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Occupational Therapy Student Experiences and Transformations During Fieldwork in Mental Health Settings

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Abstract

The purpose of this study is to better understand the transformative experiences of occupational therapy students during fieldwork. In occupational therapy education, fieldwork provides students with an in-depth experience in the field. Thirty-one students submitted narratives following completion of Level II fieldwork in a mental health setting. Concepts from transformative learning theory guided the analysis. The themes that emerged were: (1) understanding clients with mental illness; (2) understanding occupation and occupational therapy; (3) feeling like a professional; and (4) changing as a person. The results highlight the importance of understanding the transformative process and fieldwork in mental health settings.

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... Although all included studies applied and evaluated the effectiveness of Mezirow's Transformative Learning Theory in healthcare education, seven (Bagatell et al., 2013;Bernard, 2019;Elliott II et al., 2012;Foronda & Belknap, 2012;Jackson et al., 2013;Prosek & Michel, 2016;Smith et al., 2014) only used selected phases of the Transformative Learning Theory. ...
... Of the 12 studies, nine were related to experiential learning (Bagatell et al., 2013;Elliott II et al., 2012;Foronda & Belknap, 2012 contextual local learning settings, such as fieldwork, community work, placements, and short-term medical missions (Bagatell et al., 2013;Elliott II et al., 2012;Kear, 2013;Morris & Faulk, 2007;Prout et al., 2014), while three discussed study abroad programs (Foronda & Belknap, 2012;Prosek & Michel, 2016;Smith et al., 2014), and one used simulation to guide transformative learning (Kerins et al., 2020). ...
... Of the 12 studies, nine were related to experiential learning (Bagatell et al., 2013;Elliott II et al., 2012;Foronda & Belknap, 2012 contextual local learning settings, such as fieldwork, community work, placements, and short-term medical missions (Bagatell et al., 2013;Elliott II et al., 2012;Kear, 2013;Morris & Faulk, 2007;Prout et al., 2014), while three discussed study abroad programs (Foronda & Belknap, 2012;Prosek & Michel, 2016;Smith et al., 2014), and one used simulation to guide transformative learning (Kerins et al., 2020). ...
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Introduction Transformative learning exposes students to situations where they can transform their perspective, question beliefs, and become effective learners. Methods A scoping review was conducted guided by an established methodology. A search of six electronic databases was undertaken up to October 2021: 1) Academic Search Complete; 2) CINAHL; 3) Education Research Complete; 4) ERIC; 5) ProQuest Central; and 6) SCOPUS. Forward and backward searches of included studies were also performed. Results Five studies used Mezirow's theory to underpin educational program development or implementation, and seven used this theory to evaluate learning transformation following program completion. Although a range of learning and teaching strategies were used, group learning to promote student collaboration was used in seven studies. Nine studies reported learning transformation, however, the assessment of this outcome varied. Discussion The findings of this review highlight variability in the use of this theory across educational programs, underscoring the need to embed Mezirow's Transformative Learning Theory across all phases of educational program development, implementation, and evaluation. This review has also highlighted the need for the development of a tool to measure transformation due to variability in the way it was reported in the literature.
... Despite this, fieldwork in mental health can positively impact students' attitudes (Beltran et al., 2007;Gilbert & Strong, 2000). Studies have demonstrated that fieldwork in mental health can challenge students' stereotypical notions about individuals with mental illness and normalize students' attitudes towards individuals with these conditions (Bagatell et al., 2013;Beltran et al., 2007;Lyons & Ziviani, 1995). Further, a study by Penny et al. (2001) showed the percentage of students who would consider working with this population significantly increased following their Level I fieldwork experience. ...
... Overall, findings of this study support those reported in previous research regarding OT student participation in mental health fieldwork. Following a fieldwork experience in mental health, students report having a better understanding of OT and mental illness; they also have more positive views about individuals with mental illness and this area of practice (Bagatell et al., 2013;Beltran et al., 2007;Gilbert & Strong, 2000). It is a novel finding that similar results were yielded for OT and OTA students as previous research has focused only on the former (Bagatell et al., 2013;Beltran et al., 2007;Gilbert & Strong, 2000). ...
