Impact of the changing health care environment on fieldwork education: perceptions of occupational therapy educators

To investigate how clinical fieldwork educators and academic fieldwork coordinators view the impact of the changing health care environment on student fieldwork education, current practice, and future of the profession, a 48-item questionnaire assessing the influence of recent changes in the health care system on fieldwork education was sent to 125 occupational therapy fieldwork educators and coordinators (response rate 62.4%). Differences between fieldwork educators and coordinators were analyzed statistically using nonparametric methods. Alpha level was set at p < 0.01 for all statistical comparisons. Fieldwork educators and coordinators agreed productivity expectations, number of hours worked, and time spent in documentation have increased, while job security, time for continuing education, and quality of patient care under the current reimbursement system have decreased, but diverged on several other issues. Fieldwork educators believed reimbursement issues did not affect their ability to accept fieldwork students, whereas academic coordinators believed declining reimbursement had negatively affected fieldwork educators' ability to accept students. Factors thought to facilitate the fieldwork shortage included cost reductions, changes in reimbursement, and increased productivity demands on clinicians.     

The effect of first year mental health fieldwork on attitudes of occupational therapy students towards people with mental illness

Background and Aims:  Despite recent initiatives to reduce stigma towards people with mental illness, negative attitudes persist both in the community and among health professionals. Fieldwork experience has been identified as the most powerful way of modifying the attitudes of health professional students. Research to date suggests that later placements tend to have a more positive effect on attitudes than do earlier placements. However, inconsistencies within the literature suggest that it is the nature of the fieldwork experience that is the critical factor. We set out to investigate whether a program of fieldwork that included a tutorial component would bring about positive attitudinal change in first year occupational therapy students.
Methods:  We conducted secondary analysis of data collected from first year students before and after first year fieldwork experience in mental health settings. Student statements were rated to identify positive versus negative attitudes, and attitudinal themes were analysed.
Results:  Quantitative analysis revealed that students made significantly more statements reflecting positive attitudes following fieldwork than they did before. From pre- to post-fieldwork, attitudinal themes changed from: people with mental illness as different, fear of people with mental illness, and a deficit focus of mental illness, to: the 'ordinariness' of people with mental illness, students' understanding of people with mental illness, and an enabling approach to people with mental illness.
Conclusions:  A program of fieldwork that includes a structured tutorial component can bring about positive changes in the attitudes of first year students towards people with mental illness.     

The Collaborative Model of Fieldwork Education: Implementation of the model in a regional hospital rehabilitation setting

Aim:   This paper describes the implementation of a Collaborative Model of Fieldwork Education in a regional hospital occupational therapy department.
Methods:  The literature on models of fieldwork education for occupational therapy students is reviewed, and an approach to the implementation of the collaborative model with three students to one clinical educator is described after piloting of this model's recommendations, arising from the pilot placement, are proposed.
Conclusions:  The implementation of a Collaborative Model of Fieldwork Education requires careful planning, close links with the university fieldwork team and a willingness on the behalf of occupational therapist clinical educators to explore alternative approaches to the provision of fieldwork education.     

International fieldwork placements and occupational therapy: lived experiences of the major stakeholders

Introduction: Occupational therapy students obtain a great deal of their professional preparation and experience through fieldwork placements. Although many occupational therapy students have taken part in international fieldwork placements, there is little research on this topic. As fieldwork placements are an integral part of the education of occupational therapy students, literature on the subject of international fieldwork placements is necessary. Accordingly, the aim of this study was to examine the personal and professional experiences of occupational therapy students, supervisors, and on‐site staff who have taken part in an international fieldwork placement. Methods: Qualitative interviews for this phenomenological study were administered with 14 participants who had taken part in an international fieldwork placement in Trinidad and Tobago. Data were analysed using thematic analysis. Findings: Three themes emerged: collaborative learning, cultural negotiations and thinking on my own. Discussion: Considering fieldwork is a critical component in the occupational therapy curriculum, it is reassuring to uncover that international placements can be of benefit to all stakeholders while achieving its primary goal of preparing students to become competent therapists. All participants developed a greater cultural awareness and appreciation, which is necessary as occupational therapists are increasingly working in diverse settings with diverse client groups. This information can also be used to enhance international fieldwork education as students continue to travel abroad to complete their mandatory fieldwork hours.     

