Q: You have indicated that level-2 fieldwork is a time for the new hand therapist to learn the application of OT theory in hand therapy practice. Isn’t this the responsibility of the academic program?
You are absolutely right. The integration of occupational therapy theory into practice of any type is the responsibility of the academic curriculum. Unfortunately, what many fail to realize is that the fieldwork experience is a part of academic preparation for practice.
Students do not learn all there is to know about occupational therapy during their brief time in the classroom and then enter the clinical setting as expert OTs. Clinical instructors are a critical part of the educational program for all fledgling clinicians and must accept this responsibility and its challenges, which are integral. There is no distinction in educational priorities between classroom and clinicals.
New occupational therapists/hand therapists have not even arrived at the level of a novice therapist when they enter the fieldwork arena. These students have acquired volumes of theoretical knowledge but have not learned its application despite level-1 encounters or the occasional live-patient demonstration in the classroom. It is only through the nurturing guidance of the experienced clinician that the student can begin the slow process of combining book knowledge with real-life application.
On April 20, the Representative Assembly voted to have the Commission on Education investigate the needs of clinical educators as part of its fieldwork initiative, with an eye toward establishing a voluntary credentialing program for CIs. The hand therapy clinical educator has an even more challenging role: to assist the student with the integration of occupational therapy theory and to ensure that that theory is not lost or “reduced” in a specialty knowledge-base that too often forgets how occupation, activity and function must mesh together.
The occupational hand therapy practitioner has an obligation to the profession of OT to assist students with their selection of treatment plans and applications that use the basic tenets of the field. With many programs requiring only the minimum number of weeks in fieldwork (two 12-week sessions for OTs and two 8-week sessions for OTAs), students who opt for placements in hand therapy may not have enough time to fully understand OT from one site alone. That is why this responsibility may belong equally to the hand specialist; once considered specialty practitioners, we might do a better service to the profession by recreating hand therapy in the eye of the student as an “OT” placement.
Teaching protocols and precautions is of utmost importance in hand therapy, but OT students also should focus on the volitional side of therapy by addressing patients’ needs, wants and desires. Students might use the Canadian Occupational Performance Measure to understand true patient goals and then apply the modalities of functional activity, re-training and adaptation to ensure that these goals are expeditious and meaningful. This concept must be valued and taught to the student OT practitioner.
Although one might argue that students must leave hand placements with an entry-level knowledge of hand therapy, I ask you to consider that the new clinicians must first have an entry-level knowledge of occupational therapy. There will be plenty of opportunities for them to memorize and apply protocols and to learn the feel of tissue and clinical diagnosing; what the students may never have the opportunity to see again as hand therapists is true OT at work.
We must give our students the basic tools of OT, those being the application of purposeful, meaningful and function-based activity. With these building blocks, the hope is alive that new grads will incorporate OT concepts into all future treatment plans and assessment tool selections. If students are simply expected to apply hand therapy techniques to patients, then the students will not gain the skills they need to generalize occupational therapy principles to other arenas and to empower patients to reach their goals. A clinical instructor can make or break a new occupational therapy practitioner.
And through this period of reflection, hand therapists themselves can revisit the fundamentals of OT and rekindle the flame of the passion that led them down this professional path.
There are very few opportunities in our professional careers where we must stop and think about what we believe, but clinical instructors are obligated by professional bonds to ensure that practitioners of tomorrow are truly practicing occupational therapy in a holistic manner and that this knowledge will take them wherever they choose to practice.
Deborah Amini, OTR/L, CHT, is director of the occupational therapy assistant program at Cape Fear Community College in Wilmington, NC. A 1983 graduate of Quinnipiac College, Hamden, CT, she is currently a graduate student in education at the University of North Carolina at Wilmington. She has been a clinical hand therapist for 12 years. Readers may reach her at (910) 251-5196 or by e-mail at firstname.lastname@example.org or through ADVANCE at email@example.com.