Comparison of Occupational Therapy Students’ Perceived Skills After Traditional and Nontraditional Fieldwork

Research Design

This retrospective study compared the perceptions of students who did fieldwork at 33 TF and 15 CF settings. Eight CF settings had an active occupational therapist on site, and 7 did not.

We sent questionnaires as an attachment by email asking students questions referring to fieldwork done between 2008 and 2011. The study was approved by the ethical committee of Tel Aviv University. All participants included in the study signed an informed consent form.

Participants

The participants were bachelor of occupational therapy degree candidates at or graduates from Tel Aviv University who had completed their first, second, or third fieldwork placements in diverse community and traditional settings. We asked 32 students who completed CF to participate in the study; 28 (all female) returned completed questionnaires (87.5% response rate). We matched these students to control students who did their fieldwork in a traditional setting. To recruit the control group, we sent questionnaires by email to 63 students who had done TF; 28 returned completed questionnaires (44.4% response rate). We used the following criteria for matching: sequence of the fieldwork (first, second, or third placement), students’ scores on the fieldwork performance evaluation (within a 6-point range), and type of fieldwork (10 matched students in 5 different physical rehabilitation fieldwork placements, 24 matched students in 12 different pediatric fieldwork placements, and 12 matched students in 6 mental health fieldwork placements). No match was found for 4 students who did CF. One male CF student and 3 female TF students were excluded because their scores on their fieldwork performance evaluation did not meet the criteria.

Instrument

To measure students’ self-perception regarding their personal and professional skills, we developed a three-part questionnaire addressing personal skills (10 questions), professional skills (15 questions), and general questions (4 questions). All questions were answered using a 5-point scale ranging from 1 = strongly disagree to 5 = strongly agree.

The questionnaire items were based on two sources. The first source was the unpublished “Fieldwork Performance Evaluation for Occupational Therapy Students” document that is in use in the Department of Occupational Therapy at Tel Aviv University. The second source was themes from a literature review we conducted to locate instruments that might be appropriate for assessing students’ perceptions of fieldwork in general and of skills they needed for fieldwork in particular (Derdall, Olson, Janzen, & Warren, 2002; Forwell et al., 1997; Hoppes & Hellman, 2007; Miller, Bossers, Polatajko, & Hartley, 2001; Mulholland & Derdall, 2005). In the literature review, we considered both quantitative and qualitative data relating to students’ perceptions regarding fieldwork. We integrated the data presented in the literature with our previous experience in supervising students to develop this questionnaire. In building the questionnaire, we used a combination of closed- and open-ended questions, in-depth interviews, focus groups, and self-report techniques to explore the students’ experiences in fieldwork and documented the skills they were asked to demonstrate during their fieldwork.

Three experts in clinical fieldwork settings evaluated a draft questionnaire containing 29 questions that they were asked to rate as 1 = very important, 2 = not so important, or 3 = unimportant. They determined its content validity and confirmed that it was suitable for its designated use in this study. In addition, they were asked whether any questions needed to be added or deleted. At the end of the process, one question was deleted and one was added. The questionnaire was found to have good internal reliability (Cronbach’s αs = .69–.86). The general questions had the lowest reliability (.69); after the withdrawal of one question from the general questions section, the lowest Cronbach’s α rose to .75 (see Table 1).

Procedures and Data Collection

In 2008, the Department of Occupational Therapy at Tel Aviv University established a clinical program for training students in community-based practice. Community organizations in 15 communities with at-risk populations were located and provided with training and instruction; they subsequently qualified to accept occupational therapy fieldwork students. The fieldwork program included only specific, recognized groups in the community (e.g., municipalities, nonprofit organizations).

Two types of CF site were used: with and without an active occupational therapist at the location. Students were supervised accordingly either by an occupational therapist who worked on site or by a coordinator appointed by the university. In addition, some sites in the fieldwork program employed occupational therapists who wanted to promote community-based programs for specific populations even though the occupational therapy unit lacked experience in community-based practice; in these cases, the local occupational therapists were supervised by the community coordinator of the university’s occupational therapy department to ensure that a community practice model was used. Supervision of students in CF placements included a prefieldwork phase, in which introductory meetings with members of the population and community agencies were held, fulfilling the requirement of identification, and a specific program was developed for the community. In addition, the fieldwork program included weekly observations of the students’ performance, weekly personal meetings with the supervisor, and group supervision meetings. For students at sites with no occupational therapist present, a local coordinator was appointed (e.g., social worker, psychologist, counselor) who was available for communication and consultation via email and phone calls.

Our study examined 48 fieldwork settings, 33 TF and 15 CF; of the 15 CF settings, 8 had an active occupational therapist on site and 7 did not. The CF students performed interventions in the community’s own environment that emphasized health promotion and primary, secondary, and tertiary prevention.

