Initial development of a measure of evidence-informed professional thinking

Abstract

Background and aims: A number of theories have been proposed on clinical expertise and its development in occupational therapy and allied health professions. Clinical reasoning, outcome measurement and evidence-based practice are names for leading conceptualisations. The aim of this research was to develop an operational measure of habits of mind and practice that constitute these desirable professional activities amongst professional therapists.

Methods: Items were developed on the basis of literature review and feedback from an expert panel. An online self-report survey was completed by 107 occupational therapists and other allied health clinicians. Rasch analysis was used to identify and calibrate items that fit the criteria for equal-interval measurement. Residuals from identified equal-interval dimensions were examined using principal components analysis to identify multidimensionality.

Results: A two-dimension solution employing 32 items was identified. The first dimension comprised items on Critical Clinical Reasoning and had an item separation of 8.49 (0.99 reliability) and a person separation of 2.93 (0.90 reliability). The second dimension comprised items on Evidence-Informed Practice behaviours and had an item separation of 6.19 (0.97 reliability) and a person separation of 2.97 (0.90 reliability). These dimensions were positively correlated (r = .778, p < .001). We named the overall scale 'Evidence-Informed Professional Thinking', or EIPT. The EIPT measures correlated significantly with 12 of 13 relevant external criterion items.

Conclusion: Evidence-informed professional thinking can be measured in terms of two correlated probabilistically equal-interval dimensions: Critical Clinical Reasoning and Evidence-Informed Practice behaviours. The EIPT measure should be useful in research on development and application of clinical expertise, quality and outcomes of care and implementation of improved practices among practicing therapists in clinical treatment settings. Further research is recommended to understand the generalisability, strengths, limitations and correlates of EIPT.

Keywords: Rasch analysis; allied health occupations; clinical competence; clinical reasoning; evidence-based practice; knowledge translation; occupational therapy; psychometrics; rehabilitation; survey and questionnaires.