Canadian Association of Occupational Therapists

Occupational Therapy Fieldwork Levels
by Theresa Sullivan and Ann Bossers
(Reproduced from The National, Volume 15.3)

Fieldwork education can be conceptualized as occurring in three major stages along a continuum of professional development. These stages are seen as fluid and students may move forward or back at different rates (Anderson, 1988). In the past, the number of hours of fieldwork a student has completed has defined the level of placement (e.g. Level 1: 0 - 150 hours, Level 2: 150-600 hours, Level 3: 600-1000 hours). The University Fieldwork Coordinators Committee (UFCC) supports a move away from using the number of hours of fieldwork experience as the basis for assigning fieldwork levels and has adopted a new basis for describing these three major fieldwork stages/levels (UFCC/ACOTUP Meeting, June 1997). The following document provides more detailed descriptions of each of the three fieldwork stages/levels, and includes: educational expectations of the student, recommended strategies for fieldwork educator(s) and expected outcomes of the fieldwork experience. The level name pertains to the student stage of development in fieldwork practice and the term (in brackets afterwards) identifies the primary strategy of the fieldwork educator, for example, Knowledge application (educating).

This information is intended to:
Provide students and fieldwork educators with more comprehensive descriptions of the stages of fieldwork and the desired outcomes linked with each stage, assist fieldwork educators to more fully understand the specific needs of each stage, provide fieldwork educators with a variety of teaching/supervision strategies for each stage of fieldwork, allow fieldwork educators to better identify the level of placement that they are prepared to offer, and to determine the level of student for whom it will be appropriate (or if the placement is suitable or can be graded to meet the needs of various levels), and serve as a guide in planning a fieldwork education program.

Level 1: Knowledge application (educating)
Purpose - To provide students with the opportunity to:

1. Take an active role in working with clients,
2. Develop and practice interaction, assessment, intervention and professional reasoning skills,
3. Apply knowledge acquired in academic course work in a workplace environment,
4. Receive and respond to constructive feedback,
5. Become familiar with the role(s) of an occupational therapist, and
6. Engage in professional activities and learn about the realities of professional practice.

Level of student involvement and degree of supervision
The emphasis during this level of placement should be placed on the development of interaction skills with clients, family members, fieldwork educator(s), and other health care personnel. Students should endeavour to apply their current academic knowledge base to actual practice. Supervision should be consistent and always readily available. Students require direct, concrete and frequent feedback during this stage of development. Fieldwork educators are encouraged to share "client stories", and to demonstrate/model/teach professional behaviours and skills. Students should be encouraged to share and integrate previous learning experiences into the current fieldwork placement.

At this stage of development students require opportunities to observe and practise the professional behaviours and skills required for practice as an occupational therapist. These may include: assessment and intervention techniques used in a particular fieldwork setting; communication with family members or other health care personnel, and clinical/professional reasoning specific to client centred occupational therapy practice. Students should be encouraged to be active learners by becoming involved as much as possible in all fieldwork site activities.

Recommended strategies for fieldwork educator(s):
  • articulate performance expectations clearly,
  • emphasize learning and applying current knowledge base to practice,
  • model/demonstrate professional behaviours and skills,
  • provide specific versus generalized skills instruction,
  • allow "hands-on" with direct supervision,
  • prompt with appropriate questions,
  • direct student to additional readings, resources and observations,
  • provide direct, concrete and frequent feedback, and
  • tell "client stories".

Level 2: Transition (coaching)
Purpose - To provide opportunities for students to:

1. Develop professional knowledge, skills and attitudes,
2. Develop professional reasoning and problem-solving skills,
3. Develop and integrate independent work skills (eg. time management, setting priorities),
4. Plan, implement and evaluate all aspects of a client's program,
5. Integrate constructive feedback into performance, and
6. Integrate previous academic and fieldwork experiences with current experiences.

