issues in fieldwork
The 'Three Cs' of Fieldwork
Patricia Crist PhD, OTR, FAOTA
Our sister nation, Canada, hosts the World Federation of Occupational Therapy (WFOT) Congress in Montreal from May 31 to June 5. It's an event that will provide us the opportunity to share the experiences, unique approaches and varying outcomes resulting from clinical education around the world.
I believe we will see three universal themes emerging in discussions regarding fieldwork there, which I call the "three Cs" --comfort, competence and confidence. These are the primary goals and outcomes students everywhere desire from the fieldwork experience. In fact, students will discuss these primary themes with fieldwork educators and coordinators during different times of their fieldwork experience, whether they are aware of it or not. Knowledge of the three C's can provide guidance during fieldwork learning.
Comfort is defined as feeling "assured ease, encouragement or hope." If you ask students prior to fieldwork what will make them "comfortable," they nearly always talk about friendly or good relationships with their fieldwork supervisors--a desire I interpret as wanting to be approved of. Interestingly, by the end of fieldwork, they usually discuss the thoroughness of the orientation program provided at the site and seldom mention that initial criterion of friendliness.
Thus, fieldwork educators can match their students' developmental needs by initially ensuring learning experiences that minimize the students' sole reliance on their own knowledge and skills. Grade learning activities just as you grade intervention activities.
Secondly, carefully plan and implement a comprehensive orientation program. It should not be based on lecture or reading only but should be action-oriented, with problem-solving activities such as guided interviews with other disciplines, quizzes on safety precautions or other procedures, etc. Perhaps you can have the student follow a typical patient all day to understand the rehabilitation experience from the patient's perspective, or observe two different therapists' practice to identify similarities and differences in approaches. Maybe your student can practice an initial in-take with another student, or better yet, if it is a complex process, have the student do it gradually, over several sessions, taking on more difficult tasks until he or she is able to do it alone.
The fieldwork educator also must help the individual student identify cues and measures of progress as part of acquiring a sense of competence that can be internally modulated for entry-level practice.
Competence means being capable. While the fieldwork educator assures this capability through the evaluation of the students' performance, students must internalize these measures as part of on-going self-evaluation and to form the guide for life-long learning. Both are critically essential behaviors.
Regular supervision and co-treatment with experienced practitioners provide the developmental learning mechanisms for assessing one's competence. Supervision should move from a supervisor's initially cueing students to look for practice outcomes to observing the student easily and accurately defining practice progress, trying multiple approaches and ultimately reporting not being able to go further during supervision.
By moving supervision from supervisor-directed to student-centered as quickly as the student is ready, fieldwork educators will help students acquire competence.
A word of caution: sometimes observing expert practitioners at work creates more mystery than a learning opportunity for the student. We learn best when learning is at the next stage--that is, when only part of it is fundamentally new. To watch the expert clinician is mesmerizing but frequently beyond the reach of the student. Thus, the expert must help the student focus his or her learning by repeating small parts of what they are doing together or focus attention on specific activities to observe.
This is the reason a clinician with only one to two years of experience may be valuable as part of the fieldwork education experience because students can see that they could achieve this level of competence realistically.
To expect total self-reliance from a student is unreasonable. Students acquire and demonstrate their confidence through their ability to repeat interventions and have a certainty regarding the outcomes of their performances. Fieldwork students are confident when they are in command of their practitioner powers. Thus, confidence occurs through experiences that reinforce one's faith in his or her abilities as change agents. Confidence, or self-efficacy, will mediate future performance. Two major considerations come into play to help a student become confident: the length of fieldwork and the choice of fieldwork tasks.
Fieldwork should last long enough to assure that the typical or average student is confident in a primary set of entry-level skills at that site. For some sites, a month placement may be adequate; for other placements, three or more months may be needed. There is no magic in the length of a fieldwork placement. Confidence that a student's skills are predictable is the real outcome.
Fieldwork educators are tempted to give students a variety of experiences. If this variety is based on variances of previous learning, it is probably reinforcing for confidence building. For instance, seeing many children with cerebral palsy or an adult with CVA supports not only the building of service delivery competence but also, confidence. To give students in a time-limited affiliation exposure to as many difference issues or diagnoses as possible may actually limit their ability to generalize their confidence. A wise fieldwork educator matches a sufficient amount of repetition with novelty.
Are each of the three fieldwork Cs mutually exclusive? No. There is great overlap, but if the fieldwork educator recognizes the student's learning needs early and the resulting outcomes, he or she can use this information to enhance that student's skill acquisition throughout the fieldwork experience.
* About the author: 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 10 years. Readers may contact Dr. Crist by e-mail at firstname.lastname@example.org or write to her c/o "Issues in Fieldwork," OT ADVANCE, 650 Park Avenue West, King of Prussia, PA 19406 or at OT ADVANCE via Internet Mail at email@example.com