Developing a student competency exam for hand therapy clinical experiences: A cross-sectional survey of hand therapists

STUDY DESIGN

Cross-sectional survey design.

INTRODUCTION

Students pursuing hand therapy clinical rotations are expected to demonstrate foundational knowledge prior to the experience.

PURPOSE OF THE STUDY

Identify content that should be included on a potential competency exam for students pursuing hand therapy rotations from the perspectives of current hand therapists.

METHODS

This questionnaire, devised from the Scope of Practice and Domains of Hand Therapy, was emailed to members of the American Society of Hand Therapists. Data was collected and analyzed with SurveyMonkey to determine descriptive statistics and frequency distributions.

RESULTS

All knowledge areas included in the survey were ranked important or very important. Knowledge areas with the highest responses of much importance were the range of motion assessments of the upper extremity, anatomy and physiology, and interpersonal skills and therapeutic communications.

DISCUSSION

Hand therapy clinical instructors expect their students to demonstrate competency in relevant topics prior to starting their clinical experiences. A hand therapy competency exam addressing the valued knowledge areas may ensure students are prepared for the rigorous expectations of a hand therapy clinical rotation.

CONCLUSION

A competency test, including knowledge areas presented in this study, given to students before starting a specialty rotation, may ensure that the student has the foundational knowledge needed to succeed in a hand therapy setting, provide an understanding of students' strengths and weaknesses, and help clinicians become more willing to accept students for hand therapy rotations.

Student Perceptions of Growth-Facilitating and Growth-Constraining Factors of Practice Placements: A Comparison between Japanese and United Kingdom Occupational Therapy Students

This study compared growth-facilitating and growth-constraining experiences of practice placements as perceived by occupational therapy students from Japan and the United Kingdom (UK). Fifteen students from Japan and 14 from the UK used a nominal group technique (NGT) to rank, individually and in groups, their subjective learning experiences during practice placements. Qualitative analysis and simple tabulation based on ranking of items obtained in the NGT were performed. Five item categories were identified from both Japanese and UK students: self-reflection, the role of supervisor, sense of responsibility, clinical knowledge and skills, and time management. Results showed that all students perceived opportunities for self-reflection and feedback from supervisors as growth facilitating and students' passive attitudes towards requirements of practice placements as growth constraining. Country-specific differences between students were observed in clinical knowledge and skills, sense of responsibility, and time management. Japanese students perceived that preparatory study led to successfully treating clients during placement, and they tended to commit to placement assignments at the expense of time outside. UK students valued working independently with a sense of responsibility but considered time-management problems within their placement hours as growth constraining. These differences can be explained by different social norms and expectations of students from Japan and the UK.

Supervision models in physiotherapy practice education: student and practice educator evaluations

Objectives: To establish the supervision models used during physiotherapy practice placements and to determine student and practice educators' evaluations of the quality of these placements.Design: Cross-sectional study set in clinical sites providing placements for physiotherapy students in Ireland.Participants: Practice educators and students completing placements in 2015/16.Outcome Measure: Questionnaire which measured 18 indicators linked to quality assured placements. Eight additional indicators in the practice educator questionnaire addressed the overall feasibility of the supervision model. Two open-ended questions captured comments on the benefits and challenges of each model.Results: The overall response rate was 72% (112/155). The majority (75%, n = 84) of participants reported a 1:1 (one student: one educator) model of supervision. Fourteen percent (n = 16) reported a 1.2 (one student: two educators) model and 9% (n = 10) a 2.1 (two students: one educator) model. There was generally positive agreement with the questionnaire indicating that all placements, irrespective of supervision model were positively evaluated by participants. Students, however, indicated a more negative evaluation of the placement than practice educators in indictors related to communication, the provision of feedback, establishing an effective relationship with their educator and diversity of available learning opportunities. Indicators relating to productivity and the placement representing an efficient use of resources and personnel received more negative or equivocal ratings by educators.Conclusions: While the 1.1 model remains the most widely used supervision model in physiotherapy practice education, other models also score positively, offering choice to placement providers when determining the model that best suits their service.

Evaluating Practice Education Models in Occupational Therapy: Comparing 1:1, 2:1 and 3:1 Placements

Practice education is an essential part of the education of health professionals, yet in spite of this there is an acknowledged shortage of placements. At the same time, educational research indicates that peer learning, and in particular problem-based learning, has advantages for students. Studies that have investigated models of placements where more than one student at a time share an educator have shown that this may bring benefits for both educators and students.

