The history of occupational therapy assistants in Canada: a comparison with the United States

Insights into genetic assistant practice and the workforce in North America

Genetic assistant positions are now widely integrated in genetic services to address genetic counselor shortages and ultimately improve efficiency. While over 40% of genetic counselors report working with a genetic assistant ("NSGC Professional Status Survey: Work Environment," 2022), there is limited information about the genetic assistant workforce. The present study surveyed 164 genetic assistants and 139 individuals with experience working with genetic assistants (specifically genetic counselors, residents, geneticists, and administrative staff). Information was collected about genetic assistant demographics, positions, roles and responsibilities, and career paths. The data revealed that the genetic assistant workforce is demographically similar to the genetic counselor workforce and that most genetic assistants intend to pursue a career in genetic counseling. The genetic assistant positions were heterogeneous in terms of the roles and responsibilities assigned, even when separated by work setting. Lastly, participants reported that there were at least 144 genetic assistants across their institutions, a number that has likely grown since the time of the survey. The findings from this study highlight important opportunities for future research and focus, especially development of a scope of practice and competencies for genetic assistants, as well as the potential to use genetic assistant positions as an avenue to improve diversity within the genetic counseling workforce.

Refining the activities of genetic assistants: Development of task statements applicable across practice settings

Although genetic (counseling) assistants (GAs) have been implemented in many institutions, their roles vary widely. Therefore, this study aimed to refine our knowledge of GA tasks across work settings and specialties. Tasks performed by GAs were extracted from peer-reviewed articles, publicly available theses, and job postings, then analyzed using directed content analysis. Briefly, task statements were coded using broad categories from previous studies, with new categories added as emergent. Coded tasks were combined and condensed to produce a final task list, which was reviewed by subject matter experts. Sixty-one task statements were extracted from previous studies and 335 task statements were extracted from job descriptions. Directed content analysis produced a list of 40 unique tasks under 10 categories (8 from original research and 2 from the data). This study design resulted in a refined list of GA tasks that may be applicable across work settings and specialties, which is an essential step towards defining the scope of GA work. Beyond the human resource applications of the refined task list, this work may also benefit genetics services by reducing role overlap, improving efficiencies, improving employee satisfaction, and informing the development/improvement of training and other educational materials.

Integrating genetic assistants into the workforce: An 18-year productivity analysis and development of a staff mix planning tool

In recent years, genetic (counseling) assistants have been integrated in the genetics workforce, such that one-third of genetic counselors now report working with a genetic assistant. While several studies showed that adoption of the genetic assistant model leads to an increase in patient volume, the impact of this role substitution has not been studied quantitatively beyond the cancer genetics workforce. This study utilized 18 years of data from a publicly funded genetics clinic with multiple specialties and varying staff mix. Time series regression modeling was applied to describe the evolving impact of genetic assistants on genetic counselor and clinical geneticist productivity (measured as patient volume). The regression models suggest that the integration of genetic assistants led to a sustainable increase in genetic counselor patient volume, while clinical geneticist patient volume was unaffected. Importantly, the models also demonstrated an interaction between the number of genetic counselors and genetic assistants, whereby the impact of adding a genetic counselor was greater as more genetic assistants were employed in the clinic, and vice versa. The main regression model was used to create "ClinMix: A Genetics Staff Mix Planning Tool," an Excel application that allows users to explore how different staffing plans could affect patient volume, by applying the parameters estimated from this data or their own. We hope this report and the ClinMix tool can be employed by the genetics workforce to advocate for further implementation and evaluation of genetic assistant positions. Adoption of the genetic assistant model may provide clinics the support needed to meet increasing service delivery demands and subsequently foster genetic counselor practice at "top of scope."

Viewpoints of the Occupational Therapist Assistant-Physiotherapist Assistant Role on Inter-Professional Teams: A Mixed-Methods Study

Purpose: Occupational therapist assistants and physiotherapist assistants work on inter-professional teams in both institutional and community settings to facilitate patients' rehabilitation and recovery. Examination of how the assistant role is viewed by assistants and other inter-professional team members is needed to inform how to support and sustain development of the role and associated practice relationships. Method: In this explanatory sequential-design mixed-methods study, we first surveyed rehabilitation personnel, then held focus groups at a large urban health care organization. Statistical and thematic analysis was conducted to combine the findings from both data sources. Results: A total of 89 therapists and assistants completed surveys; 30 also contributed to four focus groups. Five themes were developed that expressed the perceptions of the assistant role on inter-professional teams: (1) left out of the loop, (2) living in the grey: negotiating and navigating the assistant role, (3) who's the boss? (4) things just don't fall into your lap: pursuing professional development, and (5) (not) just the assistant: the influence of norms and attitudes and external perspectives. Conclusions: The findings describe perceptions and institutional norms of the assistant practice role. They can inform discussions on regulation and accreditation as well as professional and continuing education, and they can promote reflection on team dynamics and supervisory practices.

