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By Asha Vas, PhD

Asha Vas

Asha Vas, PhD

Graduate school is challenging. For many students, adapting to a clinical professional graduate degree program requires greater effort compared to undergraduate education. Integration of factual knowledge with clinical conditions draws on higher-order cognitive abilities including gist/ abstract reasoning and innovation. Increasingly, educators are adopting theory-driven and research-supported programs to improve academic performance of college students. Universities and colleges continually offer courses, resources, and tidbits to refine and improve teaching methods.  One of the resources I was interested in bringing to my students was a cognitive training program that I found beneficial in improving my critical thinking abilities while I was administering it in clinical populations. The program is called Strategic Memory Advanced Reasoning Training (SMART) – a top-down cognitive training program that teaches strategies to improve abstract thinking abilities. Multiple randomized trials including in healthy adults and clinical populations demonstrated wide spread gains in improving abstract thinking and reasoning abilities following SMART (e.g. Chapman & Mudar, 2014; Vas et al., 2015). If I found it useful, there is a small chance that others may like it too. So, began SMART in Graduate Students.

A pilot study was proposed to offer SMART to Occupational Therapy (OT) graduate students. The program was tested outside their regular class courses.  Fourteen TWU- OT graduate students between the ages of 21-45 participated in the program. All of the students were in their 4th semester of a five-semester OT curriculum. Pre and post-SMART testing (paper-pencil assessments) included outcome variables of abstract reasoning, attention, verbal fluency, strategic learning, and memory. Researchers involved in testing and scoring were blinded to pre and post testing status. Trainers were not involved in testing and scoring.

The SMART program included ten training sessions over five weeks. Each session was an hour long. The program teaches strategies of:

  1. Strategic attention-inhibition of less relevant information, limit multitasking, and taking mental breaks
  2. Integrated reasoning– abstract gist-based concepts by combining pre-existing knowledge, compare and contrast ideas/contexts, and
  3. Innovation- flexible thinking, examination of gist-based ideas from multiple perspectives. During training (and homework), these gist-based top-down strategies are applied to multiple domains (e.g. texts, audio-video, academic material, conversations).

Results indicated significant gains on abstract reasoning abilities at post-SMART period compared to pre-SMART performance.  Specifically, post-SMART performance indicated flexible thinking in generating multiple themes from pictures and texts, and richer (deeper level processing of information) descriptions of inferred meanings. Additionally significant gains were found on the untrained domain of memory, including improved recall of factual details.

These encouraging findings led to a randomized trial that began last semester. First set of nine students graduated from the program. Current enrollees will graduate in the next two months. I hope to gather data from additional 25 students in the next semester. Positive findings from our pilot study and encouraging anecdotal reports from the current cohorts could lead to integrating SMART into core OT curriculum. Department and university administration is excited about this possibility.

“SMART training has enabled me to engage in higher order, critical thinking through receptively perceiving the world around me. Whether it be through reading, writing, or determining the gist of literature or artwork, I feel that SMART has influenced my ability to reflect, creatively think and problem solve. Through multiple strategies such as limiting distractions, thinking innovatively, and considering multiple perspectives, I am better able to visualize and verbalize the world around me and organize the steps in my mind to arrive at a gestalt. After SMART training, I understand the value of synthesizing information for long-term change rather thanmemorizing to simply retain. I sincerely feel that SMART has benefited me and highly recommend it to other graduate students. My only regret with SMART is that I wished I had taken it sooner.”
—CJ, a recent SMART graduate

I anticipate SMART strategies to help with enhanced cognitive abilities to master the OT course material. More importantly, the use of strategies could become critical in clinical reasoning skills during fieldwork rotations. I also predict that these students are more aware of the effort and time it takes to refine and hone cognitive skills (that are presumably intact).

“I truly learned so much from this study. It was very time consuming and that aspect was frustrating but I believe that was just because of the time constraints and all that I put on my own plate.”
—JJ, a recent SMART graduate

What better way to realize the need for extra time and effort to remediate top-down cognitive abilities in clinical populations (e.g., traumatic brain injury, stroke). In sum, top-down approaches to academic teaching has far reaching benefits, especially in OT education. Focusing on gist-based processing of information facilitates innovation and flexible thinking- the ‘bread and butter’ of any rehabilitation profession. We, as rehabilitation professionals adopt and administer treatments that are drawn from textbook knowledge, clinical experience with tens and hundreds of patients- all of which are valid, reliable, and clinically relevant resources. Why not add more to that repertoire by experiencing our own therapy first hand and be the best judge of it all.



Chapman, S. B., & Mudar, R. A. (2014). Enhancement of cognitive and neural functions through complex reasoning training: Evidence from normal and clinical populations. Frontiers in Systems Neuroscience, 8 doi: 10.3389/fnsys.2014.00069

Vas, A., Chapman, S., Spence, J., Keebler, M., Rodriguez-Larrain, G., Rodgers, B., Jantz, T., Martinez, D., Rakic, J., Krawczyk, D (2015). Reasoning Training in Veteran and Civilian Traumatic Brain Injury with Persistent Mild Impairment. Neuropsychological Rehabilitation.