Bridging the Gap: Promoting Clinical Fieldwork Educator Competency in Occupational Therapy Practice

Article Completed by MOT Students: AmRhein,N., Benitez, D., Clark, S., Eckhoff, E.

Corinne Painter, OTD MS, OTR/L - Faculty Advisor/ Editor

Clinical Fieldwork Educators (CFEs) are often experienced occupational therapy practitioners who supervise and mentor students during their hands-on clinical placements. They play a vital role in helping students apply theory and practical knowledge learned during their didactic coursework to real-world settings. In an ideal situation, the CFE bridges the gap between academic education and clinical work by supporting student growth and promoting the development of vital clinical reasoning skills needed for success as a practitioner. Students are dependent on their CFE to provide valuable learning experiences to support their development and maintain the standards of the profession (Karp et al., 2022). Given the obvious importance of the CFE-student relationship, it is important to ask how CFE competency can best be promoted to ensure student success and to advance the field of occupational therapy.

Promoting the relationship between the CFE and the student as symbiotic, fostering student growth and development while encouraging CFE creativity and innovation, can be important in the promotion of CFE competency (Cahill et al., 2020). The benefits are mutually beneficial as the student benefits greatly from the resources and mentorship provided, and the CFE gains a new perspective on their practice as well as a feeling of satisfaction for preparing future clinicians for independent practice. Compassion satisfaction is described in literature as a feeling an individual experiences when selflessly helping another in their career field (Eddy et al., 2021). CFEs balance the ability to provide quality care to their patients while also guiding OT students who are the future of the field, with both roles contributing to overall compassion satisfaction. The role of CFE also provides practitioners with the opportunity to maintain professional standards and confidence as an OT.  Evenson, et al. (2015) identified the top five perceived benefits of taking students, including staying current in the field and practice area, personal satisfaction, giving back to the profession, improved clinical reasoning skills, and improved supervision skills. 

The American Occupational Therapy Association’s Standards for Continuing Competence were used to develop role competencies to help evaluate and determine the role of the CFE when working with occupational therapy students (Dickerson, 2006).  The first role competency, knowledge, states that a CFE is expected to know the current rules, regulations, and standards needed for proper student supervision. The CFE must identify the student’s learning style and is expected to provide assignments and learning activities to students to reinforce their knowledge and skills. Critical reasoning, the second competency, requires that the CFE evaluates and shares knowledge with students to help them apply theory and research into practice. The third competency, interpersonal skills, outlines the importance of maintaining professional relationships with staff, students, and clients. Any issues that may arise during fieldwork involving the student should be mediated by the CFE. Next, the CFE must exhibit performance skills by contributing to course objectives and planning experiences to promote the student's competency. This includes the evaluation of student performance. Finally, a CFE is to be a role model for the student by advocating for their patients and performing professionally in all situations while showing cultural competency (Dickerson, 2006).

Fully investigating CFE competency requires examination of current barriers to CFE-student success. These can include staff shortages, academic program requirements, quality assurance, concerns about time commitment, and the increased pressure for productivity (Drynan et al., 2022). These are directly correlated with the CFEs commitment to clinical education as they add stressors that may complicate the level of guidance that can be provided for a student under a CFE juggling various responsibilities. CFEs must ultimately present empirical evidence of their effectiveness in their given roles as a practitioner and teachers, prompting the use of self-evaluation methods, often at the cost of providing proper guidance to students. Though CFEs respond well to the idea of participation in self-evaluation methods, specific use of resources such as reflection journals have been seen as time-consuming and laborious to complete (Reid & Vincent, 2001). Should another method for easier self-evaluation be utilized, more focus can be shifted back to student guidance. For example, journal clubs have received positive feedback from CFEs because they allow for networking with other CFEs, an aspect lacking in the other self-evaluation methods, and provide a more accessible opportunity to grow in their knowledge through research (Ellington & Janes, 2020). With tweaks to incorporate students in the process, CFEs could display effectiveness in their clinical role while guiding students in various skill sets like networking and the utilization of evidence-based practice (Nichols, 2017).

The delivery of fieldwork education encountered a markedly different shift during the recent COVID-19 epidemic. Due to the pandemic, multiple healthcare facilities limited their participation in OT student fieldwork rotations due to the need to reduce potential exposure to the virus. Limited fieldwork sites contributed to student’s stress levels as opportunities for placements steadily declined, and lower productivity with caseloads in clinics impacted the delivery of fieldwork education. However, the OT students present in the healthcare field during this time brought with them unique advantages such as utilizing telehealth better than older clinicians (Vij, 2022). CFE willingness to incorporate digital tools to craft traditional adjacent experiences through simulated patient experiences and virtual clinics made a difference. OT competencies in intrapreneurship, administration, and virtual care saw changes that reflected the change in the OT educational landscape during the pandemic. The innovative fieldwork placements during this time supported competency development and should be considered for future use (Gill et al., 2023).

