Abstract
Keywords
In higher education, we are approaching a crossroads in the preparation of occupational therapy professionals and being challenged from many sides. Trends in higher education are toward interprofessional education. This can, on one hand, be positive in enhancing professional skill development or, on the other hand, be negative if it reduces the core content to a universal common denominator. Trends in open access to curricular content, such as massive open online courses, make it easier to share the growing body of knowledge in our domain of practice. The positive side is opening access to more stakeholders, and the negative side is professional encroachment, when others take knowledge and apply occupational therapy practice under a different guise. Trends in expanding educational delivery models, including online, hybrid, or blended formats and satellite programs, can serve the profession positively by minimizing geographic barriers to train students where they live, be it in rural or geographically isolated areas, or they can be negative by removing opportunities for active learning in a supportive student community.
Patricia Schaber, PhD, OTR/L, FAOTA
One response to these challenges is to better understand the impact of change by empowering the stakeholders of occupational therapy professional education by stimulating faculty to accelerate the journey from educator to scholar—specifically, a scholar in teaching and learning—to continue to serve the larger profession, the teaching institution, and individual professional career development. The journey has served me—through promotion to associate professor, induction into the Academy for Excellence in Scholarship of Teaching and Learning, and a seat at the table on larger university committees—but, more important, it has revitalized my enthusiasm for the challenging job that I do daily. Let me back up and tell my story as a way of illustrating the importance of scholarship of teaching and learning.
In Minneapolis, our “9/11 experience”—referring to the notion that every person can remember what they were doing when the news of the terrorist attacks broke—was the collapse of the Interstate 35W bridge. I crossed that bridge 20 minutes before the collapse. An unthinkable tragedy of this magnitude gives pause for thought and changes one’s life’s trajectory from that point forward. Our occupational therapy program had a similar experience in 2003. Imagine going to work one day, sitting at a conference table with the dean of your school, and being told your program does not fit the school’s mission (the education of medical students) and that your program is under review for a new home (also known as closure). Fast forward 1 year.
Then imagine that the academic health center’s vice president receives a million-dollar grant to move your program to a new Center for Allied Health that will house programs with innovative, technology-enhanced teaching and learning platforms with satellite sites across the state. Strong vision, major change, and both stunning in scope: closure or transformation. With the move from classroom-based delivery to a hybrid format, faculty were swimming in uncharted waters. Our six core faculty were overwhelmed. Before we could catch our breath after this announcement, we were aligned with a teaching team of educational specialists to move the entry-level master’s program from one site to two sites and to a hybrid format with more than 70% of the curriculum online. Rapid change brings varied responses. Some faculty departed because the timing was right and other opportunities looked more inviting. Some became entrenched and fought the changes tooth and nail. Ultimately, the only choice left was “if you can’t beat ’em, join ’em.”
For many, a career path in education may follow the typical trajectory from the clinic to academic clinical specialist to assistant and then associate professor. Faculty members teach occupational therapy the way they learned it. It is critical to avidly explore how to select, teach, mold, make, educate, and guide future occupational therapy practitioners through traditional pedagogies. These pedagogies fit a classroom-based teaching model, and some would be rendered obsolete in the transformation to a hybrid format. To progress with the changes that were called for, we pondered these questions: What was the essence of our educational model? What was an essential pedagogy used to transform a student into an entry-level practitioner? What method of teaching was worth retaining (worth fighting for), preserving at all costs? What pedagogy made the discipline of occupational therapy unique? In other words, what was our signature pedagogy?
Pedagogy
The word pedagogy comes from the Latin paedagogus, defined as “a slave who supervised children including bringing them to and from school” ( American Heritage Dictionary, 1992, p. 1334). The term evolved to encompass the art, science, or profession of teaching. It involves leading by a pedant, defined as “one who exhibits one’s learning or scholarship ostentatiously” (p. 1334). Pedagogy is more than an instructional methodology, a teaching technique; it is larger than that. Pedagogy bridges teacher to student, knowledge to learning experience, and learning experience to learning outcome.
Karl Smith, a colleague and proponent of collaborative learning, elaborated on Parker Palmer’s (1997) idea of the pedant, or teacher, as the person who creates the capacity for connectedness through his or her own identity and integrity. The pedagogy is the ontology (core beliefs) and epistemology (how we know what we know) of the educational process. I visualize the pedagogical conversation as an extension of one’s own meta-experience—rising above and observing, reflecting, analyzing, and critically thinking about the full experience of teaching and learning as it is occurring.