... Following a fieldwork experience in mental health, students report having a better understanding of OT and mental illness; they also have more positive views about individuals with mental illness and this area of practice (Bagatell et al., 2013;Beltran et al., 2007;Gilbert & Strong, 2000). It is a novel finding that similar results were yielded for OT and OTA students as previous research has focused only on the former (Bagatell et al., 2013;Beltran et al., 2007;Gilbert & Strong, 2000). Students expressed surprise about how meaningful the experience was and integral to the refinement of their communication engagement and group facilitation skills. ...
Article
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Fieldwork is an integral portion of occupational therapy education that ensures students have the opportunity to develop basic competencies in real world practice settings. The national shortage of fieldwork placements, particularly in the area of mental health, in combination with the COVID-19 pandemic, have led to the adoption of increasingly innovative fieldwork models. This retrospective, qualitative study investigates occupational therapy assistant students’ experiences of completing a faculty-led (i.e. where faculty served as the primary fieldwork educator) and virtual (i.e., where services were offered in a virtual environment) Level I fieldwork with a community-based peer led behavioral health agency. Twenty-three students completed a confidential survey describing their experiences in Fall 2020. A secondary analysis of students’ responses was performed using principles of thematic analysis, which yielded results centered on four themes: knowledge, skills, attitudes, and structure. Subcategories highlighted growth across multiple areas including knowledge of occupational therapy’s role in mental health, interpersonal skills, and use of technology and other resources. Students’ preconceived notions of individuals with mental illness were challenged and many reported increased confidence in their abilities to work with these individuals. Both positive and constructive feedback were provided regarding the overall virtual fieldwork experience. The faculty-led virtual fieldwork model was viable in supporting occupational therapy assistant students’ skills to engage people with mental health and substance use challenges in a community setting. The potential use of this model is discussed in light of the anticipated increase of behavioral health problems for many across the lifespan post-COVID-19 pandemic.
... 15). These types of opportunities help to prepare students for professional challenges that the classroom or traditional fieldwork experiences cannot offer (Bagatell, Lawrence, Schwartz, & Vuernick, 2013;Gregory et al., 2011). In these situations, students are required to be leaders, rather than followers, or to model an occupational therapy fieldwork educator. ...
... While there is no body of evidence that directly compares nontraditional to traditional Level I fieldwork, research is available to support the unique learning that occurs in a community engaged fieldwork placement. For example, various studies have found that students are able to gain additional outcomes in CEL placements, such as resourcefulness, diagnostic knowledge, social duty, civic mindedness, self-directed learning, and self-awareness (Bagatell et al., 2013;Hammel et al., 2015;Nielsen, Jedlicka, Hanson, Fox, & Graves, 2017). In many cases, students are required to reflect on and face their preconceived notions or anxieties about a population that they have not encountered before, such as homeless youth, chronically mentally ill individuals, or at-risk inner-city adolescents (Bagatell et al., 2013;Fisher, 2002). ...
... For example, various studies have found that students are able to gain additional outcomes in CEL placements, such as resourcefulness, diagnostic knowledge, social duty, civic mindedness, self-directed learning, and self-awareness (Bagatell et al., 2013;Hammel et al., 2015;Nielsen, Jedlicka, Hanson, Fox, & Graves, 2017). In many cases, students are required to reflect on and face their preconceived notions or anxieties about a population that they have not encountered before, such as homeless youth, chronically mentally ill individuals, or at-risk inner-city adolescents (Bagatell et al., 2013;Fisher, 2002). As an occupational therapist, the growth and development of these skills are at the core of understanding the ability to foster healthy interactions with clients (Taylor, Lee, Kielhofner, & Ketkar, 2009). ...
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Today’s health care system requires therapists to acquire a level of confidence, flexibility, and personal growth that enables them to treat a diverse and complex clientele. Occupational therapy programs need to ensure that clinical placements can best prepare students for these demands. Community engaged learning (CEL) offers a distinctive opportunity both to meet the curricular requirements of fieldwork and to afford students the chance to develop unique sets of skills. The purpose of this mixed-methods study was to examine the experiences of graduate occupational therapy students participating in CEL fieldwork placements. The study explored the students’ self-efficacy before and after placements and the transformative learning process that occurred. Data were collected from semi-structured interviews, pre/post surveys, and reflective journals. The findings resulted in eight major themes that revealed growth in self-efficacy and personal and professional development. The results indicated the influential impression CEL leaves on the development of the student and provides a potential solution for programs to meet the demands of the current health care climate.
