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Critical Thinking in Occupational Therapy Education: A Systematic Mapping Review

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Jennifer S Pitonyak
Jennifer S Pitonyak
Jennifer S Pitonyak
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Sarah Nielsen
Sarah Nielsen
Sarah Nielsen
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Shirley O'Brien at Eastern Kentucky University
Shirley O'Brien
Cecille Corsilles-Sy at University of Puget Sound
Cecille Corsilles-Sy
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Critical thinking is a component of occupational therapy education that is often intertwined with professional reasoning, even though it is a distinct construct. While other professions have focused on describing and studying the disciplinary-specific importance of critical thinking, the small body of literature in occupational therapy education on critical thinking has not been systematically analyzed. Therefore, a systematic mapping review was conducted to examine, describe, and map existing scholarly work about critical thinking in occupational therapy education. Inclusion/exclusion criteria were set, database searches conducted, and 63 articles identified that met criteria for full review based on their abstracts. Thirty-five articles were excluded during full review, leaving 28 articles for analysis and coding using a data extraction tool. Eleven articles (39%) had a primary focus of critical thinking, and of those 11 articles, the majority were about instructional methods. Qualitative inquiry (n = 9) was the most frequently used method to examine critical thinking among the study full sample (N = 28). Four themes emerged: 1) critical thinking is a process with varied outcomes; 2) learner aptitude is essential for developing critical thinking; 3) critical thinking can be facilitated through various methods; and 4) critical thinking underpins other important constructs in occupational therapy. Needs that were identified were that critical thinking is best intentionally threaded across a curriculum with outcomes in mind; and more studies examining critical thinking in occupational therapy education, employing diverse designs, are needed.
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... This study explored critical thinking skills in terms of enhanced knowledge required for meaningful learning and problem solving; specifically, the ability to accurately interpret knowledge, understand relationships and make connections between knowledge, communicate one's rationale, and critically self-reflect on one's thinking (Facione, 2020;Garwood et al., 2019;Wu & Wu, 2020). Within occupational therapy, critical thinking plays an important role in supporting clinical reasoning, which is generally defined as the process by which healthcare professionals make decisions during patient care (Pitonyak et al., 2020). Clinical reasoning is a key competency for occupational therapy practitioners (American Occupational Therapy Association [AOTA], 2018a); however, it is strongly influenced by experiences, with minimal emphasis on challenging the practitioner's assumptions and biases (Berg et al., 2021). ...
... Additionally, critical thinking skills are used by the occupational therapy practitioner to evaluate the credibility of, interpret, and synthesize knowledge prior to applying it within the clinical reasoning process (Berg et al., 2021). Despite critical thinking's relevance to clinical reasoning and effective occupational therapy practice, there is limited research on methods to support critical thinking skills in students (Pitonyak et al., 2020). ...
... Current evidence on instructional methods for critical thinking indicates that a combination of explicit and implicit instruction may be most effective (Morris et al., 2019). This should be threaded across the curriculum with increasing complexity and is best achieved through a "backward design" approach to curriculum planning which first identifies specific critical thinking skills as intended learning outcomes and then selects instructional and assessment methods to align with these goals (Berg et al., 2021;Fink, 2003;Pitonyak et al., 2020). Explicit instruction consists of students engaging in a reading, lecture, and/or discussion focused on the required skills and dispositions associated with effective critical thinking (Bakker et al., 2015;Morris et al., 2018). ...
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... De hecho, parece que incluso algunos terapeutas ocupacionales parecen no alcanzar nunca la calificación de experto (Bolton & Dean, 2018). Tanto desde una aproximación teórica como investigadora, se enfatiza que una disciplina debe determinar qué habilidades son necesarias para la comprensión de su propio conocimiento y que éste pueda compartirse explícitamente con los estudiantes (Huber & Kuncel, 2016;Pitonyak et al., 2020;Schaber, 2014;Schaber & Shanedling, 2012). ...
