Post on 27-Jan-2022
1Oct-20
The Clinical Reasoning Tool (CRT) in Mentorship
October 8th, 2020
MENTOR TRAINING SERIES – MODULE 2
2Oct-20
Welcome!• Close other running applications to help maintain
a stable connection
• If your connection freezes, exit Go To Webinar and return
3Oct-20
Welcome!• The recording and slides for this webinar will be
posted on the Mentorship Program webpage
• Please enter your questions in the “questions” box on your screen, Jessica Laforet will be monitoring questions.
4Oct-20
Presenters
Sarah Chapman-JayAdvisor, SLP Professional
Practice & Quality Assuranceslppracticeadvice@caslpo.com
(416) 975-5347, ext. 228
Samidha JoglekarAudiology Advisor &
Manager of Mentorship (English & French)
sjoglekar@caslpo.com(416) 975-5347, ext. 220
5Oct-20
Agenda
• Background • Mentorship Version of the CRT• Examples of Clinical Reasoning• Using the CRT with a Mentee• Answers to Your Questions
7Oct-20
Previous E-Forum
Clinical Reasoning Tool - Development, Evaluation and Remediation
Access the slides and recording:https://caslpo.com/events/upcoming-events
Background
8Oct-20
Background
• Health regulators across Canada use different methods to evaluate their registrants’ clinical reasoning.
• CASLPO uses the Clinical Reasoning Tool (CRT), as part of the Quality Assurance Program’s Peer Assessment process.
9Oct-20
Clinical reasoning:
• is an expected entry-to-practice competency
• continues to evolve across career-stage
Initial registrants (i.e., mentees), are expected to apply and demonstrate clinical reasoning skills during their mentorship that are in-line with their career stage and level of experience.
Background
10Oct-20
Background The mentorship process supports and facilitates the competency of initial registrants and their preparedness for self-regulation.
The application of clinical reasoning is an important competency.
The CRT has been integrated into the mentorship process to help mentors support and evaluate clinical reasoning skills.
11Oct-20
Background
Mitigating Risk (Risk-Based Regulation)
Our goal is to:
• Mitigate the risk to the public of having new SLPs and audiologists practicing in Ontario without application of clinical reasoning skills
• Identify initial registrants who need to work on this skill early in their career
• Remediate issues with clinical reasoning through mentorship
12Oct-20
What is clinical reasoning?
Clinical reasoning describes the process by which we, as health professionals:
• collect and evaluate information • come to an understanding of a patient problem or
situation • plan and implement interventions • evaluate outcomes; and• reflect on and learn from the process
(From the Guide to the Clinical Reasoning Tool, CASLPO Quality Assurance Program)
Background
13Oct-20
What is clinical reasoning?
• Being able to reflect on and explain why you did what you did
• Learning from this process on a continuous basis (i.e., being a life-long learner)
Background
14Oct-20
Background The CRT is based on chart-stimulated recall
Research tells us that chart-stimulated recall is useful to:
🔎🔎identify critical thinking and reasoning skills 🔎🔎stimulate reflective practice 🔎🔎provide feedback 🔎🔎improve documentation 🔎🔎help demonstrate and evaluate competencies🔎🔎identify gaps in knowledge
(From the Guide to the Clinical Reasoning Tool, CASLPO Quality Assurance Program)
15Oct-20
The Mentorship Self-Assessment Tool (MSAT) has a new practice indicator on clinical reasoning as of October 1st, 2020.
Indicator 3.7“I use clinical reasoning at every stage of intervention”
• In the MSAT, 3.7 is a red flag indicator, which means mentees are expected to meet this standard of practice by the midterm evaluation.
• As a mentor you will be evaluating the mentee on this practice indicator and the mentee will also self-evaluate on this indicator.
Background
16Oct-20
The MSAT has three more new practice indicators, in addition to the clinical reasoning indicator, as of October 1st, 2020. These include indicators on:
• Conflict of Interest (1.9)• Advertising (4.5)• Professionalism (5.2)
Clinical reasoning (3.7) is the only new red flag MSAT indicator.
Background
18Oct-20
• A version of the CRT for mentorship has been developed based on the Quality Assurance Program version.
The Mentorship Version of the CRT
19Oct-20
The Mentorship Version of the CRT
The CRT for Mentorship is on the Mentorship webpage. It is also in the MSAT.
Direct Linkhttps://caslpo.com/sites/default/uploads/files/MTR_EN_Clinical_Reasoning_Tool_Mentorship.pdf
20Oct-20
The Mentorship Version of the CRT
• The CRT for Mentorship is to help both mentees & mentors facilitate and apply clinical reasoning skills.
• It’s a supportive & educational tool.
• Its purpose is to assist mentors & mentees to evaluate clinical reasoning and monitor how these skills evolve during the mentorship period.
