Exploring emerging occupational therapy identity and the development of graduate attributes among occupational therapy students

Abstract

Introduction

Strong professional identity allows for appropriate representation and promotion of occupational therapy. Academic education assists in the development of occupational therapy identity. This study aims to explore the development of occupational therapy identity and graduate attributes in occupational therapy students after the first year of a revised curriculum.

Method

Occupational therapy students (n = 58) were surveyed at the commencement of the second year. Data analysis used descriptive statistics and inferential statistics (χ² for trend).

Results

A total of 54 students (93.1%) completed the survey. Students progressively developed occupational therapy identity over time. There were no significant associations between main factors influencing the original decision to study occupational therapy and when occupational therapy identity developed. However, there were significant associations between main factors influencing students' decision to continue studying and when identity developed. Most students agreed the curriculum equipped them to develop graduate attributes, although this was not significantly associated with factors that either influenced students to study, or continue studying, occupational therapy. There was significant association between development of graduate attributes and occupational therapy identity over time.

Conclusion

This study showed an emergence of occupational therapy identity and graduate attributes in students, demonstrating the importance of first year curriculum in the development of these factors.

Keywords

Professional identity occupational therapy students first year student regional university curriculum

Introduction

A strong professional identity which allows for the appropriate representation and promotion of occupational therapy is seen as essential for the survival and growth of the profession (Edwards and Dirette, 2010; Turpin et al., 2012). A professional identity is one that is developed from professional values, beliefs and expert knowledge (Whitcombe, 2013). Effective practice demands practitioners adopt and act on the ethos and paradigms of the profession (Hooper, 2008; Peloquin, 2005).

Professional identity develops over time and while academic training fosters this development, students may have a relatively strong sense of professional identity upon commencing their programme of study (Adams et al., 2006; Turpin et al., 2012). This perception is in part based on the general public's view of the profession (Turpin et al., 2012). This perception is important as Adams et al. (2006) found that among first year allied health students in the UK, students with knowledge of their chosen profession were more likely to identify with the professional group.

Within a competitive and changing health care environment, occupational therapists are at risk of not receiving appropriate recognition and remuneration because of a poorly defined identity (Wilding and Whiteford, 2008). Role conflict and poor occupational therapy identity has been linked to chronic stress and burnout in occupational therapists (Edwards and Dirette, 2010).

Occupational therapy is a diverse profession with clinicians practicing in a wide range of areas. Regardless of area of practice, the occupational therapy profession has been encouraged to return to its foundational theoretical and philosophical paradigms which clearly identify the unique role of occupation in contributing to the health and well being of patients and clients (Waghorn et al., 2009; Whiteford et al., 2000).

Challenges in transferring this knowledge of occupational foundations to practice contexts exist within the current health care environment. The philosophical basis of occupational therapy means that occupational therapists are concerned with the ‘normality of everyday … common to everyone…. taken for granted and therefore not highly valued’ (Clouston and Whitcombe, 2008: 317). Having an occupation-based approach puts the profession somewhat at odds with the philosophy of health based on a biomedical model (Ikiugu and Rosso, 2003). This creates a conflict between the occupational therapists’ sense of self and the expectation of the workplace, perceptions of other health professionals and the community (Clouder, 2003; Davis, 2008). A strong professional identity is therefore essential for graduating therapists to ensure they can practice effectively in such contexts.

The foundations for development of an occupational therapy identity can be laid within undergraduate curriculum (Ikiugu and Rosso, 2003). Due to the importance of academic education in developing a resilient occupational therapy identity, there has been a strong call for the main emphasis of occupational therapy education to be on occupation-based practice. Wilding and Wilcock (2001) called for the embedding of curricula in the occupational foundations of the profession as a way to strengthen, integrate and unify the profession's knowledge base.

The role of education in the construction of identity has been highlighted in the literature on communities of practice. Wenger (1998, 2000) suggests that identity is constructed through active participation in social communities. While identity formation is a lifelong process, education has the potential to be transformative, allowing for the emergence of ‘meaningful forms of membership’ and identity development (Wenger, 1998: 269). The challenge of education is to balance teaching of knowledge with participation in practice and the creation of meaning for the student (Wenger, 1998). Current research into learning at university level emphasises the need to engage students in ‘deep’ learning (Ramsden, 2003). Deep learning occurs when students engage meaningfully and appropriately with a learning activity, putting it to work often in the context of problem solving, reflection and professional application (Biggs and Tang, 2007).