... La importancia del razonamiento profesional en programas de educación superior como medio para el desarrollo de hábitos profesionales, habilidades y pensamiento ha ganado importancia durante los años como necesidad del aprendizaje para enfatizar la reflexión en el pensamiento más que para sólo equipar a los educadores con procesos de seguimiento o toma de decisiones (Pitonyak et al., 2020). La manera en que los novatos organizan su conocimiento para analizar y sintetizar la información recogida durante la evaluación inicial es un elemento de primera importancia para adquirir un razonamiento profesional adecuado durante su educación académica. ...
... Sin embargo, autores comoPitonyak et al. (2020), recogen que existe una escasez de conocimiento consensuado sobre la naturaleza, características y habilidades básicas asociadas al razonamiento del profesional en nuestra disciplina. La razón parece fundamentarse en la profesión en sí, ya que la terapia ocupacional es una disciplina sociosanitaria centrada en el cliente, con poco énfasis en el proceso de pensamiento del terapeuta. ...
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... According to Dutton [17], professional reasoning skills differ significantly between experienced practitioners and new graduates: "The better our understanding of expert practice and how experts reason, the greater our capacity to provide this complex and often tacit knowledge to novices to hasten and progress their journey to expertise" ( [4] p14). The importance of professional reasoning in higher education programmes as a mean to develop professional habits, skills and thinking has gained importance over the years as "learning needs to emphasize reflection on thinking rather than just equipping learners with process-following or decisionmaking skills" ( [18] p2). The way in which novices organise their knowledge to analyse and synthesize the information gathered during the initial assessment is an element of primary importance to acquire proper professional reasoning during their academic education [19]. ...
... This excludes those studies that are linked to key responses or based on a "single answer" as the best solution to a problem. New concrete approachesquantitative, qualitative, and mixedhave arisen from this perspective, such as case studies, multiple-choice questions, threshold concepts or other standardised tests [14,[21][22][23][24]; however, there is much to explore in the field of occupational therapists' professional reasoning as many terms and issues are interwoven in the literature [18]. In this terms, Q-sort is one example of a modern assessment that can be used to identify and potentially assess learner knowledge about professional reasoning. ...
... In this terms, Q-sort is one example of a modern assessment that can be used to identify and potentially assess learner knowledge about professional reasoning. There seems to be a need to identify the limits and edges of professional reasoning and its evolution over the years as many of its determinants remain unknown and lack consensus [18,[25][26][27]. To educate quality practicians, there is a need to adequately explore the insights of undergraduate occupational therapy students to ensure the efficiency of educational programmes and to minimize the gap between study and professional/clinical practice [18,21]. ...
A Q-method approach to perceptions of professional reasoning in occupational therapy undergraduates
Article
Full-text available
Background Professional reasoning provides a firm basis for the development of teaching and assessment strategies to support the acquisition of skills by healthcare students. Nevertheless, occupational therapy educators should use diverse methods of learning assessment to examine student learning outcomes more fully with an evaluation that supports the overall complexity of the process, particularly learners’ subjective experience. The aim of this article is to identify the range of perspectives among occupational therapy undergraduates regarding terms or concepts that are key for improving their professional reasoning. Methods Q-methodology was used to address the aim of the study. A concourse relating to a series of ideas, phrases, terminology, and concepts associated with various studies on professional reasoning in occupational therapy, specifically on students in this field, was generated. The terms that had the clearest evidence, the most relevance or the greatest number of citations in the literature were collected ( n = 37). The P-set was assembled by non-probabilistic sampling for convenience. It comprised undergraduate university students in occupational therapy. Factor analysis was conducted using Ken-Q Analysis v.1.0.6, reducing the number of Q-sets to smaller groups of factors representing a common perspective. Results Through statistical analysis of the Q-sorts of 37 occupational therapy students, 8 default factors were identified. The four factors in accordance with the selection criteria were rotated by varimax rotation to identify variables that could be grouped together. Each viewpoint was interpreted, discussed and liked to different aspects of professional reasoning in occupational therapy. Conclusions The observed perceptions were linked to the various aspects of professional reasoning that have been widely discussed in the occupational therapy literature. For most of the students, there was a strong correspondence between the narrative, interactive and conditional aspects of the various components.
