Four years after graduation: Occupational therapists' work destinations and perceptions of preparedness for practice

Objective:  The present study sought to identify the work destinations of graduates and ascertain their perceived preparedness for practice from a regional occupational therapy program, which had been specifically developed to support the health requirements of northern Australians by having an emphasis on rural practice.
Design:  Self-report questionnaires and semistructured in-depth telephone interviews.
Participants:  Graduates ( n =  15) from the first cohort of occupational therapists from James Cook University, Queensland.
Main outcome measure:  The study enabled comparisons to be made between rural and urban based occupational therapists, while the semistructured interviews provided a deeper understanding of participants' experiences regarding their preparation for practice.
Results:  Demographic differences were noted between occupational therapists working in rural and urban settings. Rural therapists were predominantly younger and had worked in slightly more positions than their urban counterparts. The study also offered some insights into the value that therapists placed on the subjects taught during their undergraduate occupational therapy training, and had highlighted the differences in perceptions between therapists with rural experience and those with urban experience regarding the subjects that best prepared them for practice. Generally, rural therapists reported that all subjects included in the curriculum had equipped them well for practice.
Conclusions:  Findings suggest the need to undertake further research to determine the actual nature of rural practice, the personal characteristics of rural graduates and the experiences of students while on rural clinical placements.     

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.     

Transition of graduates of the Master of Occupational Therapy to practice

Background/aim: The transition from classroom to clinical practice is a necessary and challenging journey for occupational therapy students. In recent years, worldwide trends in occupational therapy education are moving towards graduate‐entry in professional preparation courses. Little is known about the journey experienced by these graduates when they enter practice. This qualitative study aimed to explore the lived experience of these graduates in their transition from student to practitioner within first six months of practice. Methods: A phenomenological approach was adopted for this study. Using purposive sampling, eight participants from a recent graduate cohort of the Master of Occupational Therapy from the University of Sydney were recruited. Data was collected via in‐depth, face‐to‐face interviews. The focus of inquiry was on the experience of transition. Interviews were audio‐taped, transcribed and analysed thematically. Member checking and consensus coding were conducted to increase trustworthiness of the study. Results: Four themes emerged from the interview data. The themes were (i) valuing maturity; (ii) being new; (iii) needing skills; and (iv) pursuing satisfaction. Participants described metaphors about their experience across and within these themes. Conclusions: Recognising the experience of transition from student to practitioner has the potential to assist university staff in the development of the educational curriculum. Understanding this transition can also help employers and therapists in providing adequate support and supervision for new graduates. Furthermore, awareness of the transition experience allows students to better prepare themselves for their own transition to practice.     

Perceptions of occupational therapists practising in rural Australia: A graduate perspective

Background:  The difficulty in recruiting and retaining health professionals into rural and remote areas of Australia is well recognised. This study explored the perceptions of occupational therapists practising in rural locations regarding the essential skills necessary for rural practice and the ability of undergraduate education to prepare them for rural practice.
Methods:  A qualitative study using a phenomenological approach was conducted using semistructured in-depth interviews. Participants included occupational therapists who were graduates of James Cook University, who were practising in rural areas in Queensland and Victoria, and academic staff.
Results:  This study demonstrates that it is important for universities to develop both a mindset in their graduates for rural practice, as well as developing broader skills in addition to core discipline-specific skills. While subjects developing core occupational therapy skills are at the centre of undergraduate education, the importance of developing a broader understanding of rural health issues and skills in public health, primary health care and health promotion was emphasised.
Conclusion:  The development of specific skills to become competent rural practitioners and to cope with the challenges of rural practice can be strengthened through initiatives at the undergraduate level. Ongoing commitment from all universities across Australia to include rural curriculum content has the potential to improve recruitment and retention of occupational therapists and other health professionals into rural Australia.     

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.     

Using critical incident interviews to identify the mental health knowledge,skills and attitudes of entry‐level dietitians

Aim: This paper aims to explore new graduates' experience working with clients with mental health issues using critical incident interviews. Methods: The qualitative research techniques were based on phenomenology. A purposive sample of 19 new graduate dietitians was drawn from a range of work settings and locations throughout Australia. Data were gathered using 30‐minute critical incident interviews. Audiotaped data were transcribed, coded to identify common themes, compared for congruence and then categorised into knowledge, skills and attitudes. Results: New graduates encountered a range of situations involving a variety of mental health, wellbeing, dietetic and clinical issues. Common themes revealed that graduates felt under‐prepared to deal with these situations. Themes also highlighted the mental health knowledge, skills and attitudes required for entry‐level dietitians, which then informed the review of the National Competency Standards for Entry‐Level Dietitians. Conclusion: New graduates encounter a variety of mental health and wellbeing issues in their everyday practice and therefore require training to address these situations competently.     

