On clinical reasoning: Patterns of reflection on practice

Five qualified occupational therapists and their patients were videotaped during a treatment session. The occupational therapists first were asked to describe the session in a narrative form, i.e., ''tell the story,'' and then they were asked to describe the thoughts and considerations on which they had conducted the treatment session, i.e., ''reflection on practice.'' A qualitative analysis was performed in accordance with the model for clinical reasoning developed by Fleming (1991). Both quantitative and qualitative analysis showed that procedural reasoning was predominant both in storytelling and reflection on practice, and a very small number of comments was classified as interactive or conditional reasoning. The results of this preliminary investigation suggested that we should examine the role that reflection on practice plays in examining, developing, and teaching the art of occupational therapy.