Level of student involvement and degree of supervision
The emphasis during this level of placement should be on actual practice and experience in clinical problem-solving, assessment and intervention. Students should begin to share and assume responsibility for all components of client-centred practice such as a referral analysis, assessment, planning, implementation of intervention programs, discharge planning and follow-up. Students should be encouraged to try and develop their own ideas and insights regarding their clients. They should be able to engage in discussion of several solutions to occupational performance problems and begin to make decisions about the most viable course of action. Students should be encouraged to engage in self-analysis and reflection and to share and integrate previous learning experiences into their practice.

Recommended strategies for the fieldwork educator:

  • have student identify occupational performance goals,
  • prompt with appropriate questions,
  • encourage a search for alternatives and options and engage in discussion of viable solutions,
  • lead student to see that not all solutions are equally good,
  • provide 2-3 alternative suggestions,
  • allow student to form own opinions and choose course of action,
  • provide gentle guidance,
  • facilitate student self-analysis,
  • increase challenge in complex situations, and
  • provide positive reinforcement for creativity when possible.

Level 3: Consolidation (sponsorship)
Purpose - To provide opportunities for students to:

1. Further develop professional knowledge, skills, attitudes and behaviours,
2. Further develop professional reasoning and problem-solving skills,
3. Become independent in working with clients,
4. Refine critical analysis skills within a fieldwork setting,
5. Engage in professional activities, and
6. Prepare to enter professional practice.

Level of student involvement and degree of supervision
The emphasis during this level of placement should be on final preparation of the student for assuming the role of a competent entry-level occupational therapist. Students should be encouraged to assume as much independence as possible in professional reasoning and in linking academic theory to practice. Students may still require some guidance and direction, but should take responsibility for application of all components of client-centred practice such as referral analysis, assessment, planning, implementation of intervention programs, discharge planning and follow-up (as appropriate). At this stage of fieldwork, students should be encouraged to seek new challenges, to strengthen peer relationships and to develop independent professional accountability.

Recommended strategies for the fieldwork educator:

  • Allow the student to work independently as much as possible,
  • Encourage the student to be self-directed and to demonstrate initiative,
  • Encourage student to identify and pursue professional learning needs,
  • Encourage student self-analysis,
  • Emphasize student long-term development and contribution to the profession,
  • Work "collegially" with the student,
  • Articulate professional reasoning,
  • Share "client stories",
  • Provide unique experiences,
  • Provide access to people and information, and
  • Relinquish control.

References
Anderson, J.L. (1988) The supervisory process in speech-language pathology and audiology. Boston, MA: Little, Brown and Company.
Cohn, E. (1989). Fieldwork education: Shaping a foundation for clinical reasoning. American Journal of Occupational Therapy, 43, (4), 240-244.
Collins, L.F. & Affeldt, J. (1996). Bridging the clinical reasoning gap. OT Practice, 1, (8), 33-35.
Fleming, M.H. (1991b). The therapist with the three-track mind. American Journal of Occupational Therapy, 45, (11), 1007-1014.
Mattingly, C. (1991). The narrative nature of clinical reasoning. American Journal of Occupational Therapy, 45, (11), 998-1005.
McFarlane, L. & Hagler, P. (1995) Achieving maximum student potential: The supervisor as coach. University of Alberta, Centre for Studies in Clinical Education. Handout presented at a clinical workshop, Toronto, ON.
Schon, D. (1987) Educating the reflective practitioner. San Francisco, CA: Jossey-Bass Publishers.

About the authors ...
Theresa M. Sullivan
, M.A., O.T. is the Academic Fieldwork Coordinator at the University of Manitoba.
Ann Bossers, M.Ed., O.T. is an Assistant Professor and Fieldwork Coordinator at the School of Occupational Therapy, at the University of Western Ontario.

For more information contact: 
Megram Consulting Serivces
1 - 247 Barr St.
Renfrew, ON
K7V 1J6
Phone - (613) 432-9491
Fax - (613) 432-6840
www.megram.com 

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