The process of failing occupational therapy students: a staff perspective

Assigning a fail grade, particularly when it results in the termination of a career goal, is a taboo and taken-for-granted aspect of an assessor's role. Hermeneutics provided the main framework for interpreting the subjective and objective experiences of both academic and fieldwork supervisors during this process. An incremental research design, using a principal and two supplementary methods was used to investigate the minutiae of assessing whether a student has achieved the required standard of competence. Focused interviews were conducted with 25 academic and 5 fieldwork supervisors to compare the perspective of staff with different roles, relationships and responsibilities. These were preceded by two questionnaire surveys with trained, experienced fieldwork supervisors. On the first survey 64% (n=72) ranked 'failing a student' as their most problematical responsibility. The second survey comprised immediate and follow-up evaluations of five 'failure workshops' attended by 101 supervisors. They highlighted the importance of an assessor's affective response, reinforced effective supervisory strategies and the professional obligation to act as a gatekeeper of future standards. The results revealed a diverse array of individual factors, institutional rituals and external pressures which seemed to facilitate or sabotage the quality of the process and outcome. These included an assessor's inexperience, the conflict in values and roles between therapist and educator; characteristics of the student particularly the pastoral relationship and stage of training; the valued impartiality of an external examiner or fieldwork organiser; and the threat to reputations and course viability if results provide the primary performance indicator. An understanding of the complex constellation of factors which may influence an assessor's ability and confidence to fairly judge both initial and ongoing competence is important for all 'caring' professions to ensure only safe practitioners are registered to work with vulnerable clients

The process of failing occupational therapy students: a staff perspective

Assigning a fail grade, particularly when it results in the termination of a career goal, is a taboo and taken-for-granted aspect of an assessor's role. Hermeneutics provided the main framework for interpreting the subjective and objective experiences of both academic and fieldwork supervisors during this process. An incremental research design, using a principal and two supplementary methods was used to investigate the minutiae of assessing whether a student has achieved the required standard of competence. Focused interviews were conducted with 25 academic and 5 fieldwork supervisors to compare the perspective of staff with different roles, relationships and responsibilities. These were preceded by two questionnaire surveys with trained, experienced fieldwork supervisors. On the first survey 64% (n=72) ranked 'failing a student' as their most problematical responsibility. The second survey comprised immediate and follow-up evaluations of five 'failure workshops' attended by 101 supervisors. They highlighted the importance of an assessor's affective response, reinforced effective supervisory strategies and the professional obligation to act as a gatekeeper of future standards. The results revealed a diverse array of individual factors, institutional rituals and external pressures which seemed to facilitate or sabotage the quality of the process and outcome. These included an assessor's inexperience, the conflict in values and roles between therapist and educator; characteristics of the student particularly the pastoral relationship and stage of training; the valued impartiality of an external examiner or fieldwork organiser; and the threat to reputations and course viability if results provide the primary performance indicator. An understanding of the complex constellation of factors which may influence an assessor's ability and confidence to fairly judge both initial and ongoing competence is important for all 'caring' professions to ensure only safe practitioners are registered to work with vulnerable clients

Sustaining international partnerships : the European master of science programme in occupational therapy, a case study

International partnerships are a mechanism for supporting the academic development of occupational therapy and promoting cultural competence. This case study describes the factors that have helped to sustain a post-qualifying programme implemented by five higher education institutions in Denmark, the Netherlands, Sweden, Switzerland and the UK since 1999. Data collection methods were documentary analysis and the reflections of a purposive sample of six key informants. Cohort and outcome data, from 193 students from 31 countries who enrolled between 1999 and 2011, are reported. Each cohort comprises students from an average of eight countries to optimize inter-cultural dialogue. Four factors support sustainability. These are 1) supportive professional European networks; 2) timeliness and alignment with European higher education policy; 3) partnership structures and processes that emphasize joint decision making and accountability; and 4) the stimulus and satisfaction associated with internationalization. The main limitations are considering the OT-EuroMaster as an intrinsic case study and using opportunistic data collection that undermines the rigor and transferability of the findings. Future opportunities include doctoral networks, transnational research and sharing our curricula design with other Regions to spread the collaborative, capacity building endeavours more widely

An implementation research agenda.

