Attributes of evidence-based occupational therapists in stroke rehabilitation

Stakeholders' priorities in the development of evidence-based practice competencies in rehabilitation students: a nominal group technique study

PURPOSE

Clinically integrated teaching (CIT) is an effective approach for promoting evidence-based practice (EBP) competencies among medical students. Challenges towards the implementation of CIT in rehabilitation curricula include educators' different conceptualizations of EBP, the perceived complexity of EBP and the boundaries between the academic and the clinical setting. This study aimed to identify tailored strategies to implement in rehabilitation programs and their affiliated clinical sites to support the development of EBP competencies among students in occupational therapy (OT), physical therapy (PT) and speech-language pathology (S-LP).

MATERIALS AND METHODS

Nominal group technique (NGT) with stakeholders from three rehabilitation programs in Canada, offering the professional master's in OT and PT (n = 35 participants) and in S-LP (n = 8).

RESULTS

The top two strategies identified in the OT/PT NGT were: 1) Developing a flexible definition of EBP that recognizes its complexity; 2) Providing clinicians with more access to the teaching content by pairing faculty with preceptors. The top two strategies identified in the S-LP NGT were: 1) Providing students with opportunities for decision-making with experienced clinicians; 2) Increasing interactions between faculty and preceptors using formal group meetings.

CONCLUSION

Findings laid foundations for future integrated knowledge translation projects to collaboratively implement, and test identified strategies.

Being and Becoming an Evidence-Based Practitioner: Occupational Therapists' Journey Toward Expertise

IMPORTANCE

Despite mounting evidence for the management of various health care conditions, the uptake of scientific evidence in occupational therapy is often suboptimal. Although positive attitudes and self-efficacy are key to evidence-based practices (EBPs), how one becomes an evidence-based practitioner, and how expertise in EBP manifests in practice, remains unclear.

OBJECTIVE

To describe how expert evidence-based practitioners conceptualize and enact their expertise in stroke rehabilitation.

DESIGN

Qualitative interpretive descriptive study using in-depth semistructured interviews with eight occupational therapists identified as expert evidence-based practitioners in a previous study. Transcripts were analyzed using an inductive thematic content analysis, and emergent themes were identified.

SETTINGS

Rehabilitation settings across Canada.

RESULTS

Six overarching themes emerged: (1) relying on personal attributes to engage in practice improvement, (2) acting on factors that motivate and trigger EBP, (3) achieving better outcomes because of engagement in EBP, (4) using an adaptive decision-making process, (5) participating in professional activities that contribute to practice improvement, and (6) working in a practice area with a large body of evidence.

CONCLUSIONS AND RELEVANCE

Expertise in stroke rehabilitation EBP appears to be a function of several personal attributes and habits of mind in addition to being influenced by a commitment to client-centered practice. Expertise requires a combination of deliberate effort and motivation to improve client outcomes, always in a context conducive to reflection, adaptation, and openness to innovation. Experts who model these traits and articulate the processes used to develop their expertise can be viewed as promising educational and continuing professional development resources. What This Article Adds: Expert evidence-based occupational therapists develop their expertise in this domain through commitment to client-centered practice, efforts toward honing this aspect of practice, and a willingness to innovate and adapt to challenging situations.

Return-to-Activity: Exploration of Occupational Therapy in Outpatient Adult Concussion Rehabilitation

Literature is sparse related to how occupational therapy advances symptom management and role-activity resumption after concussion. We aim to describe the occupational therapy process of evaluation and intervention for adults with a history of concussion(s) and persisting symptoms. The qualitative descriptive study used focus groups of expert occupational therapy practitioners across practice settings. Content analysis with a deductive strategy, open coding, and an unconstrained matrix was used to determine the process portion of a logic model outlining how expert practitioners framed their approach to rehabilitation. Thirteen expert occupational therapy practitioners informed the development of a logic model describing the occupational therapy process linking resources to activities of evaluation and intervention enabling people to return to their everyday life roles at their highest capacity. This study yields a description of how occupational therapy practitioners, across practice settings, aid individuals in returning to everyday activities and life roles after concussion(s).

Individual and organizational factors associated with evidence-based practice among physical and occupational therapy recent graduates: A cross-sectional national study

BACKGROUND

Occupational therapy (OT) and physical therapy (PT) programs in Canada have moved to graduate-level entry education to address graduates' readiness for evidence-based practice (EBP). Whether rehabilitation professionals with advanced training in EBP are meeting their responsibilities as evidence-based professionals upon entry into practice and the factors that influence the use of evidence is unclear. The aim of this study was to examine the individual and organizational factors associated with the use of EBP and supporting evidence-based activities among graduates of professional OT and PT master's programs.

METHODS

A cross-sectional design using a survey of recent graduates of the 29 OT and PT programs in Canada. The survey measured six constructs supportive of EBP (ie, knowledge, attitudes, confidence, organizational resources, actual use of EBP, and evidence-based activities). Analyses consisted of descriptive statistics to characterize the sample and the different variables and ordinal multivariate regression analysis.

RESULTS

257 graduates (15%) completed the survey. Attitudes towards EBP was positively associated both with evidence-based activities (odds ratio = 1.36 with a 95% CI: 1.22 to 1.52) and use of EBP (odds ratio = 1.23 with a 95% CI: 1.12 to 1.36); greater confidence was related to greater use of EBP (OR = 1.12, 95% CI: 1.01 to 1.24); and working in a private practice setting was found to be related to performing more evidence-based activities (odds ratio = 3.15, 95% CI: 1.40 to 7.12).