This study was carried out with the aim of determining the impact of different models of practice placement (1:1, 2:1 and 3:1) on the quality of education for students and on the quality of the experience for educators, in both occupational therapy and physiotherapy courses at a university in the South of England. This article focuses on the occupational therapy component of the study. Six occupational therapy educators and 11 students took part, providing examples of all three models of placement.

The findings indicated that while all three models provided both advantages and disadvantages for educators and students, the 2:1 model offered more opportunities for peer support and enhanced the quality of the educational experience through peer learning. In some settings, however, it is probably the case that only the 1:1 model is possible. The findings also suggest that the success of any placement model depends heavily on how well the placement has been planned.

Modernising Fieldwork, Part 2: Realising the New Agenda

In recent years, many discussions have taken place regarding the need for new and different forms of fieldwork education. Research was undertaken to explore the capacity for and barriers to placement provision in the West Midlands Region (reported in part 1 of this article) and to investigate the views of fieldwork educators about the Role Emerging and the Collaborative (2:1) Models of Fieldwork Education. While these have been reported to be viable approaches, as yet few attempts have been made to implement them in practice and issues of context were found to have an impact on their implementation and the provision of placements.

Part 2 of this article examines these two models of fieldwork education in the light of the findings of this study and an innovative approach that emerged from discussions with participants is presented. It is argued here that choice and diversity, in terms of the different models of fieldwork education meeting the needs of different service environments and different students, is valuable; however, the development of an appropriate infrastructure and the provision of adequate resources to support these alternatives are key issues.

The Computation of Fieldwork Achievement in Occupational Therapy Degrees: Measuring a Minefield?

Fieldwork is a distinct element of undergraduate occupational therapy degrees. Students are seconded from educational institutions to fieldwork educators in practice settings, where their vocational competence is developed and assessed. Fieldwork procedures are devised by individual educational institutions. This paper reports the findings of a survey based on data from fieldwork coordinators, which investigated the incidence of and reasoning behind the computation of fieldwork achievement in England and Ireland.

The results showed that every programme had considered computing fieldwork performance at some time and that most were actually doing this. Many programmes that were not computing fieldwork performance expressed the desire to do so, but were uncertain about this action. Highly inconsistent practice was found regarding fieldwork assessment procedures and the weightings given to fieldwork elements; consequently, students' practical fieldwork skills may not be conveyed by their degree classification award. Various factors influenced fieldwork computation, with many inconsistencies and contradictions emerging.

The study concluded that computation of students' fieldwork achievement was highly inconsistent. Further development is vital to improve this situation for students, educators, clinicians and employers alike. It is suggested that development be coordinated at a national level.

Modernising Fieldwork, Part 1: Realising the Potential

Fieldwork education has received much attention recently. Many authors have referred to a shortage of placements and highlighted the need to embrace alternative methods of placement provision. This article describes the results of a project that investigated the existing and potential placement capacity for occupational therapy students and the challenges faced by occupational therapists in health and social care. The Coventry and Warwickshire Workforce Development Confederation commissioned this project on behalf of the West Midlands Region, which was where the study was undertaken.

Part 1 presents the first three themes that emerged: placement capacity and barriers to provision; creative solutions; and modernising fieldwork education. Part 2 will present and discuss two further themes: issues of context and current and future models of fieldwork education. Overall, the findings indicate that placement capacity is not being realised and that barriers to placement provision are largely organisational in nature. It is argued here that fieldwork education needs to be seen as a key component of continuing professional development and central to the modernisation agenda, not as an added extra.

Fieldwork within the Context of Higher Education: A Literature Review

Fieldwork education is a critical and an indisputable component within occupational therapy curricula. It presents the opportunity for the integration of theory and practice, enabling the development of professional behaviour in students.

Over the last decade, several authors have evaluated, debated and reflected upon the processes and contents of fieldwork so as to present the best practices which would truly provide meaningful learning experiences for the students. This article documents a cross-section of the literature as seen within the context of higher education and professional practice in a climate of changing health care systems.

Learning experiences on role-emerging placements: an exploration from the students' perspective

BACKGROUND/AIM

Occupational therapy educators are challenged to provide students with practical experiences which prepare them for ever changing health-care contexts on graduation. Role-emerging placements have been widely used internationally to help meet this challenge, but research into the learning experiences of students during these innovative placements is limited. This research investigated the enablers and barriers to learning from the perspectives of students on such placements from two European universities.

