problem solving cycle journal

The Process of Problem Solving

• Editor's Choice
• Experimental Psychology
• Problem Solving

In a 2013 article published in the Journal of Cognitive Psychology , Ngar Yin Louis Lee (Chinese University of Hong Kong) and APS William James Fellow Philip N. Johnson-Laird (Princeton University) examined the ways people develop strategies to solve related problems. In a series of three experiments, the researchers asked participants to solve series of matchstick problems.

In matchstick problems, participants are presented with an array of joined squares. Each square in the array is comprised of separate pieces. Participants are asked to remove a certain number of pieces from the array while still maintaining a specific number of intact squares. Matchstick problems are considered to be fairly sophisticated, as there is generally more than one solution, several different tactics can be used to complete the task, and the types of tactics that are appropriate can change depending on the configuration of the array.

Louis Lee and Johnson-Laird began by examining what influences the tactics people use when they are first confronted with the matchstick problem. They found that initial problem-solving tactics were constrained by perceptual features of the array, with participants solving symmetrical problems and problems with salient solutions faster. Participants frequently used tactics that involved symmetry and salience even when other solutions that did not involve these features existed.

To examine how problem solving develops over time, the researchers had participants solve a series of matchstick problems while verbalizing their problem-solving thought process. The findings from this second experiment showed that people tend to go through two different stages when solving a series of problems.

People begin their problem-solving process in a generative manner during which they explore various tactics — some successful and some not. Then they use their experience to narrow down their choices of tactics, focusing on those that are the most successful. The point at which people begin to rely on this newfound tactical knowledge to create their strategic moves indicates a shift into a more evaluative stage of problem solving.

In the third and last experiment, participants completed a set of matchstick problems that could be solved using similar tactics and then solved several problems that required the use of novel tactics.  The researchers found that participants often had trouble leaving their set of successful tactics behind and shifting to new strategies.

From the three studies, the researchers concluded that when people tackle a problem, their initial moves may be constrained by perceptual components of the problem. As they try out different tactics, they hone in and settle on the ones that are most efficient; however, this deduced knowledge can in turn come to constrain players’ generation of moves — something that can make it difficult to switch to new tactics when required.

These findings help expand our understanding of the role of reasoning and deduction in problem solving and of the processes involved in the shift from less to more effective problem-solving strategies.

Reference Louis Lee, N. Y., Johnson-Laird, P. N. (2013). Strategic changes in problem solving. Journal of Cognitive Psychology, 25 , 165–173. doi: 10.1080/20445911.2012.719021

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Encyclopedia of Evolutionary Psychological Science pp 6287–6292 Cite as

Problem Solving

• Shameem Fatima 3  
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• First Online: 01 January 2021

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Complex problem solving ; Problem solving ability ; Social problem solving

A problem is a condition that needs to be resolved to achieve a desired goal. Problem-solving makes use of higher order cognitive processes that regulate lower order mental processes to achieve the goal. Problem solving ability is a person’s capability to transform the problematic condition to the goal state by using higher cognitive functions.

Introduction

The whole life involves problem solving from small scale to large scale problems, from simple to complex problems, and from personal and psychological to social, environmental, and collective problems. Problem solving in all problems involves three components: givens (facts or stimuli presented), goals (desired ending), and operations (methods or techniques to achieve the desired objective). Commonly, we engage in problem solving to overcome hindrances, to accomplish a goal, or to find a solution to a problem that has no readymade solution...

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Fatima, S. (2021). Problem Solving. In: Shackelford, T.K., Weekes-Shackelford, V.A. (eds) Encyclopedia of Evolutionary Psychological Science. Springer, Cham. https://doi.org/10.1007/978-3-319-19650-3_625

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OPINION article

Use of a creative problem solving (cps) approach in a senior thesis course to advance undergraduate publications.

• Department of Psychological Science, Albion College, Albion, MI, United States

We outline a creativity-based course model for supervising and promoting undergraduate research at a small liberal arts college of about 1,600 undergraduate students, with no graduate offerings. This approach could easily be modified and implemented at weekly brownbag or joint laboratory meetings at similar and larger types of schools. At our institution this course is required of all psychology research thesis students (on average 8 per year) and requires the cooperation of the students, their thesis supervisors, and the course instructor. In part because of this course, during the past 20 years, our department faculty have published a total of 47 publications with undergraduates in peer-reviewed outlets such as Personality and Individual Differences, Psychology of Music, Psychology of Women Quarterly , and Sex Roles . Importantly, according to PsycINFO, these undergraduate-generated publications have garnered more than 500 citations, attesting to the impact that undergraduate research can have on the larger field in terms of knowledge generation. In addition to impactful peer-reviewed publications, our undergraduate students have presented 163 posters at national conferences such as the Association for Psychological Science, Society for Personality and Social Psychology, Society for Neuroscience, and Psychonomic Society. Below we outline how our senior thesis course stimulates the creative dissemination of knowledge that is required during the publication process.

Our senior thesis course structure is based on the Creative Problem Solving (CPS) framework, a well-known and validated approach to creativity enhancement in educational settings. This approach emphasizes creative and critical thinking in instruction—both at an individual and a group level ( Baer, 1988 ; Isaksen et al., 1994 ; Treffinger et al., 2006 ). In the CPS framework, creative thinking occurs when a problem or challenge is considered from many different perspectives, which leads to a multitude of possible solutions or answers (this is also known as divergent thinking—see Wieth and Francis, 2018 for a review). In this stage of creative problem solving, many original solutions or answers are desired ( Boynton, 2001 ). The second aspect of the CPS framework is critical thinking (also known as convergent thinking—see Wieth and Francis, 2018 for a review). After generating possible solutions to a problem or challenge, it is essential for the student to converge on a single most useful solution for that particular problem or challenge ( Campbell, 1960 ; Mednick, 1962 ; Lundsteen, 1986 ; Amabile, 1988 ; Mumford, 2003 ; Sternberg, 2010 ). In this article, we outline how using the CPS framework in our senior thesis research course has prepare and enable our students to thrive during the publication process.

Reiterative critical feedback of written and oral production is an essential component of the CPS approach used in our senior thesis course. Written assignments in this course are no different than what advisors usually ask of their thesis students (e.g., complete a draft of the Introduction or Method), but in keeping with the CPS approach, each written component goes through a cycle of creative and critical feedback from several peers during class. As can be seen from the most recent syllabus, available as Supplementary Material , students must bring their writing to class four times across the semester to be reviewed by peers. Collaboration, social support ( John-Steiner, 2000 ), and honest critique ( Nemeth et al., 2001 ) are viewed as key factors in creative breakthroughs. Therefore, each time peer-review occurs, students are asked to provide and receive constructive feedback from at least two peers in the course. The instructor of the course orchestrates the pairings to ensure that students receive a diverse set of feedback. Typically, a student is paired with a classmate using a similar research approach AND with a classmate using a very different research approach. At a liberal arts college, there is often only one faculty member per psychological discipline (e.g., cognitive psychology), so a student may be working with an advisor that is a cognitive psychologist but receiving feedback from a student working with a social psychologist or neuroscientist. Receiving feedback from someone in a different area of psychology often encourages more divergent thinking and helps students understand the greater context of their research. In other words, the first step in the peer-review process is designed to encourage more creative thinking.

The second part of the CPS framework employed during peer-review in the senior thesis course is designed to encourage critical thinking by having students to practice converging on a best solution to a problem or challenge. For example, during the peer-review process, each student must decide which suggestions are appropriate and helpful for their project and which suggestions are counter to the purpose of the project. However, unlike when students receive feedback from their faculty advisor or an outside faculty member, students feel more comfortable critically evaluating the suggestions from their peers. This provides an excellent mechanism for students to practice critical evaluation after being exposed to a wide range of feedback.

Another way we encourage critical thinking in our course is to scaffold students' research by having students make four platform presentations, each with a different focus for a different audience. During the class, students make two 20-min platform presentations to their peers and other faculty. After receiving feedback from peers on the written portion of the Introduction and Method, the student must give a presentation that covers the Introduction and Method sections. After receiving feedback from peers on the written portion of the Results and Discussion, the student must give a presentation that covers the Results and Discussion sections. After presenting for the allotted time, there is approximately 15 min of discussion devoted to each student's project and presentation. The student's research advisor along with other faculty in the department attend these presentations throughout the semester and provide feedback in an intellectually safe environment. The attendance of faculty other than the instructor is of critical importance during these presentations and serves several purposes. In addition to instruction and practice of psychology presentation skills, the discussion after the presentation allows the faculty to model appropriate conflict resolution and problem solving strategies. Research has shown that fostering an environment where honest and thoughtful dissent is accepted and appreciated enhances productivity and fosters creativity ( Nemeth et al., 2004 ). At first students are often surprised and perhaps a bit intimidated when they experience two or more faculty members debating some aspect of their project, but by the end of the semester, students are more comfortable joining in the debate in a meaningful and appropriate way. Modeling critical and thoughtful responses not only leads our students to hone their thinking and presentation skills, it also provides them essential experience for responding to comments during the peer-review publication process.

