title: Clinical reasoning process underlying choice of teaching strategies: a framework to improve occupational therapists' transfer skill interventions.
abstract: OBJECTIVE
  Clinical reasoning, a critical skill influenced by education and practice context, determines how occupational therapists teach transfer skills. Teaching strategies affect intervention efficacy. Although knowledge about the way teaching strategies are chosen could help improve interventions, few studies have considered this aspect. Therefore, the aim of this study was to explore the clinical reasoning process of occupational therapists underlying the choice of strategies to teach older adults transfer skills.
  
  
  METHODS
  A grounded theory study was carried out with eleven community occupational therapists recruited in six Health and Social Services Centres in Québec, Canada. Data were collected through observations of teaching situations (n = 31), in-depth semi-structured interviews (n = 12) and memos, and were analysed using constant comparative methods. Memos were also used to raise codes to conceptual categories, leading to an integrative framework. Rigour was assured by following scientific criteria for qualitative studies.
  
  
  RESULTS
  The integrative framework includes the clinical reasoning process, consisting of eight stages, and its factors of influence. These factors are internal (experiences and elements of personal context) and external (type of transfer, clients' and their environment's characteristics and practice context).
  
  
  CONCLUSIONS
  The clinical reasoning process underlying the choice of strategies to teach transfer skills was conceptualised into an integrative framework. Such a framework supports clinicians' reflective practice, highlights the importance of theory and practice of pedagogy in occupational therapists' education, and encourages consideration and better documentation of the possible influence of practice context on teaching interventions. As such, this integrative framework could improve occupational therapists' transfer skill interventions with older adults.
authors.affiliation: School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Québec, Canada. annie.carrier@usherbrooke.ca
authors.forename: Annie
authors.initials: A
authors.lastname: Carrier
authors.forename: Mélanie
authors.initials: M
authors.lastname: Levasseur
authors.forename: Denis
authors.initials: D
authors.lastname: Bédard
authors.forename: Johanne
authors.initials: J
authors.lastname: Desrosiers
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009048:Motor Skills; D009788:Occupational Therapy / Q000379:methods* / Q000592:standards; D010353:Patient Education as Topic / Q000379:methods*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012648:Self Care / Q000379:methods*; D013663:Teaching / Q000379:methods