METHODS

Two separate qualitative studies tracked 10 final year students. Interviews explored their learning experiences prior to, during and after an eight- or 10-week role-emerging placement in a range of settings.

RESULTS

Four themes emerged, which were (1) adapting to less doing, more thinking and planning; (2) understanding the complexity of collaboration and making it work; (3) emotional extremes; and (4) realising and using the occupational therapy perspective.

CONCLUSIONS

These placements presented a 'roller coaster' of authentic learning experiences which created the opportunity for students to use occupation in practice and develop skills for collaborative working in an interprofessional environment. Whereas students viewed their role-emerging placement experiences positively, challenges included the emotional responses of students and placement pace. Findings suggest the need for supportive student placement experiences in both established and role-emerging areas to prepare students for a range of opportunities in an uncertain future.

Practice Educator Perspectives of Multiple Mentoring in Diverse Clinical Settings

Introduction:

In a climate of overloaded health systems and limited opportunities for practice education, there is a need to provide high quality placements that prepare students adequately for contemporary practice. Group models of supervision are one way to address this. This study trialled a multiple mentoring (group supervision) model across three different settings: a university clinic, an acute hospital and a community-based service. The perceptions of practice educators regarding its use and essential implementation features of the model were explored.

Method:

The model was trialled over an 18-month period. A total of 15 practice educators participated in three focus groups.

Findings:

Following inductive analysis, three main themes emerged: being clear in the chaos; qualities of the service and people; and challenges and benefits. Findings indicated a range of factors that influenced practice educators' experiences, including the structure of the placement, communication processes and the organisational context.

Conclusion:

A multiple mentoring model of student supervision can be implemented across a range of practice settings, providing that care is taken to tailor the practicum for each setting. Practice educators perceived that the benefits to themselves, the students, the service and the clients outweighed the challenges.

A Review of Non-Traditional Occupational Therapy Practice Placement Education: A Focus on Role-Emerging and Project Placements

Practice placement education has been recognised as an integral and critical component of the training of occupational therapy students. Although there is an extensive body of literature on clinical education and traditional practice placement education models, there has been limited research on alternative placements.

This paper reviews the literature on various practice placement education models and presents a contemporary view on how it is currently delivered. The literature is examined with a particular focus on the increasing range of practice placement education opportunities, such as project and role-emerging placements. The drivers for non-traditional practice placement education include shortages of traditional placement options, health reform and changing work practices, potential for role development and influence on practice choice. The benefits and challenges of non-traditional practice placement education are discussed, including supervision issues, student evaluation, professional and personal development and the opportunity to practise clinical skills.

Further research is recommended to investigate occupational therapy graduates' perceptions of role-emerging and project placements in order to identify the benefits or otherwise of these placements and to contribute to the limited body of knowledge of emerging education opportunities.

The Use of DVD Simulation as an Interprofessional Education Tool with Undergraduate Occupational Therapy Students

Health care professionals, including occupational therapists, are required to work collaboratively with other disciplines in order to provide high-quality care to their clients. As such, it is paramount that health care professional students learn about the professional roles of others and teamwork through interprofessional education (IPE). However, students are often educated in isolation from other disciplines and difficulties with clinically-based IPE have been acknowledged. Therefore, the purpose of this study was to evaluate occupational therapy students' perceptions of the use of digital video disc (DVD) simulations as a learning tool for IPE and practice placement education.

Eleven DVD simulations were developed by Monash University and a team of health care professionals. Students from the Bachelor of Occupational Therapy programme at Monash University viewed two or more simulations, and their perceptions were elicited using a mixed methodology approach consisting of a self-report questionnaire (n = 19) and three focus groups. Overall, the DVD simulations were perceived positively as a useful tool for IPE, to supplement practice placement education by occupational therapy students. Although the students did not feel that the simulations could replace actual practice placements, the cost benefit of using DVD simulations to teach, promote and facilitate IPE should be further investigated.

