Chapter 1 Professional Reasoning as the Basis of Practice

1. Chapter 1 Professional Reasoning as the Basis of Practice Barbara A. Boyt Schell John W. Schell

2. History of Professional Reasoning Research • Rogers & Masagatani (1982): Research how clinical decisions were made • Therapists often could not explain what they had done (or why) • Rogers’ Eleanor Clark Slagle Lecture at AOTA (1983) • Aware of emerging research in cognitive science & medicine

3. History of Professional Reasoning Research (Con’t) • AJOT Special Issue on Clinical Reasoning (1991) • Enlarges research focus in OT field • Based on Schön (The Reflective Practitioner, 1983) • Commonalities in practice among professions • AOTF & AOTA funded the Clinical Reasoning Study (Mattingly & Fleming, 1994) • Mattingly & Fleming (1994) publish • Clinical Reasoning: Forms of Inquiry in a Therapeutic Practice

4. History of Professional Reasoning Research (Con’t) • More than 50 books & articles published in recent years • The current text • Unit I – Describes the nature of clinical and professional reasoning • Unit II – Summarizes clinical & professional reasoning in OT • Unit III – Identifies implications for OT education for: curriculum planning, classroom teaching, fieldwork education, & professional development • Unit IV – Summarizes the state of literature, identifies future directions for research

5. Thinking About Thinking “There is a high hard ground where practitioners can make…use of…theory & technique, & there is the swampy lowland where…confusing “messes” [are] incapable of technical solution. The…problems of the high hard ground…are…relatively unimportant…while in the swamp are…problems of greatest human concern” (Schön, 1983, p. 42)

6. Definitions of Clinical & Professional Reasoning (C&PR) “The process used by practitioners to plan, direct, perform & reflect on client care” (Schell, 2003, p. 131) • Professional reasoning is added because: • It broadens the discussion to: • Nonmedical environments such as schools & community settings • Reasoning done by supervisors, fieldwork educators, & OT managers

7. Thinking in Context • The thinking that guides practice is: • The interplay among the person, the context, & specific therapy tasks • Theories about C&PR are focused on therapists & how they provide therapy

8. Thinking in Context (Con’t) • Some practice decisions are easy: • Scientific or technical information is applied • Most decisions require nuanced decisions & actions • C&PR research attempts to: • Identify the “high hard ground” of therapist thinking • Surface the “swampy lowland” where most live • Current research does not reach the complexities of C&PR in real life

9. Thinking in Context (Con’t) • This book seeks to promote C&PR research using: • “Hard” & • “Soft ground” methodologies

10. C&PR topical areas are: Scientific reasoning Diagnostic reasoning Procedural reasoning Narrative reasoning Pragmatic reasoning Ethical reasoning Interactive reasoning Conditional reasoning Views of Clinical & Professional Reasoning Many different perspectives exists on the nature & process of C&PR (Rogers, 1983; Mattingly & Fleming, 1994; Schell & Cervero, 1993; Rogers & Holms, 1991)

11. Scientific Reasoning

12. Diagnostic Reasoning

13. Procedural Reasoning

14. Narrative Reasoning

15. Pragmatic Reasoning

16. Ethical Reasoning

17. Interactive Reasoning

18. Conditional Reasoning

19. Putting Reasoning in a Larger Context • Brief overview of selected C&PR contributors • Purpose is to highlight key researchers & concepts shaping current C&PR thinking

20. Aristotle Darwin Gestalt & Bruner Paget Vygotsky Lave & Wenger Key Selected Contributors

21. Key Contributor: Aristotle • Artisans’ work involved thinking & reasoned action • Actions taken within artisan’s “praxis” • Praxis is reasoned actions taken to accomplish a specific task

22. Key Contributor: Darwin • Theory of evolution • Humans as “biologically continuous” with animal kingdom • Human progression as basis of learning & thinking • Strong influence on development of behaviorism & developmental psychology

23. Key Contributors: Gestalt & Brunner • Classical theories of psychology emerged • Gestalt theories focused on patterns & structured experiences • Brunner introduced schemes to illustrate cognitive structures

24. Key Contributor: Piaget • Assumed learning as an artifact of biologic functioning • Research focused on “mental or cognitive structures” as the way children organize their minds • Stages of human development

25. Key Contributor: Vygotsky • Examined the use of knowledge within social structures • Human development as social interaction • Zones of proximal development (ZPD)

26. Key Contributors: Lave & Wenger • Emphasis on context & social engagement • Situated cognition • Communities of practice

27. Reasoning in a Social World • 20th-century researchers: Social relationships form basis of human thinking & reasoning • Ricœur influenced Heidegger, Gadamer, Merleau-Ponty, Sartre, & Schütz • Examined conscious existential experience for understanding actions of individuals • Schütz emphasized “lived experiences” through “flowing consciousness” as they passed from experience into memory

28. Reasoning in a Social World: Schön • Reflective practice & organizational “systems of learning” • An avid jazz musician • Jazz improvisation perhaps led to ideas about “thinking in the moment” • Origins of “reflection in action” & “reflection on action”

29. Reasoning in a Social World: Dreyfus & Dreyfus (Athanasiou) • Mind over Machine (1986) • Influenced researchers in many professions • How experts shape novices who become experts • Five stages of expertise: • Novice • Advanced beginner • Competent • Proficient • Expert

30. Reasoning in a Social World • Many writers have influenced present-day thinking • Dewey, Lewin, Rogers, & Kolb have significantly contributed • “Thinking about thinking” has been handed down by several generations of researchers & practitioners