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... The way students manage their knowledge to analyze and summarize information in the early stages of a case is fundamental to acquire proper reasoning skills in academic education. Unlike experienced professionals who can readily identify critical cues and patterns, students may struggle to differentiate and prioritize information, often getting lost in the details (Chapparo and Ranka, 2008;Moruno-Miralles et al., 2020;Pitonyak et al., 2020). ...
Implementation and evaluation of a mobile application to support occupational therapy education
Article
Full-text available
  • Nov 2024
Purpose This study aims to evaluate the usability and effectiveness of a mobile application, ValTO, designed to enhance communication and professional reasoning skills in occupational therapy students through a case-based learning approach. Design/methodology/approach A descriptive exploratory study was conducted with 32 second-year occupational therapy students. The usability of the app was assessed using the Mobile Application Rating Scale and the System Usability Scale, complemented by the University of Oviedo’s Learning Satisfaction Survey. Findings The majority of students (77.8%) rated the app above average on the System Usability Scale, with 50% scoring it as excellent. Mobile Application Rating Scale scores revealed high ratings across functionality, aesthetics and information quality, with a significant correlation between app usability and user satisfaction. Increased student satisfaction was also observed in the Learning Satisfaction Survey compared to previous years. Originality/value ValTO integrates modern mobile health tools into occupational therapy education, enhancing students’ decision-making skills in an innovative, real-world context. This study contributes to the growing body of research on mobile health applications in educational settings, demonstrating their potential to improve both student engagement and learning outcomes.
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... The RTSS takes practice to use effectively, suggesting the RTSS could be most beneficial when embedded across a curriculum rather than a single course, as is presented in this paper. This assertion is consistent with the recommendation of Pitonyak et al. (2020), who emphasized the importance of intentionally integrating critical thinking throughout an occupational therapy curriculum. Based on the positive perceptions of students, there may be value in exploring opportunities to provide earlier learning experiences around the RTSS in a curricular course sequence. ...
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... Selecting the AE without overt instructions demonstrated emerging critical thinking skills in these second-trimester students. The lack of critical thinking abilities among OT students is documented in the literature (Pitonyak et al., 2020), and OT educators use different approaches to hone critical thinking skills (Berg et al., 2019;Dashner & Berg, 2021;de Sam LeZaro & Riley, 2019;Grant, 2019;Sakemiller & Toth-Cohen, 2020). By making their own AE, students were interested and invested in these specific pieces of AE. ...
Relating the Makerspace Movement to DIY Adaptive Equipment in an Online Intervention Course for Adults with Physical Disabilities
Article
Full-text available
  • Jan 2022
Many occupational therapy programs use hybrid instruction methods that include virtual learning. To ensure active learning techniques, instructors must alter and adapt traditional instruction methods to the virtual environment. This article explores the use of a virtual Makerspace to create adaptive equipment used throughout online intervention course experiences. Thirty-seven first year occupational therapy students participated in an exclusively online, synchronous course focusing on interventions for adults with physical disabilities. A Makerspace was created to allow students to have access to adaptive equipment (AE) and teach students how to fabricate low-cost AE for future clients. During class, guided instruction was provided to fabricate a sock aide and a universal cuff. This AE was then used throughout the course to provide hands on learning opportunities. Summative assessments were used at midterm and at the conclusion of the course. Students noted enjoyment and preference for hands on activities such as Makerspace, acknowledging how this connected with roleplaying and client interactions. Students were observably engaged throughout the course and integrated AE into learning scenarios throughout. Student feedback supported the use of a virtual Makerspace and reinforces the notion of the maker movement as shared ideas and space to build community. This not only provides a learning opportunity but offers connection in virtual environments. Makerspace activities can also be used to build competence and confidence in OT intervention. A Makerspace is an active learning opportunity that can be successful in person or virtual environments.
