In this rapidly changing health care environment, practitioners and educators need to be flexible thinkers and skilled in clinical reasoning. They need to develop divergent approaches to solutions to complex, ill structured problems. Ill-structured problems in health care are problems that are not clearly delineated in that the nature of the problem, intermediate steps and goals are often unknown at the referral and initial interview stages of intervention. The clinical reasoning used to understand and solve this type of problems requires more than just guessing, ignoring, appealing to authority, or using rote protocols (Facione & Facione, 1996). Students need to develop these skills of reasoning, establish the connection between theory and practice, and apply these skills in client intervention. My interest in the development of clinical reasoning and reflective practice grew out of a particular concern for discovering how we can facilitate students to develop these skills beyond the technical rational approach that has been adopted in the past. Thus the purpose of this qualitative research is to explore the clinical reasoning and thinking of occupational therapists and students in Hong Kong within the context of the local culture. I used an action research approach informed by grounded theory. This involved a dynamic interaction between my research, teaching, and reflection in constructing and generating propositions, thus I incorporate insights about clinical reasoning development into my teaching and my teaching informs my research development. I incorporate the literature to substantiate and expand my understanding of clinical reasoning development and constructivist approaches to learning. I refer to clinical reasoning strategies that correlate with my study and suggest relationships. I discuss methods I have developed for promoting the learning of these clinical reasoning skills by our occupational therapy students. The teaching and learning strategies reflect

Where courses have as an aim the promotion of reflective practice, it will enhance the achievement of the goal if the level of reflective thinking is assessed. To do this in a satisfactory way requires a reliable protocol for assessing the level of reflection in written work. This article presents a protocol that can be used to guide the allocation of work to four categories, namely: habitual action/non-reflection, understanding, reflection, and critical reflection. Intermediate categories can also be used. Detailed descriptors of each category to guide the process are provided. The protocol was tested by four assessors independently using it to grade a set of written work, and very good agreement was obtained.
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