the clinical reasoning tool (crt) in mentorship

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 [email protected]

(416) 975-5347, ext. 228

Samidha JoglekarAudiology Advisor &

Manager of Mentorship (English & French)

[email protected](416) 975-5347, ext. 220

mailto:[email protected]

mailto:[email protected]

5Oct-20

Agenda

• Background • Mentorship Version of the CRT• Examples of Clinical Reasoning• Using the CRT with a Mentee• Answers to Your Questions

6Oct-20

Background

7Oct-20

Previous E-Forum

Clinical Reasoning Tool - Development, Evaluation and Remediation

Access the slides and recording:https://caslpo.com/events/upcoming-events

Background

https://caslpo.com/events/upcoming-events

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


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

17Oct-20

The Mentorship Version of the Clinical Reasoning Tool (CRT)

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 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

https://caslpo.com/members/registration-and-membership-renewal/mentorship/mentorship-overview

https://caslpo.com/sites/default/uploads/files/MTR_EN_Clinical_Reasoning_Tool_Mentorship.pdf

20Oct-20


• 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


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


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


• 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.

24Oct-20

Let’s Have a Closer Look at the Mentorship Version of the

CRT!

25Oct-20

CRT Mentorship Version, pg. 3

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.”


CRT Mentorship Version

28Oct-20

CRT Mentorship Version, pg. 4-7

Collected, Applied, Linked, Patient Context, Options, Flexible, Reasonable

29Oct-20



30Oct-20



31Oct-20



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.

35Oct-20

Clinical Reasoning Examples

36Oct-20


• 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

37Oct-20


38Oct-20

How to Use the CRT with a Mentee

39Oct-20


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


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).


https://caslpo.com/sites/default/uploads/files/GU_EN_Mentorship_Program_Guidelines.pdf

43Oct-20


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.


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.


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


47Oct-20


• 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



48Oct-20


• 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”


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


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.

53Oct-20


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)


55Oct-20


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


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


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.

59Oct-20

Questions

60Oct-20

THANK YOU!

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