Significant efforts in the past decades to teach evidence-based practice (EBP) implementation has emphasized increasing knowledge of EBP and developing interventions to support adoption to practice. These efforts have resulted in only limited sustained improvements in the daily use of evidence-based interventions in clinical practice in most health professions. Many new interventions with limited evidence of effectiveness are readily adopted each year—indicating openness to change is not the problem. The decision-making (assessment and intervention selection) process in the clinical setting is highly reliant on heuristic reasoning due to the speed of real-time interactions. The selection of a specific intervention is the outcome of an elaborate and complex cognitive process, which is shaped by how they represent the client’s problem in their mind and is mostly invisible processes to others. Importantly, the cognitive representation can be “fuzzy” or incomplete even to the thinker. Therefore, the complex thinking process that support appropriate adoption of interventions should be taught more explicitly. Making the process visible to healthcare providers increases the acquisition of the skills required to judiciously select one intervention over others. Specifically, using strategies which make thinking visible supports the healthcare provider in developing a rich, evidence-informed cognitive representation of client problems and the possible interventions which should be considered. One’s cognitive framing of the problems underly the heuristic reasoning and richer, evidence-informed models are more likely to support the selection of appropriate actions.  The purpose of this presentation is to provide a review of the selection process and the critical analysis that is required to appropriately decide to trial or not trial new intervention strategies with patients.

Angela Benfield is an occupational therapist with over 22 years of clinical experience, mostly in pediatrics and an assistant professor of occupational therapy. Her research explores the skills, knowledge, and habits of mind and practice which support establishing competency and the development of expertise. She also examines the properties of educational activities which support these habits and the development of critical thinking in students. She developed the measure of Evidence-informed Professional Thinking using Rasch analysis which allows for the identification of healthcare professionals whose habits of practice may limit their ability to maintain competent practice or develop expertise.