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Clinical reasoning skills of speech and language therapy students

journal contribution
posted on 2023-06-07, 14:04 authored by Kirsty Hoben, Rosemary Varley, Richard Cox
Background: Difficulties experienced by novices in clinical reasoning have been well documented in many professions, especially medicine (Boshuizen and Schmidt 1992, 2000; Elstein, Shulman and Sprafka 1978; Patel and Groen 1986; Rikers, Loyens and Schmidt 2004). These studies have shown that novice clinicians have difficulties with both knowledge and strategy in clinical reasoning tasks. Speech and language therapy students must also learn to reason clinically, yet to date there is little evidence of how they learn to do so.


Publication status

  • Published


International Journal of Language and Communication Disorders,









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Department affiliated with

  • Informatics Publications


Originality: This is original research on reasoning in a complex task (clinicaldiagnosis). It is one of very few studies of student clinicians'diagnostic reasoning performance using real patients i.e. a study conducted under conditions of high ecological validity (as opposed to artificial tasks and settings). The clinical reasoning difficulties of a group of speech and language therapy students are reported. The performance of student subgroups is compared with that of independent experts (experienced speech and language therapists). Rigour: Students diagnosed previously unseen patient cases. These were made available to them via PATSy (, a nationally used large-scale interactive database of virtual patient cases (developed under direction of Cox). Dynamic video computer screen capture was used to record all on-screen activity. Verbal comments made by participants were analysed via protocol analysis. An original protocol (seven-level 'clinical reasoning event' coding scheme) was developed too as part of the research. Diagnostically accurate students showed use of specific professional vocabulary, and a greater use of firm diagnostic statements. Diagnostically inaccurate students typically failed to correctly interpret test results and video observations, and, inter alia, had difficulty in carrying out a sequence of tests consistent with a diagnostic reasoning path. Significance/Impact: Results have wide implications for the design of effective training programmes for pre-service and in-service clinicians. Also for reasoning more generally eg in general medicine and in broader complex cognitive task contexts eg electronic troubleshooting.

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