... In addition to the profession's broad commitment to mental health, the American Occupational Therapy Association (AOTA) identifies 'mental health' as one of six practice areas that traditionally has been described as specialized services for individuals with identified mental health challenges provided within behavioral mental health settings (Hartmann, Nadeau, & Tufano, 2013). Completion of a Level II fieldwork (FW) experience in a traditional mental health setting has long been viewed as essential in distinctly preparing entry-level occupational therapy practitioners (OTPs) to develop the specialized knowledge and skills needed to address mental health in practice (Bagatell, Lawrence, Schwartz, & Vuernick, 2013;Hartmann et al., 2013). However, the significant decline in the number of OTPs working in mental health settings (2.4%) has resulted in less opportunities for students to complete a traditional mental health Level II FW (AOTA, 2015). ...
Article
To explore the meaning and outcomes of a virtual building capacity process designed to promote knowledge translation of a public health approach to mental health with children and youth by occupational therapy students completing a Level II Fieldwork experience in school settings. A one-group (n= 19) mixed design using quantitative (pretest-posttest survey) and qualitative methods (phenomenological analysis of written reflections) was used to explore the meaning and outcomes of participation in the virtual building capacity process. Statistically significant improvements (p <.00) in pretest-posttest scores of knowledge, beliefs and actions related to addressing mental health were found in 7 of the 9 categories. Four qualitative themes emerged from the data: New thinking regarding ‘mental health’; Gearing up for change; Planning led to implementation; and the Building capacity process was meaningful and enjoyable. The building capacity process expanded student knowledge of a public health approach to mental health resulting in increased awareness and application of embedded strategies to address the mental health needs of students during a Level II Fieldwork experience in school settings.
... This study also highlights the value of student exposure to the diverse range of generic mental health roles in both coursework and fieldwork. Not only does this increase students' awareness of the breadth of contexts and opportunities in mental health (Bagatell, Lawrence, Schwartz, & Vuernick, 2013); it reinforces that the profession values these diverse roles as exciting, new and profession-expanding opportunities for employment. For decades, universities have been supporting 'role emerging' fieldwork placements as a way of achieving this goal (Rodger et al., 2009). ...
Article
Introduction: Occupational therapists are an integral part of Australian mental health services. Recent changes in the mental health sector mean that increasing numbers of occupational therapists now work in generic, non-profession-specific roles in non-government organisations. Previous research has identified a range of challenges faced by occupational therapists in generic roles, including reduced satisfaction and loss of professional identity. An exploration of potentially positive aspects and strategies that assist occupational therapists to succeed and flourish within generic roles is lacking. The aim of this study was to explore what assists occupational therapists to thrive within generic roles in Australia's non-government mental health sector. Methods: Semi-structured, in-depth interviews were conducted with 12 occupational therapists working in generic mental health roles across three non-government organisations spanning three Australian states. Data were analysed thematically using constant comparative analysis. Results: Thriving was supported in three domains. First, occupational therapists facilitated their own thriving by keeping their occupational therapy lens, and managing ambiguity. Second, workplaces were supportive when their values aligned with occupational therapy core values, they recognised and valued the occupational therapy contribution, and their roles allowed opportunities for therapists to use their profession-specific skills. Third, the broader occupational therapy profession assisted thriving through preparation, validation and ongoing inclusion. Conclusion: Despite some challenges, occupational therapists can and do thrive in generic non-government mental health roles. The preliminary framework of thriving provides valuable insights for those developing university curricula, those providing continuing professional development opportunities and for individual occupational therapists entering this expanding area of practice. Findings also provide insights into how individuals, academic curricula and the profession can respond and adapt to systemic transformations occurring in mental health service delivery.
