Clinical Reasoning during Community Health Home Visits: Expert and Novice Differences

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Very little is known about the differences between novice and expert clinical reasoning in community health practice. This article presents the findings of a study of the clinical reasoning of five expert and five novice community health occupational therapists (CHOTs) during the conducting of home visits. A head-mounted video camera was used to record the visits, followed by the participants reporting their clinical reasoning verbally using a video-assisted debriefing method. The transcripts from these verbal reports were analysed quantitatively and qualitatively.

The quantitative results demonstrated many differences between experts and novices in terms of the amounts and types of clinical reasoning used. For example, the novices used more procedural reasoning whereas the experts used more conditional reasoning and mixes of different reasoning types. The qualitative results demonstrated that the experts used a free-flowing conversational approach when reasoning during home visits whereas the novices depended on external structures such as assessment forms to guide the process. Given their experience and familiarity with the process, the experts were confident and clear in their reasoning whereas the novices were more awkward and self-conscious. The experts handled sensitive issues whereas the novices seemed to avoid them. The study findings may provide insights for student and novice therapists concerning expert CHOTs' practice and promote reflection in general on the attainment of expertise in clinical practice.

Document Type: Research Article

Publication date: May 1, 2005

More about this publication?
  • The British Journal of Occupational Therapy (BJOT) is the official journal of the College of Occupational Therapists. Its purpose is to publish articles relevant to theory, practice, research, education and management in occupational therapy internationally.

    BJOT publishes research articles, critical reviews, practice analyses, opinion pieces, editorials, letters to the editor, book reviews and an annual index. Please refer to the author's guide at

    Submissions can be made at

    The 2013 Impact Factor for The British Journal of Occupational Therapy is 0.897.

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