A Descriptive Study on Level II Fieldwork Supervision in Hospital Settings

ABSTRACT

The objective of this study was to examine the factors influencing fieldwork educators’ ability and willingness to supervise Level II occupational therapy students in hospital-based settings. Qualitative focus groups were used to explore the perceptions of occupational therapists in four urban hospitals in Nebraska. The study presents the issues facing fieldwork supervisors and their suggestions on how to improve the fieldwork process. Both personal and professional factors influenced occupational therapists’ willingness to accept students, while facility constraints were the primary reason occupational therapists would not accept Level II students. Fieldwork educators believe that their facilities need structured fieldwork programs and that students need more formalized fieldwork preparation at their academic institutions. Themes highlight the need for continued collaborative endeavors between academic fieldwork coordinators and fieldwork educators.     

Marginalisation of dental students in a shared medical and dental education programme

Objectives  Internationally, there are a number of universities at which medical and dental education programmes share common elements. There are no studies about the experiences of medical and dental students enrolled in different programmes who share significant amounts of learning and teaching.
Methods  Semi-structured interviews and focus groups were conducted with 36 students and staff in a learning programme shared between separate medical and dental faculties. They were transcribed and an iterative process of interpretation and analysis within the theoretical framework of the contact hypothesis and social identity theory was used to group data into themes and sub-themes.
Results  Dental students felt 'marginalised' and felt they were treated as 'second-class citizens' by medical students and medical staff in the shared aspects of their programmes. Contextual factors such as the geographical location of the two schools, a medical : dental student ratio of almost 3 : 1, along with organisational factors such as curriculum overload, propagated negative attitudes towards and professional stereotyping of the dental students. Lack of understanding by medical students and faculty of dental professional roles contributed further.
Conclusions  Recommendations for reducing the marginalisation of dental students in this setting include improving communication between faculties and facilitating experiential contact. This might be achieved through initiating a common orientation session, stronger social networks and integrated learning activities, such as interprofessional problem-based learning and shared clinical experiences.     

The Perspectives of Fieldwork Educators Regarding Level II Fieldwork Students

ABSTRACT

Ten occupational therapists employed in pediatric and adult rehabilitation settings participated in focus groups to discuss their perceptions of the benefits and drawbacks in working with occupational therapy students. Participants identified professional values, opportunities for continued professional development, recruitment of future employees, and pride in learning experiences available as incentives for working with students. Fieldwork educators who had supervised students lacking foundational communication, problem-solving, and clinical skills were cautious about accepting future Level II students. Time constraints and lack of preparation for the educator role were perceived as barriers to working with students. Fieldwork educators expected the academic institution to provide efficient support, including training for the educator role, information regarding the expectations of the academic program, and ongoing communication over the fieldwork experience. Strategies for strengthening the ties between academic programs and fieldwork sites were explored.     

Meeting the educational needs of fieldwork supervisors: A collaborative workshop developed by New South Wales occupational therapy fieldwork coordinators

This paper describes the collaborative preparation and implementation of a workshop for occupational therapy fieldwork supervisors which has been developed by the four occupational therapy programmes in New South Wales. The workshop was primarily designed to meet the education needs of new and inexperienced fieldwork supervisors who could subsequently be prepared to supervise students from any of the four occupational therapy programmes in the state. The workshop was also offered to more experienced fieldwork supervisors who were interested in adapting their fieldwork programmes to incorporate the needs of students from the four occupational therapy programmes. The process of constructing the workshop is outlined. Results from pre-workshop questionnaires ( n  = 237) and post-workshop evaluations ( n  = 257), during the first year of presentation of the workshop, suggested that the workshop was effective in meeting the objectives of preparing fieldwork supervisors to supervise students from a variety of educational programmes. In addition, the collaboration between the occupational therapy programmes during the workshops has enabled other state-wide fieldwork issues to be identified, and further projects have been undertaken to address fieldwork concerns.     

