow. London: Allen Lane.
71
Kuipers, K. & Grice, J. (2009a). Clinical reasoning in neurology: Use of the repertory grid technique to investigate the reasoning of an experienced occupational therapist. Australian Occupational Therapy Journal, 56, 275–284. Kuipers, K. & Grice, J. (2009b). The structure of novice and expert occupational therapists’ clinical reasoning before and after exposure to domain-specific protocol. Australian Occupational Therapy Journal, 56, 418–427. Morley, M., Smith, J. & Petty, N. (2011). Advancing reflective practice: An evaluation of an observed practice workshop for occupational therapists and physiotherapists. British Journal of Occupational Therapy, 74, 181–184. Rassafiani, M. (2009). Is length of experience an appropriate criterion to identify level of expertise? Scandinavian Journal of Occupational Therapy, 16, 247–256. Rassafiani, M., Ziviani, J., Rodger, S. & Dalgleish, L. (2009). Identification of occupational therapy clinical expertise: decision-making characteristics. Australian Occupational Therapy Journal, 56, 156–166. Robertson, D. (2012). Critical thinking and clinical reasoning in new graduate occupational therapists: a phenomenological study. Retrieved 1 October, 2013, from https:// openair.rgu.ac.uk/bitstream/10059/792/1/David%20Rob ertson%20PhD%20thesis.pdf Weiss, D., Shanteau, J. & Harries, P. (2006). People who judge people. Journal of Behavioural Decision Making, 19, 441–454.
© 2014 Occupational Therapy Australia
Copyright of Australian Occupational Therapy Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
doi: 10.1111/1440-1630.12157
Viewpoint
The critical occupational therapy practitioner: How to define expertise? David Robertson,1 Fiona Warrender2 and Sue Barnard1 1
School of Health Sciences, Faculty of Health and Social Care, Robert Gordon University, Aberdeen, UK and 2Independent Occupational Therapist, Aberdeen, UK
KEY WORDS clinical reasoning, critical thinking, expert practitioner.
Introduction Barnett (1997), a pedagogical researcher and theorist, argued that in order to function successfully in the contemporary world, higher education students are required to become ‘critical beings’ (1997, p. 63). Translation of Barnett’s theory from education into professional practice permits the conceptualisation of a critical occupational therapy practitioner, an individual equipped, through the adoption of a critical stance, to succeed in supercomplex environments such as that existent in contemporary health and social care.
The Critical Practitioner The term ‘critical’ as employed in this paper refers to open, conscious, reflective, balanced, evaluation and judgement of situations, opinions, incidents and contexts, rather than the lay understanding of the term which has a broadly negative connotation of unhelpful nit-picking. Barnett (1997) conceptualised the critical being as an individual incorporating three forms of criticality; critical reason, critical self-reflection and critical action. Translated into the domain of practice (Figure 1), these three forms of criticality are reflected in the makeup of the critical occupational therapy practitioner, i.e. an individual who is evidence informed, critically
David Robertson PhD, MSc, DipCOT; Lecturer in Occupational Therapy. Fiona Warrender DipCOT, PgCert; Independent Occupational Therapist. Sue Barnard PhD, MSc, MCSP; Senior Lecturer and Research Co-Ordinator. Correspondece: David Robertson, School of Health Sciences, Faculty of Health and Social Care, Robert Gordon University, Aberdeen AB10 7QG, UK. Email: [email protected] Accepted for publication 4 August 2014. © 2014 Occupational Therapy Australia
reflective and engages reflexively in professional occupations. Using Barnett’s terminology, critical reason is a form of criticality that is concerned predominantly with critique of knowledge that has been generated systematically, for example, evidence from research. Critical self-reflection is a form of criticality concerned with critique of oneself, one’s internal dialogue, performance, cognitive biases and development. Critical action is analogous at some levels (1–3) with clinical reasoning and at others (4) with transformational, macro-level interventions, for example, public health initiatives (Table 1). It should always be borne in mind that this conscious thinking and reasoning occurs alongside a huge well of intuitive thinking and reasoning (Evans, 2003) which guides the bulk of a therapist’s day-to-day actions. As Chaffey, Unsworth and Fossey (2010) recently evidenced, although intuition is integral to practice, it is difficult to define and intuitive thinking difficult to articulate. Where Chaffey et al might be questioned is in their characterisation of intuition as being embedded within a larger clinical reasoning framework. Empirically evidenced contemporary models of thinking (Evans, 2003; Kahneman, 2011) might, in contrast, suggest a clinical reasoning framework either sitting alongside or superimposed on and, in both instances, dwarfed by the much more significant and more frequently utilised intuitive thought. Table 1 is adapted from Barnett (1997) and reflects his illustration of how criticality can be noted on two axes, firstly by levels of criticality (1–4), at the lowest level denoted by straightforward operational skills and at the highest by a transformatory critique. The second axis consists of the three domains of criticality; knowledge (interrogated by Barnett’s form of criticality named critical reason), self (by critical self-reflection) and the world (by critical action) The material in italics illustrates how Barnett’s levels, domains and forms of criticality can be distinguished in the characteristics of the critical occupational therapy practitioner. The comments within parentheses and in italics in Table 1 are for illustrative purposes only and should not be considered definitive.
69
REVISION 2 OF: THE CRITICAL OCCUPATIONAL THERAPY PRACTITIONER
Critical person
Critical action
Critical self reflection
Professionally engaged
Critically self reflective
Critical reason
Critical occupational therapy practitioner
Informed by evidence
FIGURE 1: Critical being as the integration of the three forms of criticality (Barnett, 1997, p. 105; fig. 8.1) translated into practice. Barnett (1997) – reproduced with permission etc.
Moving back to Figure 1 it can be seen that in practice, a critical occupational therapy practitioner might be characterised by the ability to apply the appropriate form of criticality at the appropriate level, in each of the three domains. Given its high profile as a graduate attribute and professional characteristic numerous studies have been undertaken into isolated components of critical thinking such as critical self-reflection (Morley, Smith & Petty, 2011) and critical reason (Bennett, Tooth, McKenna, Rodger, Strong & Ziviani, 2003). If the proposition that clinical reasoning is analogous with certain levels of critical action is accepted, it can be recognised that there has been a longstanding interest in that form of criticality within the profession. Few authors have investigated the integration of the forms of criticality. Bannigan and Moores (2009) developed a model of professional thinking incorporating reflective practice
and evidence based practice. It is somewhat unclear from their paper how they conceptualise clinical reasoning as fitting in to this model. They initially state that clinical reasoning is ‘closely aligned’ to professional thinking but then go on to say that they will use the term professional thinking ‘in preference to clinical reasoning’. A paragraph later they list the components of professional thinking as ‘a combination of deliberation, rational thinking, clinical reasoning, professional knowing and expertise gained from previous knowledge’ (Bannigan & Moores, 2009, p. 343). They then go back to suggest that, in establishing the validity of their model, researchers should employ methodologies employed for studying clinical reasoning. Bannigan and Moores (2009) should be applauded for recognising the value in integrating components of, what they term, professional thinking rather than compartmentalising each. They support the contention that
TABLE 1: The critical occupational therapy practitioner (adapted from Barnett, 1997, p. 103 table 8.1: Levels, domains and forms of critical being) (Barnett’s concepts in bold) Domains Levels of criticality
Knowledge
Self
World
4. Transformatory critique
Knowledge construction and reconstruction. (publication, peer reviewing) Critical thought (systematic review and evidence evaluation)
Reconstruction of self (leadership, professional influence, mentorship) Development of self within traditions (continuous professional development) Self-reflection (reflection on one’s own practice and performance) Self-monitoring to given standards and norms (ethics, professional standards)
Critique-in-action (collective reconstruction of world, macro-level intervention) Mutual understanding and development of traditions (evidence implementation and re-evaluation) Reflective practice (metacompetence, adaptability, flexibility: capability) Problem-solving (means-end instrumentalism: competence – skills and knowledge)
Critical self-reflection
Critical action
3. Refashioning of traditions 2. Reflexivity
Critical thinking (reflection on understanding and implications)
1. Critical skills
Discipline-specific critical thinking skills (critique of evidence, ideas, norms, memes, practices) Critical reason
Forms of criticality
© 2014 Occupational Therapy Australia
70 integration of the forms of criticality is essential in equipping the occupational therapy practitioner for contemporary practice.