As a culminating experience, students must also present their work in two other venues: a regional undergraduate psychology conference and a college-wide research symposium. The purpose of these myriad presentations is for students to learn what components of all the work they have done are essential for presentation to different audiences. In other words, students must converge on a best solution depending on the audience to whom they are presenting. In each situation, the student must modify their presentation for the audience. For many of our research students, this is their first foray into professional psychology meetings, so rather than going initially to a national meeting, we require students in the course to present at regional undergraduate psychology research conference held each spring. This meeting provides students with the opportunity to receive additional reviews of their work, this time from psychology faculty and other psychology majors at different schools who may bring perspectives different from those in our department. To develop more critical feedback response skills, students are required to present at a college-wide symposium given to faculty and students outside the psychology department. For the all-college symposium, students learn how to present their research in a very different way than they have done for their theses and presentations to “psychology-oriented” audiences. For instance, although the importance of basic research into personality may be self-evident to psychologists, it is less obvious to faculty and students not trained in our discipline. Thus, students need to, again, think about their work from a wider perspective, this time including a very diverse audience, to find the most effective way of presenting their research. Much like the peer-review process often provides researchers with different and sometimes even conflicting suggestions; these presentations help students see their own work from multiple perspectives and forces them to choose a presentation and feedback response format that best fits the audience.

Our course outlined here prepares students for what is required during publication by exposing our students to diverse feedback from students, psychology faculty, and college-wide faculty. This is similar to the sundry reviews authors often receive after submitting a manuscript. In addition, our creativity focused classroom model also promotes critical thinking, a fundamental component of creativity, as outlined by the CPS framework ( Isaksen et al., 1994 ). By teaching students to evaluate feedback from a variety of individuals and adjust their presentations to various audiences, we are encouraging critical thinking that helps students understand the importance of finding the best way to present their research. Furthermore, these critical thinking skills help students not get overwhelmed by reviews of their manuscript and the, often many, demands reviewers make. Providing this course to all thesis students in our department has enabled us to teach students more about the research and publication process, allowed us to include more students on publications and national presentations that arise from their own research, and support our fellow faculty in their senior thesis advising endeavors by ensuring that their students meet their goals and deadlines. Using the CPS framework in a course, does take a certain amount of effort and collaboration from advisors, students, and other faculty, but we, and our fellow faculty in the department, believe that those efforts are well-spent as our senior thesis students' work often turns into influential publications in their respective fields.

Author Contributions

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00749/full#supplementary-material

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Treffinger, D. J., Isaksen, S. G., and Dorval, K. B. (2006). Creative Problem Solving: An Introduction (4th ed.). Waco, TX: Prufrock Press.

Wieth, M. B., and Francis, A. P. (2018). Conflicts and consistencies in creativity research and teaching. Teach. Psychol. 45, 363–370l. doi: 10.1177/0098628318796924

Keywords: undergraduate research, mentoring undergraduate students, faculty collaborations, student development, graduate school preparation

Citation: Wieth MB, Francis AP and Christopher AN (2019) Use of a Creative Problem Solving (CPS) Approach in a Senior Thesis Course to Advance Undergraduate Publications. Front. Psychol. 10:749. doi: 10.3389/fpsyg.2019.00749

Received: 30 November 2018; Accepted: 18 March 2019; Published: 09 April 2019.

Reviewed by:

Copyright © 2019 Wieth, Francis and Christopher. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Mareike B. Wieth, [email protected] Andrea P. Francis, [email protected] Andrew N. Christopher, [email protected]

† These authors have contributed equally to this work

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Journaling for Problem Solving: Effective Techniques and Prompts

A problem is often followed by a lot of emotions, thoughts, or information. We need to navigate through this to find the best solution. This can be overwhelming. To work through the problem, you might need to get the problem out of your head and into the open. One way to do this is with a journal for problem-solving.

Table of Contents

Your problems might come in many different shapes. You might be in emotional turmoil or have to make a difficult decision. With an issue as broad as this, there isn’t one kind of journaling effective for all kinds of problems.

Let’s have a look at 4 journaling techniques and 12 prompts for problem-solving.

Types of journals for problem solving

There are several types of journals you can use for solving problems. Let’s have a look at 4 of those.

1. Thought journal

A thought journal is a type of journaling where you let your thoughts flow uninterrupted onto the paper. There is no predefined structure, no prompts, or anything else for you to think about. Your thoughts need to run freely.

You’ll often get new insights and ideas when you let your thoughts run freely. This is great for finding alternative solutions to a problem. Sometimes you won’t get any useful insights with you journal. That’s okay. You gave your brain a chance to vent and calm down, which is just as valuable.

How to use a thought journal

Thought journaling is a simple yet effective type of journaling for problem-solving. Here’s how you can do it in 3 steps:

• Take a moment to reflect on your problem. What is it? How does it make you feel? What are you thinking right now? Take a moment to be present with whatever is going on.
• Start writing using your short reflection as a starting point. Let your thoughts flow uninterrupted onto the paper.
• Continue writing until your head feels clear, you have found a solution, or you don’t want to write anymore.

You might want to go through your journal once you’ve finished to see if there are any insights you’ve missed in the middle of writing.

When to use a thought journal for problem solving

You can use a thought journal as a tool to solve any kind of problem. But it’s most effective when it’s related to high stress or anxiety.

2. Pros and cons

You probably already know the pros and cons list. It’s a classic tool to help you make a decision when you have to choose between a limited number of options.

How to use pros and cons

The pros and cons list is probably the simplest tool on this list. Here’s how you can do it yourself.

• Have a piece of paper and divide it into two columns. Name one column pros and the other cons.
• Fill the pros column with all the good things about this option
• Fill the cons column with all the negatives about this option

Once you’ve filled the columns, it’s time to reflect. How does your situation look now that you’ve weighed your options side by side?

If you have to choose between more than one option, such as which school to pick, you can go through the process with each option.

When to use a pros and cons for problem solving

The pros and cons list works best when you have to make a decision between a limited number of options. This might be choosing a school or a job. The more options you have, the less effective this method is.

3. Fake letter for problem solving

Fake letters are a popular journaling technique where you’ll write a letter to either yourself or someone else. The reason why it’s fake is that it’ll never be sent. Nobody but you will ever see it.

There are several types of fake letters. Here we’ll look into two of them. One for problems and another for difficult emotions

How to use a fake letter for problem solving

Most people find it easier to find a solution to a friend’s problem than to find one on their own. A fake letter for problem-solving takes advantage of this.

With this technique, you’ll pretend that a friend is in the exact same situation as you. They have asked for your advice on how to solve a problem they’re facing (your problem). Write a letter to your friend and give them advice on how to solve it.

Your advice might not be perfect every time, but it’ll help you think no matter what. It’ll help you move closer to a solution.

How to use a fake letter to vent

A fake letter to vent is similar to the one for problem-solving. The main difference is that you’re looking for tension relief instead of a solution here.

With this technique, you’ll write a fake letter to someone else. Someone who has frustrated you lately but that you aren’t able to tell how you feel. Pretend to write a letter to that person. In the letter, you tell them whatever it is you need to do.

Remember, you don’t have to sugarcoat anything. Let all your anger, sadness, fear, or frustration out. Write whatever it is you need to, how you need to.

When to use a fake letter for problem solving

A fake letter for problem solving is effective for any kind problem.

When to use a fake letter to vent

A fake letter to vent should be used when a person, thing, or situation provokes a lot of strong feelings in you.

Related: Find peace with a gratitude journal

4. Prioritization journal

When we have to make a difficult decision, we often have to prioritize between several things. When you know what you want, that’ll be easy.

Most people have an idea about what they want, but once they dig a little deeper, they have no idea.

A prioritization journal can help you dig past the surface and discover what you truly want. And the more you practice this, the better you’ll know yourself. The easier it’ll be to make decisions and prioritize.

Related: Learn how to increase productivity with a journal

How to use a prioritization journal

Before you can use your prioritization journal to solve problems, you have to know what your priorities are.

• Spend some time on self-discovery. Make a list of your values, dreams, and life necessities.
• Give each item on your list a number. Give the most important thing 1, the second 2, and so on. Be sure that you rank them based on how you really feel.
• Update the list frequently to ensure that it’s still relevant.

Once you have a list of priorities, you can use it as a tool every time you face a new decision. Weight how the different decisions affect the long-term effect of your goals and values. The option which benefits your top priorities is usually the best decision.

This method is similar to a goal journal. You can read more about goal journaling here .

Related: How to beat procrastination

When to use a prioritization journal for problem solving

This type of journaling can be used for any kind of problem but are most effective when you have to make a difficult decision. This might be when choosing a school, a job, or something as simple as whether you should go to the gym today.

