A Descriptive Review of Occupational Therapy Education

Abstract

This AOTA Guidance Document describes the present state of occupational therapy education within the United States educational system.

Opening Statement

A Descriptive Review of Occupational Therapy Education is intended for practitioners, academicians, and potential occupational therapy program applicants to augment their understanding of current occupational therapy education. The review was written to describe the present state of occupational therapy education within the United States educational system and is limited to this perspective only. It does not intend to promote one occupational therapy degree over any other.

Levels of Education and Institution Types in the United States

One of the hallmarks of higher education in the United States is the diversity of institutions, degrees, and programs available. A prospective student may choose to pursue higher education at a research university, comprehensive university, 4-year college, community college, or technical school. Institutions may be public or private or for-profit or nonprofit (Bok, 2013). One well-known classification system for American higher education institutions is the Carnegie Classification^®.

Common Carnegie Classifications for institutions offering occupational therapy programs include: Research Universities (very high research activity), Research Universities (high research activity), Doctoral/Research Universities, Master’s Colleges and Universities, Baccalaureate Colleges–Diverse Fields, Baccalaureate/Associate’s Colleges, and Special Focus Institutions. Common Carnegie Classifications for institutions offering occupational therapy assistant programs include: Master’s Colleges and Universities, Baccalaureate Colleges, Baccalaureate/Associate’s Colleges, Special Focus Institutions, Associates–Public Rural-serving, Associate’s–Public Suburban-serving, Associate’s–Public Urban-serving, Associate’s–Private Not-for-profit, and Associate’s–Private For-profit. While this is not a complete list of Carnegie Classifications, it represents the range of types of institutions that house occupational therapy and occupational therapy assistant programs. Each type of institution has a different focus or emphasis in terms of research, student body, curriculum, and funding formula. Further descriptions of Carnegie Classifications can be found at http://carnegieclassifications.iu.edu/descriptions/basic.php.

Levels of education are represented by the academic degree conferred to graduates. A degree is a credential or title “conferred by a college or university as official recognition for the completion of a program of studies” (Shafritz et al., 1988, p. 145). Academic degree levels include associate, baccalaureate, master’s, and doctoral.

Associate Degree

According to the National Center for Education Statistics, an associate degree is defined as

an award that requires completion of an organized program of study of at least 2 but less than 4 years of full-time academic study or more than 60, but less than 120 semester credit hours. Most associate degrees earned in academic programs are Associate of Arts (AA) or Science (AS) degrees. Associate degrees earned in professional, technical or terminal programs are frequently called Associate of Applied Science (AAS) degrees but will sometimes carry the name of the program of study in the title. (U.S. Department of Education [USDE], 2008a, p. 1)

Baccalaureate Degree

A baccalaureate degree is an award that requires completion of 4 to 5 full-time equivalent academic years of college-level work in an academic or occupationally specific field of study, and that satisfies institutional standards of the requirement of the degree level (USDE, 2008b). Two common baccalaureate degrees are the bachelor of arts (BA or AB, for the Latin atrium baccalaureus) for programs in the humanities and the Bachelor of Science (BS) for programs in the sciences. Some institutions offer baccalaureate degrees in specialized areas, for example, Bachelor of Music (BMus) or Bachelor of Education (BEd; Unger, 1996).

Master’s Degree

The master’s degree is a graduate-level degree awarded in the United States and typically requires 2 years of postbaccalaureate education to complete. The value of a master’s degree varies depending on the field. The master’s degree may serve as entry into an area of study, as the terminal degree, or as a step toward the doctoral degree.

Research Master’s Degree

The research master’s degree typically involves advanced study in the field, a comprehensive examination, and preparation and defense of either a master’s thesis or a major project. The most commonly awarded master’s degrees are the Master of Arts (MA) and the Master of Science (MS; USDE, 2008c).

Professional Master’s Degree

Professional education has been part of higher education in the United States for more than a century and most students enrolled in institutions of higher education are in professional or preprofessional programs (Sullivan, 2012). The professional master’s degree structure can vary depending upon the profession. Some professional master’s degree programs are similar to a research master’s in that they involve advanced study in the field combined with a thesis or other major project. Other professional degrees are intended to prepare students to work in the field and typically do not include a thesis, although they often require a professional internship under supervision (USDE, 2008c).

