Evaluating Change in Skill Performance Over Time and Practice Context in Introductory Fieldwork Simulation

Simulation has been recognized for its ability to develop competency-level skills and as a replacement for some introductory fieldwork (FW) hours. This study explored how occupational therapy competency-related skills developed over sequential in-person simulations across health practice contexts during Level 1 FW. Entry-to-practice occupational therapy students (N = 66) participated in six sequential, formative, Level 1 FW simulations. The first three sequential simulations (the same patient case evolves in each successive interaction) included a trained simulated patient in a community mental health context and the following three engaged a trained simulated inpatient in a physical health context. Evaluation rubric variables included selected Competencies for Occupational Therapists in Canada (2021) scaffolded to performance expectations at an introductory Level 1 FW placement level. Quantitative pre-post comparison design with secondary data analysis was analyzed using Wilcoxon signed-rank test and ordered logistic regression. Each additional simulation demonstrated significant increases in the odds of improved performance in clinical skills, clinical decision making, responding to evolving patient’s needs and priorities, identifying their own strengths and weaknesses, articulating clinical reasoning, and receiving constructive criticism. However, students’ skills in the physical health context for decision-making and responding to the patient’s needs and priorities did not demonstrate the same improvement trajectories as the mental health context. Sequential simulations are an effective modality for developing Level 1 competency related skills in different practice contexts. Depending on the competency-related practice skill and context, three or more formative unfolding simulations in that context may be needed for a significant improvement

Sequential Simulations During Introductory Part-Time Fieldwork: Design, Implementation, and Student Satisfaction

Background: Simulation is used in various ways in occupational therapy education and is recognized as a replacement for some conventional fieldwork hours. However, design and student satisfaction has had limited exploration. Method: Sequential best practice simulations were designed for Level 1 fieldwork objectives in mental and musculoskeletal practice. The Satisfaction with Simulation Education scale (SSES) and qualitative feedback were used to assess student satisfaction. An exploratory factor analysis was used to validate the SSES in occupational therapy, and a three-factor repeated measures ANOVA was used to determine factors contributing to satisfaction across simulations. Results: A three-factor model of clinical reasoning and ability, facilitator feedback, and reflection was derived. The qualitative data identified authenticity and relevance to clinical practice as two domains not captured by the SSES items. Repeated measures ANOVA revealed a significant interaction of case by SSES factor with mental health clinical reasoning and ability mean scores lower than musculoskeletal means. Conclusion: Occupational therapy students reported high levels of satisfaction for design used to prepare for full-time fieldwork experiences. The SSES captured most contributors to satisfaction, but potential items to enhance the SSES validity in occupational therapy include those related to authenticity and relevance to practice

Trees for Shelter: The Implications in Agroforestry System

The objective of this study was to determine the horizontal and vertical variations in soil penetration resistance (PR) observed at tree-scale in silvopastoral plots that were grazed by sheep with and without trees. Sycamore trees (Acer pseudoplatanus L) were planted in the spring of 1988 at 10 m x 10 m spacing (100 stems/ha) at Glensaugh NE of Scotland on plots replicated over three blocks in Randomized Complete Block design on a predominantly rye grass (Lolium perenne L) pasture. Included in the design were pasture plots without trees (Control). The experiment is grazed by sheep yearly from April to October. Soil PR was measured in Mega Pascals (MPa) around two randomly selected trees in each plot in 8 directions of the compass - N, NE, E, SE, S, SW, W and NW at 1 m intervals starting at 0.5 m from the tree base to mid point of the separation distance (4.5 m) between the trees. The soil PR data were measured at 3.5 cm soil depth intervals at points around the tree up to depth limit of 21.0 cm. This gave six depth intervals of d1 (3.5), d2 (7.0), d3 (10.5), d4 (14.0), d5 (17.5) and d6 (21.0). In the Control plots, soil PR was measured as in the Sycamore plots around two hypothetical tree positions chosen randomly in each plot. The soil PR was found to decrease significantly within the horizontal distance of 4.5 m from the tree and depth for up to d3 (10.5 cm) only in the grazed Sycamore plots. Soil penetrometer resistance was found to increase significantly within the vertical distance of 0-14 cm of the soil around the tree in grazed Sycamore and Control plots. Beyond this soil depth, soil PR was no longer significant in these treatments

Occupational Therapy Students’ Perceptions of Feedback During Pre-Fieldwork Simulation Debrief: Useful and Why