In October 2006, the Chief Medical Officer (CMO) of England asked Professor Sir John Tooke to chair a High Level Group on Clinical Effectiveness in response to the chapter 'Waste not, want not' in the CMOs 2005 annual report 'On the State of the Public Health'. The high level group made recommendations to the CMO to address possible ways forward to improve clinical effectiveness in the UK National Health Service (NHS) and promote clinical engagement to deliver this. The report contained a short section on research needs that emerged from the process of writing the report, but in order to more fully identify the relevant research agenda Professor Sir John Tooke asked Professor Martin Eccles to convene an expert group - the Clinical Effectiveness Research Agenda Group (CERAG) - to define the research agenda. The CERAG's terms of reference were 'to further elaborate the research agenda in relation to pursuing clinically effective practice within the (UK) National Health Service'. This editorial presents the summary of the CERAG report and recommendations

Exploring factors that influence the spread and sustainability of a dysphagia innovation: an instrumental case study

Background: Swallowing difficulties challenge patient safety due to the increased risk of malnutrition, dehydration and aspiration pneumonia. A theoretically driven study was undertaken to examine the spread and sustainability of a locally developed innovation that involved using the Inter-Professional Dysphagia Framework to structure education for the workforce. A conceptual framework with 3 spread strategies (hierarchical control, participatory adaptation and facilitated evolution) was blended with a processual approach to sustaining organisational change. The aim was to understand the processes, mechanism and outcomes associated with the spread and sustainability of this safety initiative. Methods: An instrumental case study, prospectively tracked a dysphagia innovation for 34 months (April 2011 to January 2014) in a large health care organisation in England. A train-the-trainer intervention (as participatory adaptation) was deployed on care pathways for stroke and fractured neck of femur. Data were collected at the organisational and clinical level through interviews (n = 30) and document review. The coding frame combined the processual approach with the spread mechanisms. Pre-determined outcomes included the number of staff trained about dysphagia and impact related to changes in practice. Results: The features and processes associated with hierarchical control and participatory adaptation were identified. Leadership, critical junctures, temporality and making the innovation routine were aspects of hierarchical control. Participatory adaptation was evident on the care pathways through stakeholder responses, workload and resource pressures. Six of the 25 ward based trainers cascaded the dysphagia training. The expected outcomes were achieved when the top-down mandate (hierarchical control) was supplemented by local engagement and support (participatory adaptation). Conclusions: Frameworks for spread and sustainability were combined to create a ‘small theory’ that described the interventions, the processes and desired outcomes a priori. This novel methodological approach confirmed what is known about spread and sustainability, highlighted the particularity of change and offered new insights into the factors associated with hierarchical control and participatory adaptation. The findings illustrate the dualities of organisational change as universal and context specific; as particular and amendable to theoretical generalisation. Appreciating these dualities may contribute to understanding why many innovations fail to become routine

Exploring scale-up, spread, and sustainability: an instrumental case study tracing an innovation to enhance dysphagia care

Background Adoption, adaptation, scale-up, spread, and sustainability are ill-defined, undertheorised, and little-researched implementation science concepts. An instrumental case study will track the adoption and adaptation, or not, of a locally developed innovation about dysphagia as a patient safety issue. The case study will examine a conceptual framework with a continuum of spread comprising hierarchical control or ‘making it happen’, participatory adaptation or ‘help it happen’, and facilitated evolution or ‘let it happen’. Methods This case study is a prospective, longitudinal design using mixed methods. The fifteen-month (October 2012 to December 2013) instrumental case study is set in large, healthcare organisation in England. The innovation refers to introducing a nationally recognised, inter-disciplinary dysphagia competency framework to guide workforce development about fundamental aspects of care. Adoption and adaptation will be examined at an organisational level and along two, contrasting care pathways: stroke and fractured neck of femur. A number of educational interventions will be deployed, including training a cadre of trainers to cascade the essentials of dysphagia management and developing a Dysphagia Toolkit as a learning resource. Mixed methods will be used to investigate scale-up, spread, and sustainability in acute and community settings. A purposive sample of senior managers and clinical leaders will be interviewed to identify path dependency or the context specific particularities of implementation. A pre- and post-evaluation, using mealtime observations and a survey, will investigate the learning effect on staff adherence to patient specific dysphagia recommendations and attitudes towards dysphagia, respectively. Official documents and an ethnographic field journal allow critical junctures, temporal aspects and confounding factors to be explored. Discussion Researching spread and sustainability presents methodological and practical challenges. These include fidelity, adaptation latitude, time, and organisational changes. An instrumental case study will allow these confounding factors to be tracked over time and in place. The case study is underpinned by, and will test a conceptual framework about spread, to explore theoretical generalizability

Patricia Sunderland: an Irish registered mental nurse and pioneer of occupational therapy

Occupational therapy started at Cardiff City Mental Hospital in 1930, led by Sister Patricia Sunderland, a registered mental nurse and occupational therapist. This is noteworthy because neither Wales, nor Sunderland, have been recognised as pioneers of occupational therapy before. Sunderland’s description of a hospital wide service for in- and out-patients at Cardiff is one of the first accounts written by an occupational therapist.[1] Research to date indicates that Sunderland was the first Irish person to use thetitle and to write about occupational therapy in Wales.[2]</p