Use of a Logic Model to Develop an Innovative Hand Therapy Clinic to Provide Experiential Learning for Occupational Therapy Students

Occupational therapy (OT) students seek experiential learning opportunities to help them construct knowledge and meaning. Student clinics are increasing in prevalence as an effective means to engage in experiential learning. The student experiential learning clinic for hand therapy (SELC-HT) is a newly opened student clinic providing OT to under-insured individuals with upper extremity impairments. The SELC-HT used the student run free clinic (SRFC) logic model to systematically plan, implement, and evaluate its effectiveness. Planning started with evaluating the need and the context of the SELC-HT, allowing developers to state the long-term impacts of preparing students for future clinical practice, reintegrating patients without healthcare back to their roles, and contributing to the OT body of knowledge. Planning then progressed in a backward manner by first identifying measurable outcomes leading to these impacts. The output is data on the SELC-HT’s reach, indicating the clinic is moving toward these outcomes. Development of the activities followed, which will produce the output and outcome data. Lastly inputs were identified to carry out the activities. Following this careful planning, the clinic opened by moving forward through the SRFC logic model. At the conclusion of the first semester, evaluation of the SELC-HT occurred by examining the output data and measurable outcomes. Program evaluation occurred throughout the semester to assess whether the planned components were carried out effectively. As outlined in the SRFC logic model, iterative changes were made to the SELC-HT, with new outcomes, outputs, activities, and inputs implemented in the following semester to continue moving toward the impacts

Toolbox Talks: Insights for Improvement

Tool box talks (TBTs) have the potential to improve communication, empower workers, reduce injuries and improve safety; however, they can also be “missed opportunities” for providing important safety messages in construction. The goal of this paper is to share the results from two research projects designed to improve the frequency, delivery, participation, and outcomes of TBTs. The results of these projects provide suggestions for planning and delivering TBTs in construction. METHODS: In the first project, 86 residential carpentry foremen from 8 different residential contractors in the St. Louis region participated in training for delivering TBTs as part of an 8-hour fall prevention and safety communication intervention. We compared baseline measures of safety behavior and fall prevention knowledge items to follow-up between participating foremen and their crewmembers. Concurrently, surveys of 300 apprentice carpenters were collected to describe the frequency and delivery methods of TBT and to serve as a comparison group for the TBT intervention. In the second project, we evaluated the utility of ergonomics TBTs delivered by a safety representative to 36 carpenters and laborers. Workers rated their perceptions of topic relevance, delivery method, similarities to traditional TBTs, and intent to change behaviors. The safety representative provided feedback regarding the TBTs and reported their observations of improved worker use of ergonomics in work tasks post-training. DISCUSSION / CONCLUSIONS: Both interventions described in this paper improved workplace safety. The interventions demonstrate how to simply shift from non-collaborative TBTs to participatory, context-driven TBTs by using a pre-printed TBT template, modified to address the hazards present at the worksite. Delivery suggestions relate the information to the workers, and include workers in the identification of problems and safety-related solutions. These participatory methods for preparing and delivering TBTs have the potential to improve construction workplace safety practices

Occupation-Centered Anatomy and Applied Biomechanics Courses: Design and Outcomes

Occupation-centered course design allows occupational therapy (OT) educators to differentiate ourselves from other professions while communicating the distinct value of occupation to our students. While there have been numerous calls to action for centering occupation in the OT classroom and proposed models to approach course design, there is limited literature on occupation-centered course design in specific courses, notably foundational science courses like anatomy and applied biomechanics. In this study, we outline our course design process in two courses taught concurrently, as well as our prospective study to determine if an occupation-centered course design allowed students to meet objectives and the effect of undergraduate preparation on objective achievement. We also explored students’ agreement with importance of occupation-centered instruction, and our ability to stay occupation-centered. Fifty-five students completed pre and post course surveys rating their ability to perform the five objectives for each course and their level of agreement about the role of occupation in these courses. We found statistically significant increases in all objective ratings, with some ratings more than doubling. Post-course ratings among students with different undergraduate backgrounds were similar despite being statistically different at baseline. Students placed high value in occupation-centered course design at both time points. Students rated the ability to stay occupation-centered lowest in the first few weeks, with Anatomy rated lower than Applied Biomechanics in all weeks. This suggests that the incremental improvements made in the course delivery were effective; however, it was more challenging to create an occupation-centered course in Anatomy

Evaluation of a Student Experiential Learning Clinic for Hand Therapy Using a Logic Model