Journaling prompts for problem solving

Prompts are short statements or questions that can help you get started with a journal and can work on numerous things. One of them is problem-solving. Here are 12 prompts you can use for your problem-solving journal.

• Describe a recent challenge that you’ve overcome. How did you do it?
• Identity a recurring issue in your life. What is it and how can you overcome it?
• Take a complex issue you’re facing and break it into as many smaller parts as possible. Which part of the problem can you solve right now?
• Think back to a situation where you had to make a tough decision. What did you chose and how did it play out?
• Think back to a time where you faced failure or setback. How did you bounce back?
• Think back to a moment where things didn’t go as planned. How did turn out?
• What is the worst thing that can happen? How likely is it that this will happen?
• Think back to a time where you successfully collaborated with someone else. How did it turn out?
• Right now, what feels best to me?
• If I make this choice, how do I think it’ll affect my future?
• Have a faced a similar problem in the past. Did I learn anything from it?
• What would I do in this situation if I didn’t care about what other people think?

Finishing thoughts

Journaling is a great tool for problem-solving. It can give you an overview of the situation, calm your thoughts and emotions, and help you make a decision that aligns best with your values.

Hopefully, you’ll find that journaling can make dealing with your problems a bit easier.

What to read about next:

The Power of Small Wins: Achieving Success One Step at a Time

Thought journal: Journaling for stress and anxiety

Productivity Journaling: Unlocking Efficiency and Success

Gratitude Journal: A Beginner’s Guide to Cultivate Gratitude

Reach Your Goals with a Goal Journal: Turn Dreams into Reality

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Use of the ICF Model as a Clinical Problem-Solving Tool in Physical Therapy and Rehabilitation Medicine

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Werner A Steiner, Liliane Ryser, Erika Huber, Daniel Uebelhart, André Aeschlimann, Gerold Stucki, Use of the ICF Model as a Clinical Problem-Solving Tool in Physical Therapy and Rehabilitation Medicine, Physical Therapy , Volume 82, Issue 11, 1 November 2002, Pages 1098–1107, https://doi.org/10.1093/ptj/82.11.1098

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The authors developed an instrument called the “Rehabilitation Problem-Solving Form” (RPS-Form), which allows health care professionals analyze patient problems, to focus on specific targets, and to relate the salient disabilities to relevant and modifiable variables. In particular, the RPS-Form was designed to address the patients' perspectives and enhance their participation in the decision-making process. Because the RPS-Form is based on the International Classification of Functioning, Disability, and Health (ICF) Model of Functioning and Disability, it could provide a common language for the description of human functioning and therefore facilitates multidisciplinary responsibility and coordination of interventions. The use of the RPS-Form in clinical practice is demonstrated by presenting an application case of a patient with a chronic pain syndrome.

The most effective health care interventions for complex medical conditions, such as those encountered in people with chronic diseases, are thought by many authors to probably be delivered by multidisciplinary care teams. 1 This team model originates from the belief that a comprehensive therapeutic approach is required to fully address the current health care needs of patients with complex or chronic diseases. 2 , 3 Such integrated care, in our view, requires an exchange of information among all people involved in the therapeutic process. Multidisciplinary health care thus necessitates tools that function across professional boundaries 4 and that can handle differences in perspectives (eg, those shown to exist between physicians and nurses). 4 , 5 Health care professionals, as well as their patients, may perceive specific needs and disorders and their overall management quite differently. 4 , 6 – 8 Dissimilar points of view regarding a patient's health care needs and goals can lead to inappropriate treatment strategies, can hamper communication, 9 and can decrease the patient's adherence. 10 In order to avoid critical differences between the patient's and the health care professional's treatment goals, the goals need to be clarified prior to planning interventions. 11

Another important aspect is that the consequences of disease manifest differently in different people. Although many patients may have the same disease, their responses to disease can be unique, and these particulars can become crucial in the care of patients. 12 Patient-centered practice is thought by some authors 13 to improve health status and increase the efficiency of care.

To summarize our thoughts, a patient-centered evaluation tool is needed in order to acknowledge the views, experience, and perspectives of all participants involved in the health care process. Ideally, such a tool should fulfill the clinical needs of both the patient and the health care team, should be simple to use, and should have a background that can be accepted by all involved partners.

Based on the framework of the Rehabilitation Cycle (and its modified version, the Rehab-CYCLE) developed by Stucki and Sangha 14 ( Fig. 1 ), we developed a further extension that we called the “rehabilitation problem-solving form” (RPS-Form) ( Fig. 2 ). This form is used to identify specific and relevant target problems, discern factors that cause or contribute to these problems, and plan the most appropriate interventions. In addition, the RPS-Form was designed to be used as a tool to facilitate both intraprofessional and interprofessional communications and to improve the communication between health care professionals and their patients.

The Rehab-CYCLE is a modified version of the Rehabilitation Cycle developed by Stucki and Sangha. 14 It guides the health care professional with a logical sequence of activities. Endpoints of this rehabilitation management system are successful problem solving or individual goals achieved. The Rehab-CYCLE involves identifying the patient's problems and needs, relating the problems to relevant factors of the person and the environment, defining therapy goals, planning and implementing the interventions, and assessing the effects.

The Rehabilitation Problem-Solving Form (RPS-Form) is based on the International Classification of Functioning, Disability, and Health (ICF) Model of Functioning and Disability 15 (see Fig. 3 ). The main difference is that the RPS-Form is divided into 3 parts: (1) header for basic information, (2) upper part to describe the patient's perspective, and (3) lower part for the analysis of the health care professionals. Copyright 2000 by Dr Werner Steiner, Switzerland. Reprint allowed with permission only.

The aims of our article are to present the theoretical construct that underlies the recently developed RPS-Form and to advocate its use in rehabilitation. The Rehab-CYCLE is used as a framework to present this clinical problem-solving tool because the rehabilitation team followed the different steps of this approach and because we believe the RPS-Form and the World Health Organization's (WHO) International Classification of Functioning, Disability, and Health (ICF) Model of Functioning and Disability 15 that underlies this approach ( Fig. 3 ) are integrated in the Rehab-CYCLE.

The International Classification of Functioning, Disability, and Health (ICF) Model of Functioning and Disability 15 visualizes the interactions among the various components in the “process” of functioning and disability. The ICF provides a description of situations with regard to human functioning and disability and serves as a framework to organize information. Functioning and disability (“body functions and structures,” “activities,” and “participation”) are seen as an interaction between the “health condition” (“disorder/disease”) and the contextual factors (“personal factors” and “environmental factors”). This figure has been modified and reprinted with permission of the World Health Organization (WHO), and all rights are reserved by the Organization.

The Rehab-CYCLE

Rehabilitation, in our view, is a continuous process that involves identifying the problems and needs of individuals, relating the problems to relevant factors of the person and the environment, defining therapy goals, planning and implementing the interventions, and assessing the effects of interventions using measurements of relevant variables. To guide health care professionals in successful rehabilitation management, Stucki and Sangha 14 developed the Rehab-CYCLE. The ultimate goal of the Rehab-CYCLE is to improve a patient's health status and quality of life by minimizing the consequences of disease.

The Rehab-CYCLE ( Fig. 1 ) is a structured approach to rehabilitation management that includes all tasks from problem analysis to the assessment of the effects, thereby involving the patient in clinical decision making. The emphasis is on the patient's perspective (eg, through patient-rated questionnaires), taking into account the patient's needs and preferences, and discussing therapy goals by means of the RPS-Form, which will be presented in this article.

Because the consequences of disease manifest differently in different people, it is necessary to have a conceptual framework for ordering and understanding what disease means to a patient. At the Institute of Physical Medicine of the University Hospital Zurich (Zurich, Switzerland), the WHO's ICF Model of Functioning and Disability 15 was recently implemented for this purpose by using the RPS-Form.

The RPS-Form consists of a single data sheet that is based on the ICF. The ICF classifies health and health-related components (such as education and labor) that describe body functions and structures, activities, and participation.

The overall aim of the developers of the ICF was to provide a unified and standard language and framework for the description of all aspects of human health and some health-relevant aspects of well-being. 15 The ICF provides a structure to present this information in a meaningful, interrelated, and easily accessible way. The information is organized in 2 parts, with each part having 2 components. Part 1 of the ICF (functioning and disability) consists of (1) body functions and structures and (2) activities and participation, and part 2 of the ICF (contextual factors) consists of (1) environmental factors and (2) personal factors.

Each ICF component can be expressed in both positive and negative terms. At one end of this scale are the terms that indicate nonproblematic (ie, neutral and positive) aspects of health and health-related states, and at the other end are the terms can be used to indicate problems. Nonproblematic aspects of health are summarized under the umbrella term “functioning,” whereas “disability” serves as an umbrella term for impairment, activity limitation, or participation restriction.

