​

​

Expanding and Strengthening the Fieldwork and Capstone Experience through Collaborative Partnerships

Patty Laverdure, OTD, OTR/L, BCP, FAOTA

Virginia Commonwealth University

​

​

Tina M Kraft, M.A., COTA/L

South University

​

​

​

Objectives

During today’s presentation:

​

• We will discuss the development and implementation of innovative collaborative fieldwork models.

​

• We will examine tool and resources and participants will establish plans to implement an innovative fieldwork placement at their facility.

Trends in Health Care

(Halle, Mroz, Fogelberg, & Leland, 2018)

Employment Projections: 2014 - 2024

Percent change in Occupational Therapy Employment

​

(Dacey, 2016)

Fieldwork Sites

817 FWEs from 41 states and DC

​

(Evenson et al., 2015)

Value Based Care: Focus on Outcome

Shift from fee for service to value based reimbursement:

• Based on the premise that high quality care improves client health outcomes, increases satisfaction, and reduces healthcare costs
• Relies on a foundation of client centered care
• Requires reliable quality measures to identify the outcomes of intervention and projects the need for future support
• Aligns with AOTA’s stance that OT is a client centered, evidenced-based, valuable, and cost-effective healthcare service

​

Value Based Care: Implications on Student Education

Students are prepared to:

• Share research literacy skills and evidence based practice
• Work within the parameters of value based care
• Provide client centered care (evaluation, client centered/occupation based assessment and intervention planning)
• Collect data for progress monitoring and outcomes measurement (Section GG Codes)
• ADL, IADL, QOL, home safety,vision, ergonomics, driving, fall risk, swallowing, mental health
• Use collaborative team decision making approaches

​

Changing Demographics, Changing Practice Settings, Changing Reimbursement Models

Opportunity to Innovate

​

AFWC and FWEs can collaborate to demonstrate and increase OT’s value:

• Lead teams in the development of holistic and individualized client-centered care that improves health outcomes and quality of life
• Support health and wellness outcomes by building continuity across the continuum of care
• Design high quality community discharge plans and support
• Implementing of evidence based interventions in behavioral and physical health
• Addressing the needs of individuals with chronic health conditions
• Reducing hospital readmissions

​

How Can AFWC and Students Help?

Definitions - Apprenticeship Model

“Apprenticeship models of learning are based on the principle that students participate in more advanced individual activities and thus stepwise get part of the respective community of practice. This process ensures that students not only acquire knowledge, but also the ways of thinking and problem solving in communities of practice.” (Gruber & Mandl, 2001)

​

• Apprenticeship models were intended to make visible the strategies and processes of an expert.
• Using this model, both experts and learners think out loud so that different ways of approaching the problem are available to all.
• Learners tackle tasks of increasing challenge supported by an ‘expert’ and gradually take on more responsibility, moving from peripheral participation to full participation (Lave and Wenger, 1991).

Apprenticeship Through the Ages

• 1913: Course in occupations for invalids inaugurated at Milwaukee-Downer College; Incorporated an apprenticeship component

​

• 1918: OT diploma programs established at Milwaukee-Downer, Boston, Philadelphia, St. Louis, Kalamazoo’s Schools of Occupational Therapy, University of Toronto

​

• 1930’s: Conversion from certificate to bachelor’s programs

​

• 1935: AMA determines the essential requirements for an Accredited School of OT and it includes affiliation component

​

• 1942: War emergency courses
• OT educators at the time were among the 4.6% who graduated from college (the vast majority of those graduating were men)

Apprenticeship Through the Ages

• 1944: Servicemen’s Readjustment Act (GI Bill)
• Enrollment of young women triples

​

• 1947: Establishment of first advanced OT master degree program
• Expansion of bachelor’s programs 1

​

• 1962: Establishment of the first two-year entry master’s degree program

​

• 1965: Higher Education Act
• College becomes a mass market commodity supported by changing public policy
• Economy depends more on intellectual capital and services than on physical labor
• Undergraduate enrollment rates skyrocket
• Establishment of OT Assistant Programs with an affiliation component