21Oct-20
The Mentorship Version of the CRT
As a mentor, you are not required to:
• Submit completed CRTs to CASLPO or in the MSAT
• Score the CRT (required in QA but not in mentorship)
Suggestion: the mentee can attach their own completed CRTs in the MSAT as their evidence of meeting the standard of practice.
22Oct-20
The Mentorship Version of the CRT
As a mentor you are required to:
• Conduct the CRT with the mentee by or at the midterm evaluation meeting
• Consider the CRT discussions when determining your rating for the mentee on the clinical reasoning indicator.
• Comment on your observations of the mentee’s application of clinical reasoning skills in the midterm and final reports submitted to CASLPO via the MSAT
23Oct-20
The Mentorship Version of the CRT
• As a mentor, you will observe the mentee demonstrating or applying clinical reasoning outside of the CRT discussions.
• The CRT is an additional tool to help you in your assessment of this competency.
• Research has confirmed that the CRTprovides a framework & validated method for revealing clinical reasoning, which is why we are integrating it into the process.
26Oct-20
Definition of Reasonable
• “What a hypothetical, typical registrant who exercises average care, skill, and judgment would do in similar circumstances and thereby serve as a comparative standard.”
(From the Guide to the Clinical Reasoning Tool, CASLPO Quality Assurance Program)
CRT Mentorship Version
28Oct-20
CRT Mentorship Version, pg. 4-7
Collected, Applied, Linked, Patient Context, Options, Flexible, Reasonable
29Oct-20
CRT Mentorship Version, pg. 4-7
Collected, Applied, Linked, Patient Context, Options, Flexible, Reasonable
30Oct-20
CRT Mentorship Version, pg. 4-7
Collected, Applied, Linked, Patient Context, Options, Flexible, Reasonable
31Oct-20
CRT Mentorship Version, pg. 4-7
Collected, Applied, Linked, Patient Context, Options, Flexible, Reasonable
32Oct-20
TIPS FOR MENTORS
• You can skip prompting questions if the mentee provides enough information on their own.
• The prompting questions are to help you elicit more information from the mentee about their clinical reasoning. Use the questions as needed.
• You can skip to certain discussion areas and then return to previous areas.
• Not all sections of the CRT will apply to every mentee or patient
33Oct-20
TIPS FOR MENTORS
• You don’t always have to check mark all the processes for it to be “adequate” clinical reasoning.
• You do want to see that the mentee addresses the processes at some point in their explanation.
• You may notice a trend: do they neglect acknowledging patient context?, do they neglect to link information?
• Clinical reasoning discussions can range in length of time. There is no specified time required.
34Oct-20
TIPS FOR MENTORS
• As a mentor, it will be up to your professional judgement to determine if there is enough evidence of the mentee’s clinical reasoning and if the skill has been applied.
• You aren’t expected to teach clinical reasoning as a mentor, although you may need to facilitate it.
• We want the CRT to be a tool that will assist you.
36Oct-20
Clinical Reasoning Examples
• We will listen to audio examples of clinical reasoning discussions in both professions
• Voices are CASLPO employees or consenting family members enacting the discussion
• The examples are fictitious
• The examples are a snippets of clinicalreasoning discussions and do not always cover all the discussion areas
39Oct-20
How to Use the CRT with a Mentee
We consulted with a focus group of peer assessors who also mentor to bring the CRTinto mentorship.
Their feedback is integral to how we are asking you, as mentors, to use the CRT with your mentees.
40Oct-20
How to Use the CRT with a Mentee – Focus Group Feedback
“Un-guided conversations can restrict you to your own thinking patterns”
The Clinical Reasoning Tool: • Brings a level of consistency• Provides a framework to ask questions you wouldn’t
normally ask (e.g., what would you have done differently?)• Structures the conversation• Facilitates a pattern of logical reasoning and encourages
use of it long-term• Generates opportunities for learning• Creates opportunities to coach the mentee• Promotes self-reflection
41Oct-20
How to Use the CRT with a Mentee
We encourage use of the CRT early on and over the course of mentorship, as the CRT will:
✔Provide a structure for the discussion ✔Be valid and reliable at revealing clinical
reasoning skills✔Help mentors, and mentees, track progress
with this skill✔Help to identify gaps in knowledge that need
to be addressed
42Oct-20
Refer to the instructions on pg.2 of the CRT for Mentorship.
Refer to the section on the CRT in the Mentorship Program Guidelines (pg. 16).
How to Use the CRT with a Mentee
43Oct-20
How to Use the CRT with a Mentee
Mentors are required to use the CRT with every mentee. (from Oct 1st, 2020 onward)
Suggestions• Introduce the CRT early in the mentorship as
an approach to discuss patient cases
• Use the CRT as an educational or coaching tool to create opportunities for learning and support reflective practice
44Oct-20
• You will complete the CRT with your mentee by or at the midterm evaluation with at least 2 patient cases.