The intermingled history of occupational therapy and anatomical education: A retrospective exploration

Few research articles have addressed the anatomical needs of entry-level occupational therapy students. Given this paucity of empirical evidence, there is a lack of knowledge regarding anatomical education in occupational therapy. This article will primarily serve as a retrospective look at the inclusion of anatomical education in the occupational therapy curriculum. Focusing on the historical inclusion is the first step to address the gap in existing knowledge. Examining the history of anatomy in occupational therapy provides an educational context for curricular developments and helps current anatomical educators understand the evolution of occupational therapy as a profession. Exploring the educational history also offers anatomy educators an identity, as significant contributors, in the training and preparedness of entry-level professionals while focusing on the ideals of occupational therapy. However, there is a critical need for empirical evidence of best teaching practices in occupational therapy and anatomical education. This manuscript provides a foundation and a starting point for further investigation into the anatomical competencies for entry-level occupational therapists.

[Issues surrounding the participation of auxiliary personnel in occupational therapy]

BACKGROUND

With the current scarcity of occupational therapists, the idea of resorting to the use of support personnel in occupational therapy does not have consensus. In fact, occupational therapists are faced with service delivery options for which they are ill-informed.

OBJECTIVE

To provide a synthesis of the Canadian and Quebec perspectives pertaining to the possibility for "skill mix" that is to say the participation of support personnel in occupational therapy, and to discuss ways in which they can participate.

KEY ISSUES

"Skill mix" would allow an occupational therapist to delegate certain clinical activities to support personnel, so as to assert the full potential of occupational therapy. The Canadian Association of Occupational Therapists and l'Ordre des ergothérapeutes du Quebec recognize the contribution of support personnel and offer markers for the implementation of practices utilizing their services.

IMPLICATIONS

This paper offers a critical reflection on this topic that is in need of further study.

Identification of recruitment and retention strategies for rehabilitation professionals in Ontario, Canada: results from expert panels

BACKGROUND

Demand for rehabilitation services is expected to increase due to factors such as an aging population, workforce pressures, rise in chronic and complex multi-system disorders, advances in technology, and changes in interprofessional health service delivery models. However, health human resource (HHR) strategies for Canadian rehabilitation professionals are lagging behind other professional groups such as physicians and nurses. The objectives of this study were: 1) to identify recruitment and retention strategies of rehabilitation professionals including occupational therapists, physical therapists and speech language pathologists from the literature; and 2) to investigate both the importance and feasibility of the identified strategies using expert panels amongst HHR and education experts.

METHODS

A review of the literature was conducted to identify recruitment and retention strategies for rehabilitation professionals. Two expert panels, one on Recruitment and Retention and the other on Education were convened to determine the importance and feasibility of the identified strategies. A modified-delphi process was used to gain consensus and to rate the identified strategies along these two dimensions.

RESULTS

A total of 34 strategies were identified by the Recruitment and Retention and Education expert panels as being important and feasible for the development of a HHR plan for recruitment and retention of rehabilitation professionals. Seven were categorized under the Quality of Worklife and Work Environment theme, another seven in Financial Incentives and Marketing, two in Workload and Skill Mix, thirteen in Professional Development and five in Education and Training.

CONCLUSION

Based on the results from the expert panels, the three major areas of focus for HHR planning in the rehabilitation sector should include strategies addressing Quality of Worklife and Work Environment, Financial Incentives and Marketing and Professional Development.

Intraprofessional Fieldwork Education: Occupational Therapy and Occupational Therapist Assistant Students Learning Together

Background. In the past 10 years, the use of support personnel in Canada has generated significant interest from occupational therapists, professional associations, regulatory bodies, employers, educational institutions, and government agencies.Purpose. The purpose of this study was to explore the impact of a combined collaborative fieldwork placement and weekly tutorial as a teaching strategy for intraprofessional education.Methods. Seven pairs of student occupational therapists and occupational therapist assistants were assigned to fieldwork placements. Tutorials were scheduled during the placements to discuss intraprofessional issues and provision of occupational therapy services in the clinical setting. Journaling and focus groups were used to collect data from students, tutors, and preceptors.Findings. Three key themes emerged from the data: (1) developing the relationship, (2) understanding roles, and (3) recognizing environmental influences on learning.Implications. Intraprofessional learning experiences prior to graduation can help prepare occupational therapy and occupational therapist assistant students for future collaborative practice.

Collaborative fieldwork education with student occupational therapists and student occupational therapist assistants

The profession of occupational therapy has a long history of working collaboratively with support personnel. This paper describes the process of a fieldwork education partnership developed between the McMaster University, BHSc (OT) Program and the Mohawk College, Occupational Therapist Assistant and Physical Therapist Assistant Program. Eight student occupational therapists and eight student occupational therapist assistants learned together in a variety of fieldwork settings, either in pairs or in groups. Both groups of students kept weekly journals of the experience and completed a post placement questionnaire. The journals were inductively analysed using a retrospective content analysis. The four emergent themes identified from the data are learning about each other's role, collaborative learning, impact on client care and future practice, and resistance to roles. Recommendations for future collaborations are discussed.