Just as each teacher is unique in this capacity, each discipline unfolds a paradigm of what works best in the pedagological process. The disciplinary habits are characteristic of that discipline; we speak of disciplinary habits of the mind, which align with Bloom’s cognitive domain; habits of the heart, or Bloom’s affective domain; and habits of the hand, or the psychomotor domain (Krathwohl, Bloom, & Masia, 1956). The disciplinary habits that set the discipline apart from others then become the signature pedagogies, known by their uniqueness and prioritized purpose. Shulman (2005), the guru of signature pedagogies in higher education, emphasized that signature pedagogies in professional education define not only the knowledge base but how that knowledge becomes known.
Structure
How do occupational therapy educators search for the signature pedagogy in the larger effort of defining pedagogies? Shulman (2005) provided a blueprint, identifying three dimensions to guide the exploration. The first is the surface structure, or the observed acts of how the discipline teaches and learns; second is the deep structure, or the underlying knowledge being imbued; and third is the implicit structure, which binds these, like roots in the ground, and captures the moral scope of education in the form of values and beliefs (Shulman, 2005). In the search for signature pedagogies, the vision is crystallized by identifying—and this is important—what is missing or not chosen among traditional methods of disciplinary teaching and learning.
The surface structures are explored by highlighting keen observation of what is happening in the teaching and learning experience, traditionally answering the question, What is going on in the classroom or lab? Time-lapse photography can capture the patterns that typify the learning experience of a discipline. There are norms or rules to which students conform. For example, in the discipline of law, a surface structure would be a semicircle of students with a teacher generating questions about a case and students responding to the teacher in a Socratic style. Surface structures can be made apparent by classroom observation.
In the occupational therapy classroom, teaching typically proceeds as follows: After an introduction or short lecture, groups of students gather around a learning object, interacting, practicing, and questioning, and the instructor moves around the room to guide the learning experience. An observer would see a strong teacher-to-student and student-to-student social connection during the learning process. Gradually, if one observed what happened across courses, one would see repeated experiences that commence the students’ shift to deeper ways of thinking, to particular ways of behaving, and ultimately to new ways of being.
Although surface structures are identifiable, the deeper structures require probing and reflection. This requires the instructor to project what students will have gained from the course 5 years out. What are the deeper, sustainable meanings in a transformative educational experience? For example, in teaching content on working with people in pain, an instructor will want students to respect people’s description of their pain as real and valid and as a valuable indicator of healing or improvement. Students will explore a repertoire of responses to draw from in their future practice. To make the learning experience memorable, one may assign a reading from the book The Gift of Pain (Yancy & Brand, 1997), which poignantly describes an experience of leprosy, living with the inability to feel pain. This assignment can be contrasted with a video interview of a person who lives in constant pain. If the learning experience has an impact, years later students will remember both experiences when working with individuals experiencing pain.
The implicit structures of shared disciplinary values and beliefs require a larger social and scholarly discourse. How does one impart the belief that each human life has value? How does one transfer the belief that engagement in occupation heals and transforms?
Perhaps the most overt example of our shared ethos occurs at the American Occupational Therapy Association’s Annual Conference & Expo. Attending opening ceremonies to listen to “OT speak” is participating with an audience of believers, believers with shared values and perspectives on occupation and the indelible connection to meaning and purpose in life. Graphics with people “doing” abound. Similarly, through professional white papers, occupational therapists make the implicit explicit, defining themselves by stating their values and beliefs, sometimes shared with other, similar health science disciplines but re-created and emphasized uniquely in our own discipline.
Occupational Therapy Education's Signature Pedagogies
Aligned with a team of educational specialists, Lauren Marsh, Kimerly Wilcox, and I joined a cross-disciplinary project led by Nancy Chick, Aeron Haynie, and Regan Gurung to identify signature pedagogies in occupational therapy (Schaber, Marsh, & Wilcox, 2012). These editors compiled disciplinary explorations in signature pedagogies in two books, their first, Exploring Signature Pedagogies (Gurung, Chick, & Haynie, 2009) and a sequel, Exploring More Signature Pedagogies (Chick, Haynie, & Gurung, 2012). Using Shulman’s (2005) blueprint, our search for signature pedagogies in occupational therapy education began with observing what happened in the classroom; then delved into the literature, the published lessons learned through deeper thought and reflection; and finally uncovered the moral plumb line revealed through honored lectures and professional white papers.
