Table 3 Examples of developing and refining thinking routines
Clinical activity | Initial thinking routine | Evaluation of this thinking routine | Refined thinking routine |
|---|---|---|---|
1. Assessing a patient with a musculoskeletal injury (Physiotherapy) | 1. Gather information | “This routine was too complex for novices… students still struggled with what to consider” | Consider: |
2. Consider diagnosis | 1. Underlying structures | ||
3. Sort priorities | 2. Connecting structures | ||
3. Patterns of pain and symptoms | |||
2. Reassessment of a child after initial treatment (Physiotherapy) | 1. List main problems | “This routine was too challenging for a student who could only list but could not make the connections or make sense of how the previous treatment impacted on the patient.” | 1. What changes occurred in the child’s symptoms since last presentation? |
2. Compare with previous problems | 2. What is the impact of treatment on their mobility, function, muscle tone… ? | ||
3. Decide whether to continue with same treatment | 3. Whether to continue or change your treatment? | ||
3. Assessing a limb for prosthesis fitting (Prosthetics and orthotics) | 1. Feel stump | “This routine really helped students. I further refined this with sub questions” | 1. Feel what is the tissue consistency? What are the anatomical prominences? |
2. Describe shape, texture | 2. Describe what is the profile of the residuum? Is it bulbous? | ||
3. Test lining | 3. What is the distal circumference? | ||
4. Test does the skin pull in against the gel when rolled on? | |||
4. Treatment planning (Social work) | 1. Why are you/they here? | “This routine was still too complex for some students. Asking ‘what’ about a patients’ goals also involves sorting and categorising the goals” | No new routine but… |
2. What are this patient’s goals? | “The routine meant we discussed the importance of asking open-ended questions to clients and then using their answers to build further questions” | ||
3. Summarise what you could do |