experiences of occupational therapy students in the first fieldwork...

Original Articlehttp://mjiri.iums.ac.ir Medical Journal of the Islamic Republic of Iran (MJIRI)

Iran University of Medical Sciences

____________________________________________________________________________________________________________________1. PhD Candidate, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, [email protected]. (Corresponding author ) Associate Professor, Iranian Research Center on Aging, Pediatrics Neurorehabilitation Research Center, Departmentof Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. [email protected]. Associate Professor, Disaster Rehabilitation Research Center, School of Nursing, University of Social Welfare and Rehabilitation Science,Tehran, Iran. [email protected]. Assistant Professor, School of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. [email protected]

Experiences of occupational therapy students in the first field-work education: a qualitative study

Mehdi Rezaee1, Mehdi Rassafiani2, Hamidreza Khankeh3, Mohammad Ali Hosseini4

Received: 19 November 2013 Accepted: 18 January 2014 Published: 11 October 2014

AbstractBackground: Fieldwork education is a core part of all occupational therapy curriculums around the world to

enable the students meet minimum competencies required for their professional life. Student experience is avaluable source to explore the nature of fieldwork training and plan more efficient curriculums in the future.This study aimed to explore the students' experiences in the first fieldwork education.

Methods: Data were collected through a focus group and series of semi-structured interviews with 16 occupa-tional therapy students who had passed the first semester of fieldwork education at three occupational therapydepartments in Iran. The interviews were transcribed line by line and analyzed according to inductive contentanalysis.

Results: Following the analysis of the data, three main themes were identified including the importance ofsupervisors’ management, deficits in the current curriculum and challenges in the educational environment.Each theme included different categories to show students’ concerns and challenges in the first fieldwork educa-tion experience and their suggestions for more efficient trainings.

Conclusion: The research argues that several combined key factors determine the nature and utility of occupa-tional therapy (OT) fieldwork experiences of the students. However, further studies are needed to clarify theexperiences of the supervisors, department managers and others involved in the fieldwork education.

Keywords: Clinical education, Occupational tTherapy student, Professional education, Qualitative research.

Cite this article as: Rezaee M, Rassafiani M, Khankeh H, Hosseini M. A. Experiences of occupational therapy students in the first field-work education: a qualitative study. Med J Islam Repub Iran 2014 (11 October). Vol. 28:110.

IntroductionFieldwork education is a crucial part of

all occupational therapy education pro-grams, which provides opportunities forprofessional development and competencyacquisition (1, 2). It aims to engage stu-dents in clinical practice to obtain specificknowledge and skills required to be quali-fied in professional activities and treatmentof patients (3). Fieldwork education servesas a bridge between theoretical educationand clinical settings (4), which provides thestudents with an opportunity to reflect theirperception of coursework through the ap-

plication of their knowledge in a controlledclinical setting (5); and additionally, it inte-grates their theoretical knowledge with theapplication of the skills at higher levels ofperformance (6). The unique characteristicsof fieldwork education environment pro-vide conditions, under which the studentmay learn and develop various skills. Suchskills can be grouped into two categories:practical skills such as techniques requiredto treat patients and personal skills, bywhich the students may develop profes-sional behavior (7). During fieldwork edu-cation, students may develop problem-

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http://mjiri.iums.ac.ir/article-1-2483-en.html

First fieldwork education

2 MJIRI, Vol. 28.110. 11 October 2014http://mjiri.iums.ac.ir

solving capabilities, improve their clinicalreasoning (8, 9) and be encouraged to applythem in interventions (10). Furthermore,fieldwork education may influence choos-ing a practice area by the student aftergraduation (1, 11).

Transition from a classroom learning en-vironment to a clinical setting may bestressful and is of utmost importance fromthe viewpoint of the students (12-14). Suchstress may generally decrease the students’efficiency in the clinic, or may cause themto feel that they have less control over theenvironment; and therefore, they may showinappropriate adaptive reactions. Stress iscaused by several factors, which should beidentified. Some authors maintain that it isnecessary to appropriately guide the stu-dents during the fieldwork education to de-crease their stress and prepare them to enterthe clinic and adapt to the environment (1,12, 15). On the other hand, the establish-ment of a successful clinical experiencerequires contributions and collaborationsbetween the universities and clinical set-tings (16). Hence, it is important to dealwith problems and issues that may arise inthe fieldwork context and it is also of primeimportance to understand the experiencesof all involved.

Among the authors who explored thefieldwork education experiences in occupa-tional therapy, Kautzmann compared theperception of the objectives of level Ifieldwork education (the clinical observa-tion course) by the faculty members, in-structors and students and recommendedthe instructors to improve the integration ofcoursework with clinical interventions, andhe also suggested the supervisors to adoptbetter methods for providing feedback tothe students (17).

