Practice Evaluation It is accepted that practice placements are instrumental in providing an invaluable education on professional concepts, attitudes and behaviours. However, despite suggestions that practice placement education needs to be modernised to meet the demands of the current climate, there is only evidence of a limited number of role-emerging placements within the United Kingdom despite their relative popularity and history abroad. This paper describes and briefly evaluates a ‘model’ of practice placement education within role-emerging settings for a full cohort of pre-registration occupational therapy students, which meets national and international standards and guidance for such programmes.
An Evaluation of a Role-Emerging Practice Placement Model for a Full Cohort of Occupational Therapy Students Miranda Thew,1 Allyson Hargreaves 2 and Jane Cronin-Davis1
Introduction Although practice placements are a vital aspect of pre-registration occupational therapy education, there has been little change in the range of placement settings within the United Kingdom (UK), with a shrinking volume of placements available (Craik and Turner 2005). This is despite suggestions that practice placement education needs to be modernised to meet the demands of the current climate (Fisher and Savin-Baden 2002). The World Federation of Occupational Therapists advocates innovative practice placements, such as those taking place in settings that lack occupational therapy provision (Hocking and Ness 2002). Studies of these ‘role-emerging’ placements have found that the boundaries of occupational therapy practice have been expanded, with increased awareness of the profession and a corresponding demand for services (Friedland et al 2001). This paper describes a strategy to establish and supervise such practice placement settings, and provides a preliminary 1Leeds
Metropolitan University. 2 Leeds Partnerships (NHS) Foundation Trust.
Corresponding author: Miranda Thew, Senior Lecturer, Occupational Science
and Occupational Therapy, Faculty of Health, Leeds Metropolitan University, Civic Quarter, Woodhouse Lane, Leeds LS1 3HE. Email:
[email protected] Submitted: 24 October 2007.
Accepted: 21 July 2008.
Key words: Practice placement education, role emerging, innovative
placements, fieldwork, occupational therapy students. Reference: Thew M, Hargreaves A, Cronin-Davis J (2008) An evaluation of a role-emerging practice placement model for a full cohort of occupational therapy students. British Journal of Occupational Therapy, 71(8), 348-353.
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evaluation of a role-emerging programme for a cohort of students that meets national standards and guidance for such placements (Hocking and Ness 2002, College of Occupational Therapists [COT] 2006). The term ‘practice placement’ is used within this paper because it is a commonly accepted term for ‘fieldwork’ in the UK.
Background and philosophy of role-emerging placements Practice placement education prepares students to work in professional contexts by offering opportunities to engage in the experiences and models of professional behaviour (Bonello 2001). All occupational therapy students experience placements working alongside occupational therapists in settings where there is an established occupational therapy role. Role-emerging placements occur in settings that have previously not experienced or identified an occupational therapy role (Bossers et al 1997). The student, guided by an ‘off-site’ occupational therapist, considers the occupational needs of the people in the setting, and either establishes an occupational therapy role or suggests or establishes a relevant project to benefit the service users in that setting. Despite the College of Occupational Therapists having developed guidance for role-emerging practice placements (COT 2006), there is little evidence of such practice education being available to all students on the occupational therapy curricula within the UK. However, where they have been
evaluated in the UK, they have been well received by students and settings (Friedland et al 2001, Totten and Pratt 2001, Wood 2005, Hook and Kenny 2007, Jepson et al 2007). Research suggests that students are more independent and autonomous following experience in a role-emerging placement, and that students value the opportunities to promote the profession (Alsop and Donald 1996, Bossers et al 1997, Huddleston 1999). The strongest and most widely evidenced support for such placements comes from outside Europe (Fleming et al 1996, Bossers et al 1997, Sullivan and Findlayson 2000, Friedland et al 2001, Baum 2002, Strong et al 2003, Thomas et al 2005).
The role-emerging practice placement model at Leeds Metropolitan University The pre-registration occupational therapy course at Leeds Metropolitan University is at Master’s level, with a problem-based learning programme. Occupation and occupational science are embedded within the curriculum, and all these factors are likely to be significant in providing a solid foundation for such an innovative practice placement. The role-emerging experience is the penultimate practice placement within a 2-year (accelerated) course.