Critical action/Clinical reasoning Understanding and articulation of clinical reasoning is desirable for a multitude of reasons, for example to enhance communication with patients and clients and to work towards improving efficacy of treatment, to aid decision-making, to facilitate the training of students and new graduates and to communicate and share knowledge. Perhaps one of the most important reasons for articulating clinical reasoning is that challenges to our cognitive biases, assumptions and social norms are then permitted. Research into clinical reasoning (Kuipers & Grice, 2009b) has primarily revealed differences in the reasoning of ‘novices’ and ‘experts’, and has proposed a variety of forms of clinical reasoning. Careful examination might suggest that the forms of clinical reasoning identified in the occupational therapy literature are dependent to some extent on the context (cultural, historical, geographical, socio-economic, etc.), within which the underpinning research was undertaken and the background of the researchers. The body of research that has identified differences in clinical reasoning between ‘novices’ and ‘experts’ is compromised by the absence of agreed criteria on what constitutes each, although it has been demonstrated that clinical reasoning in ‘novices’ can be improved in specific situations, particularly by permitting access to the reasoning of ‘experts’, whether expert practitioners (Harries & Gilhooly, 2011) or expert systems (Kuipers & Grice, 2009b). The authors concur with Rassafiani, Ziviani, Rodger & Dalgleish (2009) that traditional methods of identifying expertise may be misleading. Evidence from studies of clinical reasoning is frequently compromised by a lack of consistency and validity in identification of participants as either expert or novice.
Expert: The criteria Much of the understanding of what constitutes an expert is built on the work of Dreyfus and Dreyfus’s (1980) model of skills acquisition via the work of Benner (1982). The major determinant of expertise in the occupational therapy research literature seems to be length of service (Kuipers & Grice, 2009a), although Rassafiani (2009) and others (Weiss, Shanteau & Harries, 2006) have demonstrated no correlation between length of experience and expertise. Dreyfus and Dreyfus’s (1980) model was based on their work with military pilots, a profession where a longstanding perception of expertise related to flight time is existent. While Benner (1982) was quite prescriptive about relating skills acquisition to duration of experience in new graduates, she was © 2014 Occupational Therapy Australia
D. ROBERTSON ET AL.
very careful not to do so when describing experts, stating quite explicitly ‘experience is not the mere passage of time or longevity’ (Benner, 1982, p. 407). Subsequent to Benner’s original work, other authors (cited in Rassafiani, 2009) have, perhaps misguidedly, extrapolated from her work to suggest somewhat arbitrary durations of service concomitant with the term ‘expert’. However, drawing on Benner’s original work and best evidence, duration of service should not be considered as a criterion for judging expertise and, for example, for the purposes of conducting research into the phenomena, the term expert should be associated with characteristics or criteria other than simply length of experience. Returning to the adaptation of the work Barnett above, Table 1 attempts to demonstrate how the critical occupational therapy practitioner might achieve integration of Barnett’s three forms of criticality at various levels. It could be suggested that achievement of levels of development of criticality in each domain might denote expertise in a practitioner with greater validity than simple duration of service.