... Practice placement experiences lead the student to experience significant changes in the ways they understand their identity and behavior. Students gain resourcefulness, a sense of social duty, self-directed learning, and self-awareness [9], which help them to understand the therapeutic use of self and the ability to foster healthy interactions with clients [9][10][11]. Mattila and Dolhi (2016) [11] found that practice placement experiences assist students to generalize learned skills and activities, and to transfer those skills to varying populations or clinical settings. ...
Article
Full-text available
Abstract Background Practice placements in occupational therapy are fundamental components in developing a student’s professional identity. Various models of placements are available to expose and expand students’ participation in various community-based services. The purpose of this study was to compare occupational therapy students’ perceptions and expectations prior to placements with their perceptions and satisfaction levels upon completion of placements, and to compare clinical placement models (role-established and role-emerging). Methods The study included 155 undergraduate occupational therapy students, who completed questionnaires prior to and upon completion of their placements. The questionnaire included items that were divided into categories of placement setting and supervision, personal skills, professional skills, and community. Paired t-tests and two-way repeated measures analyses of variance (ANOVA) were used in order to examine the change in scores over time, and a-parametric tests were used in order to compare the two models. Results For all students a significant decrease in scores was found from pre- to post-placement regarding setting and supervision (t[df] = 3.96[154], p
... Since there is a definite trend in health care practice toward health and well-being of the population and meeting clients where the needs are, the community is a natural fit for occupational therapy (McMurray & Clendon, 2015). Role emerging FW placements for occupational therapy students in the community are also key components in the profession's efforts to be recognized as a behavioral and mental health profession (Bagatell, Lawrence, Schwartz, & Vuernick, 2013;. ...
Article
Full-text available
Fieldwork education is an essential component of occupational therapy curriculum design and student development. Today’s students are faced with a variety of challenges in the changing, diverse healthcare system, and educators need to ensure there are placements that best prepare them for these demands. Role emerging fieldwork offers an opportunity to not only meet the curricular requirements of fieldwork education, but also afford students the chance to develop confidence and skills unique to this kind of placement. The purpose of this explanatory case study was to explore graduate occupational therapy students’ self-efficacy before and after a Level I role emerging fieldwork experience, and in addition, the potential personal or professional transformation that occurred as a result. Data was collected from 36 students using a pre-post survey with the Student Confidence Questionnaire (SCQ). The findings revealed a statistically significant growth in each of the seven areas of the SCQ (Risk Taking, Supervision, Communication, Adaptability, Innovation, Clinical Practice, and Professional Competence), which led to an increase in self-efficacy, personal and professional development, and a further understanding of the role of occupational therapy. Results indicated the influential impression role emerging fieldwork leaves on the growth and autonomy of the student and provides a potential solution for programs to meet the accreditation standards for all level of experiential learning.
... The study revealed that students began fieldwork with an array of assumptions and beliefs. In the course of a fieldwork placement they learn and experience things they did not previously know or understand (Bagatell et al., 2013). The findings also highlighted the importance of mental health fieldwork for student learning as this type of learning will not occur in a classroom. ...
Article
Racist practices in Occupational Therapy assessments
... It has also been observed that mental health fieldwork supports the development of skills considered foundational and preparatory to address aspects of psychological and social well-being crucial for health and recovery across populations (Costa, Molinsky, Kent, & Sauerwald, 2011;Kannenberg, Amini, & Hartman, 2010), including the psychosocial issues of individuals in physical rehabilitation settings (Ikiugu, 2010). In addition, mental health fieldwork has been found to facilitate active learners who are confident, competent and reflective regarding the role of occupational therapy and to enhance student confidence in articulating and conceptualizing the professional role of occupational therapy (Bagatell, Lawrence, Schwartz, & Vuernick, 2013). ...
Article
Full-text available
A competency assessment was developed to assess students' skills at the culmination of courses relating to mental health, including a Psychosocial Level I Fieldwork course. The intention of the assessment, titled the Psychosocial Occupational Therapy Competency Assessment (POT-CA), was to engage students in a practical skill demonstration and use of clinical reasoning in relation to brief case studies. Key skills assessed included: administration of the ACLS-5, establishing and maintaining therapeutic rapport, defining OT in client centered language, and use of clinical reasoning to identify additional assessment, intervention, and discharge recommendations. The purpose of this article is to present the tool and results from its preliminary use in a Level I psychosocial fieldwork course, in order to share a creative approach for assessing the development of clinical skills competence for mental health practice.