Doctorate: Research and Professional Degree

A doctoral degree is the highest degree conferred by an institution of higher education. Most doctoral programs require the equivalent of 3 years of full-time postbaccalaureate study (Kapel et al., 1991). Commonly, universities require a minimum of 72 hours of postbaccalaureate study plus a residence requirement. “Doctorate entitles bearers to be addressed as ‘Doctor’ and to append their names with the appropriate letters of their degrees—that is, PhD (doctor of philosophy) or MD (doctor of medicine)” (Unger, 1996, p. 305). There are two types of doctoral degrees: the research doctorate and the professional doctorate (Shafritz et al., 1988; Unger, 1996). The professional doctorate is also referred to as a clinical doctorate in many health professions (Pierce & Peyton, 1999).

Research Doctorate Degree

The research doctorate (also called the academic doctorate), or PhD, was originally awarded for the study of philosophy in the mid-to-late 19th century. However, the degree was extended to include many disciplines of the humanities and sciences, with each PhD modified to indicate the field of study (e.g., PhD in engineering, PhD in history, or PhD in chemistry). The purpose of the PhD degree is to develop graduates who are independent researchers and who are knowledgeable in a specific area of study. Requirements for the PhD degree usually include a course of didactic study, followed by written or oral comprehensive examinations (upon passing, one applies for candidacy), and the completion of a dissertation in some area of new knowledge, as deemed appropriate by a committee of senior faculty after an oral defense of the research (Shafritz et al., 1988; USDE, 2020).

The doctor of science (ScD) is a research doctoral degree similar to the PhD. Its curriculum is focused on the study of an applied science, such as audiology, occupational therapy, and so forth. ScD degree programs commonly include didactic coursework that is focused on the study of an applied science, an advanced clinical practicum, and a supervised clinical research project (Kidd et al., 2003).

Professional Doctorate Degree

A professional doctorate degree reflects academic attainment and seldom requires a master’s degree or dissertation (Unger, 1996). Unlike the PhD’s focus on developing independent researchers, “sophisticated practice competencies” are emphasized in the professional doctorate degree (Pierce & Peyton, 1999, p. 64). Professional doctorate degrees include the Doctor of Education (EdD) and the Doctor of Public Health (DPH). A person with a professional doctorate, such as an MD or Doctor of Jurisprudence (JD), must pass state or national qualifying examinations to obtain a license to practice (Unger, 1996). In the health sciences, the term clinical doctorate is synonymous with the term professional doctorate and the program of study typically requires “mentored advanced clinical experiences for autonomous practice competencies” (Edens & Labadie, 1987; Faut-Callahan, 1992; Hummer et al., 1994; Pierce & Peyton, 1999; Watson, 1988).

Postdoctoral Education

Due to globalization and the increased pace and complexity of knowledge, postdoctoral education has emerged to meet the growing need for scholars trained in both basic and translational science (Nerad, 2011). The adjective postdoctoral is frequently used to describe the variety of postdoctoral educational experiences. For example, terms such as postdoctoral fellow, postdoctoral research associate, and postdoctoral trainee are typically used. The competencies expected from postdoctoral education require skills such as project management, which are beyond those typically found in academia (Manathunga & Pitt, 2009).

Levels of Education in Occupational Therapy Within the United States

Occupational Therapy Assistant

Associate Degree Level and Baccalaureate Degree Level

Occupational therapy assistant (OTA) programs are commonly offered at community colleges, private junior colleges, and some 4-year colleges and universities. OTA programs obtain accreditation from the Accreditation Council for Occupational Therapy Education (ACOTE^®) and must adhere to the Standards for an Accredited Educational Program for the Occupational Therapy Assistant (ACOTE, 2018). New to the 2018 ACOTE standards is the addition of standards for the baccalaureate degree–level in occupational therapy assistant education. As articulated in the Preamble of the Standards, a graduate from an ACOTE-accredited associate degree–level or baccalaureate degree–level occupational therapy assistant program must

