Barriers and Solutions to Fieldwork Education in Hand Therapy

PURPOSE: This descriptive study examined barriers certified hand therapist (CHT) clinicians experience to accepting students for clinical rotations and CHT clinicians’ preferences for student preparation prior to a rotation in a hand setting.

RATIONALE AND BACKGROUND: Approximately 85% of CHTs are licensed occupational therapists, and opportunities for student education and development are needed to maintain a strong presence in this area of practice. Hand therapy is a specialty requiring advanced knowledge and skills, so opportunities for clinical education beyond the generalist curriculum are needed to develop future clinicians. Because of the complex nature and demands of this unique area of practice, barriers often exist for students pursuing fieldwork rotations in hand settings.

METHOD: A survey was developed, peer reviewed, and revised by the researchers and a Hand Therapy Certification Commission (HTCC) Board Task Force to target various areas of hand therapy practice. The survey included barriers to accepting students and recommended areas of knowledge, skills, and experience to develop before a clinical rotation in a hand setting to facilitate success. Inclusion criteria for the study were occupational and physical therapists with the CHT credential who had elected to receive communication regarding research activities from the HTCC. An email was sent to 5,615 CHTs from the HTCC listserv with a link to the survey in SurveyMonkey (San Mateo, CA). Qualitative data were obtained using open-ended questions with free-text response.

Aggregate responses were analyzed to identify trends in barriers to student clinical rotations and recommendations for students to prepare for hand rotations. Quantitative data were represented as number and percentage of participants who responded to each question. Qualitative data were analyzed using open coding by the researchers to identify predominant themes.

RESULTS: A total of 2,080 participants responded to the survey, representing a 37% response rate. Common logistical barriers to accepting students included limited clinical time and space. Many clinicians (32% agreed, 8% strongly agreed) felt that students lacked the clinical knowledge to be successful. Areas of knowledge, skills, and experience for development prior to a clinical rotation in a hand setting were surveyed. A majority of respondents (74%) reported increased likelihood of accepting a student with the recommended preparation. Novel qualitative responses to improve clinical experiences were examined as well.

CONCLUSION: Results indicate that inadequate student preparation before a clinical rotation in a hand setting is a significant barrier. Areas of recommended knowledge, skills, and experience may serve to guide both formal and informal methods of student preparation before a hand-specific clinical rotation to facilitate knowledge translation from experienced CHTs to the next generation.

IMPACT STATEMENT: This study highlights barriers to and solutions for student success in fieldwork education in hand therapy settings. This specialty area of practice has historically been made up predominantly of occupational therapists, warranting clinical education opportunities for occupational therapy students. This study relates to the American Occupational Therapy Association research agenda for health services research (American Occupational Therapy Association & American Occupational Therapy Foundation, 2011) in that it explores facilitation of clinical education for future clinicians in the specialty area of hand therapy, a widely recognized, science-driven, and evidence-based area of practice in alignment with the broader AOTA mission and vision.

References

American Occupational Therapy Association & American Occupational Therapy Foundation. (2011). Occupational therapy research agenda. American Journal of Occupational Therapy, 65(Suppl.), S4–S7. https://doi.org/10.5014/ajot.2011.65S4

Evenson, M. E., Roberts, M., Kaldenberg, J., Barnes, M. A., & Ozelie, R. (2015). Brief Report—National survey of fieldwork educators: Implications for occupational therapy education.American Journal of Occupational Therapy, 69(Suppl. 2), 6912350020. https://doi.org/10.5014/ajot.2015.019265

Kasch, M., Greenburg, S., & Muenzen, P. (2003). Competencies in hand therapy. Journal of Hand Therapy, 16,49–58. https://doi.org/10.1016/S0894-1130(03)80024-8

Keller, J. L., Caro, C. M., Dimick, M. P., Landrieu, K., Fullenwider, L., & Walsh, M. (2016). Thirty years of hand therapy: The 2014 practice analysis. Journal of Hand Therapy, 29, 222–234. https://doi.org/10.1016/j.jht.2016.02.011