National Survey of Fieldwork Educators: Implications for Occupational Therapy Education

Method

Results

The survey was opened by 1,101 respondents and completed by 817, for a response rate of 74%. As noted earlier, the respondents represented 41 states and the District of Columbia. Respondents were asked to self-identify whether they served as the contact person for fieldwork education at their site, and responses were used to uniquely identify practice settings. All practice settings within a facility were listed, so categories were not mutually exclusive. The most frequently represented practice setting was physical medicine (41%, outpatient; 31%, inpatient acute care; 17%, skilled nursing; 28%, inpatient rehabilitation), followed by pediatrics (27%, school-based practice; 17%, early intervention; 9%, inpatient hospitals). Mental health settings included inpatient acute care (15%) and inpatient psychiatric rehabilitation (6%). Other reported practice settings included home health care (10%), adult day programs (6%), and long-term acute care hospitals (3%).

Fifty-nine percent of respondents reported that they were the person primarily responsible for coordinating student fieldwork placements, 54% identified their settings as teaching institutions, and 96% reported that they supervise fieldwork students. Eighty-eight percent of respondents reported that they had supervised an occupational therapy or occupational therapy assistant student at some point in their careers; 12% reported they had never supervised a fieldwork student. A majority reported that they typically supervise two or fewer occupational therapy students per year, and 82% reported supervising two or fewer occupational therapy assistant students per year (Table 1). A small percentage had trained occupational therapy doctorate students (13%), and a few reported supervising one or two occupational therapy doctorate students per year (11%).

A majority of respondents reported they had three or more full-time occupational therapists eligible to provide Level II supervision (59%). Eighty-seven percent reported that they had two or fewer eligible occupational therapy assistant supervisors. Twenty-four percent of sites reported that they have sent only one occupational therapist to the AOTA Fieldwork Educators Certificate Program (FWECP; Johnson & Stutz-Tanenbaum, 2009), and 55% reported sending zero. Six percent reported they had sent only one occupational therapy assistant, and 92% had sent zero. Of note, 61% of respondents reported that they were not aware of the AOTA fieldwork education resources available to members on the AOTA website. Sites were asked which models of supervision they provided to occupational therapy students for Level II fieldwork. Some sites used more than one model; thus, categories were not mutually exclusive (see Table 1). Sites reported preferred time frames for Level II fieldwork as fall (58%), winter (54%), spring (53%), and summer (29%). These time-frame selections were not mutually exclusive.

Sites reported they generally preferred midsemester schedules for Level I fieldwork (40%) or had no preference (37%). Respondents reported preferred Level I schedules to be weeklong (53%) versus weekly (41%). These categories were not mutually exclusive. Regarding the shared responsibility for education and training between the fieldwork site and the academic program, respondents were asked to select on a sliding scale ranging from 1% to 100% what percentage of applied practice skills should be learned in school versus during fieldwork. On average, respondents indicated 55% of applied practice skills should be taught in academic programs, with 45% to be learned during fieldwork.

In terms of perceived benefits of participating in fieldwork education (Table 2), respondents placed professional development and altruistic ideals in the top five (Table 2). When asked to rate the most challenging factors related to participating in fieldwork education, respondents were primarily concerned with having the necessary resources to support the fieldwork program and student readiness (Table 3). Respondents also rated the perceived value of supports provided by academic partners in fieldwork education (Table 4). When asked to identify specific items that ensure a successful fieldwork experience, respondents most frequently rated self-assessment tools for students (63%). Approximately half of respondents reported sample student objectives (54%), sample weekly schedules (51%), information on management of unprofessional behavior (51%), fieldwork educator self-assessments (49%), and remediation plans before student failure (49%) to be most helpful. When asked how AFWCs could best resolve conflicts or professional behavior issues with students, the most frequently identified practices were providing education to students on professional behavior before fieldwork (82%); availability of the AFWC to discuss potential problems (76%); and face-to-face meetings with the AFWC, student, and fieldwork educator if needed (70%). Respondents who did not supervise students reported that workload and time pressures (23%) would need to change for them to begin supervising students, which was selected more frequently than concern about supervisory skill readiness (11%).

Discussion

The survey respondents are representative of the fieldwork education community across the United States, and more than half were the person responsible for student program administration; the respondents’ roles lend validity to the reported perceived benefits, challenges, and valued supports. Fieldwork placements are most frequently offered in traditional practice areas; the highest number of settings are physical medicine, followed by pediatrics. This finding is consistent with current workforce employment trends (AOTA, 2010). The low percentage of community-based fieldwork settings may be a consequence of the low number of practitioners available to supervise students, the lack of an administrative structure to support a student program, or the limited use of nontraditional fieldwork models for student placements.