Have acquired an educational foundation in the liberal arts and sciences, including a focus on issues related to diversity;

Be educated as a generalist with a broad exposure to the delivery models and systems used in settings where occupational therapy is currently practiced and where it is emerging as a service;

Have achieved entry-level competence through a combination of academic and fieldwork education;

Define theory as it applies to practice;

Be prepared to articulate and apply occupational therapy principles and intervention tools to achieve expected outcomes as related to occupation;

Be prepared to articulate and apply therapeutic use of occupations with persons, groups, and populations for the purpose of facilitating performance and participation in activities, occupations, and roles and situations in home, school, workplace, community, and other settings, as informed by the Occupational Therapy Practice Framework, 4th Edition;

Be able to apply evidenced-based occupational therapy interventions to address the physical, cognitive, psychosocial, sensory, and other aspects of performance in a variety of contexts and environments to support engagement in everyday life activities that affect health, well-being, and quality of life, as informed by the Occupational Therapy Practice Framework, 4th Edition;

Be prepared to be a lifelong learner to keep current with evidence-based professional practice;

Uphold the ethical standards, values, and attitudes of the occupational therapy profession;

Understand the distinct roles and responsibilities of the occupational therapist and the occupational therapy assistant in the supervisory process in service delivery;

Be prepared to effectively collaborate with occupational therapists in service delivery;

Be prepared to effectively communicate and work interprofessionally with all who provide services and programs for persons, groups, and populations;

Be prepared to advocate as a professional for access to occupational therapy services offered and for the recipients of those services;

Demonstrate active involvement in professional development, leadership, and advocacy; and

Demonstrate the ability to synthesize in-depth knowledge in a practice area through the development and completion of a baccalaureate project in one or more of the following areas: clinical practice skills, administration, leadership, advocacy, and education.

After completing the OTA didactic and fieldwork requirements, the OTA graduate is eligible to sit for the national certification examination for OTAs. Upon successful completion, the certified occupational therapy assistant (COTA) may apply for the appropriate state credential and, under specified supervision, render occupational therapy services.

Occupational Therapist

Master’s: Entry-Level and Postprofessional

In January 2007 the master’s degree became the minimum degree level to enter the profession as an occupational therapist in the United States (ACOTE, 1999). Some entry-level programs require students to earn a baccalaureate degree in a related field before entering the master’s degree program in occupational therapy. Other entry-level programs may require extensive prerequisite coursework but not mandate a baccalaureate degree. For example, the course of study may comprise two semesters beyond an undergraduate degree in a major such as occupational science, or, in other programs, the course of study may be a 5-year program leading to a master’s degree. Coursework that is considered prerequisite is not generally included in the total credits required for the master’s degree. Upon successful completion of the academic and fieldwork requirements, the graduate is eligible to take the national certification examination, then apply for state licensure and provide occupational therapy services at the professional level.

Postprofessional master’s degree programs are available to individuals who have a professional degree in occupational therapy (e.g., baccalaureate, entry-level master’s, or an entry-level doctorate degree). Such postprofessional degrees are typical of master’s degree programs in other disciplines with a range of 30 to 36 credits. Many postprofessional programs are developed to enhance occupational therapy skills in a specific area (e.g., pediatrics, assistive technology, gerontology). Other master’s degree programs may provide a general program with a curricular emphasis (e.g., leadership or research).

Doctorate: Entry-Level and Postprofessional

The clinical or professional doctorate degree in occupational therapy confers the degree of Occupational Therapy Doctorate (OTD) or Doctor of Occupational Therapy (DrOT). Two pathways exist for pursuing the clinical or professional doctorate degree. The first is available to postprofessional students, that is, students who have an entry-level degree in occupational therapy and who are occupational therapists. The second pathway is an entry-level doctorate. Entry-level professional doctorate degree programs are available for individuals who do not have an entry-level degree in occupational therapy but who have completed specified prerequisite coursework and, as of 2010, a baccalaureate degree.