Simulation is increasingly used in occupational therapy education with the objectives of developing practice skill competency and enhancing clinical reasoning. Debriefing, an integral part of the simulation process, is critical to achieving these objectives. This study sought to determine the types of debrief feedback Master of Science in Occupational Therapy (MScOT) students perceived as most useful and why, and how the advocacy inquiry model of debriefing influenced self-reported increases in clinical reasoning, client care, and planned implementation of feedback in practice. Using an embedded mixed method design with secondary data analysis, sixty-three first-year MScOT students provided 357 descriptions of the most useful feedback they received during 10-minute, facilitator-led debrief sessions after six simulations. Qualitative analysis revealed useful feedback was related to specific skills, interviewing and communication, the process of practice, strengths and encouragement, and client-centeredness. The advocacy inquiry approach was a useful delivery method of feedback. Logistic regression indicated that reported use of the advocacy inquiry model increased the likelihood by 4.7 times that students reported the debrief facilitated clinical reasoning. When advocacy inquiry was used in conjunction with providing feedback on specific skills, students were 5.3 times more likely to report planned implementation of the feedback in practice. Students value a variety of types of feedback during simulation debriefs. Debriefs using the advocacy inquiry method may be particularly useful for facilitating the development of clinical reasoning in the context of simulation-based fieldwork education

Client-Centered Practice when Professional and Social Power are Uncoupled: The Experiences of Therapists from Marginalized Groups

Background: Client-centeredness is foundational to occupational therapy, yet virtually no research has examined this aspect of practice as experienced by therapists from marginalized groups. The discourse of client-centeredness implicitly assumes a “dominant-group” therapist. Professional power is assumed to be accompanied by social power and privilege. Here, we explore what happens when professional and social power are uncoupled. Method: In-depth interviews grounded in critical phenomenology were conducted with Canadian therapists (n = 20) who self-identified as disabled, minority sexual/gender identity (LGBTQ+), racialized, ethnic minority, and/or from working-class backgrounds. Iterative thematic analysis employed constant comparison using ATLAS.ti for team coding. Results: Clients mobilized social power conveying direct and indirect hostility toward the therapists. Clients used social power to undermine the professional credentials and competence of the therapists. In turn, the therapists strove to balance professional and social power, when possible disclosing marginalized identities only when beneficial to therapy. Strongly endorsing client-centered principles, the therapists faced considerable tension regarding how to respond to client hostility. Conclusions: The discourse of client-centeredness ignores the realities of marginalized therapists for whom professional power is not accompanied by social power. Better conceptualizing client-centeredness requires shifting the discourse to address practice dilemmas distinct to marginalized therapists working with clients who actively mobilize systemic oppression

Professional Misfits: “You’re Having to Perform . . . All Week Long”

Background: Occupational therapy professes commitment to equity and justice, and research is growing concerning the experiences of clients from marginalized groups. To date, almost no research explores the professional experiences of therapists from marginalized groups. This qualitative study explores how exclusion operates in the profession among colleagues. Method: Grounded in critical phenomenology, semi-structured in-depth interviews were conducted with 20 occupational therapists who self-identified as racialized, disabled, ethnic minority, minority sexual/gender identity (LGBTQ+), and/or from working-class backgrounds. Iterative analysis was conducted using constant comparison and employing ATLAS.ti for team coding. Results: Across identity groups, four processes of exclusion were identified: isolation, abrasion, presumptions of incompetence, and coerced assimilation. Garland-Thompson’s (2011) concept of “misfit” is employed to analyze how therapists are constructed as not-quite-fitting the professional space delimited by occupational therapy’s white, able-body-minded, Western, heterosexual, middle-class, cisgender norms. Conclusions: Misfits are constructed by contexts, by expectations and material arrangements that assume particular bodies. Misfits make visible the inequities built into business-as-usual, an illumination that comes at often-painful cost. Yet there is possibility for change toward equity and justice for therapist colleagues: we can all choose to do differently, enacting change at micro and macro levels

Soil Nutrient Redistribution Pattern About the Tree in a Silvopastoral System

The objective of this paper is to report the effect of animal-tree interactions on soil nutrient redistribution pattern in a grazed silvopastoral experiment site at Glensaugh, in NE Scotland. Scots pine (Pinus sylvestris L) tree species were planted in square lattice arrangements at 5 m x 5 m, spacing (400 stems/ha) on plots replicated over three blocks in Randomized Complete Block design on a predominantly rye grass (Lolium perenne L) pasture which was grazed by sheep yearly from April to October. Included in the design were grazed pasture plots without trees (Control). Soil samples were collected from around two randomly selected trees in each plot in four directions N, E, S and W at 1 m interval starting at 0.5 m from the tree base up to mid point of the separation distance between trees. In the Control plots, soil samples were collected as above from two hypothetical tree positions chosen randomly. The analysis of variance result showed that soil total N, %C and Organic matter (OM) increased significantly with horizontal distance from the tree in the grazed Scots pine plots whereas soil nutrients did not vary significantly with horizontal distance from the tree in the Control plots