By comparing real fieldwork educationenvironments with ideal environments asperceived by the students and supervisors,Meyers concluded that each provided a dif-ferent list for making the environments ide-al (18). In exploring the objectives of levelI fieldwork education among the students,supervisors and faculty members, Swine-

heart and Meyers found that the relation-ship and/or lack of relationship among the-se components depend on the differences intheir perception of the objectives (19).

In a qualitative study, Tompson andRyan investigated the influences of field-work education on students. In their study,they achieved four major themes: thera-pists, environment, clients and time. Theybelieved that during the initial days of theclinical experience, particularly in the firstfieldwork settings, the therapists and theenvironment had the highest influence onthe students, followed by clients and time,respectively (20). In studying the attitudesof the students and supervisors in the firstfieldwork education, Mulholland and Der-dall found that the students believed thatthe supervisors needed more knowledge ofthe fieldwork education and that theyshould be prepared before the students en-ter the setting. Furthermore, the studentsexpressed that they needed more academicpreparation before entering the clinic andthe objectives and expectations of thefieldwork education needed to be elaborat-ed for them (21).

Occupational therapy (a four- year educa-tion) is relatively young in Iran. In Iran OTwas established in 1971; however, the Ira-nian occupational therapy curriculum wasnot approved by the World Federation ofOccupational Therapists (WFOT) until2006 (22). According to this curriculum,students are required to pass at least 1000hours of fieldwork education in their thirdand forth years. After passing the theoreti-cal courses related to each fieldwork educa-tion and observation course, the studentsbegin fieldwork from their fifth semester.The observation course aims to prepare thestudents to enter the fieldwork environ-ment. In this course, students are expectedto gain the knowledge of assessments andcommunication skills through the observa-tion of senior students. The students firstlypass fieldwork education in mental healthin children and adults, and then in pediat-rics and adult physical dysfunction. Everyfour or five students are placed in a clinical

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3MJIRI, Vol. 28.110. 11 October 2014 http://mjiri.iums.ac.ir

setting supervised by experienced full-timemaster occupational therapists. Fieldworkeducation courses are offered in differentsettings related to Iran universities such ashospitals and day centers (23).

Fieldwork education experience, as a sub-jective phenomenon, depends on academicand socio-cultural background. Culture hasa significant role in forming a variety ofdefinitions and meanings (24). The presentresearch is of significant value since nostudy has been conducted on the fieldworkeducation of occupational therapy in Iran.Previous studies have indicated that initialfieldwork experiences are particularly im-portant; thus, the current study focuses onthe students’ first fieldwork. This studycould provide a clear picture of students’experiences and define further research pri-orities in this context. Moreover, the pre-sent study aims to reveal concepts relatedto characteristics of fieldwork educationwith respect to social and educational con-ditions in occupational therapy educationenvironments.

MethodsResearch designThis was a qualitative study using content

analysis. Content analysis is a systematicresearch method for description and elabo-ration of a phenomenon (25). Depending onthe research question, if there is not enoughknowledge about a phenomenon, the induc-tive content analysis is recommended (26).As fieldwork education is an unknownphenomenon in our culture, we used induc-

tive content analysis in this study.

ParticipantsThe study population included the under-

graduate occupational therapy students whodirectly experienced the first fieldwork ed-ucation. The selection of the participantswas determined using a purposeful sam-pling method based on firsthand experienceand willingness to participation. A flyerthat indicated the aim and method of thestudy was distributed in universities in Teh-ran. Those students who were ready to par-ticipate have been called to arrange a timefor an interview. Sixteen students in theirsixth or eighth semesters participated in thisstudy (ten females and six males aged 21-24 years with a mean of 22.31 years) fromthree universities in Tehran including Sha-hid Beheshti University of Medical Scienc-es, Tehran University of Medical Sciencesand University of Social Welfare and Re-habilitation Sciences (Table 1). Samplingended when data saturation was achieved(i.e., continuation of the interview and datacollection did not yield any new data orcodes). Universities in this study are thefirst three universities providing occupa-tional therapy courses in Iran (22).

Data collectionData were collected through semi-

structured in depth interviews, following afocus group. Ten students were inter-viewed; and to interpret the primary results,one focus group was conducted with sixstudents. The duration of interviews was

Table 1. Participants’ demographic information (N = 16)Student Variable Number Percent

Gender:Male 6 37.5

Female 10 62.5Year of Current Education:

Third 9 56.2Fourth 7 43.7

Current University:USWR* 9 56.2SBMU** 4 25IUMS*** 3 18.7

* University of Social Welfare And Rehabilitation Sciences** Shahid Beheshti University of Medical Sciences*** Iran University of Medical Sciences

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between 26 and 45 minutes (Mean: 30.25),and it was 62 minutes for the focus group.After obtaining an informed consent fromthe participants, we asked them to provideus with a convenient time and place for theinterview. All the interviews and the focusgroup were carried out at the universities.The interview guide included a list of gen-eral questions used as a tool for initiatingthe interviews. The participants were askedto openly answer the questions based ontheir experiences. Several questions wereasked such as “How was your experience inthe first fieldwork education?", "Whatproblems did you encounter in the firstfieldwork education?”, and “What are theadvantages and disadvantages of the firstfieldwork education?". The questions weredesigned generally as a guide for the inter-view, which entailed open and interpretiveanswers, and the participants’ answers di-rected the process of the interviews andquestions. The interviews were recorded bya digital voice recorder and were subse-quently transcribed verbatim.

