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.     

Factors Influencing Occupational Therapists' Decision to Supervise Fieldwork Students

The purpose of this study was to identify factors that influence the decision to supervise a Level II occupational therapy fieldwork student. A survey was sent to occupational therapists identified from licensure boards and alumni rosters, including those who have and have not supervised students (n = 548). The results identified both positive and negative influences along with predictive factors of supervising a student. While positive factors included continuing education units, education on fieldwork expectations, their own fieldwork experiences, shared supervision, and access to educational resources, negative influences consisted of: job responsibilities, caseload, productivity standards, working part-time, and fear of failing a student. The discussion focuses on how to address the needs of the clinician and facilitate fieldwork placement.     

New Doors: A Community Program Development Model

SUMMARY

The need to provide occupational therapy services across a continuum of care has stimulated interest in moving into community-based arenas of practice. Limited job opportunities and lack of awareness of the benefits of occupational therapy are common barriers to this movement. This case study illustrates the “New Doors Model” and describes how a partnership between the university, master clinicians, students, and community agencies can result in (1) expanding occupational therapy services to facilities that have not historically interacted with occupational therapy, (2) training occupational therapists and occupational therapy students, and (3) promoting employment of occupational therapists by community organizations, and (4) a scholarship of practice that studies and supports the development of occupation based practice in community settings. The New Doors Model begins with exposing new sites to occupational therapy through level I fieldwork, progressing to level II fieldwork, and ending with creation of permanent occupational therapy positions     

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.     

The Collaborative Model of Fieldwork Education: A Blueprint for Group Supervision of Students

ABSTRACT. Historically, occupational therapists have used a traditional one-to-one approach to supervision on fieldwork. Due to the impact of managed care on health-care delivery systems, a dramatic increase in the number of students needing fieldwork placement, and the advantages of group learning, the collaborative supervision model has evolved as a strong alternative to an apprenticeship supervision approach. This article builds on the available research to address barriers to model use, applying theoretical foundations of collaborative supervision to practical considerations for academic fieldwork coordinators and fieldwork educators as they prepare for participation in group supervision of occupational therapy and occupational therapy assistant students on level II fieldwork.     

An Exploratory Study of Web-Based Supports for Occupational Therapy Students During Level II Fieldwork

SUMMARY

Occupational therapy students often experience high levels of anxiety about transitioning from the academic student role to the fieldwork student role. The separation from their classmates and the geographical relocation may isolate some students. Additionally, the quality and quantity of on-site supports available to individual students vary with each placement.

A web-based resource was designed to assist occupational therapy students from the University of South Alabama with the transition from student role in an academic environment to level II fieldwork in off-campus work environments. Participation was voluntary and no grades were assigned. Students were invited to participate as needed with their classmates for support and information sharing. Resources were provided asynchronously so students could access them whenever and wherever they could gain access to the Internet.

Quantitative and qualitative analysis of the data was conducted. Data analysis included frequency of web-based communication, analysis of emerging themes based on the communication, outcome of student fieldwork performance, and students' perceptions based on their participation.

The information gained during this exploratory study could be useful to other faculty in developing similar web-based resources to promote student success. Additionally, the technology skills gained by the students are hoped to improve their confidence to participate in web-based professional list serves and distance education opportunities in the future.     

Collaborative Learning Applied to Fieldwork Education

SUMMARY

Occupational therapists of the 21st century must be educated to provide intervention within health, education, community, and policy-making areas. Therapists need to solve complex problems, often in collaboration with numerous stakeholders. This article proposes that preparing occupational therapists for current practice requires a fundamental change in our educational beliefs and that a collaborative approach among students and fieldwork educators is most congruent with the interactive environments of current practice. The philosophical principles of collaborative learning are reviewed and practical considerations to apply the principles to Level II fieldwork programs are described.     

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.     

Differences and similarities in therapeutic mode use between occupational therapists and occupational therapy students in Norway

Background: The Intentional Relationship Model (IRM) is a new model of the therapeutic relationship in occupational therapy practice. Two previous studies have focused on therapist communication style, or ‘mode’ use, but to date no group comparisons have been reported.

