The Metamorphosis of Identity through the Chrysalis of Fieldwork Education

The Metamorphosis of Identity through the Chrysalis of Fieldwork Education

By: Becky Piazza, OTD, MS, OTR/L, BCPR FLOTEC Academic Fieldwork Coordinator University of St. Augustine for Health Sciences [email protected]

I was recently inspired by Stephen Covey’s internationally acclaimed book, 7 Habits of Highly Effective People (Covey, 2004). In it he states, “Self-growth is tender; it’s holy ground and there’s no greater investment” (Covey, 2004, p. 70). This reminded me of the term reflective practitioner (Adam, Peters, & Chipchase, 2013; Bannigan, & Moores, 2009; Knightbridge, 2019; O’Reilly, & Milner, 2015; Parham, 1984), and the process of self-discovery that educators hope will occur during their OT and OTA students’ level II fieldwork journeys. Self-awareness, self-discovery, and the process of self-reflection are key tenants in identity creation, which in this context, is a level II fieldwork student’s ability to establish a clinical identity as an entry-level prepared practitioner. Quality fieldwork educators are key in this identity transformation from student to occupational therapy practitioner. The maturation process that culminates in successfully passing fieldwork, thus allowing graduation, is only the beginning of the self-growth journey that has just begun for these new practitioners. As fieldwork educators, awareness of our own self-growth equips us to mentor these future colleagues and model compassionate and effective service delivery. Our ability to reflect on our clinical competencies and the identity transformations that continually occur throughout our careers and lived experiences empower our distinct value as occupational therapists. It elevates and inspires human potential within us, our clients, our colleagues, and our students. Allow me to reflect on a recent self-growth journey of my own. This year I chose to say yes to a professional opportunity that required significant self-awareness, self-reflection, and proactivity towards my career as an occupational therapy practitioner; a valued role that I take great pride in, and one that significantly contributes to my self-efficacy and sense of purpose. I said yes to academia after more than 17 years in adult inpatient rehabilitation – an area of clinical practice that will forever remain my first love. This one “big” decision, of saying yes to a new job as an Academic Fieldwork Coordinator (AFWC), was much more than a singular decision made in a one-dimensional context. It required countless smaller, yet just as “big” decisions, whose consequences affected multiple individuals, systems, processes, and relationships across a myriad of environments, both personal and professional. My decision could not be made without an awareness of the occupational disruptions that my self-perceived “big” decision would surely cause in my colleagues’ lived work experiences, as well as in their perceptions of me as their boss. It was a decision that required months of continual assessment, reassessment, reflection, and consideration of my valued roles, habits, routines, goals, co-occupations, relationships, and performance abilities. Ultimately it was a decision that challenged my occupational therapy identity (Laliberte-Rudman, 2002; Laliberte-Rudman & Dennhardt, 2008). The infrastructure of my identity consisted of my many roles: occupational therapist, rehab therapist, neuro therapist, treating clinician, fieldwork educator, student coordinator, clinical education coordinator, supervisor, electronic medical records super-user, colleague, friend, mentor, etc. My occupational participation and performance across these roles, and my ability to meet the activity demands of the many occupations that made up each role, were optimized over time through a process of continuing competency development, life-long learning, and reflective practice. My confidence and competence were symbiotic in these complex, interwoven roles. The more I participated in these roles, the more my clinical occupational identity solidified. These experiences, and the confidence and competence that came from them, afforded me the opportunity to have a “big” decision to make in the first place, however, the juxtaposition of this optimized occupational performance is that it made me doubt my ability to be as effective in a novel role within a new environment, where my identity was less established and secure. Hence, my occupational identity transformation and reconstruction journey began, 18 years after the initial establishment of my clinical identity on level II fieldwork. The truth is, it has been a continual evolution since the day I transitioned from the halls of didactic coursework into the hospital rooms of level II fieldwork, and beyond into clinical practice once I earned those beautiful letters behind my name: OTR/L. I share this to convey that many clinicians go through a similar occupational identity transformation when they consider leaping into what they consider to be the unknown realm of Fieldwork Educator (FWE).

