Diagnostic Reasoning by Experienced Speech-Language Pathologists and Student Clinicians

Document Type


SoTL Category

Student Reflections/Perspectives

SoTL Discipline


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ABSTRACT: Purpose: Clinical reasoning, or problem solving, has been described as “the often intangible, rarely explicated thought processes that lead to the clinical decisions” that clinicians make on a daily basis while caring for patients (McAllister & Rose, 2000, p. 205). In many health care–related disciplines, extensive research has been conducted in the area of clinical reasoning and how clinicians come to make the clinical decisions they do. In speech-language pathology, there has been extremely limited research in the area of clinical reasoning. The present study explored the diagnostic clinical reasoning used by experienced speech-language pathologists as well as by student clinicians for the purpose of understanding and comparing the patterns of each. Method: This qualitative study made use of the “think-aloud” (TA) method of data collection to gain insights into the thought processes of 15 experienced clinicians with at least 5 years of clinical experience and 15 speech-language pathology graduate student clinicians. Each participant was given 2 abbreviated fictional case studies—1 adult and 1 child. The TA responses were recorded and transcribed for later analysis. Results: Results suggested that student clinicians and experienced clinicians shared many thinking processes; however, experienced clinicians were more likely than student clinicians to engage in planning specific assessment hierarchies, developing contingency plans for the assessment process, and making connections between the assessment process and treatment planning. Conclusion: With greater understanding of how experienced clinicians approach diagnostic clinical reasoning, we are better prepared to develop evidence-based educational approaches to teaching graduate students how to develop effective and efficient diagnostic clinical reasoning skills.


This article was published in Contemporary Issues in Communication Sciences and Disorders. (2016). DOI: https://doi.org/10.1044/cicsd_43_S_87