... The study revealed that students began fieldwork with an array of assumptions and beliefs. In the course of a fieldwork placement they learn and experience things they did not previously know or understand (Bagatell et al., 2013). The findings also highlighted the importance of mental health fieldwork for student learning as this type of learning will not occur in a classroom. ...
Article
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A process for developing a student led programme in an acute mental health setting Practice reality Due to an increase in the number of occupational therapy students there has been a corresponding increase in the need for student placements. Consequently, there is a greater onus on both educators and clinical settings to provide learning opportunities to meet the demand. The need for innovation to enhance clinical placement opportunities has been identified by programme directors (Rosenwax, Gribble, & Margaria, 2010) yet research into sustainable student led programmes is A process for developing a student led programme in an acute mental health setting Abstract This paper will describe the process used to develop a student led programme, within a mental health setting. The goal was to provide an effective occupational therapy student placement while increasing the capacity of the service to take students. The student led role enhanced the clinical team's capacity to supervise students. Access to evidence based interventions was increased for service users while student interest in the field of mental health was increased. Student placements in mental health should be structured to include a specific clinical role that enables students to assume responsibility while contributing to ongoing service development.
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The relationship between entry-level, undergraduate occupational therapy students’ fieldwork performance and measures of professionalism, reflective thinking and resilience was examined. A group of 135 undergraduates (86% female) completed a self-report questionnaire containing the standardized instruments measuring professionalism, resilience and reflective thinking. The Australian Student Practice Evaluation Form–Revised (SPEF–R) measured fieldwork performance. Linear regression analyses identified Staying Healthy and Relationships with Others as significant predictors of students’ fieldwork performance in Professional Behaviors, Self-Management and Information Gathering. The findings highlight the importance of interpersonal skills and engagement in healthy lifestyles in key fieldwork performance areas.
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Introduction First-year practice education placements have numerous benefits for occupational therapy students but are resource intensive. In considering alternatives, it is critical to consider students’ voices to ensure that planned experiences enable students to achieve the outcomes they value and need. This study examined undergraduate occupational therapy students’ views about important outcomes and characteristics of first-year placements. Methods Focus groups were conducted with 18 occupational therapy students and analysed using constant comparative analysis. Findings Two overarching outcomes were valued: confirmation of occupational therapy as a career choice and experience to draw on for future learning and practice. These outcomes were achievable through four proximal outcomes: understanding occupational therapy; understanding clients; finding out about myself and developing skills. The extent to which the valued outcomes were attained was determined by eight critical experiences: observing an occupational therapist in action; seeing real clients with real issues; seeing positive impact; seeing the bigger picture; accessing the occupational therapist’s reasoning; hands-on doing; getting feedback on skills and thinking analytically/reflectively. Conclusion In designing first-year placements, practice educators and academics need to ensure that students are provided with experiences that incorporate reality, participation and making connections to a bigger picture of occupational therapy service provision.
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Objective. To design and implement a series of activities focused on developing interprofessional communication skills and to assess the impact of the activities on students’ attitudes and achievement of educational goals. Design. Prior to the first pharmacy practice skills laboratory session, pharmacy students listened to a classroom lecture about team communication and viewed short videos describing the roles, responsibilities, and usual work environments of four types of health care professionals. In each of four subsequent laboratory sessions, students interacted with a different standardized health care professional role-played by a pharmacy faculty member who asked them a medication-related question. Students responded in verbal and written formats. Assessment. Student performance was assessed with a three-part rubric. The impact of the exercise was assessed by conducting pre- and post-intervention surveys and analyzing students’ performance on relevant Center for the Advancement of Pharmacy Education (CAPE) outcomes. Survey results showed improvement in student attitudes related to team-delivered care. Students’ performance on the problem solver and collaborator CAPE outcomes improved, while performance on the educator outcome worsened. Conclusions. The addition of an interprofessional communication activity with standardized health care professionals provided the opportunity for students to develop skills related to team communication. Students felt the activity was valuable and realistic; however, analysis of outcome achievement from the exercise revealed a need for more exposure to team communication skills. © 2017, American Association of Colleges of Pharmacy. All rights reserved.
