The experiences of new graduates learning to make intervention decisions in diverse paediatric workplace settings: A cross-case analysis

Introduction: New graduates commonly experience challenges making client-related decisions. Current occupational therapy literature has predominantly focused on new graduates’ general experiences of commencing practice and experienced clinicians’ perceptions of clinical decision making. This study aimed to explore new graduate occupational therapists’ experiences of learning to make intervention decisions in paediatric practice. Methods: A case study approach enabled exploration of the experiences and reflections of 18 new graduate and eight experienced occupational therapists working in three paediatric service delivery contexts—private practice, acute hospital and non-government settings. Data were collected using semi-structured interviews, observations, informal discussions, review of documents and reflective journal entries. Similarities and differences across the three cases were examined. Results: Contextual influences, including time pressure, clinical risk and self-expectations, shaped new graduates’ experiences of learning to make intervention decisions. These influences impacted new graduates’ access to common support mechanisms, such as informal discussions with colleagues, formal workplace supervision and shared workplace resources, and prompted them to draw on supports and resources external to the workplace.  Conclusions: Understanding the contextual influences that shape new graduate allied health practitioners’ experiences of learning to make intervention decisions assists professional bodies, workplaces and universities to better target the training and support provided to new graduates to ensure that their intervention decisions promote positive client outcomes. Furthermore, the research findings can increase new graduates’ understanding of both workplace and external support mechanisms that assist clinical decision making and the possible impact of high self-expectations on their decision-making experiences.