Aim: To explore differences between occupational therapists and occupational therapy students with regard to their therapeutic mode use.

Methods: The study had a cross-sectional design, and convenience samples consisting of occupational therapists (n?=?109) and of second-year occupational therapy students (n?=?96) were recruited. The Self-Assessment of Modes Questionnaire was the main data collection tool. Group differences were analysed with independent t-tests.

Results: The occupational therapists responded more within the collaborative and empathizing modes than the students did. The students responded more within the advocating and instructing modes than the occupational therapists did.

Conclusion and significance: There may be systematic differences between occupational therapists and students concerning their therapeutic mode use. Some modes, such as the collaborating and empathizing modes, may be viewed as requiring more experience, whereas other modes, such as the advocating mode may be related to more recent rehabilitation ideologies. These factors may contribute to explaining several of the group differences observed.     

Growing from dilemmas: developing a professional identity through collaborative reflections on relational dilemmas

Health educators nurture future generations of professionals by helping them to navigate the complex transition from students to therapists. The purpose of this study was to illustrate how a pedagogical method of collaborative reflection (involving reflective writing, sharing, and discussion) on relational dilemmas with role partners can develop occupational therapists’ professional identity. The course, in which this method was applied, implemented the supervision and peer learning frameworks as related to student’s fieldwork experiences, and is based on the perception of growing from conflicts and exploration. The study is based on analyzing qualitative data of 392 dilemma cases and 196 texts of personal reflection on classroom work of undergraduate students in occupational therapy. A thematic analysis of the case studies revealed six overarching relational dilemmas that novice therapists are often called upon to deal with when working with patients, patients’ families and colleagues from other health professions. Analyzing the personal texts of reflection highlighted the effectiveness of collaborative reflection in bridging the gap between theory and practice, and in helping students develop their professional identity. The method can be adapted to curricula for students and therapists in other health professions, in undergraduate courses, and in group supervision programs.     

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.     

Brief or New: The Benefits of On-Line Learning in Occupational Therapy

SUMMARY

This paper discusses the benefits of incorporating an on-line program, such as Blackboard, into occupational therapy education to enhance the learning experience. An occupational therapy department at a midwestern university piloted the use of Blackboard in two classes in the spring semester of the junior year. Students (n = 16) ranging in age from 20–28 years participated in the pilot study, which lasted a period of 12 weeks. The students were given various assignments on Blackboard involving discussions, answering questions related to the lecture topic, and sharing evidence-based practice. Overall, the student perceptions of incorporating Blackboard into a traditional classroom were positive. Eighty-one percent of the students felt that Blackboard was easy to access, 75% felt that they could share thoughts and stories that they would not necessarily have shared in a classroom setting, and 81% felt that Blackboard expanded on lecture topics and relevant practice information. Data suggest that on-line learning can enhance the educational experience by building upon student fieldwork experiences, evidence-based practice, discussion of key concepts in the profession, and clinical reasoning.     

Psychosocial Considerations in Occupational Therapy Treatment for Adults with Acquired Brain Injury: A Survey

ABSTRACT

The psychosocial factors of coping, locus of control, and self-efficacy have been shown to be associated positively with real-world outcomes following acquired brain injury (ABI), although to our knowledge there are no studies investigating whether occupational therapists address these factors in practice. This study used on-line survey methodology to investigate whether Canadian occupational therapists working in ABI rehabilitation were addressing these factors in their practice. Of 151 respondents, the majority reported being able to explain the factors to clients and that they and/or their team members were incorporating them into clinical practice. Participants also provided examples that were analyzed for common themes. The majority of examples of how these factors were incorporated into practice were implicit in nature. Further education regarding these factors may be warranted as only 25% of the respondents reported learning about these factors in their occupational therapy education.     