In 2009, the occupational therapy discipline at a regional Australian university undertook a process of curriculum review and reform, with a focus on embedding occupational foundations in core occupational therapy subjects. Using an action learning approach, the academic staff established a learning community from which a revised curriculum framework and set of desired graduate attributes were articulated. The establishment of a learning community allowed consultation with occupational therapy practitioners to assist in bridging the gap between theory and practice. The graduate attributes were not generic attributes – ‘the skills, knowledge and abilities of university graduates, beyond disciplinary content knowledge’ (Barrie, 2007: 440). Rather, these were statements that described the desired attributes of students graduating from the occupational therapy programme of this university (Hooper, 2008). These graduate attributes reflected the regional location of the university (for example students will develop skills to work across locations in the tropics, including rural and remote communities); the centrality of occupation within the revised curriculum (for example, students will have a core understanding of occupation and its impact on health and wellbeing for individuals, communities and populations); and the social justice perspective of the revised curriculum (for example, students will contribute to the development of an inclusive society through enabling occupation; students will demonstrate a desire to address health inequities in indigenous communities). These desired graduate attributes were seen as central to the revised curriculum framework and became the basis of alignment of teaching and learning activities and assessment tasks (Biggs and Tang, 2007). The new occupation-based curriculum commenced in 2012 with first year core subjects focused on understanding occupation as the core construct and focus of occupational therapy.

The first cohort of the revised curriculum was surveyed at the commencement of their second year. While the survey covered a range of questions relating to first year experience, this article focuses on questions related to occupational therapy identity and graduate attributes.

The aims of this study were to explore the development of occupational therapy identity and desired graduate attributes in occupational therapy students having completed the first year of their undergraduate programme in a revised curriculum at a regional Australian university in which the authors work. Of particular interest was how factors influencing students' enrolment and continuation in the occupational therapy programme were associated with developing occupational therapy identity and acquisition of desired graduate attributes. The relationship between emerging occupational therapy identity and graduate attribute acquisition was also investigated.

Method

Procedure and participants

A total of 58 occupational therapy students at a regional Australian university were surveyed at the beginning of their second year of the programme in February 2013. Surveys were distributed in class to students in the second year, first semester core occupational therapy subject. The pre-requisite for enrolment in this subject is successful completion of all first year subjects in the occupational therapy programme. The study was approved by the James Cook University Human Research Ethics Committee (approval number H4781). Study participation consent was implied by survey completion.

Instrument

The survey was designed by a reference group of academic staff (including the authors) from the university occupational therapy department. Several revisions of the survey were undertaken within this group to assist in the refinement of the survey. The survey contained eight questions to collect information on students' personal factors, experiences of the first year of the programme (results published elsewhere) and the development of occupational therapy identity and graduate attributes.

Of the eight questions on the full survey, this article reports on five questions to enable exploration of identity and graduate attributes (see Appendix). The first question explored personal factors (age, gender, home town postcode, enrolment year and type and previous tertiary education). The second and third questions required students to select from a list the main factors influencing their decision to study and continue studying occupational therapy. The fourth question required students to rate their level of agreement/disagreement on a four-point Likert scale on statements referring to the development of their occupational therapy identity at commencement of the programme and commencement of the second year. The fifth question required students to rate their perceptions of how the first year of the programme equipped them to meet the desired graduate attributes of the occupational therapy programme. No other questions from the full survey were utilised as they were not relevant to exploring the development of occupational therapy identity and graduate attributes.

Data analysis

Data were analysed using the Statistical Package for Social Sciences (SPSS) (version 20; SPSS Inc., Chicago, IL, USA). Descriptive statistics were calculated and percentages used to explore variables. Inferential statistics (χ² for trend) were also used to explore the factors that are associated with developing student graduate attributes and developing their emerging occupational therapy identity. Home town postcodes were converted into remoteness area categories (major cities, inner regional, outer regional, remote and very remote) using The Remoteness Areas from the Australian Statistical Geography Standard (ASGS) (Australian Bureau of Statistics, 2011).

Results

A total of 54 of the 58 (93.1%) second year occupational therapy students completed the survey.

Occupational therapy graduate attributes

Students were asked to rate if the curriculum equipped them to develop their graduate attributes using a four-point Likert scale (see Figure 1). The overall trend suggests that students mostly rated that they agreed that the curriculum equips them to develop graduate attributes, followed by strongly agrees. The overall trend also suggests that only a few students rated disagree or strongly disagree.

When examining if personal factors (i.e. age, gender, regionality, type of enrolment and prior engagement in tertiary studies) were associated with the development of graduate attributes, there was a significant association between age category and the graduate attribute: working across locations within the tropics (χ² for trend = 5.49, df = 1; p = 0.019). Upon closer inspection it was evident that students in the younger age category (<20 years) mostly agreed/strongly agreed that the curriculum developed this graduate attribute, whereas students in the older age categories (20–30 years and >30 years) disagreed.