​

• 1982 - First paper examining the apprenticeship model and its impact on student development:
• A description and analysis of the educational purposes of occupational therapy clinical education

Apprenticeship Through the Ages

• 1944: Servicemen’s Readjustment Act (GI Bill)
• Enrollment of young women triples

​

• 1947: Establishment of first advanced OT master degree program
• Expansion of bachelor’s programs 1

​

• 1962: Establishment of the first two-year entry master’s degree program

​

• 1965: Higher Education Act
• College becomes a mass market commodity supported by changing public policy
• Economy depends more on intellectual capital and services than on physical labor
• Undergraduate enrollment rates skyrocket
• Establishment of OT Assistant Programs with an affiliation component

​

• 1982 - First paper examining the apprenticeship model and its impact on student development:
• A description and analysis of the educational purposes of occupational therapy clinical education

69 Years Later

Are there other models?

​

What does the literature say?

Definitions - Collaborative Model

“A specific model of fieldwork education used with a group of students in which knowledge is constructed jointly between the fieldwork educator and the students. This is an active model of student learning that places more responsibility on the student for his/her own learning. The fieldwork educator does not function as the “expert” but more in the role of facilitator of learning.” (AOTA, 2013)

​

The collaborative model does not merely mean that there is more than one student supervised by each clinical instructor. In this model, students collaborate with each other, share learning experiences, adopt the role of teacher in addition to the student role, and take on some of the responsibility for their legal and ethical supervision. (Rindflesch et. al., 2009)

​

Research

There is a growing body of literature on supervision models, processes, and outcomes in OT clinical education.

Mapping Review in progress by the AFWCCC Research Subcommittee

• Peer reviewed literature addressing Level I, Level II, Doctoral Capstone from 2009 - 2019
• >2,500 abstracts identified to date
• Abstract reviews scheduled to start April 2019
• Present and publish in 2019/2020

​

​

Research Findings: Models

• Current fieldwork education models ( e.g., 1 : 1 apprenticeship) often miss opportunities to maximize student learning and provide students with the skills and knowledge required to be effective entry-level practitioners.

​

�

(Briffa & Porteri, 2013; Hamilton et al., 2015; Hodgetts et al., 2007; Lester, 1995; Muñoz, Dix, & Reichenbach, 2006; Rodger et al., 2009; Toal-Sullivan, 2006)

Research Findings

• A lack of resources (human, physical, financial, productivity), workload pressures (lack of time), concern for student capability, and innovative or emerging practice settings often preclude opportunities for fieldwork education.

��

(Thomas et al., 2007; Roberts, Evenson, Kaldenberg, Ozelie, & Barnes, 2015)

Research Findings

• Students involved in collaborative learning models show advanced:
• High satisfaction with the FW experience
• Increased self confidence and clinical competence
• Increased independence
• Improved communication and teamwork
• FWE are reticent to make changes in FW Models

​

​

(Baldry, currens, & Bithell, 2003; Bonello, 2001; Casares, Bradley, Jaffe & Lee, 2003; Fortune,Farnworth & McKinstry, 2006; Kinsella & Piersol, 2018; Mackenzie, Zakrzewski, Walker, & McCluskey, 2001; Martin et al., 2002; Moore, Morris, Crouch, & Martin, 2003; Rindflesh et al., 2009 )

Innovation through Collaboration

Traditional apprenticeship models have not adequately facilitated student involvement in:

• Interprofessional team planning
• System change processes
• Quality improvement efforts

In our rich and complex healthcare environments, collaborative clinical education partnerships:

• Promote an understanding for quality improvement and teamwork
• Strengthen opportunity for the development of communication and independent learning of student and staff
• Support staff development and improve the quality of the workforce
• Provide valuable resources to facility and staff for program evaluation and quality improvement

(Benner et al., 2010; Didion, Kozy, Oneail, & Koffel, 2012; Moscato et al., 2007; Kinsella & Pierson, 2018)

Innovative Collaborative Exemplar: State AFWCCs

Virginia - 2 OTD, 6 MOT, 8 OTA program

• Increased collaboration among AFWCCs to build tools and resources to support fieldwork education across the Commonwealth and improve cooperation and collaboration in the placement of OT students
• Increasing access to high quality educational tools, resources, and training for fieldwork educators and capstone mentors across the state
• Increasing opportunities for the development of innovative models of fieldwork education (collaborative learning models, emerging practice settings).