We conducted a pedagogical literature review of occupational therapy professional education articles published in the American Journal of Occupational Therapy beginning in 1948. By categorizing journal article titles and abstracts and conducting a thematic analysis, three signature pedagogies that were consistent over time and distinguished occupational therapy education were identified: relational learning, affective learning, and highly contextualized, active engagement (Schaber et al., 2012). These themes were used to develop a conceptual model to serve as a starting point for the conversation. The intent of this exercise was, according to Ciccone (2012), to describe and evaluate “the current connections (and disconnections) between what a field or discipline values and how it instills (or not) those values in its future practitioners through the teaching and learning experiences it designs” (p.
Relational Learning
Relational learning is the learning that occurs through human connection. It privileges the teacher–student relationship through mentorship, apprenticeship, and modeling. By modeling empathy and caring, as well as touch and handling that accompany work in occupation, educators, whether in the classroom or fieldwork setting, guide students toward becoming mature professionals. Gail Fidler, in her Eleanor Clarke Slagle lecture in 1966, spoke of her belief that proper supervision of students was not oversight but an interactive, interdependent, and dynamic relationship. She said in her lecture that “supervision in this sense then becomes . . . the contract which binds supervisor and learner together . . . a dynamic human interactional growth process” (pp. 5–8). Modeling the interactional approach with a client along with explaining the clinical reasoning processes in designing the intervention has a powerful impact on learning and teaches students how to be an occupational therapist. This relational learning models a professional identity that exemplifies a human connection, empathy, and respect while seeing the patient as a whole person.
Affective Learning
Affective learning is learning that transforms personal identity, an outgrowth of change in attitudes, beliefs, and values. It involves teaching topics that can be deeply transformative. In 2005, Suzanne Peloquin, a prominent author in occupational therapy education and Eleanor Clarke Slagle lecturer, described professional education as a holistic milieu embedding the student in the center, a process that affects a student’s identity: “Related to occupational therapy, identity formation refers to inviting students to embody the profession’s unique ethos” (Hooper, 2008, p. 228). At the heart of this ethos resides the belief that every person has a right to engage in a self-defining, unique occupation.
In 2008, Barbara Hooper, a leader in occupational therapy education, supported Peloquin’s (2005) premise in an article stating that “professional education is about identity formation, which involves helping students form the character, dispositions, beliefs, values, ways of knowing, and ways of seeing that are characteristic of their chosen profession” (p. 228). She further described the disciplinary habits involved in how identity formation occurs: “Student identity formation is influenced through . . . the desired ways of being that are communicated through the culture of the program, its customs, its rituals, and its patterns of relating” and continued, “Students grasp what kind of person they are to be as occupational therapists” (p. 229). For students, educators open the door and usher them into an exploration of events that have an impact on the occupational life of the individual, difficult topics such as death, pain, loss, grief, stigma, and oppression that profoundly transform personal identity and build professionalism.
Highly Contextualized, Active Engagement
Highly contextualized, active engagement is learning through doing. The same philosophical underpinnings of the therapeutic approach also describe the pedagogical model for training occupational therapy students (Bing, 1981). The context has evolved throughout the past half century with recurrent themes: The former context of traditional hospitals, rehab centers, schools, and institutions now gives way to home care, community mental health sites, prisons, playgrounds, senior centers, and, recently, primary care clinics. Increasingly, educational movements are toward active engagement in natural settings with a variety of populations. Active learning incorporates the key tenets of professional practice. In other terms, educators train students by applying the occupational therapy process in the learning-through-doing experience.
Many terms have been used to describe active engagement: experiential learning, service learning, compulsory volunteering, shadowing, and fieldwork; the key is in selecting, building, and designing the environment and planning what the student does in that place to yield a predetermined outcome. From the inception of occupational therapy in psychiatric institutions to today, we have preserved the pedagogy of training on site and actively engaging with clients, our learning through doing.