Data analysisThe interviews were analyzed using

qualitative content analysis (27). The pro-cess of qualitative content analysis oftenbegins during the early stages of data col-lection. This early involvement in the anal-ysis phase helps moving back and forth be-tween the concept development and datacollection and may also help to direct sub-sequent data collection towards the sourcesthat are more useful for addressing the re-search questions (28). The content of theinterview was read by the first author forseveral times; then all sentences were in-vestigated, the meaning units were markedin the text and the condensed meaning unitsand primary codes were extracted. Thecodes were categorized based on the simi-larities and differences and sorted into sub-categories and categories, and finally theunderlying meanings were interpreted asthemes. In this study, 670 codes, 11 catego-ries and 3 themes were obtained.

Ethical considerationsThis study was approved by the Ethics

Committee of University of Social Welfareand Rehabilitation Sciences. To ensure au-tonomy, the aim of the study was explainedand an informed consent form was signedby all the participants; in addition, permis-sion was obtained to record and use the da-ta without mentioning any names. At theend of each interview, the participants wereguaranteed confidentiality and were en-sured that the recorded voices would bedeleted after transcription. Data collectionand coding phases were performed confi-dentially. The participants could withdrawat each phase of the study.

TrustworthinessCredibility and consistency were con-

firmed through several methods, includingthe allocation of enough time for data col-lection, rapport with the participants andconducting the interviews in an appropriateplace, which was chosen by the participantsand use of a focus group to achieve triangu-lation. Furthermore, the extracted meaningunits and codes were returned to the partic-ipants to be checked. Moreover, the mean-ing units, codes, sub-categories and catego-ries were provided and were peer checkedby those colleagues familiar with bothfieldwork and qualitative research. The ob-tained results were continuously discussedby the authors. Prolonged engagement withthe participants enabled the researcher togain their trust and obtain more detailedand valid information (29).

ResultsIn this study, the importance of the super-

visors’ management, deficits in the currentcurriculum and challenges in educationalenvironment were extracted as the mainfactors influencing the first fieldwork edu-cation experiences of occupational therapystudents. Table 2 demonstrates themes, cat-egories and some related codes.

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A) Importance of Supervisor’s Manage-ment

- Importance of the First SessionsAll participants emphasized the im-

portance of the first sessions. They experi-enced feelings such as anxiety, distractionand fear. Students also indicated the im-portance of the role of supervisors in con-trolling these feelings. Students thoughtthat supervisors’ behavior, introductionsand explanations were very important inovercoming anxious feelings. The follow-ing is an example of a positive experiencein this regard, which has been stated by oneof the participants:

“I think it is fearful to do any job for thefirst time because you have no experience.The clinic caused the same feeling in me;what should I do with a patient with delu-sion, How should I treat him/her, What ifthe patient is treated severely? I was reallyafraid, but when I saw that the supervisortakes it easy and the difficult patients arenot as aggressive as I read in the books, Igot used to it." (Participant 5)On the contrary, some students indicated

they needed further explanations prior to

visiting the clients due to the lack of practi-cal experience. One student said:

"… It did not know how to talk to the pa-tient or how to evaluate his/her condition inthe first session. However, the supervisorsneither provided us with any informationnor gave us any explanations on how totalk to or treat the patient in the first ses-sion; and all of the sudden they told us takecare of this patient, he/she is yours." (Par-ticipant 2)

- Experience of Relationship and Com-munication with the SupervisorIn this category, some participants expe-

rienced good and intimate communicationwhile others did not. This highlights thesignificance of the students’ relationshipwith their supervisors, and whether or notthe supervisor exercises a top-down attitudein managing the students, or whether he/shedevelops excessive closeness with the stu-dents. One student described her experienceabout excessive closeness as follows:

“In my opinion, it is best for the supervi-sors to develop managed closeness withtheir students because this closeness may

Table 2. Themes, Categories and Some Extracted CodesThemes Categories CodesImportance of super-visor’s management

- Importance of the first sessions- Experience of relationship and communi-

cation with supervisor- Need for supervision and appropriate

feedback- Challenges in documentation and report-

ing- Lecture as educational strategy- Variation in evaluation of the student's

performance

- Fear and unpreparedness feelings of the studentat the beginning of clinical practice

- Negative effect of excessive closeness betweenthe supervisor and the student

- Absence or limited availability of the supervi-sor while the student's clinical practice