The influence of fieldwork on the preferred future practice areas of final year occupational therapy students

The student fieldwork experience has been recognised as an important influence on the areas of occupational therapy practice pursued by clinicians after graduation. The recruitment patterns of graduate occupational therapists is a key issue, especially in clinical areas such as rural practice and mental health. This study aimed to investigate the future practice preferences of 50 final year occupational therapy students from two occupational therapy schools in New South Wales, in relationship to their fieldwork experience, using a focus group and a survey. General physical dysfunction was the most popular area of future practice for this group. Results suggested that fieldwork influenced students through the programme content, the timing of placements, supervision, and students' personal responses to their experiences. The study also demonstrated that students use the fieldwork experience to guide their decision to enter an area of practice.     

WebCT in occupational therapy clinical education: implementing and evaluating a tool for peer learning and interaction

As occupational therapy expands into new practice arenas such as wellness, driver rehabilitation and ergonomics, educators are challenged to revise the curriculum as well as change educational technology. One of the changes in occupational therapy educational programmes is the utilization of on-line teaching. The purpose of this study was to evaluate the learning experiences of 42 occupational therapy students who were involved in a virtual learning environment during their six-week fieldwork placement. The results indicated that the majority of students enjoyed participating in this web-based learning environment (WebCT). A vast array of themes emerged from the on-line discussion and these themes reflected different levels of learning. Participation in WebCT during fieldwork appears to have a beneficial effect on student learning and achievement of stage 1 learning objectives by supporting students in peer learning. Other benefits include improving student autonomy during fieldwork, supporting self-directed learning and stimulating higher order thinking. Although the results of this study were positive there is still a need to further evaluate the effectiveness of web-based learning as an alternative to traditional educational methods during fieldwork education.     

Exploring Arising Moments and Mindfulness in Occupational Therapists Working in Diverse Clinical Practice Areas

ABSTRACT

An online survey was conducted with 72 Canadian occupational therapists to (1) explore if and how occupational therapists were aware of “arising moments” in clinical practice, which are moments that give rise to emotions, sensations, and thoughts, and (2) to examine therapists’ responses to questions related to mindfulness. Participants described arising moments through an open-ended survey question. Framework analysis was used to develop key themes and subthemes. A modified Philadelphia Mindfulness Awareness (PHLMS) subscale with two additional survey questions “understanding of living in the moment and being present, and awareness of mindfulness” (sum = PAM) were used as indicators of mindfulness. There were significant differences in the means of PHLMS mindfulness among therapists working in diverse practice areas (F = 3.63, p = .009). Posthoc analysis revealed that therapists working in mental health had higher mean PHLMS-mindfulness scores than in all other groups. There were no significant differences in PAM mindfulness among the practice areas (ANOVA, F = 2.15, p = .08). However, posthoc tests showed that the participants in the mental health practice area had a significant difference with one group, general physical health. Findings have implications for practice in occupational therapy and education about mindfulness in occupational therapy.     

Occupational therapy students' contribution to occasions of service during practice placements in health settings

Introduction: Currently in the Australian higher education sector, the productivity benefits of occupational therapy clinical education placements are a contested issue. This article will report results of a study that developed a methodology for documenting time use during placements and investigated the productivity changes associated with occupational therapy clinical education placements in Queensland, Australia. Supervisors’ and students’ time use during placements and how this changed for supervisors compared to pre‐ and post‐placement is also presented. Methods: Using a cohort survey design, participants were students from two Queensland universities, and their supervisors employed by Queensland Health. Time use was recorded in 30 minute blocks according to particular categories. Results: There was a significant increase in supervisors’ time spent in patient care activities (F = 94.011_{2,12.37 df}, P < 0.001) between pre‐ and during placement (P < 0.001) and decrease between during and post‐placement (P < 0.001). Supervisors’ time spent in all non‐patient care activities was also significant (F = 4.580_{2,16 df}, P = 0.027) increasing between pre‐ and during placement (P = 0.028). There was a significant decrease in supervisors’ time spent in placement activities (F = 5.133_{2,19.18 df}, P = 0.016) from during to post‐placement. Students spent more time than supervisors in patient care activities while on placement. Discussion: A novel method for reporting productivity and time‐use changes during clinical education programs for occupational therapy has been applied. Supervisors spent considerable time in assessing and managing students and their clinical education role should be seen as core business in standard occupational therapy practice. This paper will contribute to future assessments of the economic impact of student placements for allied health disciplines.