The frontline and the ivory tower: A case study of service and professional-driven curriculum

Objective:  To describe the development of a postgraduate, multidisciplinary program designed to meet the needs of remote health professionals, present formative evaluation findings and to offer an analysis of the difficulties and lessons learnt.
Design:  Case study.
Setting:  University Department of Rural Health in a remote region.
Participants:  University staff, students and stakeholders involved in the development of the remote health practice program.
Results:  Formative evaluation suggests that a curriculum driven by service and professional groups, such as the Flinders University Remote Health Practice program, is able to better prepare remote health practitioners and improve their effectiveness. Difficulties in development included a lack of recognition by some university academics of the value of practitioner knowledge and a reluctance to accept a clinical component in a masters program. Lessons learnt included the importance of: (i) respect for practitioner knowledge; (ii) explicit and appropriate values; (iii) high-quality academics with strong service links; (iv) appropriate length of lead time; (v) institutional links between university and both relevant professional organisations and health services; (vi) a receptive university; (vii) location; and (viii) ongoing engagement with services and professional responsive development .
Conclusion:  The success of the program was due in large part to the relationship with professional bodies and close links with remote health services. We have described a number of lessons learnt from this experience that can be useful to other educational groups developing or revising their educational programs.     

A cooperative inquiry study to identify strategies for group supervision in occupational therapy fieldwork placements

The purpose of this study was to identify effective strategies for supervising small groups of second-year students in an occupational therapy fieldwork programme based on a collaborative group model. Contemporary models for fieldwork education over the past decade have involved more placements for students working in peer groups, to address the shortage of fieldwork placements and to create opportunities for students to work in a team environment. Discussion about these fieldwork options has focused on the perceived value of the programmes rather than on the processes used for supervising students in groups. The research methodology chosen for this study was cooperative inquiry because of its congruence with the qualitative nature of group supervision and the collaborative model on which the fieldwork programme was based. Thirteen of a total of 18 occupational therapy supervisors volunteered to participate in the study. Data about supervision skills that would enhance student learning were generated through a series of experiential action cycles in the fieldwork setting, interspersed with regular peer reflection meetings. The results highlighted a range of supervision strategies such as student orientation, the facilitation of peer discussion and reflection on practice, and encouragement by the supervisor for students to use resources in the fieldwork environment and to take responsibility for their own learning. The depth of data gained from the study may have been limited owing to time constraints and other commitments of research participants. A social culture of mutual learning and support was established through the cooperative inquiry process, with potential for building ongoing relationships and participant awareness of educational innovations. Copyright © 1999 Whurr Publishers Ltd.     

From student to therapist: Follow up of a first cohort of Bachelor of Occupational Therapy students

Aim:  This study aimed to investigate the perception of graduate students on their preparation for practice, at 7 months post graduation.
Method:  Using an anonymous postal questionnaire, 18 respondents (58% response rate) provided data on the nature of current employment, the experience as a graduate therapist, and perceptions of their undergraduate experience in preparing them for practice.
Results:  Fifty percent of the respondents were practising in a rural environment. There was a significant positive relationship between respondents perception of their curriculum and fieldwork experiences and their preparation for practice ( rho = 0.52, p  < 0.05, and rho = 0.55, p  < 0.05, respectively). Of the fieldwork experiences, respondents rated block placements as more beneficial to practice than non-traditional placements. However, a correlational analysis showed the non-traditional placement was significantly related to preparation for practice ( rho = 0.54, p  < 0.05). On a seven-point Likert scale, respondents rated themselves from 5.2 to 5.7 for perceived self-competence as a newly graduated practitioner with community-based graduates having the higher rating. Confidence in clinical decision-making was rated 5.0 to 5.6 with community-based graduates having higher rating. Respondents reported a positive perception that the undergraduate program prepared them to enter the workforce and practise as an occupational therapist (mean ratings 5.5 to 6.2).
Conclusion:  Respondents felt adequately prepared to enter the occupational therapy profession and workforce. Strengths and weaknesses in their preparation are discussed as well as the need for further research.     