Conclusion Contemporary occupational therapy practice is both intellectually challenging and stimulating. The bulk of a therapist’s day-to-day thinking and reasoning is intuitive and subconscious. Effective but effortful conscious reasoning and communication of reasoning, for example where a therapist decides to treat or not to treat, requires the therapist to juggle multiple frames of reference, data, theories and self knowledge. In order for thinking to become intuitive in, for example, new practitioners, which it must do due to the fatigue associated with effortful conscious thought, rehearsal and modelling are required (Robertson, 2012). Access to expert practitioners, mentors or systems has been shown to facilitate thinking and reasoning in new practitioners, although this would also be true of learners at all levels. It is therefore essential that the criteria used to recognise or demonstrate expertise are valid. It is the opinion of the authors that the characteristics of the critical occupational therapy practitioner provide criteria that are more valid than duration of service alone. Translation of Barnett’s theory from education into practice permits the conceptualisation of a therapist with well integrated and highly developed conscious thinking skills which can be employed to moderate, or produce a rationale for, decisions that are predominantly made intuitively (Evans, 2003; Kahneman, 2011).
References Bannigan, K. & Moores, A. (2009). A model of professional thinking: Integrating reflective practice and evidence based practice. Canadian Journal of Occupational Therapy, 76, 342–350.
REVISION 2 OF: THE CRITICAL OCCUPATIONAL THERAPY PRACTITIONER
Barnett, R. (1997). Higher education: a critical business. Buckingham: The Society for Research into Higher Education and Open University Press. Benner, P. (1982). From novice to expert. American Journal of Nursing, 82, 402–407. Bennett, S., Tooth, L., McKenna, K., Rodger, S., Strong, J., Ziviani, J. et al. (2003). Perceptions of evidence-based practice: a survey of Australian occupational therapists. Australian Occupational Therapy Journal, 50, 13–22. Chaffey, L., Unsworth, C. & Fossey, E. (2010). A grounded theory of intuition among occupational therapists in mental health practice. British Journal of Occupational Therapy, 73, 300–308. Dreyfus, S. & Dreyfus, H. (1980). A five-stage model of the mental activities involved in directed skill acquisition. Retrieved 1 October, 2013, from http://www.dtic.mil/ cgi-bin/GetTRDoc?AD=ADA084551&Location=U2&doc= GetTRDoc.pdf Evans, J. (2003). In two minds: Dual-process accounts of reasoning. Trends in Cognitive Sciences, 7, 454–459. Harries, P. & Gilhooly, K. (2011). Training novices to make expert, occupationally focused, community mental health referral decisions. British Journal of Occupational Therapy, 74, 58–65. Kahneman, D. (2011). Thinking, fast and slow. London: Allen Lane.
71
Kuipers, K. & Grice, J. (2009a). Clinical reasoning in neurology: Use of the repertory grid technique to investigate the reasoning of an experienced occupational therapist. Australian Occupational Therapy Journal, 56, 275–284. Kuipers, K. & Grice, J. (2009b). The structure of novice and expert occupational therapists’ clinical reasoning before and after exposure to domain-specific protocol. Australian Occupational Therapy Journal, 56, 418–427. Morley, M., Smith, J. & Petty, N. (2011). Advancing reflective practice: An evaluation of an observed practice workshop for occupational therapists and physiotherapists. British Journal of Occupational Therapy, 74, 181–184. Rassafiani, M. (2009). Is length of experience an appropriate criterion to identify level of expertise? Scandinavian Journal of Occupational Therapy, 16, 247–256. Rassafiani, M., Ziviani, J., Rodger, S. & Dalgleish, L. (2009). Identification of occupational therapy clinical expertise: decision-making characteristics. Australian Occupational Therapy Journal, 56, 156–166. Robertson, D. (2012). Critical thinking and clinical reasoning in new graduate occupational therapists: a phenomenological study. Retrieved 1 October, 2013, from https:// openair.rgu.ac.uk/bitstream/10059/792/1/David%20Rob ertson%20PhD%20thesis.pdf Weiss, D., Shanteau, J. & Harries, P. (2006). People who judge people. Journal of Behavioural Decision Making, 19, 441–454.
© 2014 Occupational Therapy Australia
Copyright of Australian Occupational Therapy Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
