Beyond Intuition: Mentoring the "Natural" OT/OTA Student for Deep Reflection

Chelsea Barton, MS, ORT/L

The “natural talent” student.  They just have “it.”  They establish rapport easily with clients, they have strong clinical "gut feelings" and high emotional intelligence, they rarely need a fieldwork educator (FWE) to majorly intervene.  So, the FWE gives them one client to start, and they do well, next is 2, 3, 5, 7, and before midterm, they have the whole caseload.  The FWE is of course providing direct supervision, especially in the beginning, and the student is getting the full experience, and quickly, too.  They are taking on the entire caseload for longer than your typical students do.  Which is good, right?    

This is where FWE’s need to pause, before they take the whole caseload.  For a moment, consider what might be happening with that student—not merely the check mark reflecting that they saw “X” number of patients in a safe and appropriate manner that day, but did the student process the treatments they administered?  Can they articulate what they did, or are they running on pure adrenaline and intuition?  The Fieldwork Performance Evaluation (FWPE) asks how well the student “Articulates a clear and logical rationale for the intervention process based on the evaluation results and other relevant considerations.” (American Occupational Therapy Association [AOTA], 2020)    

Fieldwork educators need to help a student of this type go from running on adrenaline, intuition, and book smarts to an unconscious competence of the whole occupational therapy practitioner experience.  Consider what might be happening for the student, the internal process of it all.  These students tend to have a high emotional intelligence and are intuitive when it comes to reading people; they are book smart, exhibit management skills, and, oftentimes, have a busy schedule. How did they learn to synchronize these skills in order to juggle all of the tasks their caseload demands of them?  Their life experiences molded them into the people they are today.  It may be that adverse life experiences have given them the ability to perform the way they do.  There may be a high fear of failure.  

In my experience, students of this type often describe going from patient to patient, relying on empathy and problem-solving skills rooted in the very life experiences that shaped them.  So, they shoulder the caseload, staying afloat and appearing stoic and centered while they are in fact an empath with little to no emotional boundaries. They are getting the job done, but this cycle can lead to burnout quickly.  Furthermore, they are not getting the chance to process and cross-check their clinical reasoning and decision making in depth.  If the FWE does not consider the aspects of the student’s journey and justifies their caseload with an outward sense that “they’re doing great!” they are missing the complexity of what’s happening inside the intuitive student; and furthermore keeping them from a full learning opportunity.

In order to help the intuitive student move beyond this space, fieldwork educators need to facilitate reflection and help students process their casework through posing the right questions.  This is where the full learning experience takes place.  Barriers such as productivity standards and last minute schedule changes can make it difficult to make this concept a consistent reality.  The good news is that there are strategies to support this type of student in their education.  

First and foremost, the FWE must hold space for the student to process their methodology and experience.  This may mean that they don’t take on the entire caseload until later in their rotation (even though the FWE may think that they could).  Prompt them to reflect on their process after treating a client by providing them with a worksheet of guiding questions.  The worksheet has pre-determined questions.  Keeping questions on hand is a strategy to avoid having to think of suitable questions on the fly.  You can tailor certain questions to suit the student’s strengths and weaknesses.  

Some examples: Ask the student to explain their reasoning and the purpose behind a particular intuitive decision.  Rather than asking why they chose a certain activity, ask them how they think that activity may help the client work toward their goals. The FWE might say, “You handled that perfectly; what frame of reference or teaching and learning strategy did you use for that?”

I hope this article has provided some insight.  Let’s make sure our natural talent students get to process, too.

References

American Occupational Therapy Association. (2020). Fieldwork performance evaluation for 

the occupational therapy assistant student. https://www.aota.org/-/media/corporate/files/educationcareers/fieldwork/fieldwork-performance-evaluation-occupational-therapy-assistant-student.pdf