Conceptual Model for Occupational Therapy Education
So why this conversation about signature pedagogies? Why now? Educators are currently being called on to be more accountable for educational outcomes. We, as professionals in the business of educating our own, must establish our own pedagogical path without leaning on others. Outsiders may perceive occupational therapy professional education as reduced to teaching technical skills or job training. They are missing the larger gestalt: We are teaching a process, ways of thinking, creative problem solving, and a method based on a science of occupation and occupation-based theory. The search for signature pedagogies will continue as we look around the classrooms, reflect on the larger aims of teaching and learning, and wrestle with the attitudes, values, and beliefs that are transferred to and inspire our students. It should be noted that nearly a century after the emergence of the discipline of occupational therapy, the signature pedagogies used to effect this student-to-professional transformation continue to reflect the principles on which the profession was founded.
Higher education is undergoing transformation that maps to trends in which education is increasingly decentralized; this creates challenges to developing mentoring relationships, affecting student attitudes, and actively engaging with students. Distance education, hybrid or blended learning, and satellite campuses, along with use of cloud technologies, increased class sizes, and faculty extenders, are expectations in higher education. They create a geographic separation and a potential chasm affecting the human connection, a means to alter student values and control what students do. As we move toward interprofessional education, we will be called to the table to justify our pedagogies, why content in our curriculum—that is, ethics, anatomy, research, or group process—should be taught by occupational therapy instructors versus other faculty or even nonfaculty. Is it purely the content of our curriculum or our signature pedagogies that define us and contribute to our uniqueness? If we better understand our signature pedagogies, we may be better able to respond to the challenges we confront and be nimble in the process.
The conceptual model presented has not been not tested and is not exhaustive, nor does it purport to speak for the discipline. The purpose of driving the discussion of signature pedagogies is to bring the conversation to the forefront and wrestle with the tensions and controversies.
The purpose of the conversation is also to bring the discipline forward in the scholarship of teaching and learning; to help frame a research agenda to probe, test, evaluate, and discard or justify educational practices; and, at the same time, to refine and preserve what occupational therapy collectively holds sacred. It is moving from what the discipline believes works in education to what can be proven. Deciding how to study how we teach and students learn is an essential starting point. The following is an example of how to use the proposed conceptual model (relational learning, affective learning, and highly contextualized, active engagement) to guide inquiry.
Studies in relational learning may involve investigating the human connections, the qualities of key stakeholders affecting the teaching and learning experience, and the nature of that relationship leading to optimal learning outcomes. For example, investigators may expand on a study by Bartholomai and Fitzgerald (2007), who broadened the construct of teacher to include multiple mentoring and looked at new collaborative models of training. Other questions could be
What, if any, curricular content is most effectively taught by an occupational therapist?
What are the essential qualifications of an adjunct professor, lab instructor, or faculty extender?
Does formal fieldwork supervisor training or certification enhance the student fieldwork learning experience?
Can virtual connections effectively substitute for face-to-face connections?
Studies in affective learning may involve investigating transformative changes in students’ identity, attitudes, and beliefs guiding the development of professionalism. Questions to study may be
Which core attitudes and beliefs are implicit and should be made explicit in curricula for occupational therapy students?
How do we measure professional competencies related to student attitudes and behaviors?
Can students learn affective topics in an online format? (Schaber, Wilcox, Whiteside, Marsh, & Brooks [2010] found that the answer is yes.)
Studies in highly contextualized, active engagement may involve investigating learning through doing by examining which settings promote stronger educational outcomes and which characteristics of the designed experience have greater impact on student professional development. Other questions may be
Can simulation labs replace fieldwork experiences?
What are the essential training requirements before administering real-time standardized assessments in Level II fieldwork?
Do student learning outcomes differ in real versus virtual designed experiences (i.e., an anatomy cadaver lab compared with an anatomy online video course)? Mathiowetz and Yu (2013) completed a study comparing outcomes of a real versus virtual anatomy lab and found students fared equally well in both formats. To carry the question a step further, are there other learning outcomes gained but not measured that can justify the higher cost of the anatomy cadaver lab experience? These are examples of linking a conceptual model of signature pedagogies to the scholarship of teaching and learning in testing the model.
The intent of presenting this conceptual framework is not to provide answers to the questions of What now? and How do we proceed? More so, the intent is to stimulate thinking on the topic as a starting point of the conversation. What are the signature pedagogies that define our discipline? Building a science of occupational therapy education also requires revisiting what has made the discipline unique, what has worked to mold occupational therapy practitioners successfully for a nearly a century. Staying connected to the past while at the same time intentionally designing our future to attain best practice in education is the ultimate goal.