Innovative Collaborative Exemplar: State AFWCCs

Innovative Collaborative Exemplar: DEC - FW I

​

​

During planning for capstone experience, students are encouraged to consider the development of FW I experiences in their setting.

Tailored FWE training is provided at the beginning of the capstone experience.

Preliminary results:

​

FW I students are more actively involved in setting and achieving learning goals

​

Capstone students are developing roles and translating research

​

Preliminary results:

​

Increased commitment to serve as FWEs after graduation.

Innovative Collaborative Exemplar: OTS - OTAS

Intraprofessional fieldwork learning experiences improve:

• Advanced clinical reasoning
• The development of team relationships
• Understanding roles
• Recognizing environmental influences on learning
• Prepare for future collaborative OT - OTA practice�

(Jung, Salvatori, & Martin 2008)

Mythbusters

• Supervision Concerns
• Full caseload
• 1 student = LOT of work; 2 students = TON of work
• Managing complexity
• Liability
• Productivity
• Ethical Billing
• Line of sight
• Patients don’t like students

Value Added Innovation

• Quality and value based assessment
• Collaboratively developed client goals
• Client centered care
• Occupation focused care
• Evidence based care
• Advocacy

Planning

and

Implementing Collaborative

Models

AFWCC Preparation and Involvement

​

• Examine the literature

​

• Establish collaborative learning and fieldwork experiences that align with the curriculum

​

• Identify sites that would support collaborative FW models

​

• Consider the training and support needs of the facilities and facility staff

​

How do I prepare myself adequately?

Hanson, D. & Deluliis, E. (2015) The collaborative model of fieldwork education: A blueprint for Group Supervision of students. Occupational Therapy In Health Care, 29:2, 223-239. DOI: 10.3109/07380577.2015.1011297

Fieldwork Educator Buy-In and Training

​

• Discuss facility, FWE and student outcomes

​

• Provide education on group learning, facilitation, and mentoring models and the value of collaborative models

​

• Establish role relationships between and among staff

​

• Consider site supports

​

• Facilitate the creation of collaborative and varied learning activities

​

​

​

How do we prepare Fieldwork Educators adequately?

Hanson, D. & Deluliis, E. (2015) The collaborative model of fieldwork education: A blueprint for Group Supervision of students. Occupational Therapy In Health Care, 29:2, 223-239. DOI: 10.3109/07380577.2015.1011297

Student Preparation

• Identify:
• Academically strong, autonomous, self-directed learners
• Students with well established professional behaviors and collaborative skills
• Prepare student expectations for:
• Increased collaboration and communication
• Increased personal responsibility for learning
• Decreased individualized attention from FWE

How do we prepare students adequately?

Kinsella, A. & Piersol, C. (2018) Development and evaluation of a collaborative model level II fieldwork program. The Open Journal of Occupational Therapy. 6:3 DOI: 10.15453./2168-6408.1448

Guidelines

• Establish site specific objectives and pacing guides for collaborative learning models
• Design caseload delegation strategies
• Including low census strategies
• Establish student activities
• Develop guidelines on group feedback and student privacy

Have I adequately developed

guidelines and expectations to all parties?

​

Hanson, D. & Deluliis, E. (2015) The collaborative model of fieldwork education: A blueprint for Group Supervision of students. Occupational Therapy In Health Care, 29:2, 223-239. DOI: 10.3109/07380577.2015.1011297

Making Connections

Next Steps

Access our materials at the following:

https://drive.google.com/drive/folders/1RK2Q9xdFmOSSzZQ8Opy6usUf0SuW7edD?usp=sharing

Use of Collaborative Models

Survey

pollev.com/pattylaverdu085

We’d love your thoughts about expanding and strengthening the fieldwork and capstone experience through collaborative partnerships.

​

Join us on CommunOT to continue the conversation and build mentorship relationships.

​