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Anxiety Reduction Strategies that Prepare Students for Level II Fieldwork: �A Scoping Review ��

Joni Watling, OTD, MOT, OTR/L , QMHP-A� March 10,2021

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Problem

�Healthcare graduate students surveyed

22.6% diagnosed with ongoing or chronic anxiety.

34.9% no difficulties with academic performance
18.1% felt anxiety impacted their performance
3.7% delayed progress towards their degree

(American College Health Association,2020)�

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Problem

Health professions students

STAI, WTAS (n=351)
56% higher than normal trait anxiety
83% higher than normal state anxiety (Macauley et al., 2018)��

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Problem

> 40% of academic fieldwork coordinators consider anxiety as a student factor for student site placement (Kemp & Crabtree, 2018 ) �
Fieldwork Level II

> 24 weeks full time (960 hours)
4 > 1 practice settings (ACOTE, 2019)
1% percent of doctoral & 2% of master’s students still do not successfully pass (AOTA, 2018)

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Purpose

Examine techniques utilized by academic institutions to reduce instance and impact of anxiety among occupational therapy graduate students

Occupational Adaptation Model

Holistic - person, interaction and environment
Challenges - adapt to achieve goals, for mastery & satisfaction � (Schultz & Schkade, 1992)

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Background��Literature Review

Peer reviewed, March 1, 2014 – February 15, 2020
ProQuest Central, PubMed Complete, CINHAL, The Cochrane Library, Search USA & Google Scholar

Inclusion: English language, full text, (fieldwork or clinical or internship) AND (student) AND (anxiety) OR (anxiety in college students) AND (occupational therapy). (n=2,129)
Exclusion: Test anxiety, outside of the United States, student outcome or impact not mentioned, not graduate or undergraduate students �(n =2,048)
Articles screened (n=81)
Met criteria (n=6)

4 quantitative, 1 mixed methods, 1 qualitative

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Findings

Student (trait + state)
Clinical educator / Clinical site (state)
Academic Institution (state)

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Findings –��Student�(state & trait)

Student characteristics & fieldwork placement (Kemp & Crabtree, 2018)�
RCT’s pre-post (n=11 to n=128)

Interventions decreased anxiety in comparison to controls
State Trait Anxiety Inventory (Hubbard & Blyer, 2016; Sturm et al., 2019) �

Mixed methods (n=32)

Case study

Statistically significant improvement in critical thinking & confidence, decreased anxiety
Improved confidence & decreased anxiety (Allen & Toth-Cohen, 2019)

Nontraditional fieldwork placement; Qualitative (n=5)

Reflective journals
Fear & anxiety of the unknown & transformation process (self-reflection, clinical reasoning, personal / professional growth) (Mattila & Dolhi, 2016)

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Findings –��Clinical Educator / Clinical Site�(state)

Role emerging fieldwork (Mattila & Dolhi, 2016)

Survey: Characteristics (n=301; 30 states)

Time management
Communication
Professional behavior
Ability to make changes based on feedback �(Kemp & Crabtree, 2018)

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Findings - ��Academic Institution�(state)

Case studies

Statistically significant reduction in anxiety, improvement in critical thinking & confidence (Allen & Toth-Cohen, 2019)

Promotion of occupational balance (Chang et al., 2017)
Promotion of stress management (PMR, yoga)

PMR reduced state anxiety (correlation with improvement in working memory practical exam)
Yoga positive effect on reducing stress & anxiety levels (bias corrected, Forest plot) (Hubbard & Blyer, 2016; Sturm et al., 2019)

Role emerging fieldwork

Decrease anxiety & improve self efficacy (Mattila & Dolhi, 2016)

AFWC fieldwork matching (Kemp & Crabtree, 2018)

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Limitations

Sample size, largely homogenous population
Pilot
Lack of blinding
Subjective data (perceptions & performance vs. physiological)
Scant details in literature (methodology, intervention)
Study length (single survey - two semesters)

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Conclusions

Limits in quantity and quality of literature specific to Occupational Therapy students and anxiety in the U.S.
Study suggests interventions and curriculum development has potential to positively impact student anxiety levels and improve performance
Stress reduction techniques have the potential to aid students in development of healthy habits during school which can be carried over into fieldwork and practice.