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“(Not) knowing what you know”: Exploring educators’ perceptions of critical thinking in occupational therapy
Article
  • Sep 2024
Background: Critical thinking is key for responsible occupational therapy practice. However, the degree to which educators understand critical thinking and the conceptualizations of such concept in teaching remains unclear. Aim: This study aimed to describe occupational therapy educators' perceptions and experiences of teaching critical thinking. Material and methods: Social constructivism underpins the study. Eight participants were included in three online synchronous focus groups. One participant was interviewed in person due to time constraints. Data were analysed using content analysis. Results: This study reveals a considerable diversity of perceptions and experiences of ambiguity regarding educators' perceptions of what they know about and how to teach critical thinking. Most educators interpret critical thinking in ways that differs from their colleagues. Furthermore, educators encounter divergent expectations pertaining to their role as educators and the readiness of their students. Conclusions: This study reveal a paradox within the occupational therapy profession, where critical thinking is highly valued yet educators experience ambiguity, differing expectations of their role, time constraints, and lack of formal education to support students' development of critical thinking. Significance: This study provides the foundation for further inquiry into the invisible effects and benefits of different understandings of critical thinking on occupational therapy practice.
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Pengembangan Instrumen Berpikir Kritis : Tutor Identifikasi Berpikir Kritis Development of Critical Thinking Instruments: Critical Thinking Identification Tutor
Article
Full-text available
  • Jun 2023
Menurut Purwanto (2018), instrumen penelitian merupakan alat yang digunakan untuk mengumpulkan data dalam penelitian. Tujuan dari penelitian ini adalah untuk menguji instrumen berpikir kritis yang valid, konsisten dan reliabel. Dalam penelitian ini, berpikir kritis terdiri dari lima konstruk, yaitu: (1) Memberikan penjelasan sederhana; (2) Mengembangkan keterampilan dasar; (3) Meringkas/kesimpulan; (4) Memberikan penjelasan yang lebih rinci; dan (5) memutuskan strategi selanjutnya. Penelitian ini dirancang sebagai penelitian survei dengan 50 responden, yang terdiri dari 3 pakar/dosen, 5 guru dan 42 siswa yang dipilih melalui teknik stratified dan random sampling. Data dianalisis menggunakan SPSS Versi 23.00 for Windows untuk menguji konsistensi internal menggunakan Cronbach Alpha. Hasil penelitian menunjukkan bahwa semua item dalam kuesioner valid dan reliabel. Rata-rata skor reliabilitas Cronbach alpha tinggi (0,897 > 0,6) dan setiap pernyataan memiliki skor tinggi (0,784 hingga 0,890). Oleh karena itu, angka- angka tersebut menunjukkan bahwa penelitian ini telah mengembangkan instrumen berpikir kritis.
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Scoping Review of Critical Thinking Literature in Healthcare Education
Article
  • Feb 2021
  • Occup Ther Health Care
Critical thinking is the process of analyzing and evaluating thinking to make decisions. Critical thinking exposes assumptions, biases, and beliefs that influence clinical reasoning. This scoping review sought to explore instructional approaches for advancing students' critical thinking in healthcare education. Through analysis of 15 articles, no common definition of critical thinking emerged, nor consensus found on measurement or instructional methods. Some alternative instructional methods such as case-based learning, reflective guided questions, and multiple case exposures, when compared to lecture, did significantly impact learner critical thinking. To determine if critical thinking is an instructional method that would impact implicit biases and healthcare outcomes, five author recommendations are offered from gaps in the existing literature to provide a pathway for future research. To effectively prepare students for clinical practice, long term outcomes are necessary to assess if critical thinking skills can be taught and become part of a professional growth mindset.