An ICF component consists of various domains and, within each domain, categories, which are the units of the ICF classification. All ICF categories are “nested” so that broader categories are defined to include more detailed subcategories of the parent category.

Health-related states of an individual are then recorded by selecting the appropriate category code or codes and then adding qualifiers, which are numeric codes, and specifying the extent or the magnitude of the functioning or disability in that category or the extent to which an environmental factor is a facilitator or barrier (for details, see the recently released full version of the ICF 15 ).

The ICF also provides a model of functioning and disability, which reflects interactions between the components of the ICF ( Fig. 3 ). The ICF Model of Functioning and Disability 15 is a biopsychosocial model designed to provide a coherent view of various dimensions of health at biological, individual, and social levels.

As illustrated in Figure 3 , an individual's functioning or disability in a specific domain represents an interaction between the “health condition” (eg, diseases, disorders, injuries, traumas) and the contextual factors (ie, “environmental factors” and “personal factors”). The interactions of the components in the model are in 2 directions, and interventions in one component can potentially modify one or more of the other components.

The RPS-Form

The RPS-Form ( Fig. 2 ) is constructed similarly to the ICF Model of Functioning and Disability ( Fig. 3 ). Each component of the ICF model is graphically highlighted by a gray background. For instance, “disorder/disease” (or “health condition”) is highlighted at the top of the model; the main components of functioning or disabilities are highlighted in the middle of the model, with (left to right) body level (“body structures/functions”), individual level (“activities”), and societal level (“participation”); and the contextual factors (“personal factors” and “environmental factors”) are highlighted at the bottom of the model. As indicated in Figure 2 by the gray arrows pointing downward and upward, “disorder/disease” as well as “environmental factors” and “personal factors” may have an impact on all components of functioning and disabilities.

The RPS-Form is designed to distinguish between the perspectives held by the patient and those of the health care professional. The patient's view is recorded in the upper part of the form denoted with “patient (or relatives): problems and disabilities,” and the health care professional's views are noted in the lower part denoted with “health professionals: mediators relevant to target problems.” The header of the RPS-Form is reserved for basic information: identification of the patient (“pat. no.”), form identification number (“form no.”), date (“date”), disorder/disease (eg, in words), current medication (“medication”) and case coordinator (“coordinator”).

RPS-Form: Case of a Woman With Chronic Pain

A 49-year-old woman of Asian origin who had been living in Switzerland for over 20 years, was married, had no children, and had worked for 10 years as a nurse was referred as an inpatient to the Department of Rheumatology and Institute of Physical Medicine at the University Hospital Zurich for treatment for generalized painful reactive arthritis. This referral followed an episode of gastrointestinal infectious disease 2 years previously, with a positive stool identification of Yersinia enterocolitica as the pathogenic agent. Upon entry, the patient had a chronic pain syndrome that mostly affected her cervical (C5-C6 degenerative modifications) and thoracic spine. The patient also had pain at multiple locations such as in the elbows, hands, knees, and feet. No additional involvement of the axial skeleton could be found. One year prior to referral as an inpatient she started receiving weekly injections of methotrexate (increasing the dose from 10 to 25 mg at time of referral), with hydroxychloroquine (2 × 200 mg/d) added after 7 months and sulfasalazine (4 × 500 mg/d) added after 10 months. This mixed drug therapy did not alleviate the patient's symptoms.

At various times in the past, the patient received at the University Hospital Zurich corticosteroid injections in both feet and elbow (Kenacort * 20 mg/injection), which together with numerous sessions of physical therapy helped to reduce the symptoms. The patient's chronic secondary depression was treated with antidepressive agents (Surmontil † 10 mg/d), which did not entirely alleviate this condition. As a consequence of this chronic pain syndrome, the patient reduced her professional activity as a nurse to 60% 3 years before she was referred as an inpatient, and she stopped all professional activity 2 years later.

The clinical laboratory investigations made at the beginning of her hospitalization were normal, with no indication of any inflammatory or infectious activity, muscle degradation, or any other metabolic or biological abnormality. The diagnosis at the time of discharge from the hospital was chronic multifactorial pain syndrome with cervical and thoracic spondylarthritis and status after reactive arthritis associated with secondary depression. The patient continued her basic medication, including her antirheumatic drugs (weekly methotrexate injections of 20 mg, hydroxychloroquine 2 × 200 mg/d). The patient was discharged from the bed unit after 2 weeks and then was admitted to the Interdisciplinary Outpatient Pain Program (IOPP), which is hosted at the Department of Rheumatology and Institute of Physical Medicine of the University Hospital Zurich.

Identification of problems and disabilities and reporting them on the RPS-Form

According to Stucki and Sangha, 14 the identification of a patient's problems and needs is the first step in rehabilitation management. In the case of our patient, a series of interviews were initially conducted with the rehabilitation team (physician, psychologist, physical therapist, and social worker). In addition, questionnaires were used to comprehensively assess her experience with chronic pain. These questionnaires were the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), 16 a generic health status measure; the Hospital Anxiety and Depression Scale (HADS), 17 which we used as a screening instrument for depressive and anxiety disorders; and the Coping Strategies Questionnaire (CSQ), 18 which we used to analyze the patient's pain coping strategies.

The concerns of the patient, as compiled by the various members of the health care team and supported by the analysis of the initial SF-36, HADS, and CSQ results, were then reported by the case coordinator on the upper part of the RPS-Form ( Fig. 4 ). In order to avoid interpretation that goes beyond the patient's statements, we argue that it is essential to describe these concerns in the patient's own words and to discuss these entries with the patient.

The Rehabilitation Problem-Solving Form (RPS-Form) applied to a patient with chronic pain. The form visualizes the current understanding of the patient's state of functioning and disability, her target problems, and how the health care professional team relates them to hypothetical mediators and contextual factors. NSAID=nonsteroidal anti-inflammatory drugs. Copyright 2000 by Dr Werner Steiner, Switzerland. Reprint allowed with permission only.

As shown in Figure 4 , the patient reported neck pain, as well as pain in the hands and feet. She often felt tired, which she said prevented her from participating in leisure clubs as she had done 2 years before. Writing or housekeeping activities that involved lifting and carrying objects with the hands (eg, using a vacuum cleaner) were very difficult tasks for her. Walking long distances became almost impossible due to the pain in her feet, and she could no longer join her husband on his walks. Above all, she was anxious about losing her job as a nurse as a consequence of the further degeneration of her health and that this would lead to financial dependency on her husband.

Relate problems to relevant and modifiable factors

So far, the problem analysis that occurred was a compilation of the patient's problems and needs. Each specialist then examined the patient, keeping in mind concerns stated by the patient on the RPS-Form.

Through this process, the rehabilitation team tried to relate these problems to impairments, activity limitations, participation restrictions, or personal and environmental factors. All team members were requested to generate hypotheses about cause and effects. That is, the rehabilitation team attempted to identify those characteristics of the patient or her environment that caused or contributed to her problems, either directly or indirectly by transmission. The multiple interactions between patient and environment, and between all components of the patient's organism, require thinking in terms of causal networks, rather than in straight lines where A causes B, which leads to C. 12

Because it is often unclear whether a variable is directly responsible for a disability or whether it is a trigger that releases certain processes linked with the disability, the umbrella term “mediator” is used on the RPS-Form to describe such variables. The concept of mediation 19 is explained in Figure 5 .

The concept of mediation as explained by Baron and Kenny. 19 (A) Variable X is assumed to affect another variable (variable Y). Variable X is called the initial (or independent) variable, and the variable that it affects (variable Y) is called the outcome variable. The direct impact of the independent variable is indicated by path c. (B) The effect of variable X on variable Y is mediated by a process or mediating variable (variable M), with path b indicating the impact of the mediator. The variable X may still affect variable Y (path c′). The mediator also has been called an intervening or process variable. Complete mediation can occur when variable X no longer affects variable Y (path c′ = zero) after variable M has been controlled.

Mediators, as identified by the various members of the rehabilitation team, are reported by the case coordinator on the lower part of the RPS-Form ( Fig. 4 ). At this stage, the RPS-Form is completed to be discussed at the next interdisciplinary treatment team meeting.

Which terms should be used to denote mediators?

In order to ensure a common language for interdisciplinary teams, we recommend that health care professionals specify the mediators on the RPS-Form, listing corresponding terms that are listed in the ICF 15 ( Fig. 4 ). Only the well-defined ICF items, we believe, can ensure consistency in the use of terminology across disciplines, and inconsistency can pose a barrier to effective communication. 20

The ICF terms can be interpreted by means of 3 separate but related constructs, 15 all using “qualifiers” for operationalization. Body functions and body structures can be described by a qualifier, with the negative scale used to indicate the extent or magnitude of an impairment (eg, the qualifier “s73021.2” can be used to indicate moderate impairment of the joints of the hands and fingers). For the activities and participation component, 2 constructs are available: capacity and performance. 15 The capacity qualifier describes an individual's ability to execute a task or an action, and the performance qualifier describes what an individual does in his or her current environment. Both qualifiers can be used with and without personal assistance or assistive devices. For simplicity, these 2 constructs are not differentiated further in this article. Therefore, the activities and participation classification results in a single list of items, denoted by a leading “d.” The item code “d240.3” ( Fig. 4 ), for example, refers to the ICF item d240 (“difficulty in handling stress and other psychological demands”), without differentiating between activities and participation. The qualifier “3” denotes a severe difficulty in accomplishing this task, disregarding aspects of capacity and performance.