• One case will be selected by the mentee and one by you (the mentor).
• 5 cases are to be prepared for record review at the midterm, so the cases can be selected from these files OR they can be cases outside of these files.
How to Use the CRT with a Mentee
45Oct-20
You will conduct the CRT as outlined in the previous training section called “The Mentorship Version of the CRT”.
When going through the CRT, keep in mind:• Not all sections will apply to every mentee
or patient. It depends on the clinical scenario or model of care.
How to Use the CRT with a Mentee
46Oct-20
When going through the CRT, keep in mind:
• You can skip questions if the mentee has already provided enough information
• You can return to earlier sections if it will help you ascertain the mentee’s clinical reasoning
• It is not expected that all areas of the CRT will be documented in the patient record
How to Use the CRT with a Mentee
47Oct-20
When going through the CRT, keep in mind:
• You are listening for the mentee to demonstrate their clinical reasoning skills (Can they explain why they did what they did?)
• Refer to the Clinical Reasoning Processes
How to Use the CRT with a Mentee
Collected, Applied, Linked, Patient Context, Options, Flexible, Reasonable
48Oct-20
When going through the CRT, keep in mind:
• You are considering if the mentee’s application of clinical reasoning is reasonable
Definition of Reasonable“What a typical registrant who exercises average care, skill, and judgment would do in similar circumstances and thereby serve as a comparative standard”
How to Use the CRT with a Mentee
49Oct-20
• The mentee may need more factual information (e.g., starting in a new clinical practice area, if they are unfamiliar with the record keeping system)
• Initial registrants will express their clinical reasoning differently than more experienced registrants. A mentee may have a different decision-making process than what you would expect. Be open-minded and listen to their perspective.
• Ask yourself, “is their decision making reasonable”? Are they meeting the minimum expected practice standards with their approach?
TIPS FOR MENTORS
50Oct-20
• The content of the mentee’s clinical reasoning explanation should be the focus.
• You are not being asked to evaluate the quality or style of the mentee’s communication (e.g., eloquence, vocabulary, expressiveness).
• Be sensitive to cultural and personal differences in communication style.
TIPS FOR MENTORS
51Oct-20
After going through the CRT, if you are unsure if the mentee has demonstrated clinical reasoning, ask yourself:
“Does the mentee:
• independently recognize where they need to improve?• ask questions and seek feedback to improve their
understanding? • make efforts to learn in order to meet practice
standards?”
If the mentee is doing these things, it’s a sign they are on the right track.
TIPS FOR MENTORS
52Oct-20
How to Use the CRT with a Mentee
In the MSAT, mentors are required to:
1.Indicate a midterm rating for the mentee on the clinical reasoning practice indicator in the “Professional Practice Standards and Indicators” section
2.Confirm that you have used the CRT with the mentee and comment on the mentee’s clinical reasoning skills in the “Midterm Mentor Report and CRT” section.
54Oct-20
The “Midterm Mentor Report & CRT” section also has:
• A link to the Mentorship Version of the CRT• A guidance document with instructions on how to use the
CRT in mentorship (excerpt from the Mentorship Program Guidelines)
How to Use the CRT with a Mentee
55Oct-20
How to Use the CRT with a Mentee
If the mentee receives a rating of “meets the standard” at the midterm, then the CRT isn’t required again.
• You may continue to use it as an educational or coaching tool!
56Oct-20
How to Use the CRT with a Mentee
If the mentee receives a rating of “Needs work to meet the standard” at the midterm, then the following is required:
• The clinical reasoning indicator will populate as a red flag indicator still needing work in the “Midterm Mentor Report & CRT” section of the MSAT.
• Mentors must comment in the Midterm Report on how clinical reasoning will be addressed during the remainder of the mentorship period.
• The mentee must prioritize clinical reasoning as a learning goal for the second half of their mentorship.
57Oct-20
How to Use the CRT with a Mentee
If the mentee receives a rating of “Needs work to meet the standard” at the midterm then the following is required:
• Mentors will conduct the CRT with the mentee for two more clinical cases by or at the final evaluation.
• Mentors will comment on the mentee’s progress with clinical reasoning from the midterm to the final evaluation in the “Final Mentor Report”.
58Oct-20
What should a mentor do if there are continued concerns with a mentee’s clinical reasoning?
• If the concerns are considerable and do not seem remediable during the course of mentorship, contact the College.
60Oct-20
THANK YOU!
Connect with CASLPO:facebook.caslpo.comyoutube.com/user/caslpo
Visit us at caslpo.com