Identifying Instructional Methods for Development of Clinical Reasoning in Entry-Level Occupational Therapy Education: A Mixed Methods Design

Occupational therapy education must teach using contemporary and evidence-based practices that yield graduates with clinical reasoning skills to successfully practice in dynamic and challenging environments. Researchers used a mixed-methods research design to identify the most frequently used and valued instructional methods for developing clinical reasoning with entry-level occupational therapy students. Researchers recruited full-time educators teaching in entry-level occupational therapy programs throughout the United States. Ninety-two occupational therapy educators completed the survey for the quantitative portion of the study. Subsequently, six occupational therapy educators participated in an interview for the qualitative portion of the study. Participants most frequently used laboratory experiences and least frequently used rotating chair discussion for developing clinical reasoning. Participants perceived experiential learning as the most valuable and rotating chair discussion as the least valuable instructional method for developing clinical reasoning. The three themes of the educator, the student, and the environment emerged from the qualitative data. Outcomes suggest occupational therapy educators must embrace the role of facilitator and continue to explore a variety of effective instructional methods. In order to achieve this role, occupational therapy educators need to engage in personal and professional development. Researchers provide additional strategies for developing the clinical reasoning skills required for successful occupational therapy practice

Promoting Student Understanding of Occupation-Centered Practice and Updated Inter-Rater Reliability of the Occupation-Centered Intervention Assessment

The Occupation-Centered Intervention Assessment (OCIA) was developed as a reflective tool for students to improve their comprehension of occupation-centered practice. Finding new and innovative ways to incorporate occupation-centered assignments can serve as a strategy to develop student integration of occupation-centered practice and allow educators to appraise student comprehension. The purpose of this study was to evaluate student understanding of occupation-centered practice by utilizing various statistical analyses, including updated inter-rater reliability, of the OCIA using student assignments. Utilizing a methodological approach, 121 first-year students analyzed 10 physical rehabilitation videos utilizing the OCIA to rate the interventions for their level of occupation-centeredness. Overall, the students demonstrated good agreement (α =.864), indicating the OCIA has good inter-rater reliability with first year students. Individual and aggregate student OCIA scores and standard deviations provided valuable information to the course instructors for threshold concepts to reinforce throughout the course and program. The use of the OCIA facilitates student comprehension and application of occupation-centered reasoning and can be woven into didactic curricula as a learning tool

A Model for Interprofessional Education between Occupational Therapy and Accounting Students: A Mixed-Methods Study

This interprofessional education (IPE) project was designed to prepare students to work and lead in an increasingly complex healthcare environment. The purpose of this project is to describe and measure accounting and occupational therapy students’ perception and value of participating in an IPE learning activity and how the activity enriched the learning environment and identified gaps of knowledge to improve teaching. A mixed methods pre- post-survey design was used to collect quantitative data from a modified version of the Interprofessional Socialization and Valuing Scale (ISVS-9a) from 115 occupational therapy and 21 accounting students. Qualitative data was collected from a post-survey using open-ended questions and the accounting students’ consultation deliverable report to the occupational therapy students. Statistically significant improvements from pre- post-survey for all ISVS-9a items were found for the occupational therapy students (all

Fee-for-Placement in Level II Fieldwork: Prevalence and Context

Occupational therapy (OT) education has utilized fieldwork experiences to develop professional identity and clinical competency of entry-level OT practitioners since 1923. Level II OT fieldwork is viewed as a necessary and valuable experience by students, clinicians, and academicians. Despite the significant role fieldwork has in the formation of the future workforce, some educational programs report a shortage of OT fieldwork placement sites and the emergence of fee-for-placement fieldwork sites. The purpose of this study was to examine the prevalence and context of fee-for-placement for Level II OT fieldwork in the United States. Investigators surveyed master’s and doctoral level OT programs to examine their experience with requests for fee-for-placement fieldwork sites. The response rate was 32% (58 of 128 programs). Approximately two-thirds (67%, n=38) of respondents reported a decrease in number of Level II placement reservations. Eighty-two percent of programs reported encountering sites who requested fee-for-placement and almost half (43%, n=25) anticipated this trend to increase in the future. The majority of programs (89%, n=52) indicated they avoid placing students at fieldwork sites who charge for placement. The observed trend in fee-for-placement fieldwork may affect OT education by yielding significant implications related to finances, selection and placement processes, and compliance with professional values and ethics for programs and students. The concerns raised by the respondents may warrant a profession-wide consensus and direction toward addressing fieldwork shortages and fee-for-placements