Qualifiers also can be added to environmental factors. A decimal point denotes a barrier (.1 to .4), whereas a plus sign denotes a facilitator (+1 to +4). 15 For our patient ( Fig. 4 ), the former medication (ie, chronic abuse of pain killers [e1101.2]), was considered a moderate barrier for her rehabilitation.

Although personal factors or resources are extremely importance in the rehabilitation process, 21 they are not classified in the ICF because of the large social and cultural variance associated with them. 15 In our opinion, however, this should not hinder the rehabilitation team in addressing personal factors relevant to the target problems or in describing their quantitative property in analogy to the qualifier system applied to environmental factors ( Fig. 4 ). In our case, personal factors considered relevant to problem solving were: command of the German language (+3 denotes a severe facilitator), personality (+1), social background (−1), and coping strategies (−2).

Define target problems and target mediators on the RPS-Form

After clinical examination of the patient and compilation of all limiting and modifiable mediators on the RPS-Form, a revision process is needed to exchange information within the rehabilitation team as well as with the patient in order to define realistic therapy goals and to plan the most appropriate interventions. The clinical examination may have revealed underlying conditions that force the health care professional to set therapy goals that differ from the personal preferences and beliefs of the patient. When using the Rehab-CYCLE to revise the problems mentioned by the patient ( Fig. 4 , upper part), there is a desire to meet the patient's expectations and to achieve his or her commitment, but always taking into account practical and evidence-based knowledge of the rehabilitation team (eg, aspects of secondary and tertiary prevention). Thus, this process of defining the target problems is usually the result of consent between the patient and the health care team. The target problems are visualized on the RPS-Form by circling the corresponding items. In the case of our patient, they include the alleviation of pain in the neck, hands, and feet and the avoidance of sick leave ( Fig. 4 ).

The importance of the mediators compiled by the health care professional on the RPS-Form might vary from low to high, as does their potential to be modified during the intervention period. It is the “art of rehabilitation” to discern the target mediators (ie, those mediators supposed to have the greatest potential to solve the target problems). This process generally takes place at the interdisciplinary team meeting, where the RPS-Form serves as a basis for team members to discuss findings and hypotheses in the framework of the ICF Model of Functioning and Disability. According to the target problems, the resulting target mediators are marked on the RPS-Form by circling the corresponding items ( Fig. 4 ). Lines can be then drawn to each of the corresponding target problems (dark connecting lines in Fig. 4 ).

The case model

Once these hypothetical relationships are stated by the health care team, the RPS-Form represents an explicit and interdisciplinary elaborated “case model,” explaining by which mediators the target problems can be solved. Because this case model is based on assumptions, the rehabilitation team must carefully explore associations or causal links between mediators and target problems during the intervention period. Individual therapy goals can now be formulated, usually including both target problems and target mediators, and the RPS-Form serves as an excellent tool for communicating these goals to the patient.

The model of our case ( Fig. 4 ) shows that the target problem “pain in neck, hands, feet” is mediated by 3 pathways: (1) by mechanisms related to the body functions (ie, “general physical endurance,” “hypertonia of neck,” and “muscle power functions: arms/feet”), (2) by an indirect mechanism (ie, “difficulty in handling stress and other psychological demands,” and (3) by poor coping strategies. Similarly, the target problem “partial incapacity for work (60%) → avoid sick leave” was related to the same mediators except coping strategies.

Mediators considered by the health care professional to have a low potential to solve the patient's problems during the treatment process are not directly included in this initial case model ( Fig. 4 ). However, their importance might change with progress of the rehabilitation process.

Plan, implement, and coordinate interventions

The concept of the IOPP emphasizes the active participation of the patient and a multidisciplinary team approach to treatment. According to the target mediators specified on the RPS-Form, the initial program for our patient included physical therapy to decrease the muscle contractures of the neck, to improve her general physical endurance, and to increase the muscle force in her arms and feet. The psychological therapy focused on learning daily living strategies to manage pain (ie, coping strategies), to better handle stress (eg, at work), and to deal with other demands (eg, her husband wanted her to accompany him on long walks). Medical therapy included the use of nonsteroidal anti-inflammatory drugs to manage her joint problems.

Assess effects of interventions

A rehabilitation management program for complex medical conditions, we believe, needs a routine check of goal attainment by comparing outcomes with target problems ( Fig. 1 , “assess effects”). Use of qualifiers, as shown in Figure 4 , allows the rehabilitation team to quantitatively monitor results in longitudinal care. However, information about the sensitivity and reliability of this new qualifier measurement system is still absent. A better solution to measure longitudinal changes of outcomes would be to use validated instruments such as psychometrically sound questionnaires and standardized clinical parameters. 22 In the case of our patient, outcomes have been measured by a battery of instruments. The corresponding assessment information was presented in the interdisciplinary team meeting. The presentation of these results would go beyond the aims of this article and is disregarded here.

According to the patient's progress in the rehabilitation process, it might be necessary to adjust treatment. After the assessment of effects ( Fig. 1 ), or when a full round of the Rehab-CYCLE is completed, the rehabilitation team compares changes of target problems and target mediators with therapy goals. The degree of problem solving, among other topics, is then a key factor for the rehabilitation team to decide whether a new “problem-solving cycle” should be completed.

The Rehab-CYCLE is therefore an evolutionary and interactive approach that implies continuous survey and a dynamic handling of all elements of the problem-solving process. Each RPS-Form represents a snapshot model of a patient's functioning and disabilities. We therefore advocate that, for every patient with complex health problems, several consecutive RPS-Forms should be used in longitudinal care, these forms should be collected as comprehensive documentation of the treatment process, and this process should be related to observed outcomes. Thereby, sound instruments such as internationally validated, patient-rated questionnaires can help the health care professional to measure whether therapy goals are achieved.

The RPS-Form described in this article has been applied to many different health conditions (eg, cardiovascular disease, neurologic problems such as hemiplegia, musculoskeletal problems such as arthritis and low back pain) at the Institute of Physical Medicine of the University Hospital Zurich. This tool, we believe, is simple to use, helps to fully address the patients' perspectives, and serves as a platform where multidisciplinary care teams can exchange information using a common language. The RPS-Form supports care teams in offering a visual representation of the salient aspects of a disease, as well as of the relationships between disabilities and underlying factors. Therefore, this tool also forms a basis for treatment team meetings to discuss the individual goals of the interventions. The underlying ICF Model of Functioning and Disability provides both the common language and the rational framework for the description of health states associated with diseases and disorders.

The ICF (and the preceding ICIDH-2: International Classification of Disability and Health 23 ) is the result of an effort that started in 1993 and that focused on cross-cultural and multisectoral issues and involved the active participation of 1,800 experts from 65 countries. 15 Studies have been undertaken in an effort to ensure that the ICF is applicable across cultures, age groups, and genders, and it can be used to collect reliable and comparable data on health outcomes of individuals and populations. The ICF was accepted in November 2001 by 191 countries as the international standard to describe and measure health and disability. At present, the ICF is available in 6 languages (English, French, Spanish, Arabic, Chinese, and Russian); translations into other languages (eg, German) will follow in 2002. Because the ICF contains the collective views of an international group of experts, 23 we believe the RPS-Form permits international communication about clinical problem solving at any level of health.

There are other major conceptual models that can guide health care professionals in understanding disabilities and functioning. Earlier conceptual models used in the same context were reviewed by Jette. 24 One of the first models was developed by the sociologist Nagi. 25 Nagi's classification scheme varies from that of the WHO 23 , 26 primarily by suggesting the concept of functional limitations, that is, the physical manifestation of functional problems at the level of the organism as a whole. According to Nagi, 25 a functional limitation represents a direct way through which impairments contribute to disability. This conceptualization often is considered useful for differentiating between performance-based measures of function and self-reports, an important aspect that was not explicitly integrated in the WHO's International Classification of Impairments, Disabilities, and Handicaps (ICIDH). 26 However, this aspect is handled by the ICF with the introduction of the concept of capacity and performance.

