Professional competence for private practitioners in occupational therapy

Education leads to increased adherence to the 'Australian Competency Standards for Occupational Therapy Driver Assessors'

BACKGROUND

Occupational therapy competency standards provide an evidence-base to inform clinical best practice, however it is not known whether education about competency standards will increase occupational therapists' adherence to their use.

AIMS/OBJECTIVES

To investigate if education about the 'Australian Competency Standards for Occupational Therapy Driver Assessors' leads to increased adherence to the competency standards in the clinical practice of occupational therapy driver assessors.

MATERIALS AND METHODS

A mixed methods multiple case study design was used to evaluate 5 occupational therapy driver assessors' adherence to the competency standards. An audit of 25 client files and interviews were conducted to evaluate practice against the competency standards prior to an education session, followed by an audit of a further 25 files, interview and feedback after education.

RESULTS

Qualitative and quantitative analyses suggest that education about the 'Australian Competency Standards for Occupational Therapy Driver Assessors' was associated with increased adherence to the competency standards in clinical practice. The results also support the use of competency standards in clinical practice.

CONCLUSIONS AND SIGNIFICANCE

Competency standards can be used to inform and guide clinical practice, and individualised education and feedback of practice against the competency standards can increase occupational therapists' adherence to these standards.

Predictors to Private Practice Occupational Therapy Fieldwork Opportunities in Canada: New Evidence suggests New Solutions

The study examined predictors to increasing and enhancing fieldwork education opportunities provided by occupational therapists working in private practice. A cross-sectional design that used a self-administered questionnaire was provided to Canadian occupational therapists in private practice. Participants receiving funding from the workers' compensation sector, those with between 11 and 20 years of work experience, and therapists working full-time hours were more likely to accept a student in fieldwork placement. Respondents who indicated that physical space and resources were not barriers to taking students on placement were more likely to accept students. Therapists more comfortable with the criteria and methods for appropriate and effective student teaching and supervision were also more likely to accept a student for fieldwork placement. The study findings can inform academic programs on how best to support preceptorship and guide university fieldwork coordinators' strategies for outreach and education for private practitioners.

Les enjeux éthiques de la pratique privée de l’ergothérapie : perceptions d’ergothérapeutes

Au Québec, 31% des ergothérapeutes travaillent dans le secteur privé, lequel est en constante croissance. À ce jour, aucune étude n’a spécifiquement répertorié les enjeux éthiques de cette pratique. Cette étude avait pour objectif d’explorer ces enjeux, c’est-à-dire les situations susceptibles de compromettre le respect d’une valeur éthique. Optant pour un devis d’inspiration phénoménologique, sept ergothérapeutes ont été rencontrés dans le cadre d’entrevues individuelles semi-dirigées. Basé sur le cadre conceptuel de Swisher et ses collaborateurs, le canevas d’entrevue a permis d’identifier différents types d’enjeux éthiques. Les résultats attestent que plusieurs valeurs sont susceptibles d’être compromises, soit : le bien-être du patient, l’autonomie du patient, la sécurité publique, la justice distributive, la qualité des interventions, la pratique compétente, l’indépendance professionnelle, l’honnêteté et le professionnalisme. Bien que les ergothérapeutes aient à coeur le bien-être des patients, plusieurs éléments semblent contribuer à cet état de fait, comme les situations de double allégeance vécues par les ergothérapeutes, l’ingérence des tiers payeurs dans le processus clinique et le mode de financement des cliniques. Plus encore, les enjeux éthiques de la pratique privée de l’ergothérapie sont principalement de nature macroscopique. La capacité des ergothérapeutes à percevoir certains de ces enjeux semble être reliée à certaines de leurs caractéristiques, en l’occurrence leur sensibilité éthique et le fait qu’ils soient novices. Les résultats de cette étude rejoignent en général ceux décrits dans les écrits en physiothérapie et montrent le manque de soutien offert aux ergothérapeutes, notamment aux novices, pour surmonter ces enjeux avec aisance et efficacité.

Continuing competence assessment and maintenance in occupational therapy: Scoping review with stakeholder consultation

BACKGROUND/AIM

Continuing competence activities hold the promise of improving health-care service quality, especially given concerns about system inefficiencies and fragmentation. The aim of this scoping review was to describe the assessment and maintenance of occupational therapists' continuing competence and identify knowledge gaps for future research. A secondary aim was comparing scoping review findings with those from other health-care fields and considering possible impact of varying international regulations.

METHODS

A series of database searches retrieved peer-reviewed and grey literature on assessment and maintenance of occupational therapy continuing competence from 1995 to 2015. Themes were developed and findings shared with stakeholders, whose comments drove a second phase: searching for reviews related to continuing competence from allied health, medicine, and nursing, and reviewing websites and documents concerning regulatory requirements for occupational therapy continuing competence in seven English-speaking nations.

