One of the most important goals of the fieldwork education process is for the fieldwork student to develop a firm identity as an occupational therapy practitioner. However because this is second nature to the fieldwork educator's own practice, sometimes he or she may forget to guide this fundamental process for students.
To avoid such an oversight, fieldwork educators can program identity development into fieldwork experiences by integrating the occupational profile process (AOTA, Occupational Therapy Practice Framework: Domain and Process (2nd edition) 62 (6): 625-683) into student learning processes and supervision for OT and OTA students. By using the profile to facilitate students' skill development in gathering and infusing profile information to guide clinical reasoning, fieldwork educators will be intervening early to encourage students' development of their identities as OT practitioners.
As the initial step in the evaluation process, the occupational profile provides an understanding of the client's occupational history and experiences, patterns of daily living, interests, values and needs. Together the clinician and client identify the client's problems and concerns about performing occupations and daily life activities, and determine the client's priorities (p. 646).
The information collected in the occupational profile answers the following questions:
• Who is the client (person, including family, caregivers and significant others; population; or organization)?
• Why is the client seeking services, and what are the client's current concerns relative to engaging in occupations and daily life activities?
• What areas of occupation are successful, and what areas are causing problems or risks?
• What contexts and environments support or inhibit participation and engagement in the desired occupations?
• What is the client's occupational history (life experiences, values, interests, previous patterns of engagement in occupations and daily life activities, and the meanings associated with them)?
• What are the client's priorities and desired outcomes (p. 650)?
Gathering of occupational therapy profile information, which the Framework includes as part of both initial and continuous evaluation, can also help the student begin to identify herself as providing a specialized, valuable contribution as a service provider. The profile process is fundamental to effectively analyzing and prioritizing occupational performance needs, whether the focus is on individuals or populations/communities. Fieldwork educators can frame supervision around encouraging students to use occupational profile information as the basis for analyzing the occupational performance needs of clients and prioritizing occupation-centered intervention goals.
Fieldwork educators can review with students, during fieldwork orientation, the definition of the occupational therapy profile and key questions outlined in the Framework; during supervisory sessions, they can discuss how these resources relate to their fieldwork experiences.
During supervision, fieldwork educators should ask students to justify their intervention planning based on occupational profile information and explain how their interventions are both client- and occupation-centered. Students should be encouraged to use this information periodically to evaluate the effectiveness of their interventions as well as delineate outcome measures.
While students' development of their identities as occupational therapy practitioners is essential in all fieldwork, it is particularly critical in emerging areas of practice, where OT-specific role models are not fully developed or where there is role blurring or overlap among professions because of the way practice is delivered. Regardless of site or practice context, fieldwork educators must ensure that students are able to see their practice roles through an occupational lens and confidently voice their occupational therapy approach.
With many other professions focusing more on function, we must encourage our entry-level practitioners to advocate for and demonstrate the unique contributions occupation and occupational performance provide our clients. Helping fieldwork students to filter their clinical reasoning and service delivery through the lens of the Framework's occupational profile will ensure individual growth as occupational therapy practitioners. Engaging the profile during fieldwork education and through reflective supervision with students can provide an early-intervention approach to this critical aspect of professional development.
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 email@example.com or at firstname.lastname@example.org.