Identifying settings and establishing the role-emerging placement The aim of the MSc Occupational Therapy (Pre-registration) programme is to enable students to become competent occupational therapists who are clinical scholars, with the necessary skills, knowledge and attitudes to develop, deliver and evaluate traditional and innovative occupational therapy services in a range of settings. The problem-based nature of the learning on the course contributes to the skills required to be a clinical scholar, and the role-emerging placement provides the resources to satisfy the curiosity of a clinical scholar: Clinical scholars are characterized by a high level of curiosity, critical thinking, continuous learning, reflection and the ability to seek and use a spectrum of resources and evidence to improve effectiveness of clinical interventions. They consistently bring a spirit of inquiry and creativity to their practice to solve clinical problems and improve outcomes (Sigma Theta Tau International 1999, p4).
The learning outcomes for the module in which the role-emerging placement sits are detailed in Table 1. The module assessment essentially reflects student learning on placement, in terms of being a critical discussion of the setting including existing service provision; an analysis of the chosen project, intervention or role from an occupational perspective; and evidence-based justification of the intervention, proposed intervention or new service development which the student introduced. Appropriate settings were identified through local charity groups that had supported the programme or the
Table 1. Specific learning objectives of the module On successful completion of the module, the student should: Knowledge ■ Discuss methods of developing and facilitating therapeutic relationships ■ Identify a range of methods for assessing individuals, groups and communities ■ Discuss a range of intervention approaches suitable for individuals, groups and communities ■ Recognise opportunities for the development of innovative occupational therapy services ■ Discuss occupational therapy clinical reasoning theories and models ■ Discuss the global and local factors that have an impact on the health of individuals, groups and communities ■ Discuss the global and local factors that have an impact on occupational performance ■ Discuss how and why various contexts influence occupational therapy practice. Skills Develop programmes to improve and maintain an individual’s capacities and abilities ■ Grade and adapt a range of occupations ■ Modify a range of environments and contexts ■ Initiate, maintain and end therapeutic relationships ■ Tailor methods and tools of intervention to ensure cultural sensitivity ■ Assess individuals, groups and communities and produce an occupation-focused action plan ■ Plan and deliver occupational therapy intervention for individuals and groups ■ Outline the contribution that an occupational perspective could make to current societal issues ■ Apply a range of theories and models when undertaking and reflecting on own practice ■ Utilise current evidence to develop and deliver occupational therapy. ■
Attitudes Commit to an occupational perspective of humans and health ■ Accept individual and cultural differences in occupations ■ Demonstrate confidence in the contribution that occupational therapy can make to issues of health and wellbeing ■ Value the contributions of others involved in working with clients. ■
university in the past, or by contacts given by practising occupational therapists. Once a setting had been identified, initial contact was made (usually by phone) to arrange a visit by a member of the university staff. At this visit, an information pack setting the scene and ‘selling’ the ethos of such placements to potential setting managers was employed. Each setting was checked to ensure suitable provision for health and safety and for supervision, in accordance with the requirements of COT (2006).
Roles and responsibilities Practising occupational therapists provided professionally relevant supervision through distance supervision and were approached using the usual request procedure. The roles and responsibilities of the staff involved in the placements were agreed following a literature review and in consultation with potential educators (Table 2).
