Apprenticeship programs--United States; Experiential learning--United States


In order to practice as an occupational therapist, students must complete clinical educational experience as part of their graduation requirements. During this experience, a supervising clinical instructor (CI) provides feedback and guidance that builds the foundation for clinical reasoning skills of the student. The CI-student learning alliance represents the relationship that supports this educational experience. This study used qualitative methodology based in grounded theory to examine the role of the CI-student learning alliance in facilitating students’ development of clinical reasoning by studying the relationship between CIs and fourth semester graduate occupational therapy students during a level I fieldwork experience at a university on-campus teaching clinic. Five themes emerged from the data including: 1) Clinical Instructors Assessed How a Student Learns Best; 2) Clinical Instructors Used Different Ways to Facilitate the Clinical Reasoning Process and the Learning Alliance; 3) The Nature of Feedback was Important; 4) Students Took a Positive, Active Approach to Learning; and 5) Student Autonomy was Preserved. The themes that emerged appeared to simultaneously support the learning alliance and the development of clinical reasoning. This information may provide CIs and occupational therapy students with a better understanding of strategies used in fieldwork settings that contribute to the development of an effective CI-student learning alliance and the development of students’ clinical reasoning.

First Advisor

Anne Birge James, PhD, OTR/L

Second Advisor

Kirsten Wilbur, MSOT, OTR/L

Date of Completion

Spring 2013

Degree Type







Degree Name

Master of Science in Occupational Therapy (MSOT)

Date of Award



Occupational Therapy


University of Puget Sound