Student clinics (SC) provide experiential learning opportunities in occupational therapy (OT) education that develop clinical reasoning, while providing much needed rehabilitation to under and un-insured patients in the community. The Student Experiential Learning Clinic for Hand Therapy (SELC-HT) is a SC that used a logic model for planning, implementing, and evaluating the SELC-HT. The purpose of this study is to report on outcome data on students and patients, as outlined in the evaluation phase of the logic model. The 13 OT master/doctorate students, who delivered care in the SELC-HT, demonstrated growth in self-reported hand therapy knowledge (p=0.002) measured with the Hand Therapy Certification Commission Self-Assessment Tool. Nine of the 12 students responding to alumni survey were employed in hand therapy positions shortly after graduation. Five students authored six manuscripts published in peer-reviewed journals or practice journals about their work in the SELC-HT. Of the 57 patients with baseline data, fractures were the most common diagnosis, and most patients were Black and males. One-third of injuries were due to violence, primarily gunshot wounds. At discharge (n=25) mean disability, measured with the Disability Arm Shoulder Hand, decreased 14.8 points (p=.001), which exceeds minimal clinical difference of 10.83. Statistically significant improvements in work disability (n=18) and work ability (n=21) also occurred. Most importantly, five patients who were not able to work at baseline had returned to work at discharge. These positive student and patient outcomes are due in part to the systematic planning and implementation of procedures defined in the SELC-HT logic model

Needs Assessment, Program Development, and Pilot Testing: Training for Occupational Therapy Students Working with Survivors of Gun Violence

After the first year of operation, members of a student-staffed occupational therapy (OT) clinic found that 36% of their patients’ injuries were violence-related, mostly due to gun violence. The purposes of this project were to identify unmet needs of survivors of violence seen in a clinic setting, identify treating professionals’ preparedness to meet these needs, and develop and pilot test a program within the scope of OT to address these needs. A literature review and key informant interviews, surveys, and focus groups identified potential solutions to address gaps between patients’ needs and professionals’ preparedness to meet those needs. The need for student training was prioritized and a one-hour electronic module was developed using peer-reviewed literature, content matter expert input, and evidence-based teaching and learning strategies. The training utilized interactive activities to help learners reflect on personal beliefs and biases, recognize relevant person and environment factors, understand underlying causes of gun violence, gain trauma-informed communication skills, and identify referral options. To pilot test the training, eight first-year OT students completed the training and pre- and post-surveys measuring knowledge and attitude changes. The mean knowledge score improved from 78% correct pre-training to 97% correct post-training, with improvement in one item statistically significant at p=0.025. Four items measuring attitudes also demonstrated statistically significant improvements post-training. Participation in this training program can help OT students develop the knowledge, attitudes, and skills to work with patients who have experienced trauma from community gun violence

Pilot Study Evaluating a Brief Chronic Pain Education Program in Occupational Therapy Practitioners, Occupational Therapy Students, and Lay People

Background: Chronic pain and resultant disability can persist long after tissue healing. Past research suggests educating individuals about chronic pain is efficacious in changing knowledge, health beliefs, and healthcare utilization. This study piloted an educational intervention to teach participants about the nature of chronic, nociplastic pain. Design: Pre-post study using three groups: occupational therapy (OT) practitioners, OT students, and lay people. Methods: Participants rated their agreement with four statements pre-intervention regarding the relationship between chronic pain, tissue damage, and activity performance to ascertain accurate knowledge. Participants were presented with studies comparing acute and chronic pain and acknowledging that some people have chronic pain after tissues heal. The intervention lasted approximately fifteen minutes. Results: Eleven OT practitioners, 11 OT students and 18 lay people participated. The entire cohort demonstrated improvements with each statement post-intervention. Lay people demonstrated statistically significant improvements in three statements, OT students in two statements, and none for OT practitioners. OT practitioners demonstrated significantly higher pre-intervention knowledge than students in two statements and lay people in one statement. Lay people had the lowest accurate knowledge pre-intervention, demonstrated by a composite score, but made the greatest improvements post-intervention. Conclusion: This educational program shows promise as an intervention to educate individuals including potential patients, current students, and practicing clinicians about the nature of chronic, nociplastic pain and to address potential incorrect health beliefs regarding pain. The program was brief, included multiple stakeholders, and included easy-to-understand language all key components of successful knowledge translation

A Dyad Model of Peer-Assisted Learning in an Occupational Therapy Student Experiential Learning Clinic for Hand Therapy

Peer-assisted learning (PAL) in healthcare education encourages critical thinking, professional development, knowledge acquisition, and enhancement of clinical skills. In this paper, we describe the pilot of a dyad model of PAL used in an occupational therapy (OT) student experiential learning clinic for hand therapy, where two students at the same knowledge level provided peer support to one another in clinical responsibilities. Example activities where dyad learning occurred include evaluation and treatment planning, care delivery, documentation, presenting during clinic rounds, practicing administering assessments and treatment techniques, and role-playing sensitive patient conversations. We developed two supplemental tools to support feedback between peers: the Session Rating Tool for post-treatment feedback and the Documentation Checklists for evaluating documentation. We assessed the effectiveness of the dyad model and the two tools by first exploring students’ anticipated impact on a total of nine criteria essential to professional growth and hand therapy clinical practice, which was rated on a Likert Scale. After a six-week pilot period, the same questions investigated students’ perception of actual impact. Students also provided qualitative feedback via open text on each survey. Students rated the dyad learning model highest for overall confidence in clinical skills/treating patients and rated the model’s impact higher than anticipated on clinical reasoning skills, therapeutic use of self and other communication skills, upper extremity diagnoses and conditions, and OT process. Students rated the Session Rating Tool similarly to anticipated impact. The dyad model of PAL supported student learning and clinical performance in this student experiential learning clinic