In the history of rehabilitation management at the Institute of Physical Medicine of the University Hospital Zurich, the first model used in physical therapy was the model of Pope and Tarlov, 27 which is an extension of Nagi's basic disablement formulation. 24 With progress in the initial version of the ICIDH, 26 a revised version, the ICIDH-2, 28 was introduced as a tool for thinking about and describing health and health-related states such as functioning and disabilities. The ICIDH-2 differs substantially from the 1980 version of ICIDH in the depiction of the interrelationships between functioning and disability. The ICIDH-2 was found to be useful in rehabilitation, because the underlying model allows health care professionals to state the complex relationships between “health condition” (eg, diseases, disorders), the components of health (body structures and functions, activities, and participation), and the contextual (ie, environmental and personal) factors. Along with the growing international acceptance of the ICF, the ICF Model of Functioning and Disability and the corresponding classification scheme are considered the future tools for organizing information about functioning and disabilities.

Each model mentioned can be used to generate hypotheses about the interrelationships of different components included in the model. The key to successful rehabilitation management, however, is understanding the relationship between target problems and the components (impairments, functional limitations, and psychosocial and environmental factors) that affect them and addressing those (ie, the target mediators) with the most potential for improvement. In this process, the Rehab-CYCLE is open to all ideologies of hypothesis generating, clinical reasoning, and decision making.

The Rehab-CYCLE ( Fig. 1 ) is a structured approach to rehabilitation management that should help to systematically review disease consequences, to define therapy goals, to relate problems to mediators, and to optimize treatment by relating interventions to results during the rehabilitation process. It is thus similar to the hypothesis-oriented algorithm for clinicians (HOAC) described by Rothstein and Echternach 29 in that it guides the health care professional with a logical sequence of activities and relies on the patient to describe his or her problems and on the health care professional to generate testable hypotheses. Both approaches are open to any treatment strategy. The main difference, we believe, is that the Rehab-CYCLE is a more patient-centered approach with a biopsychosocial perspective.

In the case management at the Institute of Physical Medicine of the University Hospital Zurich, applying the new and unfamiliar systematic coding scheme of ICF classification initially hampered teamwork and communication among the health care team. It is not the correct coding of ICF items, but the problem-solving technique that can lead to better care for the patient. Therefore, when introducing the RPS-Form, health care professionals should feel free in how to describe health and disability (eg, permit initial flexibility in wording, neglect alphanumeric ICF codes and “qualifiers”). Even this simple version of the RPS-Form trains health care professionals in proceeding through the Rehab-CYCLE, permits both health care professionals and patients to focus on salient aspects of the disease, and assists with treatment decision making shared by both the patients and the health care professionals. Because understanding and motivation of the patient is usually a requirement for his active involvement in the rehabilitation process, the simple version of the RPS-Form could even be advantageous in the communication with certain patients.

After establishing the procedures associated with the RPS-Form, we believe the time may have come to introduce the standardized terms of the ICF classification. 23 Use of these terms then can ensure consistency in terminology across disciplines, improve interprofessional communication, and facilitate multidisciplinary responsibility and coordination of interventions in physical therapy and rehabilitative medicine.

Dr Steiner, Ms Ryser, Ms Huber, Mr Aeschlimann, and Mr Stucki provided concept/idea/design. Dr Steiner and Ms Huber provided writing. Ms Ryser provided data collection. Dr Steiner, Ms Ryser, and Mr Uebelhart provided data analysis. Dr Steiner and Mr Aeschlimann provided project management. Mr Aeschlimann provided fund procurement and clerical support. Ms Huber, Mr Uebelhart, and Mr Aeschlimann provided institutional liaisons. Mr Uebelhart and Mr Aeschlimann provided consultation (including review of manuscript before submission). The authors thank Leanne Pobjoy for her help in preparing the manuscript and Professor Beat A Michel, Director of the Department of Rheumatology and Institute of Physical Medicine, for his continuous support

The Rehab-CYCLE project has been supported, in part, by an unrestricted educational grant from the Zurzach Rehabilitation Foundation.

Bristol-Myers Squibb, La Grande Arche Nord, 92044 Paris, France.

Wyeth-Ayerst Pharmaceuticals, Div of American Home Products Corp, PO Box 8299, Philadelphia, PA 19101.

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ICIDH-2: International Classification of Functioning and Disability. Beta-2 draft, full version . Geneva, Switzerland : World Health Organization ; 1999 .

Rothstein JM , Echternach JL . Hypothesis-oriented algorithm for clinicians: a method for evaluation and treatment planning . Phys Ther . 1986 ; 66 : 1388 – 1394 .

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Problem-solving cycle.

The Problem-Solving Cycle (PSC) is a National Science Foundation funded project that has developed a research-based professional development (PD) model.  This model is highly adaptable and can be specifically focused on problems of practice that are of interest to the participating teachers and administrators.  Additionally, it can be tailored to highlight federal, state, district, and school-based initiatives that are ever-changing and ongoing in the life of a teacher.

The PSC project is a research-practice partnership with the San Francisco Unified School District.  The current focus is on creating teacher leaders in middle school math classrooms and studying the effect on student learning.  

PSC Project Products:

Borko, H., Carlson, J., Jarry-Shore, M., Barnes, E., & Ellsworth, A. (2017, May). All students & teachers as math learners: A partnership to refine and implement two interconnected models. Presented at Stanford University’s CSET’s Pondering Excellence in Teaching Talk Series, Stanford, CA.

Borko, H., Carlson, J., Deutscher, R., & Ryan, J. (2018, May). A research-practice partnership to build district capacity. Video presented at 2018 STEM For All Video Showcase. http://stemforall2018.videohall.com/presentations/1299  

Borko, H. (2021 August). The Problem-Solving Cycle and Teacher Leadership Preparation Program: Developing and Researching a Model for Bringing Mathematics Professional Development to Scale . Research Seminar [Zoom] presented at IPN Leibniz Institute for Science and Mathematics Education, University of Kiel. 

Borko, H., Carlson, J., Mangram, C., Anderson, R., Fong, A., Million, S., Mozenter, S., & Villa, A. M. (2017). The role of video-based discussion in model for preparing professional development leaders. International Journal of STEM Education, 4 (1), 1-15.

Borko, H., Carlson, J., Deutscher, R., Boles, K. L., Delaney, V., Fong, A., Jarry-Shore, M., Malamut, J., Million, S., Mozenter, S., & Villa, A. M. (2021). Learning to Lead: an Approach to Mathematics Teacher Leader Development. International Journal of Science and Mathematics Education , 1-23.

Conference Presentations

Borko, H. (2015, February). Design-based implementation research in schools: Benefits & challenges . Paper presented at AACTE, Washington, D.C.

Borko, H., & Carlson, J. (2016, April) Design-based implementation research: adapting a professional development leadership model with a school district” Paper presented at AERA in a symposium entitled A Behind-the-Scenes Look at Effective Video-Based Professional Development , Washington, D.C.

Borko, H. (2016, June). Preparing mathematics teachers to facilitate the problem-solving cycle professional development . Paper presented at the Symposium and Workshop on Video Resources for Mathematics Teacher Development at the Weizmann Institute, Rehovot, Israel.

Mozenter, S. (2017, February). Video-based discussions: Meeting the multiple demands of PD for content teachers serving English language learners. Presented at National Association for Bilingual Education, Dallas, TX.

Borko, H., & Villa III, A. M. (2017, March). Facilitating Video-Based Mathematics Professional Development. Presented at Teacher Development Group Leadership Seminar, Portland, OR.

Villa III, A. M., & Jarry-Shore, M. (2017, March). Facilitating video-based mathematics professional development. Research symposium at National Council of Teachers of Mathematics Research Conference, San Antonio, TX.

Carlson, J., Jarry-Shore, M., Barnes, E., & Ellsworth, A. (2017, March). All students & teachers as math learners: A partnership to refine and implement two interconnected models.   Presented at Stanford-SFUSD Partnership Annual Meeting, Stanford, CA.

Jarry-Shore, M., Fong, A., Dyer, E., Gomez Zaccarelli, F., & Borko, H. (2018, February).  Video for equity: Designing video-based discussions of student authority.  Presentation at Association of Mathematics Teacher Education, Houston, TX.

Fong, A., Dyer, E., & Gomez Zaccarelli, F. (2018, February).  A shared vision for teacher improvement: Adapting professional development for local context by leveraging district-developed tools.  Presentation at Association of Mathematics Teacher Education, Houston, TX.

Mozenter, S., Gomez Zaccarelli, F., & Ellsworth, A. (2018, February ).  Video-based discussions in service of student agency, authority, and identity. Presentation at the Association of Teacher Education, Las Vegas, NV.

Mozenter, S., Ellsworth, A., & Gomez Zaccarelli, F. (2018, March). Video-based discussions in service of student agency, authority, & identity. Presentation at the American Association of Colleges for Teacher Education, Baltimore. MD.

Borko, H., & Villa III, A. M. (2018, March ). Building district capacity to address student access & equity: A research-practice partnership to develop teacher leaders. Presentation at the Teacher Development Group Leadership Seminar, Portland, OR.