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The purpose of this qualitative pilot study is to further understand the transformative experiences of Master of Occupational Therapy students who engaged in a role emerging fieldwork. Five students were interviewed and their reflective journals were analyzed following a fieldwork experience at an at-risk youth shelter. Four themes emerged through the coding process: fear and anxiety of the unknown, clinical reasoning and self-reflection, personal and professional growth, and further understanding of occupational therapy. Results indicate the powerful impact of role emerging fieldwork on the development of the student and provide a framework for meeting the standards of psychosocial fieldwork experiences.
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There is a growing interest in 'therapeutic narratives' and the relation between narrative and healing. Cheryl Mattingly's ethnography of the practice of occupational therapy in a North American hospital investigates the complex interconnections between narrative and experience in clinical work. Viewing the world of disability as a socially constructed experience, it presents fascinatingly detailed case studies of clinical interactions between occupational therapists and patients, many of them severely injured and disabled, and illustrates the diverse ways in which an ordinary clinical interchange is transformed into a dramatic experience governed by a narrative plot. Drawing from a wide range of sources, including anthropological studies of narrative and ritual, literary theory, phenomenology and hermeneutics, this book develops a narrative theory of social action and experience. While most contemporary theories of narrative presume that narratives impose an artificial coherence upon lived experience, Mattingly argues for a revision of the classic mimetic position. If narrative offers a correspondence to lived experience, she contends, the dominant formal feature which connects the two is not narrative coherence but narrative drama. Moving and sophisticated, this book is an innovative contribution to the study of modern institutions and to anthropological theory.
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Occupational therapy and occupational therapy assistant students enter into academic programs and fieldwork experiences with many ideas about various patient and client populations, how occupational therapy should be provided, what motivates individuals to engage in the therapeutic process, and so on. These preconceptions, which are influenced by an individual's worldview and sociocultural context, can result in assumptions that lead to actions. Transformative learning is a process that uses critical self-reflection to question those assumptions and facilitate new ways of thinking and acting in regards to individuals, challenges, and the therapeutic process. This article will present the reader with a background on transformative learning and methods for applying it to fieldwork education, though the content has broader application and will have us thinking about why we choose any given course of action.
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Narrative medicine has emerged in response to a commodified health care system that places corporate and bureaucratic concerns over the needs of the patient. Generated from a confluence of sources including humanities and medicine, primary care medicine, narratology, and the study of doctor-patient relationships, narrative medicine is medicine practiced with the competence to recognise, absorb, interpret and be moved by the stories of illness. By placing events in temporal order, with beginnings, middles and ends, and by establishing connections among things using metaphor and figural language, narrative medicine helps doctors to recognise patients and diseases, convey knowledge, accompany patients through the ordeals of illness – and according to Rita Charon, can ultimately lead to more humane, ethical and effective healthcare. Trained in medicine and in literary studies, Rita Charon is a pioneer of and authority on the emerging field of narrative medicine. In this important and long-awaited book she provides a comprehensive and systemic introduction to the conceptual principles underlying narrative medicine, as well as a practical guide for implementing narrative methods in health care. A true milestone in the field, it will interest general readers and experts in medicine, humanities and literary theory.
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The recruitment of students in health professions into the area of mental health has been shown to be influenced by their attitudes towards the area, with such attitudes possibly shaped in the same way as many of the attitudes towards mental illness are by the general community. The purpose of this study was to examine the attitudes of occupational therapy students and compare them with the attitudes of the general community, and further, to examine any changes in attitudes which occurred after completion of a fieldwork placement working with mentally ill people in community settings. Seventy-four third year occupational therapy students completed the Community Attitudes Towards the Mentally Ill (CAMI) instrument before, and at the completion of a 12 week fieldwork placement. Results showed that, before placement, students' attitudes towards the mentally ill were more positive than the attitudes of a community population, and after their community placement, the students' attitudes showed a significant and positive improvement. The implications of these findings are discussed and related to methods of teaching.
