Editor's Note: This initiates a series of articles in which the author will focus on the application of OT approaches and models to fieldwork education processes.
Practice models that organize information in occupational therapy also are relevant for understanding and guiding fieldwork education processes because of their common assumptions related to learning, adapting and improving occupational performance through person-environment interaction.
Jeanette Schkade and Sally Schulz at Texas Woman's University created and refined the Occupational Adaptation (OA) Model that, from its inception, has been used in the clinical education process as well as practice. OA provides strategies for interpreting and enhancing observed performance and guides how the OT practitioner facilitates mastery over desired performance. This column applies the fundamental OA concepts, the occupational challenges and subsystems, to structure beneficial learning experiences generically.
Using a developmental approach, OA focuses on evaluating and facilitating adaptation of the student's observed response to fieldwork education demands. OA does not prescribe discrete skill development for practice.
OA is student-centered. The fieldwork educator helps the student learn to identify performance problems and initiate desirable professional development strategies. By habituating OA processes to reassess his or her evolving professional competence, the student leaves fieldwork empowered to pursue individual lifelong learning to support continuing practice competence.
Occupational challenges stimulate change or adaptation in attitudes or actions that lead to competence. Competence, or relative mastery, involves three properties: efficiency (the use of time, energy and resources), effectiveness (the degree to which one achieves a desired result) and satisfaction (the extent to which the outcome was not only personally satisfying but well-regarded). Applying these three properties to observed fieldwork student performance provides a useful taxonomy for analyzing performance deficiencies.
For instance, one student may not know how to administer an evaluation (a resource), which means he or she needs to direct, time and energy in training in the tool. All of this involves efficiency problems.
Another student may not be getting the desired response in teaching an individual paralyzed on one side to don and doff a shirt (effectiveness). In this situation, the fieldwork educator and student discuss other ways to reach the desired outcome or ways to modify the chosen process to increase success. The student is encouraged to try this new way and evaluate the results.
The fieldwork student who is client-centered from the first contact is more likely to have successful results, and the student's satisfaction will come from positive outcomes that follow his or her intervention.
Certainly, encouraging feedback from fieldwork educators is an important aspect when a student engages in a fieldwork task for the first time or is performing in a highly stressful situation. Feedback serves as external validation of a specific event and contributes to satisfaction. Later in fieldwork, and with familiar tasks, students should use internal motivation and satisfiers to sustain performance.
Successful occupational adaptation to fieldwork challenges is based on the availability of support within three subsystems of the student's environment: physical, cultural, and social. Adequate physical resources are the most obviously necessary to student learning and adaptation. This includes access to the correct mix of learning opportunities in which the student can try out and become competent in a specific fieldwork activity. Culture creates the boundaries or rules for performance that include effective compliance with standard operating procedures and organizational communication expectations. Enculturation begins with thorough orientation to a facility.
But the most critical contributor is the social subsystem of the fieldwork environment. The student-supervisor relationship is at the heart of this. Effective supervision, including addressing student needs and modeling effective professional behaviors and skills, provides a positive social environment that supports student occupational adaptation.
So OA provides guidance to analyze student mastery of learning tasks and provides ways that educators can use three sub-systems of the occupational to modify resources to promote student performance, and this includes removing deterrents as well.
I used a series of notes from various readings and workshops to create this column. Suggested readings to understand basic OA principles would be:
- Garrett, S.A. & Schkade, J.K. (1995). Occupational adaptation model of professional development as applied to Level II Fieldwork in occupational therapy. AJOT, 49, 119-126.
- Schkade J.K. & Schultz, S. (1992). Occupational adaptation: Toward a holistic approach in contemporary practice, Part I. AJOT, 46, 829-837.
- Schultz, S. & Schkade J.K. (1992). Occupational adaptation: Toward a holistic approach in contemporary practice, Part II, AJOT, 46, 829-837.
Next time, we'll take a look at how fieldwork educators can apply OA concepts to performance adaptation and problems during fieldwork.
Patricia Crist, PhD, OTR, FAOTA, is chair of the occupational therapy department at John G. Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA. She has been a fieldwork coordinator for more than 18 years. Readers may contact Dr. Crist by e-mail at firstname.lastname@example.org or at email@example.com, or write to her c/o "Issues in Fieldwork," OT ADVANCE, 2900 Horizon Drive, King of Prussia, PA 19406.