Mixed-Method Study of the Experiences and Routines of Caregivers of Children with Type 1 Diabetes

Background: Type 1 diabetes is one of the most prevalent chronic childhood conditions that affects family roles, routines, and the ability to participate in meaningful occupations after a child’s diagnosis. Because of the complex health management routines required to ensure the safety and well-being of a child with type 1 diabetes, caregivers may experience decreased overall health and well-being. Method: This sequential mixed-method study used a cross-sectional survey (n = 37) and phenomenological interviews (n = 6) to explore burden (the Burden Scale for Family Caregivers), quality of life (the WHO Quality of Life-BREF), and role engagement (a questionnaire) for caregivers of children living with type 1 diabetes. Results: The findings suggest that as caregiver burden increased, quality of life decreased (r = -.73, p \u3c 0.05). The caregivers described how caring for their children affected relationship maintenance with spouses, family, and friends; impacted their productive occupations involving work, home responsibilities, self-care, and finances; and revealed a pressing need for education and advocacy. Conclusions: The findings highlight the importance of supporting caregivers in their roles in providing diabetes management care to children with type 1 diabetes. Future research is needed to develop and test novel occupational therapy interventions aimed to simultaneously improve family-centered participation goals that support the medical management of diabetes care and the caregiver’s psychosocial well-being

Thirty-Day Unplanned Readmission and Its Effect on 90-Day Mortality in Hepatocellular Carcinoma Patients Undergoing Partial Hepatectomy

Background: Despite advances of surgical techniques, hepatectomy continues to be potentially dangerous and is associated with postoperative mortality, morbidity and readmission. The objective of this study was to determine the effect of 30-day unplanned readmission on ‘conditional’ 90-day mortality among hepatocellular carcinoma (HCC) patients who underwent partial hepatectomy. Methods: National Cancer Database (NCDB) was queried from 2004 to 2012 for patients with hepatocellular carcinoma (HCC) who underwent partial hepatectomy. Thirty-day unplanned readmission rate, and associated risk factors, was determined for 7,696 patients. The association between 30-day unplanned readmission and conditional 90-day mortality was further addressed. Results: The 30-day unplanned readmission rate for patients with HCC who underwent partial hepatectomy was 5.2%. Risk factors associated with 30-day unplanned readmission were sex, race/ethnicity, Charlson-Deyo score, and annual hospital hepatectomy volume. An overall adjusted odds of having conditional 90-day mortality was 2.325 times higher (95% CI 1.643 - 3.219) among patients with a history of 30-day unplanned readmission than those without. This association was dependent on age, sex, race/ethnicity, insurance status, alpha-fetoprotein (AFP), liver fibrosis, Charlson-Deyo comorbidity score and annual hospital hepatectomy volume. Conclusion: Efforts in patient care should be taken to reduce 30-day unplanned readmission after partial hepatectomy for patients with HCC to reduce conditional 90-day mortality

Retrospective Analysis of Graduates’ Outcomes in a Post-Professional Occupational Therapy Doctorate Program

There are limited studies within occupational therapy literature assessing the outcomes of advanced degrees. Specifically, there is a scarcity of literature about the benefits of completing a post-professional occupational therapy doctorate (POTD) program. The purpose of this study was to retrospectively examine graduates’ professional and personal outcomes at a midwestern university with an established POTD program. A total of 64 graduate exit surveys completed by POTD graduates between the years of 2008 and 2017 were analyzed using a mixed methods research design. Emergent categories from the data included a greater sense of self-empowerment and confidence, expanded career opportunities, and increased professional knowledge and skills. Quantitative data indicated new employment opportunities and increased pay. Overall, graduates reported increased personal and professional growth, however continued research regarding the benefits of completing a POTD is needed to help guide occupational therapists considering an advanced degree

The Impact of an Educational Human Trafficking Panel on Occupational Therapy Students’ Knowledge and Self-Efficacy