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Implications

Academic Institution curriculum should include built-in content for education, training, practice and measurement of stress and anxiety reduction techniques.
Future research should include larger sample sizes and blinding but same content to better measure interventions and improve generalizability
Student characteristics for site placement would be worthy of investigating in further detail, along with creation of standardized assessment that can be utilized by student, institution, and potential fieldwork site.
Tracking of anxiety in a more formal manner would be beneficial at the national and state levels to guide improvements in methodologies, change processes, and outcomes

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Discussion

This review was conducted pre-COVID -19 Pandemic.

No additional peer-reviewed, published literature to update��

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Discussion

Questions: �

Pre-COVID. What was your institution doing that supported any of these suggestions / methods?��Post-COVID. What has your institution changed? ��What feedback are you getting from students & clinical educators now regarding anxiety impact on performance? ��Has the pass rate for Level II FW remained the same?

In a perfect world (no barriers) what would you implement as an academic fieldwork coordinator to better prepare students, thus decreasing anxiety & increasing pass rate?

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References

Accreditation Council for Occupational Therapy Education (2019). Accreditation council for occupational therapy education accreditation manual. [PDF document]. Retrieved from https://www.aota.org/~/media/Corporate/Files/EducationCareers/Accredit/Policies/ACOTE%20Manual%20Complete.pdf
Allen, D. D., & Toth-Cohen, S. (2019). Use of case studies to promote critical thinking in occupational therapy students. Journal of Occupational Therapy Education, 3 (3).https://doi.org/10.26681/jote.2019.030309
American College Health Association (2020). American College Health Association-National College Health Assessment III: Graduate/Professional Student Reference Group Data Report Fall 2019. [PDF document]. Retrieved from https://www.acha.org/ documents/ncha/NCHAII_FALL_2019_GRADUATE_REFERENCE_GROUPDATA_REPORT.pdf
American Occupational Therapy Association (2018). Academic programs annual data report: Academic year 2017-2018. [PDF document]. Retrieved from https://www.aota.org/~/media/Corporate/Files/EducationCareers/Educators/2017-2018-Annual-Data-Report.pdf
Chang, M., Moreno, M., Pham, J., Hope, J., Lai, A., & Young, K. (2017). Relationship Between Stress Factors and Occupational Engagement Among Occupational Therapy Graduate Students. American Journal of Occupational Therapy, 71(4_Supplement_1), 7111510187p1-7111510187p1.http://dx.doi.org/10.1080/13561820.2016.1244175
Hubbard, K. K., & Blyler, D. (2016). Improving academic performance and working memory in health science graduate students using progressive muscle relaxation training. American Journal of Occupational Therapy, 70(6), 7006230010p1-7006230010p8.
Kemp, E. L., & Crabtree, J. L. (2018). Differentiating Fieldwork Settings: Matching Student Characteristics to Demands. Occupational therapy in health care, 32(3), 216-229 http://dx.doi.org/10.1080/07380577.2018.1491084
Macauley, K., Plummer, L., Bemis, C., Brock, G., Larson, C., & Spangler, J. (2018). Prevalence and predictors of anxiety in healthcare professions students. Health Professions Education, 4(3), 176-185.
Mattila, A. M., & Dolhi, C. (2016). Transformative experience of Master of Occupational Therapy Students in a non-traditional fieldwork setting. Occupational Therapy in Mental Health, 32(1), 16-31. https://doi.org/10.1080/0164212X.2015.1088424
Schkade, J. K., & Schultz, S. (1992). Occupational adaptation: Toward a holistic approach for contemporary practice, part 1. American Journal of Occupational Therapy, 46(9), 829-837.
Sturm, B., Cozzolino, M., & Harenberg, S. (2019). The Effects of Yoga on OT Students. American Journal of Occupational Therapy, 73(4_Supplement_1), 7311515334p1-7311515334p1.