Identification of occupational therapy clinical expertise: Decision-making characteristics

Abstract

Background: Experts are usually determined on the basis of length of experience, reputation, peer acknowledgement, and certification. While these characteristics are important they may, however, not be sufficient for this purpose. Another method for determining clinical expertise is to look at how individuals make decisions in their area of expertise. This study aims to identify clinician expertise on the basis of participants’ decision performance and examines this in relation to their length of experience and type of decision-making. Methods: The Cochran–Weiss–Shanteau (CWS) is a statistical method that can be used to examine individuals’ expertise on the basis of how they discriminate between hypothetical cases and consistency in their decision-making. Participants comprised 18 occupational therapists, each with more than 5 years of experience working with children with cerebral palsy. They were required to make treatment judgements for 110 cases (20 of which were repeated) of children with cerebral palsy. The CWS was calculated for each participant. Results and conclusions: Two groups of participants were identified on the basis of their CWS index — one with both high consistency in decision-making and the ability to discriminate between cases, the other with low consistency and poor discrimination. These two groups did not differ significantly on the basis of length of experience or work setting but did differ on the basis of intervention chosen and their type of decision-making. The CWS method seems to offer promise as a means of determining clinical expertise on the basis of clinical decision-making. Its application to the investigation of clinical reasoning and education is discussed.