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Master’s of Occupational Therapy Student Perceptions of Creative Thinking Across the Academic Program
Article
Full-text available
  • Oct 2017
This study was part of a larger study to describe how master’s of occupational therapy (MOT) students define and perceive their own creative thinking across the academic program. This study involved a cross-sectional quantitative study based on the self-reflective creative thinking surveys completed by the MOT students at Texas Woman’s University (N = 136). Principal component analysis (PCA) was used to reduce a large number of variables by finding which variables are redundant and measuring the same construct. The PCA resulted in three new components accounting for 68% of the variance. Three ANOVAs were conducted to explore possible differences in the students’ perceptions about creative thinking during phases of the program. This study did not reveal any significant differences among the students across the program regarding their perceptions of creative thinking. However, analysis showed rich information about the students’ perceptions of creativity. Three new components were created in response to the PCA. Overall, the students demonstrate high levels of agreement that the MOT students value creative thinking, believe it can be learned, and believe that it is important for occupational therapy practice. This study can serve as a basis for a larger study to develop assessment and/or MOT curriculum design
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Student Perceptions of Non-traditional Level I Fieldwork
Article
Full-text available
  • Aug 2017
Academic programs commonly face challenges in developing Level I fieldwork where students have ample opportunity to practice and understand occupation. In response to this challenge, our academic program developed a non-traditional Level I fieldwork. The purpose of this study was to understand the student perceptions of this learning experience. Focus group methodology was employed. Fifty-nine students participated in one of six focus groups. Six themes were identified through the data analysis process. These included challenges and rewards of effective communication, learning to think like an OT, a greater understanding and focus on occupations, developing skills in cultural understanding and advocacy, gaining confidence through doing, and the logistical challenges of getting everyone on the same page. These themes supported that students viewed non-traditional Level I fieldwork paired with structured classroom learning activities positively. A pattern across all themes was that students learned because they were able to make mistakes, reflect on them, and change their action. Limitations include that student perceptions are only one aspect of understanding the impact of learning experiences; therefore further study is needed.
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Traditional Lectures and Team-Based Learning in an Occupational Therapy Program: A Survey of Student Perceptions
Article
Full-text available
  • Mar 2017
Background: Team-Based Learning (TBL) is an active instructional approach used in health care education that incorporates group work. Methods: Two occupational therapy professors adopted a TBL instructional approach in two courses for firstand second-year occupational therapy master’s degree level students. The investigators administered a survey to evaluate student perceptions of TBL and lecture-based instruction (LBI). A principal components factor analysis with varimax rotation identified two 5-item factors: “perceptions of LBI” and “perceptions of TBL.” Internal consistency for each factor was strong (Cronbach’s alpha 5 0.856 [preference for LBI]; 0.865 [preference of TBL]). A Wilcoxon matched pairs signed rank test was conducted to determine whether there was a difference in the ranking of two teaching approaches. Results: The results indicated a significant difference in how the students ranked the instructional approaches, z = -3.19, p < .05, with the students having more positive perceptions of LBI than TBL. Conclusion: The implications for occupational therapy educators are discussed.
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High-Fidelity Simulation: A Tool for Occupational Therapy Education
Article
Full-text available
  • Oct 2015
High-fidelity simulation (HFS) is an educational tool commonly used by professional education programs of medicine and nursing for student training and assessment. Although its use in occupational therapy (OT) education is emerging, implementation of simulation in OT education varies broadly across programs, and, in general, the tool remains underused. This paper describes how the OT education program at Samuel Merritt University (SMU) has systematically expanded the use of HFS in various formats throughout the curriculum. The specific processes and procedures of using HFS in facilitating student critical thinking and clinical skills are explained to emphasize the potential educational value of HFS. Although student responses to simulation have been positive, methodical studies are needed to validate the use of this teaching and learning tool in OT education. The paper also suggests additional ideas for implementing aspects of HFS based on various levels of resources available to an OT education program.