Amount of Experience prior to taking first fieldwork student


Pre-experience reflection


Post-experience reflection

R.B. 20 months “Initially before taking my first student, I had a lot of nerves and anxiety. ‘Can I give them the education they need/ deserve?’ ‘What if I can’t answer their questions?’ ‘What if they don’t agree with my treatment sessions??’ ‘How can I be responsible for someone else’s success when I am still unsure of my own competency?’. These were only a few of the thoughts running through my mind as I agreed to take my first student.” “My actual experience with having my first student was far from the nightmare I was envisioning. I really enjoyed being able to educate someone in real time what we were working on, why we were working on it, and empowering the patients to be part of the education. I felt like it helped me grow as a clinician to have to think out my explanations and interventions more and challenged me to be more creative. I realized I knew more than I gave myself credit for and even learned a few treatment interventions my student came up with that I wouldn’t have thought of on my own. Even when there were times I didn’t have exact answers to the questions she would ask, it turned into a learning experience for us both as we took the time together to figure it out together. It also was good real-life examples of how you don’t always have all the answers but it’s important
B.Y. 16 months To say that I was nervous and anxious to take my first Level II student is quite an understatement. As a “new grad” I felt a lack of confidence in my knowledge as a neuro OT, and everyone knew this about me. Despite constant encouragement and words of affirmation from my fellow OT family I admired so much, I felt kind of guilty taking my first Level II student. I was constantly comparing myself to my colleagues with many, many years of experience. I thought I wouldn’t be able to give my student an amazing fieldwork experience due to my self-perceived below-average skillset. The neuro field is so complex and dynamic and I just didn’t feel prepared. Fortunately, I had a kind and encouraging mentor who believed in me when I didn’t believe in myself. “Boy did I think WRONG! I fell in LOVE with having a student... She was awesome. She pushed me to think outside the box and challenge myself and my patients each and every session. Her ‘fresh mind’ reminded me about complex anatomy and pushed me to always relate therapy sessions to functional skills. She made me passionate about constantly learning and teaching others the beauty of skilled OT. Now, I want a student all the time! I write this in October 2019 and I’ve already had three students with my first one starting in May 2017!”
K.D. 15 months “Before taking my first level II student, I had a fear of not knowing enough. Not knowing enough about diagnoses, not being able to be a good teacher, not being able to be an example of an excellent therapist. I had fears of unpredictable patient situations and being able to demonstrate how to navigate these scenarios.” “Having a student actually made me realize how much I DO know. It makes you realize how much multi-tasking and managing patient discharges you do on a daily basis. One of the biggest things I realized was that I had to fight feelings of wanting to control treatment sessions [my student was leading] when I felt it wasn’t going the way that I might have wanted it to. Realizing that is ok - as long as the patient is safe and that these moments serve as learning opportunities for the student (and sometimes myself). I also learned a lot about communication. My first level II student needed a bit more guidance and I worked a lot with her to figure out what communication style worked best for her and how to help her progress in areas that needed improvement.”


Questions such as:

Do I know enough? Am I qualified? Do I want the responsibility of a student? I don’t know enough about research or literature reviews. How do I know what to do? Have I been a therapist long enough to have a student? The metamorphosis of identity can be seen below through three first time fieldwork educators’ reflections: Have you experienced similar selfgrowth through the process of mentorship? Would you like a professional development opportunity that transforms your personal clinical practice while actively investing in both our current and future profession?

The fieldwork educator’s role is essential to a student’s ability to establish a clinical identity and to the advancement of the profession as a whole. The following are level II MOT and OTD student descriptions of the role of a fieldwork educator, which were collected during week 10 of their level IIA fieldwork rotations. The role of the fieldwork educator is enormous. They are shaping the future of our professional career. They have to guide you into your own style of ethical, effective, practical, safe practice. That is extremely difficult to do when you have a style completely your own. You have to be able to set aside your ideas of how to get things done and allow a new therapist to thrive in your environment while providing a safety net. A FWE is responsible to guide their students down their pathway to becoming a clinician. FWE share their knowledge of their passion and provide experiences for the student to feel prepared. I would absolutely love to be a FWE in the future. I think it is a great learning experience for the student as well as an experience to keep the clinician on their toes!

