Service-Learning and Case-Based Learning’s Impact on Student’s Clinical Reasoning: A Repeated Measures Design Study

Abstract

Clinical reasoning is crucial for the occupational therapy profession to thrive in an ever-changing healthcare environment but is seldom isolated for explicit instruction and outcome measurement in educational course curricula. A single-factor repeated measures design study was conducted to compare the impact of didactic case-based learning and experiential service-learning on the development of the clinical reasoning of students at a midwestern public university’s entry-level Master of Occupational Therapy program. The participants were sixteen graduate occupational therapy students who had completed their foundation-level courses. Participants explored modes of clinical reasoning in occupational therapy for eight weeks (the first half of the semester), using didactic case-based learning, and then participated in an eight-week (the second half of the semester), experiential service-learning practicum engaging uninsured and underinsured adult clients in occupational therapy evaluation and intervention. The dependent variable of clinical reasoning was measured using the Self-Assessment of Clinical Reflection and Reasoning (SACRR) survey which was administered at the start and end of both phases of the study. SACCR scores generally increased and were significant during the experiential phase (MD =7.384, t (12) = 2.27, p = .042, d = 0.63, 95% CI [0.02, 1.22])An analysis of changes in individual SACRR items provided insights into the development of clinical reasoning modes of practice in novice clinicians. The comparison of didactic case-based learning and experiential service-learning supports the use of either or both approaches. The sequence and weightage of each strategy could be individually adjusted in course syllabi and curricula to fit student learning needs.