- Leaving the student alone in clinic and no su-pervision by the supervisor

- Lack of a definite scientific method for clinicalreporting

- Evaluating the lectures as non-scientific by thestudent

- Unclear process for evaluation of the student'sclinical practice

Deficits in currentcurriculum

- Gap between coursework and fieldwork- Less effective clinical observation course- Curriculum planning

- Theoretical subjects learned during courseworkdoes not work in clinical practice

- Poor organization in providing clinical observa-tion course

- Large gap between coursework and fieldwork incurriculum

- Inappropriateness of beginning the clinic fromsemester six

Challenges in educa-tional environment

- Staff as influential factors- Non- educational characteristics of clini-

cal settings and physical structure

- Students are required to be further respected bythe staff

- Limited numbers of facilities in clinic- Low space of clinic for working with patient

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cause the relationship to change to anotherform of closeness such as one existingamong two friends and this may causemany problems in different occasions."(Participant 1)Another participant, speaking about the

top down attitude of the supervisor said:“Although the supervisors’ level is higher

than the students’, it would be better forthem not to put too much emphasis on thisstatus difference when communicating withthe students. I mean they should providefeedback and communicate with the stu-dents friendlily." (Participant 6)

- Need for Supervision and AppropriateFeedbackFor the supervision and provision of

fieldwork education, the participants haddifferent experiences from continuous su-pervision and appropriate support to limitedsupervision and feedback. The variation inexperiences can be seen in the followingquotes:

"… Our clinic supervisor neither inter-fered in our practice nor stood by us. Imean, we had to experience everything byourselves. At first, it was very difficult forme as my knowledge of clinical practicewas not sufficient enough."(Participant 3)

"… I think we were not assessed thor-oughly during the semester by our supervi-sors. For instance, the supervisor neverasked us if we were doing well ornot."(Participant 8)

Some participants stated the feedbackgiven by the supervisors in the presence ofthe patients and their family had a negativeeffect on their professional role. One stu-dent said:

"The most important thing which I no-ticed in this clinic which made me thinkwas that the weaknesses and mistakes ofthe students should not be mentioned inthe presence of the patients and their fami-lies because it causes distrust in the pa-tients and their families …. Because fami-lies already have serious doubts in the abil-ities of the students due to their lack of ex-perience, so when the supervisor provides

feedback to the students not consideringthis matter, the problem gets even worse."(Participant 1)The necessity of collaboration of the su-

pervisors with the students in performingthe interventions for the first patient and thecontinuous attendance of the supervisors inthe clinic were among the subjects stated inthe interviews. One student described herneeds as follows:

"It would be good if the supervisorsstand by the students from the very firstday and visit the patients together; for ex-ample, it is better if the supervisors teachthe items instead of attending to the pointsevery now and then; they should have con-tinuous presence at the clinic. For example,they should visit the patients and performtherapeutic techniques on them simultane-ously." (Participant 6)

- Challenges in Documentation and Re-portingExperiences of the participants in this

category included such issues as the lack offormal reporting format, no clear guidancefor students, repetition of the reports andignorance of documentation. One student’scomment was as follows:

"The material our supervisor requiredwas lectures and a series of assignments, inwhich we wrote our objectives and plans.One disadvantage of this approach was thatthe supervisor only read the material andcommented that the plan needed to bemore complete and comprehensive, but Ireally had no idea how to improve it. Iliked to have a hint or clue"(Participant 3)

- Lecture as an Educational StrategyAll participants emphasized the im-

portance of lectures and the need for groupinvolvement. They emphasized the need forthe lectures to be both scientific and practi-cal and mentioned that the timetabling ofthe lectures had to be sufficiently flexibleto accommodate their needs. Finally, thestudents also highlighted the need for suffi-cient resources for lectures. One participantsaid:

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"I think the lectures are not scientific. Forexample, if a lecture was about aggressive-ness and defiance, as an occupational ther-apist, I wanted to understand more thanwhat I could find in the internet from theparents of a disobedient child." (Participant3)

- Variation in the Evaluation of the Stu-dents’ PerformanceNegative attitude towards the pre-clinic

exam, the preference of written or oral ex-am by some participants and the tendencyto be evaluated only by the clinical supervi-sor are among the issues stated by the par-ticipants. One student commented on theattendance of other instructors during theevaluation as follows:

"In the pediatric mental clinic, there wasan instructor who never attended the clinicwith us and it made the situation more dif-ficult. He did not even know what to ask,he asked more theoretical questions. Wehad to take the same exams we had alreadypassed, except for the questions asked byour supervisor, which were good. Otherinstructors asked theoretical questions be-cause they did not have seen our work orhad never seen our cases." (Participant 7)

