Document Type (Journals)

Original Research


The purpose of the study was to establish and quantify the minimal important change (MIC) value necessary to determine gains or losses in clinical reasoning during student fieldwork assignments as measured by the Self-Assessment of Clinical Reasoning in Occupational Therapy (SA-CROT). This multicenter prospective longitudinal study was conducted with students on their occupational therapy fieldwork in Japan. Two anchor-based methods were used to estimate the MIC values: a receiver operating characteristic-based method and a predictive modeling-based method. The MIC was adjusted based on the percentage of participants who exhibited improvement. Administered were the SA-CROT and the Global Rating of Change (GRC) scale as an anchor. A total of 111 students from 11 occupational therapy educational programs in Japan responded (response rate 29%). Overall, there was a significant difference (p < .001, effect size was r = .80) in SA-CROT before and after fieldwork, and 81% of students showed improvement in the GRC scale. The adjusted MIC value was 3.69, with 95% confidence interval of 2.29–4.97. This anchor-based, adjusted MIC value is the most reliable value to interpret the changes in SA-CROT before and after fieldwork. The SA-CROT's MIC value can be used as a cut-off point from a learner-centered perspective when considering educational methods and environments in fieldwork.


Sho Maruyama, PhD, OTR is a visiting researcher at Tokyo Metropolitan University and an occupational therapy department manager at Shonan-Keiiku Hospital. He holds a Master's Degree in Rehabilitation Sciences and a Doctor's Degree in Occupational Therapy Sciences. His research interests focus on clinical reasoning, reflection, and clinical education for occupational therapy students and practitioners.

Reiko Miyamoto, PhD, OTR currently holds the position of Associate Professor at the Department of Occupational Therapy, Tokyo Metropolitan University. Her research focuses on several areas, including decision-making and self-recognition using fMRI and fNIRS, basic handwriting skills, stigma related to individuals with disabilities, the education of occupational therapists in clinical training, and the development of new educational tools using virtual reality. Her educational topics encompass cognitive rehabilitation and vocational therapy for clients with brain injuries, as well as support for clients in decision-making processes.

Satoru Amano, PhD, OTR is an associate professor of rehabilitation at Kitasato University, where he teaches occupational therapy, including functional assessment and practice, rehabilitation for physical disorders, and other courses. He also serves as a part-time lecturer for Hyogo Medical University. He holds a Master's Degree in Health Sciences and a Doctor's Degree in Medical Sciences. His research interests focus on stroke rehabilitation and psychometric properties of functional assessment. His research on rehabilitation practices has been published in Topics in Stroke Rehabilitation, Disability and Rehabilitation, Physical Therapy, Clinical Rehabilitation, and Stroke.

Takuto Nakamura, PhD, OTR is an Assistant Professor at Kanagawa University of Human Services with a Master's Degree in Rehabilitation Sciences and a Doctor's Degree in Health and Social Services. His research focuses on Autism Spectrum Disorder, family support, and scale development.

Peter Bontje, PhD, OTR is a professor in the occupational therapy department at Tokyo Metropolitan University. He holds a Ph.D. from the Karolinska Institute. His research topics are occupational science, client-centered inter-professionalism, peer support, and first-person perspectives.

Declaration of Interest

We have no conflicts of interest to disclose.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.