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Table 2. Brief list of roles and responsibilities of staff involved in the role-emerging placements Role and responsibilities of the on-site practice placement educator (OSPPE) ■ Prepares the placement setting team and the staff for the student placement ■ Provides and oversees induction ■ Provides support and guidance to the student regarding placement setting issues ■ Acts as the principal placement setting ‘expert’ ■ Liaises regularly (at least once a week) with the appropriate OTPPE regarding student progress ■ Provides regular supervision both individually with the student and jointly with the OTPPE and student ■ Maintains communication with university staff ■ Ensures that the student is not treated as ‘another pair of hands’ and supports recognition of the student role ■ Provides information and resources regarding relevant policies and procedures, for example, health and safety, and risk and workload management. Role and responsibilities of the occupational therapy practice placement educator (OTPPE) ■ Supports student to consider an occupational perspective ■ Supports student in identifying role of the occupational therapist ■ Provides professional accountability ■ Provides guidance with theory into practice (clinical reasoning) ■ Acts as a role model for the profession ■ Facilitates and supports student reflection and signposts other resources for the student to learn from ■ Assesses the student in regards to the competencies in the Competency-based Fieldwork Evaluation ■ Offers evaluation and feedback on the placement ■ Ensures regular informal dialogue on performance, and one hour of ‘formal’ dedicated supervision per week ■ Discusses assessment outcomes and comments with the student and university staff. Role and responsibilities of university-based staff member ■ ■
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Oversees and ensures the smooth running of the practice placements Keeps the practice placement educators informed of any changes to placements Provides named university educator contact details Provides appropriate support for the students on practice placement, for example, placement visit Ensures that the student has the opportunity to fulfil the requisite number of hours Provides ongoing education and support for practice placement educators Oversees the monitoring and evaluation of the practice placement as an appropriate learning environment for pre-registration students Ensures that the settings and learning opportunities are appropriate to achieve learning outcomes Facilitates the student learning from placement within the university Ensures all documentation matches the requirements of the College of Occupational Therapists, the World Federation of Occupational Therapists and relevant policies.
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Structure of the role-emerging placement model The students initially attended the placement setting one day per week for 5 weeks, with the support of the university staff and peers either side of their one-day attendance. This was essentially in order broadly to fulfil the aims shown in Table 3. Table 3. Aims of one day a week for 5 weeks ■ To allow students gradually to familiarise themselves with the setting and liaise with peers and university staff to explore potential projects ■ To provide opportunities to explore the experiences of placement with peers and university staff ■ To allow the OTPPE to advise the student regarding any potential ideas, and to visit the role-emerging setting at least once within this stage of the placement ■ To allow the placement setting opportunities to develop the resources needed to assist the student when he or she attends full time ■ To provide an opportunity for the swift identification and resolution of potential problems that could have an impact on the service or setting and/or the student ■ To facilitate reflective practice, and self-directed learning, reviewed by both the practice placement educators and the university, to ensure continuity from one week to the next, prior to commencing full time.
In considering the full-time 5-week attendance on placement, this stage is designed to meet the aims shown in Table 4. Table 4. Aims of 5 weeks full time at the role-emerging practice placement ■ To provide the student with substantial time to establish a meaningful contribution to the practice placement setting, as well as allowing opportunities for his or her own learning to take place ■ To include a half-way report and a visit by a university-based member of staff ■ To allow the student sufficient time to concentrate on establishing the contribution of an occupational perspective of humans and health within the context of the needs of the setting and in constant dialogue with both practice placement educators ■ To offer the opportunity for the student to present a project with a view as to how it could be sustained post-placement ■ To allow the student access to resources from a variety of means, including visits to other agencies or settings, to enhance learning and experiences.
Allocation and supervision of the students and settings The students were largely allocated into pairs (as advocated by Bossers et al 1997), but were assessed separately. The students and the supervising occupational therapists chose the setting in which they wished to work or supervise. The occupational therapy supervisors met with the named on-site supervisor at a training workshop, where all the relevant documentation was explained and the methods of supervision were clarified. All students received one hour of formal supervision per week from
each educator. This was also supported with informal supervision by either phone or email with the off-site occupational therapist or verbally during the week by the on-site educator.
Fig. 1. Students’ rating of a role-emerging placement as a learning experience (2006) (n = 10).
Projects, settings and assessment The student considered a project that demonstrated the role or value of occupation and occupational therapy to the placement setting. The assessment of his or her professional competence was measured, as with other placements on the course, using the Competency-based Fieldwork Evaluation for Occupational Therapists (CBFE-OT) (Bossers et al 2002). This generic, applicable and well established practice placement assessment allows for core occupational therapy competencies (such as practice knowledge, clinical reasoning, facilitating change within a practice process, communication, professional development and performance management) to be measured within a wide range of settings. Importantly for a role-emerging setting, it allows the student some autonomy in establishing his or her learning needs, as Bossers et al (2002, p vi) stated:
Fig. 2. Placement evaluation (2006) (n = 17).
In addition, student occupational therapists are encouraged to take ownership of their own professional development by creating personalised learning objectives, which can be used to guide their fieldwork experience.
