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Health Sciences and Practice & Medicine Dentistry and Veterinary Medicine Higher Education Academy Subject Centres. eLearning in Health 2011 conference collaboration, sharing and sustainability in the current environment.

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Health Sciences and Practice &Medicine Dentistry and Veterinary MedicineHigher Education Academy Subject Centres

eLearning in Health 2011 conference

collaboration, sharing and sustainability in the current environment

Randomized controlled trial to test the effectiveness of a referral prioritization decision training tool for student occupational therapists.

Dr Priscilla Harries*, Libby Notley (Brunel University), Dr Chris Tomlinson (Imperial College London)

*Senior Lecturer and Course Leader MSc Occupational Therapy, Brunel University.

intended learning outcomes
Intended learning outcomes

To gain knowledge of :

  • Educational methods for enhancing professional decision-making.
  • Research methods for testing the effectiveness of an educational tool through a randomized controlled trial
educational methods for enhancing professional judgement and decision making
Educational methods for enhancing professional judgement and decision making.
  • Need to provide methods and practice in clinical reasoning in order to be effective when
  • selecting,
  • weighting,
  • combining relevant information
  • and deciding on an optimal outcome.
referral prioritisation
Referral prioritisation
  • In community mental health, research has shown that occupational therapy students need to improve their capacity to prioritize referrals (Harding, K., Taylor, N., & Shaw-Stuart, L. 2009) .
  • Study expert practice in order to identify how best to make judgements and decisions
  • Expertise is domain specific
  • Social judgement theory used to identify a gold/consensus standard.
studies needed to identify a consensus standard
Studies needed to identify a consensus standard
  • To identify experienced therapists’ prioritisation policies (Harries & Gilhooly 2003a)
  • To examine the capacity for self -insight into these policies (Harries & Gilhooly 2010)
  • To identify factors that effect policy use (Harries & Gilhooly 2003b)
  • To validate expertise in referral prioritisation (Weiss, Shanteau and Harries 2006)
  • To validated ‘consensus standard’ with service providers (Harries 2007)
  • To test decision aid with pre-test post-test design (Harries & Gilhooly 2010)
developing a decision aid
Developing a Decision Aid
  • Collected 45 expert practitioners’ prioritization decisions on 88 referrals.
  • Those who worked according to professional policy and were most expert used three key cues in their prioritization policies: reason for referral (ß = 0.69), diagnosis (ß = 0.48) and a history of violence (ß = 0.12).
randomized controlled trial
Randomized controlled trial
  • Effect of on-line web-based decision-training aid demonstrated through a double blind, parallel-group, longitudinal trial (N=165).
  • Baseline (prioritise 52 referrals)
  • Immediate post-test (prioritise 36 referrals)
  • 2 weeks post test (prioritise same 36 referrals)
randomized to group
Randomized to group



Analysed at baseline

(n= 81 )

Analysed at immediate post test (n= 81)

Analysed at 2 week post test (n= 74)

  • Analysed at baseline

(n= 84 )

  • Analysed at immediate post test (n= 84 )
  • Analysed at 2 week post test (n=74 )
results using pearson s correlations also confirmed with icc testing
Results using Pearson’s correlations (also confirmed with ICC testing)
  • Baseline- no statistically difference in groups (demographics/ratings) p=0.34
  • At immediate post test
  • Cohen’s effect size r =0.697. This result was classified as a medium effect.
  • At post 2-week follow-up the statistically significant difference was maintained p<0.001
  • As demand far exceeds service capacity, this decision training aid could be used to improve novices’ referral prioritization ability thereby ensuring services are targeted at those in most need.
benefits and future plans
Benefits and Future plans
  • In the UK, the web tool has been used in practice guidelines, CPD training, and 75% of occupational therapy programmes in the UK.
  • International use, which has commenced, is likely to be extended as the decision aid is freely available via the World Wide Web (
other applications of method
Other applications of method
  • To detect and prevent elder abuse (Gilhooly et al 2011)
  • To assess driving ability of disabled people and older adults (Unsworth)
  • To select interventions for upper limb hypertonicity in children with cerebral palsy (Rassafiani)
facilitated discussion on approaches to expertise development
Facilitated discussion on approaches to expertise development.
  • Questions
  • How do we recognise expertise?
  • How can we research expert practice?
  • How can we use this knowledge to educate novices in Higher Education?