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

Delany and Golding

Delany and Golding BMC Medical Education 2014 14:20   doi:10.1186/1472-6920-14-20

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