Although clinical doctorate degree programs vary in philosophy, curriculum, and delivery method (particularly postprofessional programs, which often offer part-time and/or online options), typically the postprofessional clinical doctorate programs are shorter in duration and/or require less coursework than entry-level clinical doctorate programs. The rationale for the difference in program length is that postprofessional clinical doctorate students are occupational therapists who have previously completed an entry-level occupational therapy degree, and is also in consideration of the amount of clinical practice experience applicants possess. Unlike entry-level clinical doctorate programs, postprofessional clinical doctorate degrees are not currently accredited by ACOTE.

Doctorate: Research

In addition to clinical or professional occupational therapy doctoral degrees, there are research doctorates, such as a PhD in occupational therapy. These doctoral programs focus on preparing graduates who are independent researchers and who will develop original knowledge pertinent to occupational therapy. Other doctoral degree programs related to occupational therapy exist, such as the PhD degree in rehabilitation science or occupational science or the ScD. Although many of these programs focus on the application of occupational therapy, it is beyond the scope of this guidance document to describe the variations of doctoral programs that are closely aligned with occupational therapy.

Fellowships

Fellowships are a form of postdoctoral education that is becoming more common in occupational therapy. Fellowships are focused on advancing the knowledge, performance, and interpersonal skills as well as the critical and ethical reasoning of practitioners in a focused area of practice (American Occupational Therapy Association [AOTA], 2020). Fellowship programs are between 9 months and 12 months in length and may be situated in hospitals, schools, organizations, or community sites. As of 2020, there are several approved occupational therapy fellowship sites in various practice settings, such as acute and critical care, mental health, burns, pediatrics, gerontology, dysphagia, physical rehabilitation, neurology, and assistive technology (AOTA, n.d.). For more information on fellowships and approved sites, visit the AOTA website (https://www.aota.org/).

Accreditation

Institutions of higher education may choose to pursue accreditation, an external review to ensure that established standards are met. There are two types of accreditation: institutional accreditation and program (or specialized) accreditation (USDE, 2021). Accreditation of an occupational therapy program (or specialized) is completed by ACOTE, which is recognized by the USDE as well as by the Council for Higher Education Accreditation (CHEA).

Institutional Accreditation

Regional and national accrediting bodies are recognized by the USDE and accredit institutions based upon established evaluation criteria (USDE, 2021). The Accreditation standards from regional or national accrediting bodies influence ACOTE in that ACOTE standards must be aligned with requirements from the USDE and CHEA (Kramer & Graves, 2005).

Program or Specialized Accreditation

Program or specialized accreditation “applies to a particular school, department or program within the institution” and “may also apply to an entire institution if it is a free-standing, specialized institution . . . whose curriculum is all in the same program area” (Kaplin & Lee, 1995, p. 873). Currently ACOTE accredits occupational therapy assistant programs as well as entry-level programs in occupational therapy. The educational standards are developed through ACOTE with input from stakeholders. For postprofessional OT programs, there is no specialized accrediting body. However, institutional accrediting bodies can require a focus visit of a particular program. A focus visit does not result in the accrediting of a specific program. When choosing an occupational therapy educational program, important factors must be considered (see Table 1).

Table 1.

Considerations for Occupational Therapy Entry-Level and Postprofessional Education

Location of program

Tuition, return on investment, cost–salary considerations

Length of program

Availability of student scholarships

Full- or part-time programs

On-campus, distance-formatted, hybrid or bridge-weekend programs

Admission requirements:

∙ Interview

∙ Entrance exams (e.g., Miller’s Analogy, Graduate Record Exam)

∙ Letters of recommendation, essays

∙ Prerequisite classes or degree

∙ Observation hours in occupational therapy

∙ Undergraduate and prerequisite GPA

∙ Community service and work experience

Type of program:

∙ Degree awarded (e.g., AA, MS, MA, MOT, PhD, ScD, OTD)

∙ Thesis requirement

∙ Dissertation requirement

∙ Curriculum (e.g., courses offered, course descriptions printed in catalog)

∙ Program mission and philosophical grounding

∙ Postprofessional specialization (e.g., gerontology, pediatrics, entrepreneurialism)

