Critical thinking in occupational therapy education: A mixed-methods study

Critical thinking is widely recognised as essential for occupational therapy education and practice, yet its conceptualisation, teaching, and assessment remain inconsistent across international contexts. Existing literature highlights a lack of clarity regarding effective pedagogical approaches and a limited understanding of how educators make sense of critical thinking within occupational therapy curricula. This study examined how occupational therapy educators across different countries conceptualise critical thinking and how it features in the programmes they teach.

A convergent mixed-methods design was used. Occupational therapy educators completed an online survey (available in Spanish, Portuguese, and English) containing 28 quantitative items and six open-ended qualitative questions. Quantitative data were analysed using descriptive statistics, and group comparisons were made using the Kruskal-Wallis and Dunn tests. Qualitative data underwent inductive content analysis within language groups and were later synthesised across datasets through reflexive, collaborative analysis.

No consumers were involved in the study conceptualisation or analysis.

Responses revealed a spectrum of conceptualisations of critical thinking, ranging from concrete, pragmatic, and clinically focused understandings to abstract, socially oriented, and transformative perspectives. English-language responses tended to emphasise clinical reasoning, evidence use, and decision-making, whereas Portuguese and Spanish responses more strongly foregrounded reflection on knowledge, sociopolitical structures, and critical action. Teaching practices mirrored this spectrum: Critical thinking was taught unevenly across curricula, most commonly within clinical reasoning or foundational occupational therapy subjects, with fewer programmes explicitly addressing broader sociocultural or transformative dimensions.

Findings highlight significant epistemological variation shaping how critical thinking is conceptualised and enacted in occupational therapy education. Recognising these epistemological foundations, rather than seeking a universal definition, may support more intentional, inclusive, and socially responsive curriculum design.