Although more research is necessary within this area, there is some shared consensus on common facilitators to a positive fieldwork experience. Collaboration and supportive communication, an extension of good interpersonal skills, were rated highly by both students and CFEs as being qualities that created a positive fieldwork experience (Koski et al., 2013). The fostering of motivation and interest were also noted in studies as important outcomes of the fieldwork education process (Pashmdarfard et al., 2022). Additionally, students responded well to CFEs who discussed specific expectations and took the time to tailor the fieldwork experience to the individual student’s style of learning to best facilitate growth (Grenier, 2015). Finally, deficiencies on the part of the CFE to plan for the incorporation of educational curriculum from the student’s program could be a barrier to the success of the OT student (Pashmdarfard et al., 2021).

It is clear that the role of the CFE is indispensable in setting OT students up for success as they step into the field as clinicians. Showing practitioners the benefits of becoming a CFE, including compassion satisfaction and personal growth is one strategy to engage OT practitioners. Addressing role competencies and how the CFE can be prepared with knowledge, reasoning, and interpersonal skills is a way they can better provide positive learning experiences. It is also important to address negative qualities and experiences a CFE may experience like staffing shortages, increased pressure for productivity, and how those can play a role in the fieldwork experience for the student. Creating good strategies for the CFE is crucial to creating an encouraging system for them to set their students up for success. The professional teaching relationship between CFE and OT students is vital to both individuals and the field of OT and can be an opportunity for symbiotic learning. 

References

Cahill, S. M., Davis, C., & Dorsey, J. (2020). Guidelines for supervision, roles, and responsibilities during the delivery of occupational therapy services. The American Journal of Occupational Therapy, 74 (3). https://doi.org/10.5014/ajot.2020.74S3004

Dickerson, A. E. (2006). Role competencies for a fieldwork educator. The American Journal of Occupational Therapy, 60(6), 650-651. https://doi.org/10.5014/ajot.60.6.650

Drynan, D., Eichar, K., Chahal, P., & Boniface, J. (2022). Time use in occupational therapy fieldwork education: A pilot delphi study to identify time use items. The Clinical Supervisor, 41(1), 88-103. https://doi.org/10.1080/07325223.2022.2048159

Eddy, E. Z., Tickle-Degnen, L., & Evenson, M. E. (2021). Occupational therapy fieldwork educators: Examining professional quality of life. Work, 70(2), 479-491. https://doi.org/10.3233/WOR-213586

Ellington, A., & Janes, W. E. (2020). Online journal clubs to enhance fieldwork educator competency in support of student experiential learning. The American Journal of Occupational Therapy, 74(3). https://doi.org/10.5014/ajot.2020.035733      

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

Gill, M., Hunt, A., & Duncan, A. (2023). Innovation and competency development in occupational therapy fieldwork during the COVID-19 pandemic. Canadian Journal of Occupational Therapy, 91 (2). https://doi.org/10.1177/00084174231190768

 Grenier, M. (2015). Facilitators and barriers to learning in occupational therapy fieldwork education: Student perspectives. The American Journal of Occupational Therapy, 69 (2). https://doi.org/10.5014/ajot.2015.015180

Karp, P., Lavin, K. A., & Collins, T. (2022). Exploring fieldwork educator development: Preparation methods and support tools. Journal of Occupational Therapy Education, 6(1). https://doi.org/10.26681/jote.2022.060113

Koski, K. J., Simon, R. L., & Dooley, N. R. (2013). Valuable occupational therapy fieldwork educator behaviors. Work, 44(3), 307-315.            https://doi.org/10.3233/WOR-121507

Nichols, A. (2017). Changes in knowledge, skills, and confidence in fieldwork educators after an evidence-based practice short course. The Open Journal of Occupational Therapy, 5(1). https://doi.org/10.15453/2168-6408.1204

Pashmdarfard, M., Hassani Mehraban, A., Shafaroodi, N., Soltani Arabshahi, K., & Parvizy, S. (2022). Strategies to promote the quality of occupational therapy fieldwork education: A qualitative study. Medical Journal of the Islamic Republic of Iran, 36. https://doi.org/10.47176/mjiri.36.27

Pashmdarfard, M., Shafaroodi, N., Mehraban, A. H., Arabshahi, K. S., & Parvizy, S. (2021). Barriers to occupational therapy fieldwork education in Iran: The perspectives of fieldwork educators and students. Iranian Journal of Nursing and Midwifery Research, 26(3), 204-209. https://doi.org/10.4103/ijnmr.IJNMR_206_20

Reid, A., & Vincent, J. M. (2001). Self-evaluation and occupational therapy fieldwork educators: Do they practice what they preach? British Journal of Occupational Therapy, 64(11), 564-571. https://doi.org/10.1177/030802260106401108

Vij, S. B. (2022). Impact of coronavirus disease 2019 on occupational therapy students' fieldwork in the United States of America. The Indian Journal of Occupational Therapy, 54(3). https://doi.org/10.4103/ijoth.ijoth_67_22