∙ Experiential components

∙ Fieldwork and internship opportunities

∙ Length of clinical preparation

∙ Opportunities for postdegree experiences (e.g., residencies/fellowships)

Institutional variables:

∙ Carnegie Classification

∙ Library resources

∙ Information technology/computer support

∙ Stability of program as measured by accreditation status, retention, and degree completion rates

∙ Graduate or professional school

∙ Ratings and rankings of programs

∙ Community partnerships and international collaborations

Graduate/alumni accomplishments:

∙ Graduation rate

∙ Employment rates, sites

∙ Employer satisfaction with graduates

∙ Consumer satisfaction with graduate performance

∙ NBCOT^® exam pass rate for entry-level education

∙ Graduate scholarly activity

Faculty:

∙ Faculty credentials (e.g., doctorally prepared, specialty certified)

∙ Faculty-to-student ratios

∙ Faculty accessibility

∙ Faculty projects (e.g., grants, publications)

∙ Faculty clinical practice

∙ Faculty community engagement, university citizenship, and professional service

In addition, it is important to answer the following questions:

What are my future career goals?

Does the degree offered contribute to accomplishing my short-term and long-term goals?

If considering an online program, do I have the necessary skills to be successful (e.g., motivation, self-initiative, technical skills)?

A variety of resources provide information about specific education programs. Institutional websites can be helpful in acquiring information about a program’s curriculum and faculty. Brochures, catalogs, and bulletin descriptions often present the program’s mission, philosophy, curriculum, or policies. These materials can be requested from the admissions office for each institution. Contacting faculty within the program is frequently useful to answer specific questions. Prospective students may request contact with a current student or alumni to gain a consumer’s perspective of the program.

Authors

Commission on Education Members:

Tina DeAngelis, EdD, MS, OTR/L

Inti Marazita, MS, OTR/L

Wanda Mahoney, PhD, OTR/L

André Johnson, OTS, BHS, COTA/L

Celeste Z. Alexander, MS, OTR/L

Alexandra N. Keehn, MOT, OTR/L, CBIS

Erika Kemp, OTD, OTR/L, BCP

Shannon Levandowski, EdD, OTD, OTR, MS, BCP, SCSS

Julie McLaughlin-Gray, PhD, OTR/L, FAOTA

Bridgett Piernik-Yoder, PhD, OTR

Kim Qualls, OTD, MS, OTR/L

Kenyatha Richardson, OTA/L

Audrey Wilson-Alston, MBA, COTA/L

Janie Yue, S/OT

Neil Harvison, PhD, OTR, FNAP, FAOTA

Note. This document replaces the 2016 document A Descriptive Review of Occupational Therapy Education, previously published and copyrighted in 2016 by the American Occupational Therapy Association in the American Journal of Occupational Therapy, 70, 7012410040. http://dx.doi.org/10.5014/ajot.2016.706S03

Citation. American Occupational Therapy Association. (2023). A descriptive review of occupational therapy education. American Journal of Occupational Therapy, 77(Suppl. 3), 7713410100. https://doi.org/10.5014/ajot.2023.77S3006

References

Accreditation Council for Occupational Therapy Education. (1999, August). ACOTE Motion and Resolution J [Minutes at the meeting of the Accreditation Council for Occupational Therapy Education] . Bethesda, MD: Author.

Accreditation Council for Occupational Therapy Education. (2018). 2018 Accreditation Council for Occupational Therapy Education (ACOTE^®) Standards and interpretive guide (effective July 31, 2020). American Journal of Occupational Therapy, 72, 7212410005p1–7212410005p83. https://doi.org/10.5014/ajot.2018.72S217

American Occupational Therapy Association. (2020). AOTA fellowship program criteria and interpretive guidelines. https://www.aota.org/-/media/Corporate/Files/EducationCareers/Advance/Fellowship/AOTA-Fellowship-Program-Criteria-and-Interpretive-Guidelines-2020-NL.pdf

American Occupational Therapy Association. (n.d.). AOTA fellowship program . https://www.aota.org/Education-Careers/Advance-Career/fellowship-program.aspx

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