A total of 21 students, mostly in pairs, attended a total of 13 separate placement settings, including a mainstream primary school, an organic farm, further education programmes for people with learning difficulties, a remand prison, a hospice, a personality disorders service, and a self-harm team. From a practical perspective, the projects completed by the students generated a variety of professionally relevant outcomes, for example, session plans for an anxiety management group; suggestions to engage boys in meaningful occupations to promote learning and social participation; a video of service users describing the benefits of engaging in organic gardening; and an activity analysis of a service user craft group. All students were able to meet placement objectives and all passed their placements.
Student evaluation and educator feedback Student evaluation Most students (17/ 21) completed online anonymous module and practice placement evaluation questionnaires. Focus groups were then used to capture more extensive views (n = 10). All students were assured of anonymity in their feedback and informed that, in the dissemination of any of the evaluations, it would not be possible to identify either the placement setting or the individual student. In this small scale evaluation, most of the students rated the learning experience of the placement as ‘very good’; only one student rated the experience as ‘poor’ (Fig. 1). In the usual practice placement questionnaire (Fig. 2),
most students felt that the placement helped them to gain confidence in professional practice and would recommend the placement for future students. However, the students did make negative observations (Table 5), which included some criticism regarding communication between the educators and inconsistency in the expectations of the students. Despite this, one new post for an occupational therapist was created, and another was put before service managers.
Feedback from the occupational therapy practice placement educators (OTPPEs) Feedback was, overall, positive following the OTPPEs’ experience of supervising students (measured informally via feedback workshops and telephone discussions). Many of the educators from the previous year either offered to supervise or recommended colleagues. Indeed, the 2008 role-emerging programme has considerably more settings and occupational therapists offering to supervise them than in previous years. This is quite a change from initial concerns, as one observed: Role-emerging placements challenge the current culture of practice placements and I have encountered some scepticism amongst staff who question the wisdom of sending inexperienced students into settings that lack occupational therapy.
Although distance supervision has advantages, in that part-time and managerial staff can supervise students who normally have limited clinical contact, there were problems encountered in time constraints in travelling to the setting and in scheduling feedback with someone off-site.
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Table 5. Collated themes of comments from student feedback workshops (2006/2007) Positive aspects of the placement ■ Knowledge of client group/condition/lived experience ■ Learnt more personal skills in role-emerging placement, for example, building rapport/relationships/how to communicate with clients ■ Learnt more reflective skills, rather than occupational therapy techniques ■ Increased confidence in own knowledge; learnt about local policies/legislation ■ Freedom to try new things ■ Providing occupational therapy knowledge/how to promote occupational therapy and concept of occupation ■ Opportunity for using occupation was overwhelming ■ Really had to apply clinical reasoning/define your role to client group ■ Learnt about how to evidence unmet needs assessment/didn’t realise the extent of unmet need until completed placement setting ■ Staff came to realise how occupation, when engaged in meaningfully, is important. Negative or dissatisfying aspects of the placement ■ On-site educators: some better prepared than others, and more committed ■ Would have liked to have met/known other students who had been on one ■ Not knowing if your proposal/project would be developed after you left ■ Staff attitudes – negative about occupational therapy ■ Lack of support/educators working part time – in placement ■ Supervision – could have been better formalised/would have liked more ■ Heart breaking to see so much potential and so little resource ■ Different expectations from university and from educators ■ Would have liked more opportunity to explore own ideas for placement setting than occupational therapy educator one (one comment)
There were some clashes in expectations encountered between the students’ concerns and those of the occupational therapist, for example: I found my focus was on the students’ progress, whereas, the students appeared more anxious to complete a satisfactory placement project.
There were some learning opportunities identified by the occupational therapists for themselves: I feel such placements offer opportunity to promote the importance of occupation to health and wellbeing as opposed to supplying occupational therapy per se, this in itself has been very satisfying.