An Evaluation of a Role-Emerging Practice Placement Model for a Full Cohort of Occupational Therapy Students

It is accepted that practice placements are instrumental in providing an invaluable education on professional concepts, attitudes and behaviours. However, despite suggestions that practice placement education needs to be modernised to meet the demands of the current climate, there is only evidence of a limited number of role-emerging placements within the United Kingdom despite their relative popularity and history abroad. This paper describes and briefly evaluates a ‘model’ of practice placement education within role-emerging settings for a full cohort of pre-registration occupational therapy students, which meets national and international standards and guidance for such programmes.

No model of clinical education for physiotherapy students is superior to another: a systematic review

QUESTION

Which models of undergraduate/entry-level clinical education are being used internationally in allied health disciplines? What is the effect and, from the perspective of stakeholders, what are the advantages, disadvantages, and recommendations for successful implementation of different models of undergraduate/entry-level clinical education?

DESIGN

Systematic review with data from quantitative and qualitative studies synthesised in a narrative format.

PARTICIPANTS

Undergraduates/entry-level students from five allied health disciplines undergoing clinical education.

INTERVENTION

Six broad models of clinical education: one-educator-to-one-student (1:1); one-educator-to-multiple-students (1:2); multiple-educators-to-one-student (2:1); multiple-educators-to-multiple-students (2:2); non-discipline-specific-educator and student-as-educator.

OUTCOME MEASURES

Models were examined for productivity; student assessment; and advantages, disadvantages, and recommendations for implementation.

RESULTS

The review found few experimental studies, and a large amount of descriptive research and opinion pieces. The rigour of quantitative evidence was low, however qualitative was higher. Evidence supporting one model over another was largely deficient with few comparative studies available for analysis. Each model proffered strengths and weaknesses, which were unique to the model.

CONCLUSION

There is currently no 'gold standard' model of clinical education. The perception that one model is superior to any other is based on anecdotes and historical precedents, rather than on meaningful, robust, comparative studies.

Project placements for undergraduate occupational therapy students: design, implementation and evaluation

This study aimed to document the process undertaken to incorporate project placements as an effective fieldwork option for second- and third-year occupational therapy students, by evaluating the experience of both students and supervisors and identifying areas for improvement. Project placements are full- or part-time placements where a project is completed by a student under the supervision of an occupational therapist. The study is primarily descriptive, and includes a pre-post design using qualitative and quantitative data. The results indicate that the objectives of the study were achieved. Both supervisors and students expressed positive views about the placements. Students also identified changes that could improve the placements. Second- and third-year students gave similar ratings about aspects of the learning experiences during the project placements. The small cohort of third-year students and the low response rate from supervisors limited results. These project placements have shown an applicable model for students in earlier years of the course instead of the usual practice of non-traditional fieldwork being focused on final-year students. The project placements described are presented as one more potential fieldwork model in the range currently offered by curricula worldwide. Future research needs to concentrate on the longitudinal impact of these placements on the developing practice and attitudes of occupational therapy students.

Fieldwork education: The future of occupational therapy depends on it

Fieldwork continues to be the cornerstone of preparation for entry-level occupational therapy clinicians. During the past five years the Canadian healthcare system has experienced decreases in federal funding, organizational changes such as the movement to programme management, and increased focus on community-based needs. Two fieldwork projects were tested at a large health sciences facility, to meet the challenge of providing effective fieldwork experiences that build on current educational methodologies while still responding to changing realities in healthcare practice. The academic programme with which the health sciences facility is affiliated has developed a strong focus on self-directed learning, using problem-based and small group learning formats. The development, implementation and evaluation of the two fieldwork projects is described. Discussion focuses on the processes needed to facilitate innovative, flexible fieldwork models.

Expanding the boundaries of occupational therapy practice through student fieldwork experiences: description of a provincially-funded community development project

The numbers of occupational therapists in community practice are not yet large enough to provide fieldwork placements to accommodate all students. This article describes a project designed to educate community agencies that do not employ occupational therapists, about our service while at the same time securing new fieldwork placements. We used on-site different discipline and offsite same discipline supervision to provide students to selected agencies without cost. Funding for one year from the Ontario Ministry of Health to the Ontario University Programs in Rehabilitation Science enabled us to initiate and evaluate the project. Students in the project developed their ability to work independently and to see their potential role in health promotion and prevention. Despite the lack of ongoing government funding, four years later, community sites are not only being maintained, but the number of sites has increased from 28 to 39, providing a total of 75 student placements. By educating a growing number of community agencies about the work of occupational therapists, the project has also expanded the boundaries of practice.