B) Deficits in the Current Curriculum- The Gap between Coursework and

FieldworkIneffectiveness, inapplicability and insuf-

ficiency of coursework, the gap betweencoursework and fieldwork needs and thenecessity of content revision and course-work timetable were among the most im-portant items stated by the participants inthe interviews. The following quote illus-trates this matter:

"Our coursework should not be just theo-retical; we should also have practicalwork. For example, we passed sociologywhich was more like a high school course.If you ask me now, I can’t remember thecontent at all. Some courses such as mentalretardation, psychiatry and the like weregood, but some others were really uselessand impractical." (Participant 3)

- Ineffective Clinical Observation CourseClinical observation is a course passed by

occupational therapy students before be-ginning of the first clinic. The objective ofthis course is to familiarize the studentswith fieldwork environment and to preparethem for the fieldwork. The participantsexpressed their experience of this course,stating such issues as ineffectiveness, inac-tiveness and ignorance of students, beingdisregarded by the supervisors and the ne-cessity of revision of the clinical observa-tion course with respect to the timetableand method of execution. One student said:

"In the observation course, we just ob-served the situation.… I remember that Iobserved the senior students, who did nothave any practical knowledge themselvesand their practice might have not been cor-rect or accurate; therefore, I may havelearned their mistakes …." (Participant 10)

- Inappropriate Administration of theCurriculumThe relatively late start of the clinic

fieldwork, non-congruent programs in dif-ferent fieldwork education settings, the lim-ited time for the intervention on the activi-ties of daily living and an inappropriate se-lection of inexperienced supervisors for thefirst clinic are among the important issuesfalling in this sub-category. One of the stu-dents commented on the fieldwork educa-tion onset as follows:

" The clinic work starts at the 5th semesterwhich is very late because it has little inter-val with the 4th semester, and the studentsremember many things and can reviewthem easily and there will be less pressurein the final semesters, but we are now un-der a lot of pressure." (Participant 7)

Considering the importance of the super-visors’ role in the first fieldwork education,some participants were interested in ac-companying a determined and experiencedsupervisor in the first clinic. One of thestudents confirmed:

"I want my supervisor to be experiencedenough to have something to offer. Be-cause occupational therapy has some prob-

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lems due to its nature, so in the first en-counter, I prefer to have a supervisor whoknows his/her field well enough to maneu-ver comfortably and with confidence in thefield." (Participant 2)

C) Challenges in the Educational Envi-ronment

- Staff as an Influential FactorThe most important experiences of the

participants were overlaps between thepractices of the occupational therapistsworking in the setting without a positiveattitude towards OT, inappropriate referralof patients, being disregarded by the staffand ignorance of occupational therapy inthe treatment team were more experiencedin the centers outside of the faculties likehospitals. One of the students stated his ex-perience about the referral of the patients:

"Sometimes, a patient had no referral atall; then, the matron would say to us not totake the him/her to the occupational thera-py ward, because it may cause a mess inthe ward. However, the nurses, for theirconvenience and because they could notsatisfy the patients’ needs and are unableto keep them happy would tell us to takethem to the occupational therapy ward(Participant 4)

Another participant, speaking aboutteamwork said: “There is no teamwork. Noone cares about teamwork and everyoneignores occupational therapy. For example,a nurse is perhaps more valued than an oc-cupational therapist in the mental healthward, and the physicians do not value oc-cupational therapy and this makes the pa-tients to be ignorant as well." (Participant2)

- Non- Educational Characteristics ofClinical Settings and Physical Structure

The deficiency of devices and equip-ments, low number and variety of patientsin centers, difference in training methodsbetween the centers inside and outside ofthe faculty, lack of screening and inappro-priate referral of the patients are among themost important issues stated by the partic-

ipants. One of the participants reportedclinical conditions as follows:

“There were very few facilities, and thedevices were very plain and primitive. Bysuch devices, we could not provide the pa-tients with appropriate activities or treat-ments they needed." (Participant 2)

DiscussionThe results of this study indicated that the

students encountered some issues in rela-tion to the supervisor, curriculum and edu-cational environment in their first attend-ance in the fieldwork training. They experi-enced feelings of fear and unpreparednessat the beginning of the fieldwork education.Previous studies have shown that the be-ginning of fieldwork education and transferof the students from the coursework to clin-ical environments is stressful (12-14).However, in this study, the students be-lieved that awareness of the plans and ex-pectations, evaluation and interventionstrategies used by the supervisor, review ofthe related coursework, familiarity withclinical environment and communicationconsiderations including guidance and col-laboration by the supervisor may help themcontrol such feelings at the beginning of thefieldwork. Since the first fieldwork of thestudents is in pediatrics or in adult mentalhealth, the most stated problems were relat-ed to mental health centers. Prior studieshave indicated that mental health centerscause specific issues (20, 30) and more fearin the students, and the students do nothave positive attitudes towards the patientswith psychiatric disorders (30-32). Howev-er, it has been suggested that the supervi-sor, as a model, can play the most im-portant role in decreasing the students’stress (13). It is, therefore, necessary toconsider special needs of these settings inthe curriculum of occupational therapy forfurther preparation of both students and su-pervisors.