Discussion This paper has demonstrated that it is feasible and beneficial to establish role-emerging practice placements in a variety of settings for a full cohort of occupational therapy students, with supervision from practising occupational therapists. This provides an occupation-focused experience to address need, despite a shrinking climate of suitable occupational therapy placements (Craik and Turner 2005). It is also now increasingly evident that role-emerging placements are becoming an essential element of occupational therapy
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curricula (Fortune et al 2006). However, setting up several placements in non-traditional settings requires considerable time and effort, with the introduction of a new set of administrative tasks. There is a need to promote and describe occupational therapy, and a ‘marketing’ approach is usually required. The students identified the importance of a uniform clarity of expectations by educators, a finding that is echoed elsewhere (James and Prigg 2004, Hook and Kenny 2007). Despite training and a one day a week gradual ‘exposure’ to the setting, there clearly needs to be more emphasis on the understanding that the aim of the placement is to bring an occupational perspective and not to provide a occupational therapy service per se, which may not be maintained following the departure of the student. However, the gradual exposure of one day a week for 5 weeks allows students to obtain clarity of their role, increase confidence, meet with peers and have access to university resources. Engaging occupational therapy practitioners to provide supervision offers a separate role for the university staff, as well as reducing the costs to the academic programme, and engaging managers of occupational therapy services to supervise students offers opportunities that traditional placements preclude. The placement project provides a focus for the student and educators to measure leaning outcomes; it offers something tangible to address occupational need in the setting, as advocated by Fortune et al (2006): Experience in, and development of, skills in project scoping and management offer far greater opportunity to influence occupation, than mere project implementation. Furthermore, experience in project management would lead to a wider employment base, opening up new practice niches for occupational therapists, as well as opportunities to influence national health priorities (p235).
Farrow (1995) supported student project proposals that can be instigated and designed alongside university curricular activity, but then carried out on placement. Indeed, a project with an occupational perspective demonstrates the health and wellbeing benefits derived from meaningful occupation, and offers examples of how occupational therapy can have a far larger role to play in society than in its traditional niche in the health and social care services (Hammell 2004). These benefits have not been to service user and student alone but also, seemingly, to the supervising occupational therapists in terms of offering experiences away from their usual sphere of expertise. Generally, the placement was seen as a positive learning experience for the majority of the students. Some of the successes of the projects may be attributed to the fact that the whole cohort, being at Master’s level, could be classed as mature students with, therefore, some life experience. However, there is little evidence to suggest that undergraduates may not fare just as well. There was little that could be seen to be a collective criticism, other than the importance of communication between the educators. Fisher and Savin-Badin (2002) and Thomas et al (2005) suggested
that supervising therapists must take on the responsibility for the students and work in collaboration with the on-site educators. If staff shortages suggest that supervision may be compromised, the placement setting may not be a viable one.
Conclusion This paper has described a ‘model’ for a full cohort role-emerging practice placement programme. Although evaluated within a very small sample of principally student and supervising occupational therapists, it would appear that role-emerging placements can provide rich and applicable experiential learning. The most satisfying aspect was the opportunity to bring the importance of meaningful occupation into areas that were largely unaware of what occupational therapists can offer. Generally, there has been a willingness from occupational therapy practitioners to provide supervision and support into areas outside their own realm of practice. This can offer opportunities to develop professionally relevant experience, which they would not normally receive from traditional placement education. There are some areas that need careful attention, the most important being that there is a clear agreement of the roles and responsibilities of the two educators involved in the placement, emphasising regular supervision and communication. Also, using a project focus rather than applying the occupational therapy process can demonstrate occupational potential, but the project must be sustainable otherwise expectations may not be fulfilled and frustrations arise. This area of occupational therapy pre-registration education clearly needs much more rigorous and extensive research, incorporating the experiences of placement setting educators and service users. It may be useful to research how such a placement experience has influenced the practice or career development of occupational therapy graduates. However, providing placements in innovative settings has offered an opportunity to market and raise the profile of occupational therapy, which is vital within the ever diverse and changing health and social care arena. Acknowledgements We would like to thank the practice placement educators and the MSc Occupational Therapy (Pre-Registration) students for engaging so positively in these placements. This article draws on documents devised by the Occupational Science and Occupational Therapy Group at Leeds Metropolitan University. References Alsop A, Donald M (1996) Taking stock and taking changes: creating new opportunities for fieldwork education. British Journal of Occupational Therapy, 59(11), 498-502. Baum C (2002) Creating partnerships: constructing our futures. Australian Occupational Therapy Journal, 49, 58-62. Bonello M (2001) Fieldwork within the context of higher education: a literature review. British Journal of Occupational Therapy, 64(2), 93-99.
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