Understanding clinical reasoning skills to improve psychologist training

School psychologists spend a significant amount of time on assessment-related activities. These assessments inform interventions and treatment plans for students, and accuracy is critical to an effective assessment. Assessments require advanced clinical reasoning skills – thinking processes that consider the child’s history, current functioning, and test performance.

Understanding how clinicians reason effectively can provide foundational information to guide the training of new psychologists, as well as help practicing clinicians avoid biases and errors which can lead them astray. Finding out what psychologists pay attention to in a case, and how they work with that information, is central to addressing these needs.

While this area has been studied in greater depth in medicine and nursing, far fewer studies have been conducted in psychology. This brought this problem to the attention of Drs. Meadow Schroeder, Michelle Drefs, and Gabrielle Wilcox, who have been exploring clinical reasoning in school psychologists for a number of years.

Novice and expert

In one study, the researchers compared the clinical reasoning processes of expert and novice psychologists. The team observed graduate students (novices) and practicing clinicians (experts) to consider how these two groups engaged in clinical reasoning as they conducted a “think aloud” while working through a case study.

The team noticed a number of similarities and differences in how the groups approached the assessment. Both groups identified similar areas of concern, and both paid similar attention to the descriptive information which guided their understanding. The experts, however, were more open to searching for their diagnostic conclusion, spending more time making connections between the salient information. In comparison, novices initially ‘anchored’ their hypotheses in a particular problem area, and then ruled other information in or out, shifting the hypothesis if necessary.

The experts all provided recommendations paired with the diagnosis, while only 1 of 3 students provided suggestions at this stage. These recommendations are important for informing how to intervene in the case, and provide effective measures to support these students in their learning.

Further insights

The team is continuing to explore this area, building on the work of their initial studies. The next phase of the research aims to gain deeper insights into how clinicians work with the data. By only providing the psychologists with one piece of a case at a time, they can better understand what clinicians find important, how they integrate the information with previous information, and at what state they develop a working hypothesis.

See more from Dr. Meadow Schroeder on her profile

See more from Dr. Gabrielle Wilcox on her profile

See more from Dr. Michelle Drefs on her profile

Connected Citations

Wilcox, G., & Schroeder, M. (2014). What comes before report writing? Attending to clinical reasoning and thinking errors in school psychology. Journal of Psychoeducational Assessment, 33(7), 652-661.