There was also a significant association between age category and the graduate attribute: competence in interdisciplinary learning and practice (χ² for trend = 4.24, df = 1; p = 0.039). When examining this finding closer, it appears that students in the younger age category (<20 years) mostly agreed/strongly agreed that the curriculum developed this graduate attribute, whereas students in the older age categories (20–30 years and >30 years) disagreed.

Similarly there was a significant association between previous tertiary studies and the graduate attribute: competence in interdisciplinary learning and practice (χ² for trend = 3.84, df = 1; p = 0.050). Students without prior tertiary studies mostly agreed/strongly agreed that the curriculum developed this graduate attribute, whereas a higher proportion of students who had undertaken previous tertiary studies disagreed that the curriculum developed this graduate attribute.

Students were asked what the main factors were that influenced their decision to study occupational therapy, as well as the factors that influenced them to continue studying occupational therapy. The χ² for trend analyses revealed there were no significant associations between the main factors that influenced students to study occupational therapy and any of the graduate attributes. Furthermore, there were no significant associations between the main factors that influenced students' decision to continue studying occupational therapy and graduate attributes.

Development of an emerging occupational therapy identity

Students were asked to rate when they developed an occupational therapy identity using a four-point Likert scale. Figure 2 provides a summary of their responses. The overall trend suggested that students progressively developed their occupational therapy identity over time.

There were no significant associations between developing an occupational therapy identity and student personal factors (i.e. age, gender, regionality, type of enrolment and prior engagement in tertiary studies). Similarly χ² for trend analysis revealed that there were no associations between when students developed an occupational therapy identity and the main factors that influenced them to study occupational therapy. However, there were significant associations between the main factors that influenced students' decision to continue studying occupational therapy and developing an occupational therapy identity at the commencement of their programme (χ² for trend = 9.77, df = 1; p = 0.002), as well as at the start of second year (χ² for trend = 4.54, df = 1; p = 0.033).

Graduate attributes and developing an occupational therapy identity

There were significant associations between all graduate attributes and having an occupational therapy identity at both the commencement of the programme, as well as at the start of second year (see Table 1). The overall trend suggested stronger associations between developing graduate attributes and developing an occupational therapy identity at the end of the second year, compared with developing an occupational therapy identity at the commencement of the programme for most graduate attributes but not all. The exceptions were: (1) working across locations in the tropics; (2) having a core understanding of occupation and its impact on health and wellbeing; and (3) having a desire to address health inequities in indigenous communities.

Table 1.

Associations between when students develop an occupational therapy identity and graduate attributes.

Graduate attributes	Commencement of occupational therapy programme		Start of second year
	χ² for trend	p	χ² for trend	p
Development of an inclusive society	10.73	0.001**	11.08	0.001**
Work across locations within the tropics	15.45	<0.001***	12.03	0.001**
Creative and adaptable to a range of settings	14.65	<0.001***	21.97	<0.001***
Work in a culturally diverse world	15.33	<0.001***	18.79	<0.001***
Competent in professional communication	13.24	<0.001***	15.37	<0.001***
Applying occupational therapy theory and knowledge to practice	10.74	0.001**	15.04	<0.001***
Core understanding of occupation and its impact on health and wellbeing	14.82	<0.001***	13.13	<0.001***
Competent in interdisciplinary learning and practice	4.59	0.032*	7.99	0.005**
Respect and understanding of indigenous health issues	5.65	0.017*	12.77	<0.001***
Desire to address health inequities in indigenous communities	8.03	0.005**	6.44	0.011*
Value and role of research in developing evidence-based practice	10.58	0.001**	15.81	<0.001***

Note: df = 1. *p < 0.05; **p < 0.01; ***p < 0.001.

Discussion and implications

This study was undertaken with the first cohort of students in a revised occupational therapy curriculum. The curriculum review occurred as part of a university-wide curriculum refresh and in response to the trend towards a more occupation-focused paradigm within the profession. The aim of this study was to explore the development of occupational therapy identity and graduate attributes in occupational therapy students in a revised curriculum at a regional Australian university in which the authors work. As anticipated, students' development of an occupational therapy identity increased over time. This was encouraging to see as it suggests the revised curriculum is enabling students to develop an occupational therapy identity. It also suggests an alignment between the desired graduate attributes and the teaching and learning activities within the curriculum.