The role of the supervisors and theircommunication with the students in theclinics is of prime importance and couldpositively influence the fieldwork educa-

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tion process to such an extent to provide aproper support to the students and decreasetheir fear (20). In this context, the findingsindicate the concerns of some participantsabout the inappropriate communication be-tween the supervisors and the students, acommunication that could vary from a hier-archical attitude to excessive closeness. Allparticipants, however, believed in the ne-cessity of establishing a friendly and closerelationship between the supervisors andstudents.

Findings of previous studies have indicat-ed that supervision plays the most im-portant role in fieldwork education (1, 33).Kautzman showed that the students seekprofessional growth in clinical practice andprefer to receive feedback in relation totheir performance in all contexts (17). Inaddition, Sheerer suggested that feedback isa very valuable resource from the students’viewpoint, especially when it is positiveand face-to-face (34). Findings of our studyalso indicated that the students wanted ap-propriate support and continuous attend-ance of the supervisors during clinical prac-tice and believed that the feedback mightbe given by the supervisors directly or indi-rectly depending on the patients’ problem,bearing in mind the fact that the method ofgiving feedback did not jeopardize theircredibility in the eyes of the patients ortheir families.

Since the students encounter the profes-sional role of the occupational therapy inclinical settings for the first time in theirfirst clinical experience, the participantsstressed the necessity of recruiting deter-mined and experienced supervisors in thefirst clinic. This demand may be due to thedifference between novice and experiencedsupervisors with respect to supervision andtraining methods. In their study, Christie etal. found that novice supervisors are inflex-ible and address needs of the students less,but experienced supervisors are more flexi-ble, which seems to make them to be moreself-confident and pay more attention to thestudents (15). Although the aim of thefieldwork education process is to make the

students independent in clinical practiceand promote their professional prepared-ness, our findings are indicative of the dif-ference between the supervisors in themethod of education and establishment ofindependence. Therefore, in some clinicsthe supervisors gradually establish inde-pendence and in some cases, the studentshave an experience of being free with lim-ited supervision and collaboration, whichforces them to move more rapidly towardsindependence. This difference between theattitudes of different supervisors can be as-sociated with their preparedness for thefieldwork education. In another qualitativestudy, the students stated that the supervi-sors needed more knowledge of the field-work education and had to acquire the nec-essary preparation skills before beginningof the clinic (21, 33).

Documentation and reporting are amongthe duties assigned to the students in occu-pational therapy clinics. The findings inthis context revealed low motivation of thestudents to do such assignments. They rec-ognized such reasons as lack of an estab-lished scientific method, ignorance of re-ports by occupational therapists and otherstaff, duplication of the reports and in somecases the supervisors’ lack of interest inreporting.

Lecture presentations can enhance thestudents' knowledge and their readiness forpractice in clinics. The experiences of thestudents indicated that they emphasized thenecessity and importance of lectures, butthey believed that the lectures should bediverse, practical and organized in groups.The limited access of the students to theresources and not determining the resourcesby the supervisors were among the prob-lems stated by some participants. The find-ing of our study about the problem of hav-ing access to the resources was highlightedby the students in the study conducted byMulholland and Derdall (21).

This study also indicated that there wasno clear-cut structure for the evaluation ofthe students’ performance in the clinics;and written, oral, collective and individual

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forms of evaluation were seen in the clin-ics. The students had different preferencesin this regard, but they all mentioned it inthe evaluation. The students’ functional as-pects should be considered more than thetheoretical aspects and the pre-clinic exam;and the method of evaluation should be de-termined from the very first day. It seemsthat the lack of a specific conductive planhas produced diverse ways to evaluate thestudents.

According to the approved curriculum ofoccupational therapy at undergraduate lev-el, all students should pass the theoreticalcourses before the beginning of the field-work education. From the viewpoint of thestudents, the long interval between thecoursework and clinical practice causedthem to forget many concepts. As believedby the students, some theoretical courseswere not applicable and the arrangement ofthe courses in the educational semestersshould be revised. Some studies indicatedthat the students need preparation beforeentering the clinic (21) and pre-fieldworkpreparation may ensure a successful clini-cal practice experience for OT students(30).

Among the pre-clinic courses, the clini-cal observation course is presented with theaim of preparation of the students for thepresence in the clinic and beginning thefieldwork education, but the students statedthat this course was not effective and didnot meet their needs. In their opinion, thisis due to the inappropriate organization ofthis course, which has made its sessionslow in number. The students have an inac-tive role during clinical observation, andthe supervisors have little supervision onthe students and underestimate this course.The experience of the students about inac-tiveness is a finding that is consistent withthe experiences of American students in the1980s as suggested in the studies of Kau-tzman (17) and Shalik (35).

