Purpose: The purpose of this study was to investigate how learning in two graduate health science courses at a comprehensive state university was structured and provided opportunities for clinical reasoning. Method: This study adopted a grounded theory approach. Participants included two graduate instructors, one in Occupational Therapy (OT) and one Communication Disorders (CD), and their students (n = 62). Three data sources included transcripts from 36 h of instructor–student discourse within graduate health science classrooms over the course of a full semester, detailed field notes about the environment and instructor–student interactions, and transcripts from in-depth, open-ended interviews with each instructor focusing on their intended participation frameworks and scaffolding strategies. Results: The findings indicate that students' demonstration of clinical reasoning skills in the classroom were impacted by the participation frameworks instructors adopted and that instructor perceptions did not always match recorded interactions. Discussion: The pedagogies instructors use, the social dynamics in the classroom, class structure and format, and instructor expectations are highly influential on the high-level problem solving required in clinical reasoning that graduate health science students need to demonstrate. Conclusion: Results of this study highlight how instructional practices can inadvertently undermine the clinical reasoning skills students demonstrate in the classroom environment and are representative of a common struggle in education.
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