Inspiring future generations of occupational therapists

Mention the word fieldwork and the ‘too hard’ basket appears. A recent editorial in the British Journal of Occupational Therapy highlighted the ongoing difficulties of finding sufficient placements to meet demands from higher education programs (Craik & Turner, 2005). Subsequent letters to the editor reinforced this as a shared problem, for the educational institutions, practitioners, managers and the professional association.

Similar problems have been identified in Australia and New Zealand with this issue being a regular topic of discussion at a range of meetings across both countries (Thomas, Penman & Williamson, 2005). The issues are complex and not just about ‘numbers’. Many placements offered are not taken up, especially in rural areas. Students identify costs linked to travel and relocation from their homes and paid employment as being barriers to participation in fieldwork at a distance. On the other hand, therapists frequently feel pressured to provide placements even when they might need a break. Common reasons for not taking students include organisational change, staff on leave, or the lack of space to accommodate students. However, students don't necessarily rate their experiences by the desk space allocated to them. They respond to the range of experiences and a positive supervisory relationship and value ‘opportunities to discuss ideas openly, to offer ideas without being shot down in flames and to have some validation that they are on the right track’ (Fortune, 1999, p. 142). Negative impressions are created when the clinicians they look to as role models convey stressed and pessimistic messages, for example, about the work environment or the university program.

Universities often fall down in their role to interact with students and practitioners. Contact may be limited to a quick phone call to make sure all is okay and relief that there is no need for a visit. I've done my share of ‘begging’ on the phone for a placement, hoping a professional friendship will mean the chances of a positive response are increased. I've lost sleep worrying that students will be disappointed and/or disadvantaged if a placement is not found, and felt guilty that arrangements always seem to be last minute. Despite these moments of stress, I have also shared the pride, and amazement at the enthusiasm and achievements of students. Their enthusiastic willingness to confront challenges, engage in community projects and create new possibilities for clients of occupational therapy services is always greeted with admiration.

The fact that health professionals face current and future challenges is clear, ‘… without question the environment around us has broader and grander expectations of us as practitioners than in the past’ (Baptiste, 2005, p. 179). How these challenges impact on fieldwork education and how we in turn shape fieldwork to equip our graduates is multifaceted. Learning in the field has moved beyond current areas of practice to encompass new areas and opportunities for occupational therapy. Emerging and sometimes the ‘same old’ issues arise, constantly competing with each other within the higher education and health sectors. For example, we are yet to consolidate our efforts in areas of interprofessional education, a growing interest in some universities. The development of more graduate entry level courses also presents challenges for fieldwork. Are there differences in the expectations of learners and practitioners? How do we include students in our future planning: where is their voice in our deliberations?

Strategies to address the challenges are within reach. Models of supervision are being explored, particularly where there are no occupational therapists to provide the day-to-day supervision (Fisher & Savin-Baden, 2002; Thomas et al., 2005). Within Australia, many universities are using a common performance evaluation tool. With the growth of university programs, forums are being established to enhance communication between universities, professional associations, managers and practitioners, with the intention of speaking ‘with one voice’ to advocate for more effective funding and resources for our fieldwork education.

Despite these efforts, there is still a need to confront the challenges with new ideas. Can we identify some opportunities to enhance our efforts? Craik and Turner (2005) advocate for a culture shift, moving to a position where there is a greater sense of the shared responsibility between educators and practitioners. Is there a need for us also to look at our ‘fieldwork culture’? Can we question who does the ‘gatekeeping’ in making the decisions about whether an organisation offers placements? Are there real structural barriers, or are there ways to encourage as many occupational therapists, and other team members, as possible to be active in student education? Do we still need to work on greater recognition for the education role of practitioners, regardless of area of practice or organisational sector? Can universities become more flexible within the constraints of their programs and can they improve information and communication with the field? Are we missing some vital information from students about their experiences, and are we contributing to knowledge about educating health professionals?

As Baptiste (2005) suggested, there are many of us ‘… who have been fortunate to grow with our profession over the past 30 years’ (p. 179). We have been part of significant changes, with our work changing in ways we would not have envisioned, and have faced challenges that have at times been ‘… overwhelming, sapping our energy and commitment’ (p. 179). Yet more lies ahead and we must lead the way in the creation of greater opportunities for learning, and continue the dialogue ‘with mutual respect and regard’ (p. 180). Can we foster the culture change required to secure the place of fieldwork within our entry level education, and as Fortune (1999) suggested, can we consolidate our message to students ‘along the lines of “welcome to this practice of unknowns, where you and I will continue to learn together throughout our careers”’? (p. 142).

Educating our future generations is a well recognised responsibility of the profession, underpinned by the World Federation of Occupational Therapists and our national associations. Those of us who implement the vision are challenged to foster a culture of learning based on trust, shared visions, and better understanding of the many perspectives that will shape the ways we inspire occupational therapists of the future.