Some categories explained in this studywere related to the planning of occupationaltherapy departments. The participants be-lieved that the start of the fieldwork clinics

from the sixth semester was inappropriate,and it imposed excessive pressure on themduring their last semesters. They also indi-cated that the rules of clinics were unclearand inexperienced and newly-graduatedsupervisors were recruited in some clinics.In general, the lack of a well-structuredfieldwork education plan is a drawback ofoccupational therapy departments.

The experience of the students in the clin-ical settings outside of the faculty indicatedthat the presence of other occupationaltherapists in the environment might haveboth positive and negative effects on thefieldwork education process. Furthermore,the negative attitude of other staff towardsoccupational therapy services made thestudents witness inappropriate referrals ofpatients to occupational therapy and igno-rance of occupational therapy in the treat-ment team. Positive attitude can be en-hanced by further interactions between theoccupational therapists working in thesesettings with other professionals. Physicalcharacteristics of educational environmentsalso influenced the experiences of the par-ticipants as they complained about absenceof facilities and lack of space, dispropor-tionate number of students and size of theclinics and low number of patients; theyalso believed that the presence of the pa-tients with various diagnoses in the centersmight have positive effect on fieldwork ed-ucation.

Generally, the findings of this study couldhelp the instructors to improve the integra-tion of course work with fieldwork educa-tion. Also, it can help the supervisors toprovide feedback to the students usingmore appropriate methods. In addition, thefindings of this study could benefit educa-tional programs and it may also help de-partment managers and fieldwork coordina-tors to select experienced and skillful su-pervisors for the first fieldwork educationand provide practical guidelines for the su-pervisors. However, further investigationsare necessary to explore the experiences ofmanagers, coordinators and other involvedparties in the fieldwork education process.

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M. Rezaee, et al.


This study was conducted only on the stu-dents of three occupational therapy depart-ments in Tehran. Therefore, the results ofthis study may not be generalized to stu-dents of other majors or other occupationaltherapy departments.

ConclusionThe results of this study indicate that the

research participants did not have satisfyingexperiences during their first fieldwork en-counter. Furthermore, the findings clarifiedthree main areas as the most important fac-tors of students’ experience: the importanceof supervisors, the fieldwork environmentand the curriculum. The researchers rec-ommend educational planning authorities toconsider the implications of these three keyareas, while addressing the feedback andcomments of the students. Further researchis suggested to explore each of the study’skey themes, and examine the relationshipsbetween them. Moreover, further investiga-tion is needed to capture the experiences ofthe supervisors, department managers andother parties involved in the occupationaltherapy fieldwork. Furthermore, it is note-worthy to mention that a grounded theoryapproach may be valuable in identifyingfactors, which underlie fieldwork dynam-ics.

AcknowledgmentsWe wish to acknowledge the occupational

therapy students who willingly participatedin this study. This article was based on thefirst author’s PhD dissertation at the Uni-versity of Social Welfare and Rehabilita-tion Sciences. The support of the Universi-ty is kindly appreciated.

References1. Christie B.A, Joyce P.C, and Moeller P.L.

Fieldwork experience, Part1: impact on practicepreference. The American Journal of OccupationalTherapy, 1985a. 39(10): p. 671-674.

2. Gaiptman B. and Anthony A. Contracting infieldwork education: The model of self-directedlearning. Canadian Journal of OccupationalTherapy, 1989. 56(1): p. 10-14.

3. Henderson A, et al. Students’ perception of thepsycho-social clinical learning environment: anevaluation of placement models. Nurse EducationToday, 2006. 26(7): p. 564-571.

4. Cohn E.S, and Crist P. Back to the future: newapproaches to fieldwork education. The Americanjournal of occupational therapy.: official publicationof the American Occupational Therapy Association,1995. 49(2): p. 103.

5. Kramer P, and Stern K. Approaches toimproving student performance on fieldwork.American Journal of Occupational Therapy, 1995.49(2): p. 156-159.

6. Hays C. Statement: Purpose and Value ofOccupationalı Therapy Fieldwork Educationı.American Journal of Occupational Therapy, 1996.50(10): p. 845.

7. Missiuna C, Polatajko H, and M. Ernest-Conibear, Skill acquisition during fieldworkplacements in occupational therapy. CanadianJournal of Occupational Therapy. , 1992. 59(1): p.28-39.

8. Cohn E.S. Fieldwork education:professionalsocialisation, in Willard and Spackman'soccupational therapy,H. Hopkins, L. and H. Smith,D., Editors. 1993, Philadelphia:lippincott.

9. McKay E.A, and Ryan S. Clinical reasoningthrough story telling: examining a student's casestory on a fieldwork placement. British Journal ofOccupational Therapy, 1995. 58(6): p. 234-238.