Perceptions towards rural and remote practice: A study of final year occupational therapy students studying in a regional university in Australia

Background/aim: Rural and remote health education during undergraduate training is a strategy to alleviate the shortage of rural health professionals. Undergraduate rural exposure can be beneficial in improving students’ perceptions towards rural and remote practice as well as their decision to work rurally. This study examined James Cook University (JCU) final year occupational therapy students’ perceptions towards rural and remote practice and if their perceptions had changed over the course of their study. Methods: Questionnaires were administered to 58 final year occupational therapy students at JCU during a block class. Quantitative data analysis was performed on responses. Results: The change in the students’ career intentions from not considering to considering rural and remote practice over the duration of their study was found to be significant (exact P = 0.003). The influential factors identified in students considering rural employment included the rural location of their close family and friends (exact P = 0.006), the overall occupational therapy programme (U = 171.5, P = 0.045), good fieldwork experience (U = 144, P = 0.039) and inspiring fieldwork supervisors (U = 135.5, P = 0.01). The course curriculum was not found to influence the students’ perceptual change. Conclusion: This study has found that students’ perceptions towards rural and remote practice changed over the course of their university programme. A greater focus on the academic staff and fieldwork supervisors’ perceptions towards rural and remote practice may be required in the development of rural undergraduate programmes. Identification of students who have family/close friends living in rural and remote areas may encourage occupational therapists to work in rural areas.     

Using problem-based learning to improve educational outcomes

As the health care industry and the occupational therapy profession experience rapid change and growth, our professional preparation and continuing education must prepare graduates and therapists for an evolving practice environment. By exploring and evaluating alternative teaching methods and their impact on educational outcomes, occupational therapy educators demonstrate their commitment to improving the quality of student education. This article proposes that the traditional educational paradigm prepared clinicians for the old health care environment, and that problem-based learning (PBL) is an educational strategy that could prepare occupational therapists for success in a new practice environment that values cost, quality, and customer satisfaction. The PBL approaches used by various international occupational therapy educators are reviewed to highlight the strategies that have been implemented to achieve educational objectives that parallel the requirements of this new practice environment. Copyright © 1996 Whurr Publishers Ltd.     

A survey of recruitment and retention issues for occupational therapists working clinically in mental health

Background:  Mental health services Australia-wide have difficulty recruiting and retaining clinical occupational therapists.
Methods:  A survey of occupational therapists to identify factors that could influence their retention or loss from clinical mental health practice was undertaken.
Results:  Typically, respondents were female, aged 30 years or younger, working full-time at a grade 2 or 3 level, and had worked entirely in mental health. The main positive aspects that respondents identified about their positions were the 'social/emotional environment', 'aspects/nature of their roles', and 'using occupational therapy skills'. The main position constraints were 'insufficient time/workload' and 'insufficient use of occupational therapy skills/generic nature of work'.
Conclusions:  Recruitment and retention strategies are required to retain occupational therapists in clinical mental health positions.     

Impact of Rural Training on Physician Work Force: The Role of Postresidency Education

Many innovative strategies have been developed over the years to improve the recruitment and retention of physicians in the shortage areas of rural America. These strategies have met with varying success. Postresidency education, or fellowship training, for family physicians is yet another strategy that has been developed for the same purpose. Most applicants have been interested in obstetrical and rural health fellowship programs as a means for preparing for rural practice. This paper describes these programs (demographics, funding, applicant pool, curriculum) and reviews their graduate outcomes (practice location after matriculation, clinical privileges). Twenty-nine obstetrical and nine rural health fellowships are currently operational in the United States. Fellows who complete a rural health fellowship have a higher tendency to locate in rural settings. Almost all graduates from obstetrical and rural health programs attain general hospital privileges in family practice, including low-risk obstetrics. A significant number of graduates from both types of programs attain privileges in high-risk and operative obstetrics as well. Fellowship training can play an integral role in the preparation of family physicians for rural practice.     

Clinical placement and rurality of career commencement: a pilot study

This article reports on a project that aimed to discover whether rural placement can influence new graduates to take up rural positions, and what factors play a role in the decision-making. This pilot study reports the findings from a pre-survey of students (n = 110) who completed a questionnaire at the end of their rural placement in the Greater Green Triangle region, Australia. Findings are compared with matched questionnaire responses for students who subsequently completed a post-survey after graduation and who commenced work (n = 28). Rural placement appears to be associated with commencing rural practice after graduation. More graduates with an urban home address commenced rural practice than graduates with a rural home address who started their careers in the city. Longer placements may sway those with a city background to start work in a rural area.     