RESULTS

Twenty-seven sources from the scoping review search met inclusion criteria. Stakeholder consultation validated the themes and preliminary knowledge gaps. Research into other health-care specialties corresponded to findings from the scoping review. The website/document review of occupational therapy regulatory requirements revealed wide variation on both the state/province and national levels.

CONCLUSIONS

This scoping review highlights gaps in research on effective methods and assessment of occupational therapy continuing competence. Findings suggest a need for research on approaches to continuing competence that incorporate the translation of evidence to practice and address the influence of external factors. Regulatory agencies may address the quality of occupational therapy services by incorporating a variety of professional development options into requirements.

Learning management by self-employed occupational therapists in private practice

BACKGROUND/AIM

This study explored how occupational therapists in private practice developed the business skills needed to operate a successful private practice. The literature shows that many small-business owner-managers have poorly developed business skills, and some experience high rates of failure. This indicates that to be successful in private practice, occupational therapists need to gain mastery of management competencies in addition to their professional clinical competencies.

METHODS

A qualitative study, using in-depth interviews, collected data from twenty-six self-employed occupational therapists on their experiences of becoming a small-business owner-manager. A narrative analysis built an understanding about how these therapists developed their business competencies.

RESULTS

Analysis revealed the factors affecting the development of business competencies were interactions between the initial motivations for start-up, growth aspirations and engagement with external business environments. Business competencies developed through a combination of formal learning prior to starting their businesses, and informal learning once their businesses were in operation. Lower level learning occurred in the routine and operational processes, with higher level learning through discontinuous events resulting in a transformation in the therapists' understanding about themselves as business owner-managers.

CONCLUSIONS

Findings led to a proposition that occupational therapists make the transition to becoming successful small-business owner-manager through management learning that includes elements of self-reflection, identifying environmental opportunities and risks, developing capabilities, and strategic planning for growth and development. It provides insights on what occupational therapists need to consider to become successful small-business owner-managers.

Regional and remote occupational therapy: a preliminary exploration of private occupational therapy practice

BACKGROUND/AIM

Private providers of Medicare funded services are an integral part of the Australian primary health-care system. Evidence on private occupational therapy practice in rural and remote Australian settings is sparse.

METHODS

Providers of private occupational therapy services in outer regional and remote areas were surveyed regarding location and type of services provided, practice models and demographics. Descriptive statistics were used to summarise the findings.

RESULTS

Thirty-seven respondents completed the survey. In remote areas a number of occupational therapy services are not provided and no practices are based in very remote towns. One quarter of respondents visit at least five towns each week and one third had other paid employment. Nearly half indicated they will leave private practice within the next five years and nearly one third believed they could not sustain their practice. Medicare Chronic Disease Management was the main income source of only around half the respondents.

CONCLUSIONS

There is a potential market failure of private occupational therapy in rural and remote areas, impacting on people who need these services and on workforce replacement. Contributing factors include population imbalance between cities and regional/remote areas, financial implications where only face-to-face contact is paid for and low incomes and levels of health insurance in regional/remote areas. Potential strategies include addressing the lack of reimbursement for travel, enabling private providers to overcome barriers to providing student placements and recognising rural practice as a specialist field.

Confidence in clinical practice of Chinese medicine degree graduates 1 year after graduation: a pilot study

BACKGROUND

The issue of transition from student to practitioner of Chinese medicine (CM) in Australia and other Western countries has received little formal attention. Workforce studies, while not up to date nationally in Australia, suggest that the majority of CM practitioners practice as sole practitioners or in small practices. Data from the state of Victoria suggest that a significant proportion of the CM workforce is relatively new to the profession. It is not known how many graduates successfully enter the workforce and importantly, remain in it.

OBJECTIVES

An initial survey of final-year bachelor degree CM students in Australian education institutions in 2008 suggested that students felt "somewhat" prepared for clinical practice in eight dimensions of clinical practice. The authors conducted a follow-up study to this initial one, seeking to investigate perceptions of confidence in CM graduates in various aspects of clinical practice within the first year of completing their degree.

METHODS

A content-validated survey based on the previous study was distributed to a subset of 30 graduates from the original study cohort who had indicated a willingness to participate in this follow-up survey.

RESULTS

There were a small number of responses (n=12), limiting the usefulness of the quantitative questions. However, some interesting qualitative outcomes from the long-answer part of the survey support findings from the previous study that recent practitioners would like more clinical experience, as well as support in developing their business and interpersonal skills, and the option to participate in a professional mentoring arrangement.

CONCLUSIONS

Results of this study suggest that both education providers and professional associations may be able to play important and complementary roles in assisting CM students to successfully transition into the workforce. If CM is to continue to develop as a profession in Australia, it will be important that more attention be given to how to assist new graduates to successfully transition into and remain in clinical practice.