Australian Occupational Therapy Journal (2008) doi: 10.1111/j.1440-1630.2007.00718.xBlackwell Publishing AsiaResearch ArticleIdentification of occupational therapy clinical expertise: Decision-making characteristicsMehdi Rassafiani,1 Jenny Ziviani,1 Sylvia Rodger1 and Lenard Dalgleish21Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia, and 2Department of Nursing and Midwifery, The University of Stirling, Stirling, Scotland, UKBackground: Experts are usually determined on thebasis of length of experience, reputation, peer acknow-ledgement, and certification. While these characteristics areimportant they may, however, not be sufficient for this pur-pose. Another method for determining clinical expertise isto look at how individuals make decisions in their area ofexpertise. This study aims to identify clinician expertiseon the basis of participants’ decision performance andexamines this in relation to their length of experience andtype of decision-making.Methods: The Cochran–Weiss–Shanteau (CWS) is a statis-tical method that can be used to examine individuals’ expertiseon the basis of how they discriminate between hypotheticalcases and consistency in their decision-making. Partici-pants comprised 18 occupational therapists, each with morethan 5 years of experience working with children withcerebral palsy. They were required to make treatmentjudgements for 110 cases (20 of which were repeated) ofchildren with cerebral palsy. The CWS was calculated foreach participant.Results and conclusions: Two groups of participantswere identified on the basis of their CWS index — one withboth high consistency in decision-making and the ability todiscriminate between cases, the other with low consistencyand poor discrimination. These two groups did not differsignificantly on the basis of length of experience or worksetting but did differ on the basis of intervention chosenand their type of decision-making. The CWS method seemsto offer promise as a means of determining clinical expertiseon the basis of clinical decision-making. Its application to theinvestigation of clinical reasoning and education is discussed.KEY WORDS cerebral palsy, decision-making, policy-making, professional competence, upper limb function.IntroductionThere are many areas of clinical practice in occupationaltherapy where strong evidence about the efficacy ofinterventions is not yet available. In these circumstancesreference to expert judgement may be undertaken(Gigerenzer & Goldstein, 1996; Weiss & Shanteau, 2003).Yet, how are experts identified and how confident canwe be with their level of expertise?Experts have been thought of as individuals at the topof their profession who achieve this status through formaltraining and experience (Shanteau, 1999). Expertise isdomain specific (Weiss & Shanteau, 2001) and relates toa defined area of knowledge. Experts differ from novicesin the methods they employ when solving problems.While novices use a search processing model in whichthey look for relevant information, experts use schematicprocessing in which they match decisions against storedpatterns of information. Schematic processing is rapidand automatic and the expert is often not conscious ofusing it (Hagedorn, 1996). Experts have also been foundto have superior short- and long-term memory, and seeproblems at a deeper level (Glaser & Chi, 1988).In studying clinical reasoning, researchers may useexperienced occupational therapists to examine thera-pists’ reasoning process as well as reasoning outcomes(Chapparo, 1997; Mattingly & Fleming, 1994). The studyof clinical reasoning of experienced therapists providesresearchers with an understanding of the ways in whichthey view dilemmas and solve problems (Burke &DePoy, 1991). This type of research has been useful ininforming both graduate and undergraduate education(see for example, Case-Smith, 2001; Copley & Kuipers,1999). Yet central to this research is the means by whichexperts are determined. Traditionally, several proce-dures have been employed for identifying experts withinMehdi Rassafiani BS(OT), MS, PhD; Senior Research Assistant.Jenny Ziviani BAppSc(OT), BA. MEd, PhD; AssociateProfessor. Sylvia Rodger BOT, MEd St, PhD; AssociateProfessor. Lenard Dalgleish BSc(Hons), PhD; Professor.Correspondence: Mehdi Rassafiani, Division ofOccupational Therapy, School of Health and RehabilitationSciences, The University of Queensland, Brisbane, Qld 4072,Australia. Email: [email protected] for publication 11 June 2007.© 2008 The Authors Journal compilation © 2008 Australian Association ofOccupational Therapists2 M. RASSAFIANI ET AL.© 2008 The AuthorsJournal compilation © 2008 Australian Association of Occupational Therapistsareas of clinical practice (Shanteau, Weiss, Thomas &Pounds, 2001, 2003). The number of years of job-relevantexperience is the most widely used criteria. However,while this is a necessary condition it may very well notbe sufficient. Accreditation is another recognised method.Peer identification or social acclamation can also beemployed, but can be confounded with ‘popularity’.Consistency in decision-making has also been identified asoccurring more in experts than novices. High consistency,however, does not necessarily ensure correct decisions.Consensus reliability (that found between experts) canbe used to identify or confirm experts, however, this canbe confounded by artificial consensus such as groupthinking in which a group of experts may agree on acourse of action without this necessarily being the mostappropriate. Subject Matter Experts (SMEs) in whichdecisions of ‘top experts’ become a gold standard is thefinal method. All these approaches have limitationsrelated to subjectivity and can be susceptible to politicalpressure (Weiss & Shanteau, 2001). In the absence ofgold standards it has been argued that looking at indi-vidual behaviour is the most effective way forward(Weiss & Shanteau, 2003), because experts are expectedto demonstrate better clinical results, as a consequenceof accurate and relevant reasoning (Higgs & Jones,2000).Weiss and Shanteau (2003) proposed a method calledCochran–Weiss–Shanteau (CWS) index to assess the levelof expertise based on actual performance. This methodaims to assess expertise purely on the basis of dataobtained from judgement exercises (Weiss & Shanteau,2005). It further assumes that experts should