The Need for Occupational Therapy Graduates in New South Wales and the Australian Capital Territory

The balance between the new graduates from a school of occupational therapy and the occupational therapy positions available for those graduates is a critical factor in the decision regarding student intake each year. Surveys of the occupational therapy workforce in New South Wales and the Australian Capital Territory, and patterns of employment for new graduates are reported to support a recommendation to maintain the current student intake for the School of Occupational Therapy at the Cumberland College of Health Sciences in New South Wales.     

The Relationship of Rural Clinical Rotations to Where Registered Nurses Practice

An objective of exposing health profession students to rural clinical experiences was to overcome problems of geographic maldistribution of health personnel. Nevertheless, little can be said about the impact of rural training rotations on the supply of health personnel in rural areas or on students' decisions about where to practice. To assess the relationship between rural clinical rotations and practice locales, surveys were administered to all applicants taking registered nurse exams in Arizona in July 1990, February 1991, and July 1991. The students most likely to be working in rural locations were rural high school graduates with rural clinical experience during nursing school. Students who were urban high school graduates with rural clinical experience were only slightly less likely to locate in rural areas. Rural and urban high school graduates with no rural clinical experience were far less likely to choose rural practice. Rural rotations were associated with rural job selection only if students attended rural educational programs.     

Undergraduate nursing students' experiences in a rural clinical placement

Objective: This paper draws on questionnaire findings and analysis of students' comments to demonstrate the aspects of rural placements that were effective in engaging students in the learning process. It also examined how a primary health care clinical placement in Aboriginal communities can provide nursing students with a rich and varied learning experience and an insight into the complex aspects of rural life including Aboriginal health. Design: A cohort of eight second‐year nursing students from the Australian Catholic University, North Sydney, in partnership with the Broken Hill University Department of Rural Health (BHUDRH), participated in a 4 weeks' rural placement in far western New South Wales. A pre‐test/post‐test questionnaire was used to capture their experiences with the students completing the questionnaires before and after their clinical placements. Such placements offer students opportunities to deepen their understanding of issues related to rural health in clinical, professional, social and community contexts. Results: The results suggest that clinical experience in rural areas can positively influence attitudes, preparedness for practice and engage students on many levels, deepened their understanding of rural communities and issues related to rural health. Conclusion: This group of undergraduate nursing students indicated they all had a positive learning experience in their rural clinical placement. The value of rural placements as a method for increasing nursing student's practical experience should be promoted.     

Retention: An unresolved workforce issue affecting rural occupational therapy services

Failure to retain health professionals in rural areas contributes to the poor health status of these communities through an inability to deliver reliable and consistent services. Considerable attention has been focused on factors affecting recruitment of health professionals. Far less is known about factors affecting the retention of occupational therapists. This was the focus of this study. Ethnographic interviews were used to explore the experiences of 10 occupational therapists who had left rural practice. Six themes emerged from the participants' experiences, from when they first considered rural practice to reflections following their departure from it. These themes were initial appeal, facing the challenge, rural practice issues, the social sphere, reasons for leaving and the value of rural experience. These factors gave rise to a proposed Model of Retention Equilibrium, which suggests that retention can be improved by addressing the imbalance between incentives to leave and incentives to stay. The model provides a useful framework for occupational therapists contemplating rural practice, as well as for health services managers responsible for service delivery in rural areas.     

Too many applicants for available graduate medical education positions--are we on a collision course?

Until the last few years, graduate medical education (GME) positions were so plentiful in the United States that even with a heavy influx of both U.S. and alien graduates of foreign medical schools, many positions remained unfilled. In the future, however, it is unlikely that all those planning to enter GME in the United States will be able to do so. Applicants for U.S. GME positions increased from 15,000 in 1980 to 20,000 in 1983, while the positions offered declined to fewer than 18,000. Increasing financial pressure may cause some U.S. hospitals to cut back on their GME positions. Recent Federal regulations require them to isolate the cost of education from patient care costs, and community hospitals may no longer with to provide GME if they can no longer recover educational costs. On the other hand, State legislatures may react to pressures to provide GME positions for U.S. citizens graduating from foreign medical schools. Another factor increasing the demand for GME positions is the greater number of U.S.-citizen graduates from foreign medical schools in the Caribbean. The Caribbean schools generally lack the facilities to provide clinical training, so that efforts are made to provide such training for U.S. citizens in the United States. For example, it has been reported that opportunities for two to five thousand clerical clerkships exist in New York State. Alien and U.S. graduates of foreign medical schools have been required to take different examinations to qualify for GME in the United States, but beginning in 1984, both groups will be required to pass a new Foreign Medical Graduate Examination in the Medical Sciences. Ways are also being sought to assess the clinical skills of these graduates. It is hoped that an equitable system to evaluate all foreign medical graduates will soon be in place, so that those who meet standards comparable to the ones required of U.S. medical students will be able to enter U.S. graduate medical education programs.