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Critical Thinking in Graduate Medical Education
Article
Full-text available
  • Sep 2000
Context Tools to assess the evolving conceptual framework of physicians-in-training are limited, despite their critical importance to physicians' evolving clinical expertise. Concept mapping assessment (CMA) enables teachers to view students' organization of their knowledge at various points in training.Objective To assess whether CMA reflects expected differences and changes in the conceptual framework of resident physicians, whether concept maps can be scored reliably, and how well CMA scores relate to the results of standard in-training examination.Design, Setting, and Participants A group of 21 resident physicians (9 first-year and 12 second- and third-year residents) from a university-based pediatric training program underwent concept map training, drew a preinstruction concept map about seizures, completed an education course on seizures, and then drew a postinstruction map. Maps were scored independently by 3 raters using a standardized method. The study was conducted in May and June 1999.Main Outcome Measures Preinstruction map total scores and subscores in 4 categories compared with postinstruction map scores; map scores of second- and third-year residents compared with first-year residents; and interrater correlation of map scores.Results Total CMA scores increased after instruction from a mean (SD) preinstruction map score of 429 (119) to a mean postinstruction map score of 516 (196) (P = .03). Second- and third-year residents scored significantly higher than first-year residents before instruction (mean [SD] score of 472 [116] vs 371 [102], respectively; P = .04), but not after instruction (mean [SD] scores, 561 [203] vs 456 [179], respectively; P = .16). Second- and third-year residents had greater preinstruction map complexity as measured by cross-link score (P = .01) than first-year residents. The CMA score had a weak to no correlation with the American Board of Pediatrics In-training Examination score (r = 0.10-0.54). Interrater correlation of map scoring ranged from weak to moderate for the preinstruction map (r = 0.51-0.69) and moderate to strong for the postinstruction map (r = 0.74-0.88).Conclusions Our data provide preliminary evidence that concept mapping assessment reflects expected differences and change in the conceptual framework of resident physicians. Concept mapping assessment and standardized testing may measure different cognitive domains.
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Effectiveness of Two Methods for Teaching Critical Thinking to Communication Sciences and Disorders Undergraduates
Research
  • Jan 2019
The purpose of this study was to evaluate the effectiveness of two methods for teaching critical thinking skills to communication sciences and disorders students. It was hypothesized that a short course of critical thinking training would result in improved student scores on critical thinking assessments, and that students taught using a mixed instruction method would exhibit greater improvement in their critical thinking skills. Pre-and post-test critical thinking assessments were compared for students who completed 10 weeks of critical thinking instruction. The students were instructed using either (a) a mix of direct instruction on critical thinking concepts along with problem-based learning communication sciences and disorders examples or (b) infused problem-based learning critical thinking instruction with communication sciences and disorders based problems. The pretests and posttests consisted of a general and content specific critical thinking assessment. All of the students exhibited improved scores on both critical thinking measures. In addition, the students who received the mixed instruction method exhibited greater improvements. The greatest improvements for all students occurred for the trained critical thinking skills. These results indicate that both mixed and infused instruction can be effective in teaching students critical thinking skills; however, the mixed instruction was more effective.
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An international systematic mapping review of fieldwork education in occupational therapy: Revue de mappage systematique internationale de la formation clinique en ergotherapie
Article
  • Mar 2014
Background Owing to its importance in preparing occupational therapists, fieldwork education has generated numerous studies. These have not been collected and reviewed, leaving researchers without a map for growing a science of fieldwork education. Purpose This study aimed to systematically categorize the topics, research designs, methods, levels of impact, and themes that have and have not been addressed in fieldwork education scholarship. Method Guided by a systematic mapping review design, 124 articles, identified through database searches and inclusion coding, were studied. Data were collected using a data extraction instrument and analyzed using Microsoft Access queries. Findings Papers primarily addressed curriculum ( n = 51) and students ( n = 32). Conceptual/descriptive inquiry methods ( n = 57) were predominant. Qualitative ( n = 48) and quantitative methods ( n = 49) were used equally. Research outcomes mainly targeted perceived participation in fieldwork. Recurring themes included student perceptions, external influences, and transition to practice. Implications Three recommendations were identified: strengthen procedures for studying singular fieldwork experiences, broaden rationales for studying fieldwork, and translate educational concepts for occupational therapy.
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