Borko, H., Carlson, J., & Treviño, E. (2018, April).  A research-practice partnership to develop district capacity: Learning with & from each other.  Paper presented at the American Educational Research Association, New York, NY. 

Mozenter, S., Borko, H., & Jarry-Shore, M. (2018, June). Complicating the connection: Immigrant-background teachers . Paper presented at Teaching & Teacher Education Special Interest Group of the European Association for Research on Learning and Instruction, Kristiansaand, Norway.

Treviño, E. Brown, A., Villa III, A.M., & Borko, H. (2018, November).  Deconstructing student math content knowledge and groupwork through video-based discussion. Presentation at California Mathematics Council - Northern Section Conference Asilomar, Pacific Grove, CA.

Jarry-Shore, M. (2018, November ). The in-the-moment noticing of the novice mathematics teacher. Paper and presentation at the North American chapter of the International Group for the Psychology of Mathematics Education, Greenville, SC.

Villa III, A.M., & Boles, K. (2019, February).  Actualizing agency, authority, identity, and access to content in two contrasting cases of mathematical groupwork . Presented at Association of Mathematics Teacher Education, Orlando, FL.

Borko, H., & Villa III, A.M. (2019, February/March). Building teachers’ capacity to promote students’ access to rigorous and meaningful mathematics through video-based discussions. Presentation at the Teacher Development Group Leadership Seminar, Portland, OR.

Gomez Zaccarelli, F., Villa III, A.M., Mozenter, S., Boles, K., Deutscher, R., Borko, H., & Carlson, J. (2019, April).  How students are oriented toward a mathematical task and their peers: Access to content, agency, authority, and identity. Paper presented at the American Educational Research Association, Toronto, Canada. 

Mozenter, S., & Borko, H. (2019, April ). “ Not many people ask me this kind of question.” Three contrasting cases of immigrant-background teachers . Paper presented at the American Educational Research Association, Toronto, Canada.

Borko, H., Carlson, J., & Deutscher, R. (2019,  April ). Learning environments to support teacher leaders’ learning to lead video-based discussions. Poster presented in the structured poster session at the American Educational Research Association, Toronto, Canada .

Villa III, A.M., Boles, K.L., & Borko, H. (2019, November ).  Teacher leader learning through participation in and facilitation of professional development addressing problems of practice . Paper and presentation at the North American chapter of the International Group for the Psychology of Mathematics Education, St. Louis, MO.

Boles, K. L., Jarry-Shore, M., Muro Villa III, A., Malamut, J., & Borko, H. (2020, June). Building capacity via facilitator agency: Tensions in implementing an adaptive model of professional development. In M. Gresalfi, & I. S. Horn (Eds.),  The Interdisciplinarity of the Learning Sciences, 14th International Conference of the Learning Sciences (ICLS)  (pp. 2585-2588). Nashville, TN: International Society of the Learning Sciences. 

Jarry-Shore, M., & Allen, T. (2020, December). Noticing Struggle to Support Student Understanding [Conference Presentation]. California Mathematics Council - North Conference, Pacific Grove, CA, United States.

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Rich mathematical tasks to develop powerful mathematical thinking

Flick through the eBooks for My Problem-Solving Journal and try out the sample problems

Overview      Books      Teaching Notes   

  Author Team   Webinar   Videos   

Check out this short overview video of My Problem-Solving Journal! 

My Problem-Solving Journal for rich mathematical tasks

• Inspire a love of maths with real-life scenarios and problems that are relevant to children
• Deepen conceptual understanding and explore the big ideas of mathematics
• Challenge all children at their level with low threshold high ceiling tasks
• A bank of age and stage appropriate problems at your fingertips
• Matched to the key topics in core maths programmes, including Planet Maths and Busy at Maths
• Teaching notes offer a comprehensive guide on how to approach each problem

Check out the books

Maths Week Challenge

Explore one problem in depth each week

• Strand and Strand Unit labels make it easy to map problems to the content you are covering in class.
• Maths Talk boxes encourage meaningful maths discussion.
• Top Tips provide helpful hints and prompts.
• Extension activities offer further opportunities to explore each topic.
• Dedicated workspaces scaffold children and create a record of learning.

Join teacher and author, Patrick Neary, to explore mathematical modeling in the primary classroom. See how seamlessly mathematical modeling can be emphasised through context-rich, open-ended problems, such as those found in My Problem-Solving Journal.

Join teacher and author, Elaine Dillion, to explore what problem-solving looks like for younger children . Examine how rich, meaningful tasks, such as those found in My Problem-Solving Journal, can be used to enrich children’s mathematical learning.

Teaching Notes

Teaching notes

Online teaching notes accompanying each problem:

• Provide an overview of the task
• List the specific skills addressed
• Guide teachers with specific teaching points
• Include anticipated student responses and possible solutions

See sample Teaching Notes

• We have created this handy guide for you to reference when using My Problem-Solving Journal in the classroom 

My Problem-Solving Journal in Three Simple Steps

"It provides everything teachers need to help children in their class become critical thinkers and problem solvers"

Patrick Neary, experienced teacher and one of the authors of My Problem Solving Journal explains how MPSJ provides rich mathematical tasks to develop powerful mathematical thinking, and inspires a love of maths with real-life scenarios and problems that are relevant to children.

Author Team

Author team

All of our authors are currently teaching different classes.

Patrick Neary is the author of 5th & 6th Class, and Series Editor of the programme. He holds a M.Ed., specialising in Mathematics Education, from DCU, where he has also lectured part-time. Patrick has worked closely with Maths4All to promote best practice in Maths Education.

Grace Lynch is the author of 3rd & 4th Class. She holds a M.Ed., specialising in Mathematics Education, from DCU, and has supervised undergraduate dissertations for students specialising in Mathematics Education in Marino Institute.

Elaine Dillion is the author of 1st & 2nd Class. She holds a M.Ed. from Maynooth University, where her thesis focused on exploring an effective use of play in the teaching and learning of mathematics. Elaine is an active participant and contributor to Maths4All.

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Clinical Reasoning: Defining It, Teaching It, Assessing It, Studying It

Clinical reasoning is a perennial focus of medical education, performance assessment, and study. It might be argued to be the defining characteristic of the profession. It is, however, a very complex and multi-faceted phenomenon that can create considerable confusion and cross-communication. Its importance makes it worthwhile to consider some of those complexities.

Defining it

Like the fable of the blind men and the elephant, each of whom, feeling a different part of the elephant, described it in very different ways, clinical reasoning is a vast, complex construct that is described and used in different ways by different people. There is no generally accepted definition of clinical reasoning and, indeed, many articles about clinical reasoning never define it explicitly; it is often assumed as a universally understood construct. For the present commentary, we can describe the clinical reasoning process as including the physician’s integration of her own (biomedical and clinical) knowledge with initial patient information to form a case representation of the problem. The physician uses this problem representation to guide the acquisition of additional information and then, on the basis of this information, revises the problem representation. She repeats the information gathering – representation revision cycle until she reaches a threshold of confidence in that representation to support a final diagnosis and/or management actions. 1 This very broad description subsumes numerous additional phenomena and questions: how is knowledge organized and accessed, how does expertise manifest itself in clinical reasoning, how are alternative representations evaluated, and so forth.

It is readily apparent to anyone reading the literature that “clinical reasoning” is used for a considerable variety of activities. Indeed, a skeptic may well ask “what is NOT clinical reasoning?” If the term comes to encompass any physician thinking about clinical problems, the concept becomes so expansive as to risk becoming useless as a guide to teaching, assessment and study. It is unlikely that we will achieve a clean taxonomy of clinical reasoning activities anytime soon, so in the meantime, it is important for anyone trying to teach, assess, or study clinical reasoning to recognize the complexity of the terms and be explicit about their operational definition.

In spite of this conceptual sprawl, there are still significant aspects of clinical reasoning that are largely ignored in the literature. Because it is often defined in terms of cognition, such things as context, affect, and institutional factors have rarely been examined for relevance to clinical reasoning. There is, however, a growing awareness of the importance of context and the larger system in which clinical reasoning takes place. 2 Thinking about clinical reasoning as if it were isolated in the physician’s head is no longer viable.

Another aspect of clinical reasoning that has suffered significant neglect is management–attention is primarily devoted to diagnostic reasoning, not therapeutic reasoning. The preoccupation with diagnostic tasks is understandable. There is the prospect of a “correct” diagnosis and the attraction of being able to classify reasoning as successful or unsuccessful is undeniable. If one can be “scored” as right or wrong, all the reasoning steps that led up to that answer can be examined in the same right-wrong light. In contrast, therapy is much more difficult to classify as “right” and “wrong.” It depends on many variables that can be combined in numerous ways and it is often proven right or wrong only in hindsight. Individual physicians can make plausible arguments for very different management alternatives. It is much more a “matter of opinion” or judgment than a universally correct solution.