A rise in attention to and assistance for human trafficking (HT) victims and survivors has resulted in a call to action for occupational therapists and other healthcare professionals. Victims and survivors often seek healthcare services in a variety of settings, yet ill-equipped healthcare professionals lacking training and self-efficacy with this population have left many unidentified needs unaddressed. Occupational therapists possess the skills necessary to support and assist survivors of HT in their reintegration and healing processes. However, little to no specific training for practitioners in this field has been developed. This study explored how an educational panel of OTs and HT experts who have worked with occupational therapists impacted occupational therapists’ knowledge and perceived self-efficacy regarding HT and its intersection with occupational therapy. A 1.5-hour interactive panel was assembled and prepared for a synchronous Zoom meeting by the researchers. Eighty students completed both pre- and post-surveys. Post-panel surveys revealed that students’ knowledge of the intersection between HT and occupational therapy improved, their perceived self-efficacy in assisting victims and survivors of HT increased, and their perspective on the panel format and content was favorable. The survey findings also indicated students’ desire for continued professional education and occupational therapy practice skills focused on the topic of HT. One way to address the gaps in the knowledge and self-efficacy of healthcare providers is to equip them with knowledge and skills on treating HT victims through training during their didactic curriculum and in clinical practice

Are Attitudes Toward Evidence-Based Practice Different Between the United States and Chinese Occupational Therapy and Physical Therapy Students?

Purpose: Evidence-based practice (EBP) integrates the best evidence from research, clinician expertise, and patient preferences and values to deliver the highest quality of care to improve patient outcomes. Occupational therapy (OT), physical therapy (PT), and rehabilitation students gain exposure to EBP through both didactic and experiential learning. The differences in cultural, educational systems, and student learning styles between the United States and China may lead to different students’ perceptions and attitudes towards EBP. The purpose of the study was to characterize and compare the perceptions of and attitudes towards EBP between the U.S. and Chinese OT and PT students. Methods: A cross-sectional survey of the Evidence-Based Practice Process Assessment Scale (EBPPAS) was sent to professional students enrolled in Doctor of Occupational Therapy (OTD), Doctor of Physical Therapy (DPT), and Master of Occupational Therapy (MOT) programs at three universities in the U.S. (n=1,062) and OT, PT, and rehabilitation students of four-year bachelor programs at four universities in China (n=1,017). Students’ perception of the overall and individual domain of EBP was compared between the U.S. and China with independent samples t-test. Results: In general, all students showed a positive attitude towards EBP across the five domains. The U.S. DPT students had the highest mean score of 3.90 in the domain of “attitude about EBP” followed by the U.S. MOT students (mean=3.88), and the U.S. OTD students (mean=3.84). On average, the U.S. students scored 0.44 (13.8%) higher than Chinese students in all domains combined. Responses from both countries showed the highest scores in the domain of “attitude about EBP” followed by “familiarity with EBP” and “intention to engage in EBP”. In addition, the overall mean score increased non-significantly by 0.07 for the U.S. students from 1st year to 3rd year while it increased significantly by 0.15 (pnd year to 4th year. Conclusion: Few research studies have compared professional students’ attitudes towards EBP between the U.S. and China. This study demonstrated that the U.S. students were more positive overall and in all five domains. Future studies may focus on novice ways to promote EBP in didactic teaching and in clinical practice

Interprofessional Team Reasoning Framework as a Tool for Case Study Analysis with Health Professions Students: A Randomized Study

Background: This pilot study evaluated the efficacy of the Interprofessional Team Reasoning Framework (IPTRF) to facilitate teaching and learning case studies with health professions students.Methods and Findings: Eighteen interprofessional students were randomized to teams of six and were videotaped while completing a case. Team 1 (control) received only the case; team 2 received the case plus framework; and team 3 received the case, framework, and was shown videotaped examples of interprofessional interactions. The primary endpoint was students’ perceptions of interprofessional skills as measured pre and post intervention using a modified Team Skills Scale. The secondary endpoint was student performance as assessed by blinded individuals using a standardized rubric. The results revealed that students’ perceptions of team skills were significantly improved in team 2 and team 3 but not team 1. Students’ performance of their case as assessed by blinded faculty was significantly better in team 3 compared with teams 1 and 2.Conclusions: In this study of six disciplines, the IPTRF, in combination with modeled examples of interprofessional communication, was an effective tool to teach skills necessary to workup a patient case, which included collaboration, communication, and values/ethics. As the landscape of interprofessional education evolves, tools like the IPTRF will facilitate incorporation of these skills into health professions education