In the first couple of weeks of my rotation, my fieldwork educator role was about allowing me to observe the role as an OT in the ICU neuro setting. She wanted me to gain an understanding of how OTs work in inpatient acute and to establish a routine that works for me. She allowed me to ask any questions and also explain to me why she did something with a patient or why she asked the nurse/doctor about a specific detail on a patient. By week 2, she started to let me work with patients and co-treat with PT and PTA to help me gain confidence and start establishing a routine. She would still step in at times to help cue me to help me improve my technique or to correct me if I was forgetting something or doing something wrong. She would slowly back off as I got more comfortable and showed improvement, and she would just observe in the room.Now at week ten she stays outside the room but has a tech with me or has me co-treating, so I am not alone. She is always observing me even if I do not know, to make sure I am not missing an opportunity to learn. Another critical role my fieldwork educator does is at the end of every day she tells me if I need to improve on anything and if not, then what I did correctly. 

The role of a fieldwork educator is to be direct and guide a student throughout their fieldwork rotations. The educator in a way shapes the students learning in that specific setting and is to be a role model for the student in being the best clinician possible. The student learns from the fieldwork educator what OT is to them and the role that OT plays in that setting. Fieldwork educators are essential to the learning process of students, and an asset to the progression of occupational therapy as a whole. I have nothing but appreciation for the time my fieldwork educator has dedicated to helping add more therapists to the field, it has definitely inspired me to seek opportunities to take students in the future. In my current setting, I think the world of my fieldwork educator, as she has helped me to discover the kind of therapist I want to be. She is patient, creative, and has great relationships with her clients and their families.The role of a fieldwork educator is to enhance the field of occupational therapy by supervising students on their level 2 fieldwork in order to gain knowledge and experience.

In my opinion, without fieldwork educators, there would be no occupational therapy profession. Fieldwork educators are crucial in providing knowledge to students to help them become entry-level practitioners by challenging students. For example, a fieldwork educator may challenge a student by providing less supervision and having the student learn to not rely on the fieldwork educator for advice and feedback. These student reflections showcase the importance of occupational therapy practitioners’ willingness to say yes to taking students: Without fieldwork educators, there would be no occupational therapy profession. The Florida Occupational Therapy Educational Consortium (FLOTEC), made up of multiple OT and OTA academic institutions across the state, is committed to supporting students and clinicians through these identity transitions of professional development with fieldwork education. FLOTEC is a group of passionate and committed academic fieldwork coordinators (AFWCs) who work strategically and collaboratively to ensure that clinicians have the resources, tools, and opportunities to develop themselves as quality fieldwork educators. Whether or not your clinic or organization currently accept students or not, connect with FLOTEC to grow yourself as a reflective practitioner, a future educator, and to network with practitioners across the state who are committed to advancing the profession through the gift of fieldwork education. Join the journey of identity transformation. Our profession depends on it!

Adam, K., Peters, S., Chipchase, L. (2013). Knowledge, skills and professional behaviours required by occupational therapist and physiotherapist beginning practitioners in work-related practice: A systematic review. Australian Occupational Therapy Journal, 60(2), 76–84. doi: 10.1111/1440-1630.12006
Bannigan, K. & Moores, A. (2009). A model of professional thinking: Integrating reflective practice and evidence-based practice. Canadian Journal of Occupational Therapy, 6(5), 342-350.
Covey, S. (2004). The 7 Habits of Highly Effective People. New York: Simon & Schuster.
Knightbridge, L. (2019). Reflection-in-practice: A survey of Australian occupational therapists. Australian Occupational Therapy Journal, 66(3), 337–346. doi: 10.1111/1440-1630.
Laliberte-Rudman, D. (2002). Linking Occupation and Identity: Lessons Learned Through Qualitative Exploration. Journal of Occupational Science, 9(1), 12-19. doi: 10.1080/14427591.2002.9686489
Laliberte-Rudman, D. & Dennhardt, S., (2008). Shaping knowledge regarding occupation: Examining the cultural underpinnings of the evolving concept of occupational identity. Australian Occupational Therapy Journal, 55(3), 153–162. doi: 10.1111/j.1440- 1630.2007.00715.x
O’Reilly, S., & Milner, J., (2015). Transitions in reflective practice: Exploring student development and preferred methods of engagement. Nutrition & Dietetics Journal of the Dietitians Association of Australia, 72(2),150-155. doi: 10.1111/1747-0080.12134
Parham, D. (1984). Toward professionalism: The reflective therapist. The American Journal of Occupational Therapy, 41(9), 555-561.
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