Opportunities to increase fieldwork capacity may exist in traditional settings by strengthening the sustainability of year-round Level II fieldwork placements and implementing collaborative supervision models. Fieldwork facilities with established year-round Level II fieldwork programs could serve as models and share strategies, including how to build a sustainable administrative infrastructure. Finding ways to support training of more occupational therapy and occupational therapy assistant practitioners as fieldwork educators seems paramount because a limited number of facilities reported having trained staff via the AOTA FWECP.

Study results related to the timing and structure of Level I and Level II fieldwork have provided valuable information to academic programs. Facilities that offer Level I fieldwork have reported flexible preferences for weeklong (condensed) and once-per-week schedule models, with a slight preference for mid-semester placements. The lack of summer Level II fieldwork placements may necessitate academic programs reevaluating their curriculum sequence. Preferences for timing of placements are an important consideration because they are likely based on available staffing, resources, and time.

Fieldwork educators regard their role to be significant in contributing to students’ acquisition of applied practice skills and entry-level competencies. Respondents ranked opportunities for professional development and being of service to the profession more highly than incentives such as tuition credit vouchers and access to online library resources (see Table 2). Results point to the personal-level benefits of being a fieldwork educator, coinciding with outcomes of a focus-group pilot study (Hanson, 2011).

The challenges identified by respondents were primarily extrinsic factors, including workload, cost of staff time, and student learner characteristics and competencies (see Table 3). Although practice patterns of staff productivity are not affected by the presence of a fieldwork student (Ozelie, Janow, Kreutz, Mulry, & Penkala, 2015), concerns about lack of time remain a theme for fieldwork educators (Hanson, 2011). Administrators and fieldwork educators with these concerns may respond to recent evidence suggesting that practitioners with requisite skills are able to meet their productivity expectations while serving as fieldwork educators (Ozelie et al., 2015).

Limited student capabilities were also reported as a perceived challenge, which is consistent with earlier findings (Hanson, 2011; Jensen & Daniel, 2010). Research to inform the best approaches to educating students for readiness for fieldwork and practice is lacking. Academic programs are increasingly implementing the use of simulation methods to assist with clinical preparedness (Bethea, Castillo, & Harvison, 2014). However, further research is needed to better understand learning outcomes related to simulation experiences.

In contrast to concerns, readiness and high-quality educational preparation of students were rated as the most valued supports from academic programs (see Table 4). Readily available support from AFWCs was also viewed as important. Integrating the needs and perspectives of the student and the fieldwork educator and the realities of the practice environment is part of the customization of the learning process (Stutz-Tanenbaum et al., 2015). The AFWC role requires the ability to manage conflict as well as to analyze student, fieldwork educator, and contextual elements of the learning environment.

The valued supports identified by respondents point to the need for AFWCs to have adequate time in their schedules along with sufficient resources to manage complex tasks and emotional situations to effectively collaborate with fieldwork educators. Self-assessment tools for students and fieldwork educators were identified as the most helpful tools, along with clear performance expectations. Criteria for student performance can be outlined using site-specific learning objectives and weekly schedules for skills progression as well as remedial learning plans for students who need extra support. More research is needed in the area of fieldwork education to develop versatile resources to support effective implementation of the AFWC role (Stutz-Tanenbaum et al., 2015).

Limitations

The findings of this study are limited because the respondents were self-identified and not randomly selected. In addition, the survey was distributed and administered electronically, and respondents needed to have access to and knowledge of survey technology. Finally, snowball sampling does not allow for random selection. Therefore, it is not feasible to determine possible sampling error and make statistical inferences to the general population.

Implications for Occupational Therapy Education

Interpretation of these data provides valuable information for the profession, notably academic programs, regarding needs and resources to foster collaborative relationships with fieldwork facilities to meet the growing need for fieldwork education. These study findings have the following implications for fieldwork education research, which relate to AOTA’s Education Research Agenda (AOTA, 2014b). Future fieldwork education research is needed to explore

Conclusion

One intended outcome of this research is to provide a platform for future efforts to further understand barriers to therapists’ interest in and ability to assume the role of a fieldwork educator. Specifically, further research is needed to examine the group of therapists who do not participate in fieldwork education. Additional investigation of the perceived and tangible barriers that limit their willingness to supervise fieldwork students is needed.