CONCLUSIONS

Despite a greater focus on EBP knowledge in these curricula across Canada, knowledge was not related to EBP use nor evidence-based activities upon entry into practice. On the other hand, attitudes, confidence and working in private practice were. University programs should consider curricular strategies that increase the use of EBP, provide opportunities to engage in evidence-based activities with an emphasis on promoting the development of positive attitudes towards EBP and increasing learners' confidence in their ability to be evidence-based professionals.

Building evidence-based practice competencies among rehabilitation students: a qualitative exploration of faculty and preceptors' perspectives

Medical education literature suggests clinically-integrated teaching may be the most effective approach to teach evidence-based practice (EBP). Before implementing this educational best practice in rehabilitation curricula, it is imperative to better understand the current context, barriers and facilitators to teach EBP in rehabilitation from the academic to the clinical setting. The aim of this study was to explore faculty and preceptors' experiences and perceptions of teaching EBP in rehabilitation professions, namely occupational therapy, physical therapy and speech-language pathology. We gathered data from seven focus groups and an individual interview with a sample of 24 faculty and 15 preceptors, i.e., clinical supervisors. Data collected were subjected to inductive thematic content analysis. We identified three overarching themes and corresponding strategies. First, "Recognizing EBP as a multifaceted concept" denoted participants' lack of consensus regarding the meaning and scope of EBP, and their awareness of such discrepancies. Second, "Complexity of EBP is at the core of teaching practices and experiences" referred to participants' perception of EBP as a complex process involving high-level cognitive skills, which influenced their teaching practices and challenged students and themselves. Third, "Connections and divides between research and practice" represented the limited and delicate connection between faculty and preceptors, the factors either bridging or maintaining the gap between them, and the impacts of such connections and divides on teaching. Improving collaboration between faculty and preceptors constitutes an essential first step towards more effective EBP training programs in rehabilitation that could be facilitated through online communities of practice or integrated knowledge translation research projects.

What occupational therapists' say about their competencies' enactment, maintenance and development in practice? A two-phase mixed methods study

BACKGROUND

Understanding how professional competencies are actually enacted in clinical practice can help university programs better prepare their graduates. The study aimed to describe 1) the perceived competency level of occupational therapists holding an entry-to-practice master's degree 2) the factors perceived as impacting the enactment of competencies; and 3) the strategies used to maintain and further develop level of competency in the seven practice roles: expert in enabling occupation, communicator, collaborator, practice manager, change agent, scholarly practitioner and professional.

METHODS

Descriptive two-phase mixed methods sequential design. The quantitative phase consisted of an online survey sent to all occupational therapists holding an entry-to-practice master's degree in Quebec, Canada (n = 1196), followed by focus group discussions with a subset of participants. Analysis used descriptive statistics and the Framework Approach for content analysis of focus group data. Competencies were theoretically anchored into the Profile of Occupational Therapist Practice in Canada (an equivalent to CanMEDS framework) and we used the Theoretical Domain Framework to collect and describe perceived factors and strategies.

RESULTS

Response rate to Phase 1 was 26.5% (n = 317/1196). The communicator, collaborator and professional roles were perceived as highly solicited in practice, valued and were rated more frequently at a higher competency level as compared to the other four roles (expert, manager, change agent and scholar roles). Focus group participants (n = 16) mentioned that both individual and organisational factors influence enactment of competencies. Consulting colleagues was the preferred strategy to support the scholar role, often described as foundational for the development of expertise.

CONCLUSION

This descriptive study provides valuable information as to how the seven roles are enacted in practice. Though the scholar role is highly valued by clinicians and organizations, insufficient time is allotted to searching for evidence and reflection in practice. Strategies emerging from the results are mainly directed toward this role with an emphasis on using of peers as a source of evidence. Future studies could explore how contextual factors influence the enactment of competencies across different professions as well as how these evolve over time.

What is "shared" in shared decision-making? Philosophical perspectives, epistemic justice, and implications for health professions education

BACKGROUND

Drawing from the philosophical work of Hans-Georg Gadamer and the perspectives of theorists Mikhail Bakhtin and Kenneth Burke, the aim of this paper is to critically reflect on the meaning of the word "shared."

METHOD

The authors draw on the concept of epistemic justice, which they argue permeates the clinical encounter, to discuss how various forms of, and claims to, knowledge may influence the attainement of shared decision-making in health care contexts. The specific objectives are twofold: first, the authors draw key concepts from key Gadamerian, Burkean, and Bakhtinian philosophical perspectives to consider shared decision-making in relation to two types of epistemic injustice: testimonial and hermeneutic epistemic injustice. Second, building on philosopher Paulo Freire's critical pedagogy, the authors emphasize that major changes in educational structures and systems are required to promote the critical reflexivity required to address issues of epistemic justice, in the broader pursuit of authentic shared decision-making.

RESULTS

They propose three main areas of focus for helath professions education: (a) changes in content (moving from a focus on biomedical knowledge to more content on social sciences) and methods of teaching (more dialogue and the creation of moments of dissonance); (b) a re-examination of teachers' role in promoting epistemic justice; and (c) inclusion of patients as partners.

CONCLUSIONS

Without major transformation in what, how, and with whom we teach, future clinicians may be unprepared to enact shared decision-making in a manner that does justice to the various ways of knowing.