The finding that at commencement of the programme the majority of students agreed or strongly agreed that they had a strong identity of becoming an occupational therapist is consistent with that of Adams et al. (2006), who reported a strong professional identity of health students (including occupational therapy students) on entry into a programme. Wanting to become an occupational therapist (and therefore subsequent enrolment and commencement of the programme) may be associated with already having begun developing an occupational therapy identity. For example, students may have started developing perceptions of occupational therapy via career educational material (programme description provided by the admission centre through which applications are submitted; programme information on the university website) (Turpin et al., 2012).

The clear alignment between emerging occupational therapy identity and self-reported attainment of all graduate attributes was also encouraging. This suggests the content embedded within the revised curriculum assists in the development of an occupational therapy identity and that the identity being established correlates with the attributes expected of graduate therapists. Many occupational therapists report difficulties in making sense of their practice in a biomedically oriented health care system (Davis, 2006; Ikiugu and Rosso, 2003). Therefore, ensuring a robust and relevant occupational therapy identity is established within the education programme is of considerable value to the profession.

Furthermore, as noted within the study findings, the strength in association between self-reported attainment of most graduate attributes and development of an occupational therapy identity increased over time. This overall change in association over time clearly demonstrates there is an increased association of development of graduate attributes and occupational therapy identity. This would suggest that students' ongoing involvement in the academic programme supports a continued shift towards an occupational therapy identity that is aligned with desirable graduate attributes.

There were a few exceptions to the increase in association strength over time between graduate attributes and occupational therapy identity. Most notably, there was a decrease in association of the graduate attribute ‘core understanding of occupation and its impact on health and wellbeing’ from commencement of the occupational programme to the start of second year (although both associations were still significant). A possible explanation for this may be a belief by students that they have a good understanding of occupational therapy (and occupation) at commencement of their programme, with a greater self-awareness of the limits to their knowledge developing as they progress through their first year of study. This explanation would be consistent with the findings of Turpin et al. (2012), who found that undergraduate students entering occupational therapy study had an understanding of occupational therapy consistent with that of the general public, whereas graduate entry students had a more robust awareness of advanced occupational therapy concepts. A second potential explanation is that students may perceive the first year, first semester core occupational therapy subject as more clearly focused on occupation than the first year, second semester core occupational therapy subject. This would warrant further qualitative exploration with students, via a focus group or individual interviews, in order to better understand in depth the reasons for this trend.

Establishment of an occupational therapy identity is associated with factors influencing students' decision to continue studying occupational therapy. On close inspection, students' learning as well as placement experience appears to be the main factors influencing this association. This finding points to the value of a curriculum emphasising the early establishment of a sense of occupational therapy identity to promote student retention and supports that of Tinto (2006/2007) who noted the importance of the first year in influencing students' decision to continue or leave university. Further research into this relationship is warranted through longitudinal follow-up with students to examine whether this trend continues as students progress through the programme.

The significant, inverse associations between (1) the older age category (>20 years) and the graduate attributes of working across locations within the tropics and competence in interdisciplinary learning and practice; and (2) students with prior tertiary studies and the graduate attribute of competence in interdisciplinary learning and practice, are worth further consideration. This could be a result of older students and/or those with previous tertiary study experience feeling they had developed these skills via other means prior to entering the occupational therapy programme. Regardless, it is indicative of the potential need to adjust some elements of the curriculum to better draw on and build on the previous knowledge and experience of students who are older and/or have completed previous tertiary studies. Doing so would be in keeping with the key principles of adult learning (Knowles, 1980) on which this curriculum was founded and would most likely improve the learning experience for all students.

Limitations

This study did not include students who were not enrolled in the second year occupational therapy subject in which the survey was distributed. Students who were not enrolled in this subject were likely to have not met the prerequisites of this subject (completion of all first year subjects) and thus may have experienced a different development of occupational therapy identity and graduate attributes which was not captured in this study. These students were provided with the opportunity to participate in the study, but there was no response to this recruitment attempt.

Cross-sectional surveys do not allow the researchers to delve deeply into underlying phenomenon (in this case occupational therapy identity and graduate attributes). This was not the intention in this study, however, future qualitative research to explore the way in which curriculum shapes occupational therapy identity and graduate attributes is recommended.

Due to the sample size, the findings from this study are limited to this cohort of students and cannot be generalised to other cohorts within this university or to cohorts in other universities. As such, no comparisons were made to students in the previous (old) curriculum or to students in other universities. However, this article does provide discussion on the development of occupational therapy identity and graduate attributes in occupational therapy students which can be used as the basis for further research.