Teaching it

Considerable effort goes into teaching clinical reasoning. Sometimes, this is the focus of specific courses, but it is a key goal of almost any course, clerkship or clinical rotation. Numerous innovations have been developed for teaching various aspects of clinical reasoning using carefully designed and selected cases, mnemonics for gathering information, identification of critical information to discriminate among diagnostic alternatives, appropriate methods for judging and managing uncertainty, de-biasing methods, and the like. These interventions are often designed to address common problems that learners demonstrate in clinical reasoning: inadequate knowledge, faulty data gathering, faulty data processing, or faulty metacognition. 3

A risk in all of these efforts is that we come to believe we are teaching “clinical reasoning” as a generalizable skill that can be applied to any clinical problem. Unfortunately, this fond hope has little empirical support. From the earliest studies of medical problem solving 4 , 5 to the present, the most reproducible result is that clinical reasoning performance is highly content (and context) specific. Solving a clinical problem in one discipline holds little predictive value for how one will do with a problem in another area. Even in problems with the same diagnosis, there is little consistency in performance. It is apparent that “reasoning skills” or “critical thinking” do not go far in helping develop clinical reasoning. Instead of general processes, it is knowledge that is key to performance. Indeed, most educational interventions that focus on clinical reasoning are also (perhaps implicitly) conveying knowledge in critical areas of medicine and it is this knowledge acquisition that fosters better performance.

At the extreme, this can be seen in the development of pattern recognition, in which knowledge of common patterns and relationships among information lead to recognition of disease possibilities WITHOUT conscious reasoning. Indeed, some do not consider “mere” pattern recognition as a manifestation of clinical reasoning simply because it bypasses the conscious, effortful thought processes and relies on automated cognitive processes. 6 Clinical reasoning extends well into non-conscious as well as conscious processes.

Assessing it

Numerous methods have been developed to assess clinical reasoning – or some part of it. A few examples are provided in the table . Each method addresses a component of the larger clinical reasoning process, often in the form of focusing on a particular sub-task, such as information gathering, adjusting diagnostic hypotheses for new information, using basic science knowledge to reason through an electrolyte problem, or prioritizing diagnostic alternatives. Each assessment method makes assumptions about the underlying construct (clinical reasoning) that must be considered before making general conclusions about an examinee’s competence.

Methods of assessing clinical reasoning.

Like teaching clinical reasoning, assessing it confronts the vexing phenomenon of content specificity. Even more challenging is the growing recognition that, even within the same content domain, the context of the task influences performance. Context includes psychological variables, such as fatigue and stress or immediately preceding patient experiences, social variables, such as team relationships and support, and institutional/environmental factors, such as inpatient vs. outpatient setting. 7

Studying it

As might be predicted from the centrality of clinical reasoning, there is a substantial body of research associated with it. This research can be divided into two broad perspectives – a descriptive perspective that focuses on the actual cognitive activities and actions of physicians while engaged in clinical reasoning, and a prescriptive perspective that defines optimal, rational models for reasoning and investigates how and to what extent physicians deviate from these normative models.

The descriptive perspective has its roots in cognitive psychology and began as a special case of general problem-solving studies. It focuses on clinical reasoning as a domain in which the problems are complex and there is a clear role for expertise. The critical role of knowledge distinguishes medicine from many other domains of problem-solving research, such as games, mathematics or logic, in which a relatively small number of rules were adequate for correct solutions. Descriptive studies often highlight four research themes: knowledge organization, cognitive processes, problem structure, and expertise characteristics.

Knowledge organization is a lynchpin of research on cognition generally and this interest extends to medicine as well. Theories of knowledge organization posit a wide range of explanatory constructs (prototypes, schemas, scripts, mental models, networks, etc.) and address questions about knowledge acquisition, retrieval and transfer. Many of these cognitive theories have concentrated on the use of knowledge rather than its acquisition, but educational theories of how knowledge is best acquired are also common in medical education.

A great deal of the research on clinical reasoning addresses the various cognitive processes involved. For example, foundational processes such as perception turn out to be essential to expertise. Experts “see” the world differently from novices by virtue of sophisticated “pattern recognition” capabilities that effectively move some of their knowledge to the unconscious, rapid, and automated process of perception. Attention is another cognitive process in which clinical expertise has an advantage in focusing on relevant information and not getting distracted by irrelevancies. Information gathering and evaluation are other critical cognitive processes that drive many studies. Comprehending and building a cognitive representation of a clinical problem are more advanced cognitive processes that are also heavily influenced by underlying knowledge. There are other cognitive processes and numerous theories that inform and stimulate a wealth of research questions.

The prescriptive perspective on clinical reasoning has its roots in computer science, economics, and probability theory. These disciplines provide the normative models for dealing with uncertainty, modeling complex decision alternatives, and balancing competing values. In comparison to these normative models, people (including physicians) are often irrational, illogical, and badly flawed reasoners. They regularly violate many of these normative principles and make predictable errors (biases) because they use simple shortcuts (i.e, heuristics).

The flawed (from the prescriptive perspective) nature of clinical reasoning leads to two kinds of research. One is the investigation of the conditions under which physician reasoning is more or less problematic and understanding how these errors and biases emerge. Often, the objective is to improve reasoning through educational interventions (e.g., de-biasing techniques). The second is to improve reasoning through decision support tools or computer-based programs that relieve physicians of many of the components of reasoning that produce errors. Decision support tools and reasoning models may be diagnostic or therapeutic in focus and are promoted as ways to reduce the undesirable variability in physician decisions that arise from faulty and inconsistent reasoning.

In summary, clinical reasoning is something of a “god term,” which supersedes and dominates many subordinate terms and concepts. 8 Its “power” leads to rather indiscriminate and unthinking use which, in turn, contributes to confusion and conflicting discussions of the nature and function of clinical reasoning. If nothing else, I hope this commentary contributes to recognizing that we need to be careful about what we mean when we talk about clinical reasoning. We need to be more precise in defining what aspect of clinical reasoning we are interested in. We also need to use theory to help frame our thinking about this complex construct. Arguments about which is the “right” theory are moot – there is no one right way to think about clinical reasoning, but all will benefit from complementary perspectives that each contribute a piece to the greater puzzle.

Section Editor: Jeffrey Love, MD

Full text available through open access at http://escholarship.org/uc/uciem_westjem

Conflicts of Interest : By the West JEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

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Problem Solved

Middle school math instruction gets a boost from a flexible model for learning

By Learning Forward

Vol. 33 no. 2.

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Jennifer Jacobs, Karen Koellner, and Joanie Funderburk

Jennifer Jacobs ([email protected]) is faculty research associate at University of Colorado Boulder. Karen Koellner ([email protected]) is associate professor of mathematics education at Hunter College at the City University of New York. Joanie Funderburk ([email protected]) is secondary mathematics coordinator of Cherry Creek School District in Centennial, Colo.

How the problem-solving cycle works

• The problem-solving cycle starts with teachers working collaboratively on a math problem, and then using that problem in their classrooms.
• Everyone is videotaped and the group analyzes and discusses select clips.
• The learning design uses active engagement, where teachers’ voices and classroom images are highlighted.

DuFour, R. & Eaker, R. (1998). Professional learning communities at work: Best practices for improving student achievement. Bloomington, IN: Solution Tree.

Jacobs, J., Borko, H., Koellner, K., Schneider, C., Eiteljorg, E., & Roberts, S.A. (2007). The problem-solving cycle: A model of mathematics professional development. Journal of Mathematics Education Leadership, 10 (1), 42-57.

Koellner, K., Jacobs, J., & Borko, H. (2011). Mathematics professional development: Critical features for developing leadership skills and building teachers’ capacity. Mathematics Teacher Education and Development, 13 (1), 115-136.

Koellner, K., Jacobs, J., Borko, H., Roberts, S., & Schneider, C. (2011). Professional development to support students’ algebraic reasoning: An example from the problem-solving cycle model. In J. Cai & E. Knuth (Eds.), Early algebraization: A global dialogue from multiple perspectives (pp. 429-452). New York: Springer.

Koellner, K., Jacobs, J., Borko, H., Schneider, C., Pittman, M., Eiteljorg, E., Bunning, K., & Frykholm, J. (2007). The problem-solving cycle: A model to support the development of teachers’ professional knowledge. Mathematical Thinking and Learning, 9 (3), 271-300.

Learning Forward. (2011). Standards for Professional Learning. Oxford, OH: Author. Available at www.learningforward.org/standards/standards.cfm.

Learning Forward is the only professional association devoted exclusively to those who work in educator professional development. We help our members plan, implement, and measure high-quality professional learning so they can achieve success with their systems, schools, and students.

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The Journal of Problem Solving (JPS) was a multidisciplinary journal that published empirical and theoretical papers on mental mechanisms involved in problem solving. This journal is no longer accepting submissions.

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