Effective fieldwork supervision: Occupationa therapy student perspectives

Qualitative research methodology was used to explore occupational therapy student perceptions of the characteristics of effective fieldwork supervisors and the limitations on effective fieldwork supervision. In addition, the study investigated differences in perceptions between students in each of the 4 years of the undergraduate course. Forty-eight students completed an open-ended questionnaire. The two major characteristics of effective fieldwork supervisors identified by the students were well-developed interpersonal skills and the use of collaborative and facilitatory teaching/learning strategies. The major environmental issue limiting the effectiveness of fieldwork supervisors was a lack of time for student supervision. Although students in all years of the occupational therapy course expressed similar viewpoints, variations were identified across the years, particularly with teaching/learning strategies used. Findings from the study need to be interpreted in light of its limitations, which include small student numbers.     

Increasing the occupational therapy mental health workforce through innovative practice education: A pilot project

Aim:  This paper describes the evaluation of a pilot trial of two innovative placement models in the area of mental health, namely role emerging and collaborative supervision. The Queensland Occupational Therapy Fieldwork Collaborative conducted this trial in response to workforce shortages in mental health.
Method:  Six occupational therapy students and eight practice educators were surveyed pre- and post-placements regarding implementation of these innovative models.
Results:  Students participating in these placements reported that they were highly likely to work in mental health upon graduation, and practice educators were positive about undertaking innovative placements in future. An overview of the placement sites, trials, outcomes and limitations of this pilot trial is provided.
Conclusion:  Though limited by its small sample size, this pilot trial has demonstrated the potential of innovative placement models to provide valuable student learning experiences in mental health. The profession needs to develop expertise in the use of innovative placement models if students are to be adequately prepared to work with the mental health issues of the Australian community now and in the future.     

What makes a quality occupational therapy practice placement? Students’ and practice educators’ perspectives

Background/aim: Practice placement experiences are crucial to enable students to integrate theory with practice, demonstrate professional and interpersonal skills and build confidence in their practice skills. This study addressed practice educators’ and students’ perspectives regarding quality practice placement experiences. Method: In total 29 students, 41 practice educators and eight practice education staff members across three Queensland universities participated in focus groups or individual interviews (N = 78) focusing on their views about quality learning experiences on placements. Results: Key themes described university preparation and processes, a welcoming learning environment, detailed orientation and clear expectations, graded program of learning experiences, quality modelling and practice, consistent approach and expectations, quality feedback, open and honest relationships and supervisor experience and skills. These findings were consistent with research previously undertaken in Australia and Canada that had investigated either student or practice educator perspectives. Conclusions: This article synthesises the perspectives of these stakeholder groups and has led to the development of quality indicators across the phases of placement establishment, preparation, maintenance and review. Although having sufficient placements can be challenging for university programmes, ensuring that the experiences provided are of high quality is also important and requires significant attention by university academics and practice education staff, practice educators, managers and practice organisations alike.     

Learning style preferences of Australian occupational therapy students

Background/aim:  The learning styles and teaching implications for nursing and health science students have been well researched in other countries. Less research has considered the learning styles and implications for occupational therapy students. The current study examines the learning styles of occupational therapy students at one Australian university.
Methods:  The learning style preferences of first year undergraduate occupational therapy students ( n  = 120) were investigated. The students completed the Kolb Learning Style Inventory (LSI) and Fleming's VARK (Visual, Aural, Read/Write, and Kinaesthetic) Questionnaire in the first weeks of their course.
Results:  The response rate was 97% ( n  = 116). Learning style preferences as determined by the Kolb LSI were spread over all four Kolb LSI learning styles with 'diverging' (30.2%) and 'converging' (28.4%) being the most preferred. Instructional preference as measured by the VARK Questionnaire was kinaesthetic learning (33%), followed by the multimodal preference VARK (18.1%). Visual and aural categories were these students' least preferred methods of learning.
Conclusions:  The results of the current study support previous research indicating a range of teaching methods should be utilised to accommodate for the variability of students' learning styles within educational programs. To accommodate the range of learning experiences encountered in fieldwork and later in professional practice, students need to strengthen their capacities to use a variety of learning styles. This paper proposes that student learning for evidenced-based practice be facilitated by a range of learning opportunities including practical experiences.     

