Fieldwork is a core element of occupational therapy education and Clinical placements assist students to integrate theory and practice by providing opportunities for observation and practice of clinical skills in real clinical settings. Clinical placements also enhance students’ clinical reasoning, problem solving and professional skills (Cook & Cusick, 1998; Bonello, 2001; Sadlo & Richardson, 2003). As clinical reasoning is the thought process that occupational therapists use during evaluation and treatment (Mattingly & Fleming, 1994; Dutton, 1995), teaching clinical reasoning is, therefore vital to the professional preparation of occupational therapy students (Royeen, 1995; Higgs & Jones, 2000; Ranka & Chapparo, 2000; Ryan, 2000).
3.5.1 Learning Outcomes – Development of Competence
The concept of competence within the health care professions appears vague and ill defined and debate continues around the definition of competence and the performance standards that students should be assessed (Cheetham & Chivers, 1999; Philips, Schostak & Tyler, 2000; Alsop, 2001). It is acknowledged that both a judgement and a definition of competence are subjective and thus a valid and reliable evaluation of clinical competence in occupational therapy and other health care professions remains a challenge (Polatajko, Lee, & Bossers, 1994, p21). What became clear through reviewing the literature were the many ambiguities that surround the challenging concept of competence (Eraut, 1994; Neary, 2000; Alsop, 2001; Hocking & Rigby, 2002; Duke, 2004).
Cognitive theorists approach the subject of thinking and the development of competence from a variety of perspectives. Some theorists focus on the individual acting as sole agent in the process of constructing and reconstructing meaning. Others focus on the socio-cultural context in which the individual lives and still others on both the individual and social contexts (Powell & Waters, 1996; Hocking & Rigby, 2002).
Chapter three BSc (Hons) OT Programme & Curriculum
These theories have implications for teachers and learners. The cognitive theories suggest that teachers need to create environments in which shared meaning can develop, and individual meaning can be challenged. Furthermore, these theories also have a bearing on the development of clinical reasoning and learning strategies appropriate for students as well as clinicians. All this suggests that teachers should focus on the process skills that optimise learning that they should facilitate learners to gradually construct the representations of experts, moving them along the continuum from novice to expert using a supportive model of cognitive development.
A major difference between the expert and the novice is in the way that they organise their knowledge. Experts organise their knowledge in meaningful schemata or multilevel knowledge structures. Thus their knowledge is more likely to be accessible. For students or novices, it is the development of these knowledge structures that will have a significant on future learning and development of clinical reasoning skills (McCriddle & Christensen, 1995; Alsop & Ryan, 1996; Patel & Kaufman, 2000), which in turn affect their study strategies as well as the outcomes of learning (See Chapter 6
for more details on Novice-Expert Continuum).
Though there are subject-specific differences in the development of expertise, Biggs & Collis (1982) found that generally students learn quite diverse material in stages of increasing structural complexity. Biggs & Collis (1982) proposed a structure of the observed learning outcomes, using the acronym, SOLO (Structure of the Observed Learning Outcome). The SOLO taxonomy (Biggs & Collis, 1982) is a qualitative measure, which is useful in defining the level of cognitive responses and suggests certain dimensions or characteristics of the levels (Figure 3.5.1). The cognitive dimensions are the indicative of ability to form schemata and the knowledge structures for integration of theory and practice.
Chapter three BSc (Hons) OT Programme & Curriculum
Figure 3.5.1
SOLO (Structure of the Observed Learning Outcome) Taxonomy (Biggs &Collis, 1982)
The SOLO Taxonomy
Reference to the above (Figure 3.5.1), Biggs & Collis (1982) described five levels of the structure of observed learning outcomes. These ranged on the basis of the structural organisation of the knowledge in question in a particular mode, from incompetence to expertise in hierarchical order as follows:
1. Prestructural: incompetence, nothing is known about the area. The task is
engaged but the learner is distracted or missed by an irrelevant aspect belonging to a previous or simpler mode of operation.
2. Unistructural: The learner focuses appropriately on the task but picks up one or very few relevant aspects of the task.
3. Multistructural: The learner identifies a several relevant features, but is
independent of each other, and does not integrate them appropriately.
4. Relational: The learner now integrates the parts so that the whole has a coherent structure and meaning.
5. Expended abstract: As relational, but the whole is generated to a related domain of knowledge. The learner generalises the structure to develop abstractions, representing a higher mode of operation.
Chapter three BSc (Hons) OT Programme & Curriculum
Higher education should lead ideally to higher order thinking for most graduates. This means that the preferred learning outcomes for all graduates completing university education should be understanding, integration and potential application of the crucial aspects of their discipline. It follows that lecturers should teach to facilitate such outcomes. This would require a conception of teaching, at least, as one of facilitating knowledge but preferably as “an activity aimed at changing students’ conceptions or understanding of the world” (Samuelowicz & Bain, 1992; Entwistle, McCune, & Walker, 2000; Kember & Kwan, 2002). The outcome of such teaching should be students who have deeper knowledge and more sophisticated levels of reasoning than those with which they began university study, and who are beginning to think in a manner similarly to an expert in their area. To facilitate such thinking lecturers need to utilise strategies that will cause students to learn in such a way. It is suggested in that the use of adaptations of the SOLO taxonomy is one such way of influencing and assessing learning outcomes to facilitate higher order thinking. The comparison of SOLO with aspects of students’ performance assessment in BSc (Hons) Occupational Therapy programme is discussed in Table 3.7.2.