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Declining numbers of occupational therapists and students are choosing to practice in the area of mental health. A longitudinal study was conducted using a class of 20 Professional Masters students to investigate the factors that influence a student's practice area preference at six points, ranging from pre-admission to selection of the first job. The results indicate that pre-admission and level II fieldwork experiences were the most influential factors in practice area preference. Patient population was found to be a positive influence related to the level II fieldwork experience and the most important factor when selecting the first job. Since mental health courses were reported to have a more negative influence on the preference for practice in mental health, educators may need to focus more attention on improving students' experiences in these courses.
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Background and Aims: Despite recent initiatives to reduce stigma towards people with mental illness, negative attitudes persist both in the community and among health professionals. Fieldwork experience has been identified as the most powerful way of modifying the attitudes of health professional students. Research to date suggests that later placements tend to have a more positive effect on attitudes than do earlier placements. However, inconsistencies within the literature suggest that it is the nature of the fieldwork experience that is the critical factor. We set out to investigate whether a program of fieldwork that included a tutorial component would bring about positive attitudinal change in first year occupational therapy students. Methods: We conducted secondary analysis of data collected from first year students before and after first year fieldwork experience in mental health settings. Student statements were rated to identify positive versus negative attitudes, and attitudinal themes were analysed. Results: Quantitative analysis revealed that students made significantly more statements reflecting positive attitudes following fieldwork than they did before. From pre‐ to post‐fieldwork, attitudinal themes changed from: people with mental illness as different, fear of people with mental illness, and a deficit focus of mental illness, to: the ‘ordinariness’ of people with mental illness, students’ understanding of people with mental illness, and an enabling approach to people with mental illness. Conclusions: A program of fieldwork that includes a structured tutorial component can bring about positive changes in the attitudes of first year students towards people with mental illness.
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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.
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From the framework of transformative learning, this chapter explores how professional development can lead educators to be authentic, individuated, critically reflective practitioners. Practical strategies are provided.
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Critical and autonomous thinking must take precedence over the uncritical assimilation of knowledge. Transformative learning is a route to the development of critical thinking.
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The aim of the study was to examine the changes in attitudes towards mental illness after theoretical education and clinical placement among students from university programmes preparing for different kinds of health professions. Three different questionnaires were used, measuring the level of familiarity with mental illness and attitudes towards mental illness in general and towards specific mental illnesses. The data were collected on two occasions, before the theoretical course and after the completed clinical placement. The result showed that the attitudes toward mental illness in general had changed in a less stigmatising direction after the clinical placement. On the other hand, attitudes toward specific mental illnesses did not show any major changes. A conclusion is that the clinical placement included in the university programmes to some extent could affect attitudes in a de-stigmatizing direction, possibly because of the interaction with persons suffering from mental illness and experienced supervisors.
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Narrative reasoning is a central mode of clinical reasoning in occupational therapy. Therapists reason narratively when they are concerned with disability as an illness experience, that is, with how a physiological condition is affecting a person's life. In this paper, narrative reasoning is contrasted with propositional reasoning, and two kinds of narrative thinking are examined. The first is the use of narrative as a mode of speech that can be contrasted with biomedical discourse, in which disability is framed as physical pathology. The second involves the creation rather than the telling of stories. Therapists try to "emplot" therapeutic encounters with patients, that is, to help create a therapeutic story that becomes a meaningful short story in the larger life story of the patient.
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The shortage of occupational therapists choosing to practice in mental health and the increase of therapists electing to specialize in other areas led to a pilot study designed to gather information regarding the value of psychosocial Level II fieldwork. A survey was mailed to 152 practicing occupational therapists who had graduated from Colorado State University in Fort Collins between 1983 and 1988; of the surveys returned, 116 were used in this study. The results indicate that the psychosocial Level II fieldwork experience provides therapists with valuable training and experience regardless of their current area of practice or specialization. The results also suggest that to preserve the holistic approach that occupational therapists offer their clients, psychosocial Level II fieldwork must remain a requirement of occupational therapy programs.