Conclusion

This study found a growth in the emergence of occupational therapy identity among a cohort of students undertaking a revised, occupationally focused curriculum in a regional Australian university. This occupational therapy identity was found to be more closely aligned with desired graduate attributes at commencement of the second year of study than on entry to the programme demonstrating the success of the first year of the programme. An association between the early development of occupational therapy identity and students' decisions to continue studying was also identified, reinforcing the importance of identity in supporting student retention. Longitudinal follow-up with students is warranted to examine the continued development of occupational therapy identity and graduate attributes over the duration of the programme and into their practice as qualified occupational therapists.

Key findings

Occupational therapy identity is aligned with graduate attributes.

An association exists between the main factors that influence students' decision to continue studying occupational therapy and developing an occupational therapy identity.

What the study has added

This research demonstrates the importance of the first year curriculum of an occupational therapy programme in the development of occupational therapy identity and graduate attributes in students.

Footnotes

Research ethics

The study was approved by the James Cook University Human Research Ethics Committee (approval number H4781).

Declaration of conflicting interests

None declared.

Funding

This research received no specific grant support from any funding agency in the public, commercial, or not-for-profit sectors.

Appendix—Survey questions

References

Adams

Hean

Sturgis

(2006) Investigating the factors influencing professional identity of first-year health and social care students. Learning in Health and Social Care 5(2): 55–68.

Australian Bureau of Statistics (2011) 1270.0.55.005 – Australian Statistical Geography Standard (ASGS): Volume 5 – Remotes structure. Available at: www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1270.0.55.005July%202011?OpenDocument (accessed 11 Novemver 2013).

Barrie

(2007) A conceptual framework for the teaching and learning of generic graduate attributes. Studies in Higher Education 3(4): 439–458.

Biggs

Tang

(2007) Teaching for Quality Learning, 3rd ed. New York: Open University Press.

Clouder

(2003) Becoming professional: Exploring the complexities of professional socialization in health and social care. Learning in Health and Social Care 2(4): 213–222.

Clouston

Whitcombe

(2008) The professionalization of occupational therapy: a continuing challenge. British Journal of Occupational Therapy 71(8): 314–320.

Davis

(2006) The importance of the community of practice in identity development. The Internet Journal of Allied Health Sciences and Practice 4(3): 1–8.

Davis

(2008) Occupational therapy students' metaphors for helping. (Images of practice). The American Journal of Occupational Therapy 62(2): 242–250.

Edwards

Dirette

(2010) The relationship between professional identity and burnout among occupational therapists. Occupational Therapy in Health Care 24(2): 119–129.

10.

Hooper

(2008) Stories we teach by: Intersections among faculty biography, student formation, and instructional processes. The American Journal of Occupational Therapy 62(2): 228–241.

11.

Ikiugu

Rosso

(2003) Facilitating professional identity in occupational therapy students. Occupational Therapy International 10(3): 206–225.

12.

Knowles

(1980) The Modern Practice of Adult Education: From Andragogy to Pedagogy, Englewood Cliffs, NJ: Prentice Hall/Cambridge.

13.

Peloquin

(2005) 2005 Eleanor Clarke Slagle Lecture: embracing our ethos, reclaiming our heart. American Journal of Occupational Therapy 59(5): 611–625.

14.

Ramsden

(2003) Learning to Teach in Higher Education, 2nd ed. London: Routledge Falmer.

15.

Tinto

(2006/2007) Research and practice of student retention: what next? Journal of College Student Retention 8(1): 1–19.

16.

Turpin

Rodger

Hall

(2012) Occupational therapy students' perceptions of occupational therapy. Australian Occupational Therapy Journal 59(5): 367–374.

17.

Waghorn

Lloyd

Clune

(2009) Reviewing the theory and practice of occupational therapy in mental health rehabilitation. British Journal of Occupational Therapy 72(7): 314–323.

18.

Wenger

(1998) Communities of Practice: Learning, Meaning and Identity, Cambridge: Cambridge University Press.

19.

Wenger

(2000) Communities of practice and social learning systems. Organization 7(2): 225–246.

20.

Whitcombe

(2013) Problem-based learning students’ perception of knowledge and professional identity: occupational therapists as ‘knowers’. British Journal of Occupational Therapy 76(1): 37–42.

21.

Whiteford

Townsend

Hocking

(2000) Reflections on a renaissance of occupation. Canadian Journal of Occupational Therapy 67(1): 61–69.

22.

Wilding

Whiteford

(2008) Language, identity and representation: occupation and occupational therapy in acute settings. Australian Occupational Therapy Journal 55: 180–187.

23.

Wilding

Wilcock

(2001) Centralising occupation in the occupational therapy curricula: Imperative of the new millennium. Occupational Therapy International 8(2): 81–88.