Data Analysis

SPSS Version 17.0 (SPSS, Inc., Chicago) was used to process the data. Students’ perceptions regarding their professional and personal skills (see Table 2) were the dependent variables, and the independent variables included CF or TF placement, presence or absence of an active occupational therapist in CF placements, sequence of fieldwork (first, second, or third), and type of fieldwork (pediatric, mental health, or physical).

Because multiple comparisons were performed and the questionnaire included 29 questions, a Bonferroni correction was needed (.05/29), and therefore the significance level for the analysis was p < .001. The Mann–Whitney U test was used to determine whether students’ perceptions regarding their professional and personal skills differed according to CF (n = 27) versus TF placement (n = 23). The Mann–Whitney U test was also used to compare the perceptions of CF students in placements with (n = 15) versus without (n = 12) an active occupational therapist on site. In addition, an independent-sample t test was done twice to compare students’ scores on the personal, professional, and general questions within the same groups. The Kruskal–Wallis one-way analysis of variance was used for comparisons among the three fieldwork sequences (first, second, or third) and the three fieldwork types (pediatric, mental health, or physical).

Personal Skills

Students’ perceptions of their personal development were reflected in their personal responsibility scores (which differed significantly between groups) and in their overall scores, which included items on self-efficacy, creativity, and improvisation skills. These results are consistent with those of other studies describing the unique learning opportunities and challenges afforded by community placements in general and by those without an occupational therapy model in particular (Alter, 2011; Bossers, Cook, Polatajko, & Lane, 1997; Meyers, 2009; Mulholland & Derdall, 2005; Velde et al., 2011). This type of fieldwork enabled changes in students’ attitudes that were a reflection of personal values, a high level of self-esteem, and a sense of responsibility.

Professional Skills

Students who did CF without an active occupational therapist present reported a higher perception of their cultural competence than students at placements with an active occupational therapist present. Studies addressing self-perceptions of professional skills are difficult to compare because of variation in the way professional skills are defined. Many studies have addressed cultural awareness and understanding as a professional skill, and it is often mentioned as a skill that tends to improve with a community-based experience (e.g., Black & Wells, 2007; Doll, 2011; Gitlow, 2011; Meyers, 2009; Morton, 2012; Perrin & Wittman, 2001; Scott, 2004; Velde & Wittman, 2001; Velde, Wittman, & Mott, 2007). Black and Wells (2007) indicated that every clinical interaction involves multiple cultures and cited Fitzgerald (1992), who observed that in clinical interaction at least three cultures are involved: the personal culture of the provider, the personal culture of the client, and the culture of the primary medical system.

Israel is a multicultural society; students and clients come from different backgrounds and face the challenges of multicultural interaction. In our study, the students did their fieldwork in communities that were culturally diverse and engaged in activities that challenged their cultural values and beliefs. Most students who participated in CF without an active occupational therapist present intervened in communities with at-risk populations, such as Ethiopian immigrants, foreign workers, or refugees from Africa, whose cultures were very different from the students’ Western culture. The clients who originally came from African countries differed from the students in their patterns of perceiving the world; behaviors; beliefs; and attitudes about disability, treatment, therapy, and maternal and child health. These students’ experiences were consistent with those of students described in the literature who were involved with African-American populations, whose culture required the students to become more culturally competent (e.g., Black & Wells, 2007; Perrin & Wittman, 2001). Moreover, the literature contains reports about the success of higher education experiences in communities as a viable learning approach and as a teaching tool to promote cultural competence (Doll, 2011; Meyers, 2009; Velde & Wittman, 2001).

In contrast to the study’s hypotheses, we found no significant differences in student perceptions of their professional skills between students who completed CF and those who completed TF. Other studies have reported that students involved in CF improved their professional skills, such as knowledge of the community, crystallization of professional identity, professional communication skills, and understanding of occupations and occupational performance (Gitlow, 2011; Klinger & Bossers, 2009; MacRae, 2012; Moffett & Garbarini, 2004; Perrin & Wittman, 2001; Scott, 2004). A tentative explanation for our unexpected results is that previous studies did not have a control group; rather, most researchers focused their comparison on students’ skills before and after CF (e.g., Derdall et al., 2002; MacRae, 2012; Perrin & Wittman, 2001; Velde et al., 2011).

Velde et al. (2011), who like us found no difference in student perceptions after CF versus TF, believed that these findings reflected not necessarily a lack of difference but rather the limitation of the questionnaires in measuring changes. Likewise, our questionnaire may not have been sensitive enough to accurately identify change in knowledge and skills.