Enhancing Clinical Reasoning in Occupational Therapy Education Through Miller's Pyramid
In occupational therapy education, Miller's Pyramid of Clinical Competence (1990) serves as a relevant framework for developing students' clinical reasoning abilities. Within the context of education, the levels of the pyramid correspond to the acquisition of theoretical knowledge, practical application, supervised clinical practice, and autonomous clinical decision-making.
Here's a look at Miller's Pyramid and how it can be applied in occupational therapy education:
Knows (Knowledge): This is the foundation of the pyramid, encompassing the factual knowledge base of the principles and concepts underlying occupational therapy. For example, knowledge of anatomy, physiology, psychology, and the occupational therapy practice framework.
Knows How (Competence): Here, students develop the ability to apply their knowledge of therapeutic principles to solve problems. This involves clinical scenarios, case studies, simulations, and other problem-based learning exercises.
Shows How (Performance): Next, students demonstrate their competence in simulated settings. Learning experiences like practicing techniques in a lab or role-playing client interactions are appropriate at this stage.
Does (Action): The pinnacle involves students applying their knowledge and skills in real-world clinical situations through fieldwork placements and internships, thereby gaining exposure to diverse clinical populations and refining clinical skills under the guidance of experienced practitioners.
Pyramid graphic from Ramani, S., & Leinster, S. (2008). AMEE Guide no. 34: teaching in the clinical environment. Medical Teacher, 30(4), 347–364.
How to Use Miller's Pyramid of Clinical Competence with OTu to enhance clinical reasoning:
Build the “Knows” level through video-based lectures/handouts and assess factual recall through MicroLearning.
Elevate students to “Knows How” with Case Studies and other problem-solving activities.
Allow students to “Show” their knowledge through clinical simulations found in MiniSIMS using standardized patients.
Provide the crucial “Does” experience through MacroSIMS to augment students’ supervised fieldwork.
By aligning educational objectives and curricula with Miller's Pyramid, occupational therapy educators can systematically cultivate students' clinical reasoning skills throughout their academic training. This holistic approach prepares future occupational therapists to deliver evidence-based, client-centered care and to thrive in diverse practice settings.
Ready to transform your classroom? Schedule a meeting with our Education Lead, Sheila R. Krajnik, EdD, OTR/L.