Article
A phenomenological study explored occupational therapy students' experiences in psychiatric fieldwork. Of particular interest were students' experiences with and perceptions of persons using psychiatric services. Data were gathered from 16 informants, via in-depth interviews and participant observation, on multiple occasions throughout the students' fieldwork affiliations in hospital and community psychiatric service settings. Triangulation of data gathering methods and member checking were used to strengthen the interpretive validity of the study. Informants manifested stereotyped preconceptions and associated anxiety regarding persons labeled as mentally ill, though the strength of such beliefs and feelings was found to diminish as fieldwork progressed. Sensationalized popular images of mental illness (e.g., that it is linked with malevolence) and some aspects of academic and clinical education (e.g., a deficit focus) seemed to adversely affect students' perceptions. Assisting students to acquire a sound appreciation of the humanness of persons with psychiatric disorders is an educational imperative. There is a need to critically appraise academic and fieldwork practices in psychiatric occupational therapy.
Article
This paper describes the development of an instrument designed to examine the level of confidence of occupational therapy students during their fieldwork experiences. Confidence in this context refers to Bandura's concept of self-efficacy in Social Cognitive Theory. As this subject has received little formal study, no appropriate tool was found to measure confidence in students. The purpose of this study was to design a measure to provide students with an opportunity to self-assess their levels of confidence both within a placement and throughout their entire fieldwork experiences. The instrument was constructed in three phases: I - Instrument Development; II - Instrument Testing; 111 - Instrument Implementation. In Phase III, the instrument was distributed to all students entering the first year of occupational therapy studies at the University of Alberta. Data was collected from these students during their four fieldwork placements to address the questions of whether confidence increases during a fieldwork placement regardless of placement level, whether confidence increases by placement level, and whether student or placement characteristics affect levels of confidence. Results of the study support the hypotheses that confidence levels increase both during a fieldwork placement and with successive placements. Reliability and validity analyses indicated that the measure may be a useful tool to assess confidence in students during fieldwork placements. Cet article décrit l'élaboration d'un instrument conçu pour évaluer le degré de confiance des étudiants en ergothérapie pendant leurs stages en milieu clinique. Dans ce contexte, le concept de la confiance est utilisé en référence au concept d'efficacité personnelle présenté dans la théorie sociale cognitive de Bandura. Comme ce sujet a fait l'objet de peu d'études formelles, on n'a trouvé aucun instrument pouvant mesurer adéquatement la confiance des étudiants. Le but de cette étude était de concevoir une mesure qui permettrait aux étudiants d'autoévaluer leur degré de confiance au cours d'un stage et pour l'ensemble de leur formation clinique. L'instrument a été construit en trois étapes: I - Conception de l'instrument; II - Mise à l'essai de l'instrument; 111 - Mise en oeuvre de l'instrument. À l'étape III, l'instrument a été distribué à tous les étudiants de première année de l'Université d'Alberta. Des données ont été recueillies auprès de ces étudiants pendant leur quatre stages, pour déterminer: si la confiance augmente au cours d'un stage, peu importe le niveau du stage; si la confiance augmente en fonction du niveau de stage et si les caractéristiques de l'étudiant ou du stage ont un effet sur le degré de confiance. Les résultats de l'étude appuient les hypothèses selon lesquelles le degré de confiance augmente à la fois pendant un stage et d'un stage à l'autre. Les analyses de la sensibilité et de la validité indiquent que la mesure peut être un outil utile pour évaluer le degré de confiance des étudiants pendant les stages.
Article
An aesthetic pattern of knowing involves moving beyond classifications and knowing the whole individual. Students are taught to provide holistic care to patients, but instructors evaluate students primarily from a scientific, empirical perspective. To add balance between the art and the science of nursing practice, students were assigned to write an original poem about their clinical experience in mental health nursing. This article reports a qualitative analysis of those poems to expand the instructors' knowledge of the student experience. Five themes and one consistent pattern were identified. Insights and implications of student poetry writing are explored.
Transformative learning as a professional develop-ment goal. New Directions for Adult and Continuing Education
  • P Cranton
  • K P King
Cranton, P., & King, K. P. (2003). Transformative learning as a professional develop-ment goal. New Directions for Adult and Continuing Education, 98, 31–37.