Graduate Theses and Dissertations (2019 - present)
Date of Award
5-2026
Document Type
Dissertation
Degree Name
Ph.D.
Department
Instructional Design and Development
Committee Chair
Joel Billingsley, Ph.D.
Advisor(s)
James Van Haneghan, Ph.D., Shenghua Zha, Ph.D. Anjanetta Davis, Ph.D.
Abstract
The objective of this research was to explore the effects of the think aloud (TA) method on the development of clinical reasoning in occupational therapy students completing an online simulation assignment. The study aimed to determine if thinking aloud develops clinical reasoning in occupational therapy students as evidenced by a change in clinical reasoning skill scores and investigates the relationship between students' overall clinical simulation competency scores.
This study used a mixed methods design, combining quantitative and qualitative data to explore and measure the use of the TA strategy on the development of clinical reasoning skills. The sample from this study consisted of twenty participants. Fifteen participants were first-year students in a doctoral occupational therapy program and five were second-year students from the same program. All participants took the Health Sciences reasoning (HSR T) test before and after the online simulation. Students were divided into two groups often, one group designated as the TA group and the other designated as the non-TA group. The TA group was required to verbalize their thoughts as they completed the simulation, while the non-TA group did not. Both groups were asked to complete an online survey, explaining what they learned about their clinical reasoning skills after completing the simulation. The quantitative data was analyzed using two-way mixed analysis of variance (ANOVA) and correlational analysis, while the qualitative data was analyzed using thematic analysis. The study also used verbal protocol analysis (VPA) to examine the TA group's verbalizations.
The quantitative data from this study revealed no statistically significant increase in overall critical thinking scores for the think aloud group, nor a statistically significant difference in HSRT scores between the TA and non-TA groups. The study also found that the participants' clinical simulation competency scores were high, with nineteen out of twenty scores falling within the range of 90 -100. The study also noted that the restricted range in competency scores limited correlational findings between competency scores and HSRT scores. However, the qualitative data identified four central themes related to the impact of thinking aloud, which included cognitive processing, active learning, metacognition, and self-regulation.
The study concluded that while the TA protocol did not significantly improve critical thinking scores, it facilitated metacognition, self-awareness, and self-regulation of cognitive processes. The study had limitations, including the small sample size, which made drawing valid inferences from the data difficult. Future research should investigate the effectiveness of the TA methods in different contexts and with larger sample sizes.
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Recommended Citation
Talylor, Candra Selene, "Exploring Clinical Reasoning in Occupational Therapy Students Using Think Aloud During Computerized Patient Simulation" (2026). Graduate Theses and Dissertations (2019 - present). 244.
https://jagworks.southalabama.edu/theses_diss/244
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Curriculum and Instruction Commons, Educational Methods Commons, Medical Education Commons, Occupational Therapy Commons, Other Medicine and Health Sciences Commons