Cultural awareness among Queensland undergraduate occupational therapy students

Aim:  Australia's cultural diversity generates substantial challenges and implications for students and health-care professionals. This study investigated the cultural perceptions and self-rated level of cultural competence of undergraduate occupational therapy students in Queensland, Australia.
Results:  Two hundred and ninety-three students completed the Cultural Awareness Questionnaire. The findings indicated that the majority of students have a positive attitude towards cultural differences and influences on occupational therapy services. Students also recognised the importance of cultural awareness and highlighted the need for increased incorporation of cultural information and experience throughout the undergraduate course.
Conclusion:  The implications of this study are discussed with reference to the future academic planning of culturally sensitive occupational therapy course and fieldwork experiences.     

Development of the student placement evaluation form: A tool for assessing student fieldwork performance

Evaluation of students undertaking fieldwork education placements is a critical process in the health professions. As training programs and practice evolve, systems for assessing students need to be reviewed and updated constantly. In 1995, staff of the occupational therapy training program at the University of Queensland, Australia decided to develop a new tool for assessing student fieldwork performance. Using an action research methodology, a team developed the Student Placement Evaluation Form, a flexible and comprehensive criterion-referenced evaluation tool. The present paper examines action research as an appropriate methodology for considering real-life organisational problems in a systematic and participatory manner. The action research cycles undertaken, including preliminary information gathering, tool development, trial stages and current use of the tool, are detailed in the report. Current and future development of the tool is also described.     

“We Are Our Own Worst Enemies”: A Qualitative Exploration of Sociocultural Factors in Dietetic Education Influencing Student-Dietitian Transitions

BackgroundThe transition from student to dietitian is an implicit expectation of dietetic education. Although there has been an expanding literature around elements of competency-based education, little attention has focused on sociocultural aspects of learning and professional identity formation in dietetic education.ObjectiveThe aim of this study was to explore sociocultural factors in dietetics education influencing the transition into the profession from the perspective of dietetics students and educators.DesignAn exploratory qualitative study underpinned by social constructionism.Participants/settingFrom March 2018 until June 2019, interviews (individual and group) with final-year students (n = 22), dietetic preceptors (n = 27), and university faculty members (n = 51) from 17 of the 18 universities in Australia and New Zealand with accredited dietetic programs were undertaken and explored sociocultural factors in dietetic education.Analysis performedData were analyzed into key themes using framework analysis and applying the sociocultural theory of landscapes of practice.ResultsSociocultural factors are powerful influences on the student-professional transition. Dietetic cultures and minicultures of cohesion, conformity, competition, and conflict aversion exist. Boundaries exist within learning environments, which can limit or pose challenges to professional identity formation and transition into the profession.ConclusionStakeholders involved in dietetics education play pivotal roles in shaping the microcultures students learn and work within, which influence and impact socialization and transition into the profession. Opportunities exist to re-vision curriculum and foster positive learning cultures with a focus on sociocultural learning, including supporting boundary crossing and professional identity development.     

A self-directed fieldwork program to provide alternative occupational health placements for undergraduate occupational therapy students

Second-year students of undergraduate occupational therapy at the University of Newcastle, NSW, undertake a fieldwork placement in occupational health. However, sufficient placements are not always available. A new fieldwork program attempts to meet this need. Three groups of students conducted risk assessments throughout the academic year, with generally positive results. Students enjoyed the self-directed nature of the placement and the opportunity to learn generic and occupational health related skills. Although there were some limitations to the program, we believe that fieldwork placements met the learning needs of second-year students and offered them an excellent opportunity to gain practical experience related to occupational health practice in prevention.