Clinical Reasoning Development: Enhancing Independent and Group Rational Decision Making

Kelly Galvin

Research output: Types of ThesisDoctoral Thesis


Technology is ranked as one of the most important factors influencing education in Australia, with a growing demand for digital innovation to elevate the learning experience. Online opportunities for clinical education have also recently expanded, as evidenced by 80 new health portfolio subjects developed at Torrens University of Australia (TUA) during the years 2018 – 2021, with clinical reasoning being a key skill for learners in Health sciences and Nursing courses to cultivate. While there are documented reasons why problem-based learning (PBL) and team-based learning (TBL) are both used in clinical education, research has often focused on assessment scores and learner perceptions when comparing Face-to-Face (F2F) traditional lecture style with a group learning experience. This thesis explores the potential for combining elements of traditional PBL and TBL (hybrid approach) to enhance development of independent and group clinical reasoning skills for undergraduate learners within an online environment.

A longitudinal research approach encompassed multiple design-based research (DBR) phases using qualitative reflexive thematic analysis (RTA) method for data interpretation. An initial scoping review and pilot cycle resulted in a set of four draft design principles used to inform testing, refining and retesting an online decision wheel tool artefact and hybrid PBL approach in the situated context of Torrens University. Bounded rationality theory was used as an analytical guide to reflect on enhancing decision-making holistically. In total (excluding focus group numbers), participants included 34 learners, 26 teachers , 5 digital designers and 1 central researcher involved in developing, delivering and reviewing levels of undergraduate health science and nursing subjects across Face-to-Face (F2F), Blended Learning (BL) and Fully Online Learning (FOL) platforms. Data generated before and during the impact of COVID-19 consisted of 44 interviews, 20 focus groups, 10 participant reflective journal entries (4 learners and 6 teachers), 65 researcher reflective journal entries and 40 learner decision wheel attempts over five DBR action cycles (12-week Trimesters).

This study makes an original contribution to both practice and theory by offering a set of six innovative final design principles to assist enhancing clinical reasoning development for a situated context. Although there is a fast-paced universal move towards digital innovation in higher education, identification and response to contextualised learning needs for stakeholders is important for quality experience. From this research a new PBL-informed model, named BE-HIVE, was conceptualised to operationalise specific final design principles inclusive of having a central teacher guide, adequate coaching support, simple learning designs, time for reflexive practice, and enhancing the ability for a diversity of key stakeholders to collaborate and be partners in curriculum. Additionally, this project has generated new understanding into the potential expansion of bounded rationality theory, along with how to adopt a methodologically cohesive and solely qualitative approach for design-based research.

Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Townsin, Louise, Supervisor
  • Moss, Timothy, Supervisor, External person
Award date1 May 2023
Publication statusPublished - 2023


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