10. Cohn E.S. Fieldwork education: Shaping afoundation for clinical reasoning. The AmericanJournal of Occupational Therapy, 1989. 43(4): p.240-244.

11. Crowe M.J, and Mackenzie L. The influenceof fieldwork on the preferred future practice areasof final year occupational therapy students.Australian Occupational Therapy Journal, 2002.49(1): p. 25-36.

12. Greenstein L.R. Student Anxiety TowardLevel II Fieldwork. The American Journal ofOccupational Therapy, 1983. 37(2): p. 89-95.

13. Mitchell M.M, and Kampfe C.M. Copingstrategies used by occupational therapy studentsduring fieldwork: An exploratory study. TheAmerican Journal of Occupational Therapy, 1990.44(6): p. 543-550.

14. Mitchell M.M, and Kampfe C.M. Studentcoping strategies and perceptions of fieldwork. TheAmerican Journal of Occupational Therapy, 1993.47(6): p. 535-540.

15. Christie B.A, Joyce P.C, and Moeller P.L.Fieldwork experience, Part 2: The supervisor’sdilemma. The American Journal of OccupationalTherapy, 1985b. 39(10): p. 675-681.

16. Snow T, and Mitchell M.M. Administrativepatterns in curriculum-clinic interactions. TheAmerican Journal of Occupational Therapy, 1982.36(4): p. 251-256.

17. Kautzmann L.N. Perceptions of the purpose of

Dow

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ded

from

mjir

i.ium

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.ir a

t 1:0

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ST

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2020




Level I fieldwork. The American Journal ofOccupational Therapy, 1987. 41(9): p. 595-600.

18. Meyers S.K. Program evaluations ofoccupational therapy Level II fieldworkenvironments: A naturalistic inquiry. OccupationalTherapy Journal of Research, 1989. 9(6): p. 347-361.

19. Swinehart S, and Meyers S.K. Level Ifieldwork: Creating a positive experience. TheAmerican Journal of Occupational Therapy, 1993.47(1): p. 68-73.

20. Tompson M, and Ryan A. Influences onstudents during their early fieldwork placements.Canadian Journal of Occupational Therapy, 1996.63(3): p. 173-182.

21. Mulholland S, and Derdall M. An earlyfieldwork experience: student and preceptorperspectives. Canadian Journal of OccupationalTherapy, 2007. 74(3): p. 161-171.

22. Rassafiani M, and Zeinali R. Occupationaltherapy in Iran. Therapies and TherapeuticTechnology, 2007.

23. Fallahpour M. A review on occupationaltherapy in Iran. Iranian Rehabilitation Journal,2004. 2(2): p. 5-8.

24. Iwama M.K. Meaning and inclusion:Revisiting culture in occupational therapy.Australian Occupational Therapy Journal, 2004.51(1): p. 1-2.

25. Downe-Wamboldt B. Content analysis:method, applications, and issues. Health care forwomen international, 1992. 13(3): p. 313-321.

26. Elo S, and Kyngäs H. The qualitative contentanalysis process. Journal of Advanced Nursing,2008. 62(1): p. 107-115.

27. Graneheim U.H, and Lundman B. Qualitativecontent analysis in nursing research: concepts,procedures and measures to achieve

trustworthiness. Nurse Education Today, 2004.24(2): p. 105-112.

28. Zhang Y, and Wildemuth B.M. Qualitativeanalysis of content. Applications of social researchmethods to questions in information and libraryscience, 2009: p. 308-319.

29. Krefting L. Rigor in qualitative research: Theassessment of trustworthiness. The AmericanJournal of Occupational Therapy, 1991. 45(3): p.214-222.

30. Chiang H.-Y.A, et al. An Investigation of theSatisfaction and Perception of FieldworkExperiences Among Occupational TherapyStudents. Hong Kong Journal of OccupationalTherapy, 2012. 22(1): p. 9-16.

31. Beltran R.O, et al. The effect of first yearmental health fieldwork on attitudes of occupationaltherapy students towards people with mental illness.Australian Occupational Therapy Journal, 2007.54(1): p. 42-48.

32. Penny N.H, Kasar J, and Sinay T. Studentattitudes toward persons with mental illness: Theinfluence of course work and Level I fieldwork.American Journal of Occupational Therapy;American Journal of Occupational Therapy, 2001.55(2): p. 217-220.

33. Li-Tsang C.W.P, et al. An Explorative Studyof an Emerging Practice Clinical EducationProgramme for Occupational Therapy Students.Hong Kong Journal of Occupational Therapy, 2009.19(2): p. 44-49.

34. Scheerer C.R. Perceptions of effectiveprofessional behavior feedback: Occupationaltherapy student voices. The American Journal ofOccupational Therapy, 2003. 57(2): p. 205-214.

35. Shalik L.D. The level I fieldwork process. TheAmerican Journal of Occupational Therapy, 1990.44(8): p. 700-707.

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