The Next Paradigm Shift in Occupational Therapy Education: The Move to the Entry-Level Clinical Doctorate.

The occupational therapy profession in the United States is considering another shift in the level of entry-to-practice education. Currently, all accredited U.S. occupational therapy education programs offer graduate-entry master's degrees or clinical doctorates. In 2014, the American Occupational Therapy Association Board of Directors published a position statement supporting the idea of moving all entry-level occupational therapy education programs to the clinical doctorate level by 2025. This article provides an overview of the proposed reasons for doing so and the potential impact of this move on future students, education providers, clients and families, employers, and third-party payers and funding bodies along with the implications for the occupational therapy profession internationally. An open, informed, transparent, multiperspective, comprehensive debate about this education paradigm shift is recommended. In August 2015 the Accreditation Council for Occupational Therapy Education decided that the entry-level qualification will remain at both the master's and the doctoral degree; it is anticipated, however, that the move toward the entry-level clinical doctorate will continue.

The entry-level occupational therapy clinical doctorate: advantages, challenges, and international issues to consider.

Internationally, occupational therapy education has gone through several paradigm shifts during the last few decades, moving from certificate to diploma to bachelors to masters and now in some instances to clinical doctorate as the entry-level professional credential to practice. In the United States there is a recommendation under consideration by the American Occupational Therapy Association (AOTA) that by 2025, all occupational therapy university programs will move to the clinical doctorate level. It should be noted, however, that the AOTA Board can only make recommendations and it is the Accreditation Council for Occupational Therapy Education (ACOTE) who has regulatory authority to approve such a change. What are the potential implications for the profession, our clients, and funders of occupational therapy services? What are the primary drivers for the move towards the clinical doctorate being the educational entry point? Is the next step in the evolution of occupational therapy education globally a shift to the entry-level clinical doctorate? This article reviews current literature and discusses issues about the occupational therapy entry-level clinical doctorate. The published evidence available about the occupational therapy entry-level clinical doctorate is summarized and the perceived or frequently cited pros and cons of moving to the clinical doctorate as the singular entry point to occupational therapy practice are considered. The potential impacts of the introduction of the clinical doctorate as the entry-to-practice qualification across the United States on the occupational therapy community internationally will be briefly discussed. If the United States moves toward the entry-level clinical doctorate as the only educational starting point for the profession, will other jurisdictions follow suit? Further discourse and investigation of this issue both inside and outside of the United States is needed so that informed decisions can be made.

A Historical Cross-Professional Perspective on the Fellowship in Occupational Therapy.

Health professions education is increasingly creating learning experiences after one's entry-level practice degree. Such experiences include residency and fellowship experiences for health professions practitioners. This review of residency and fellowship programs across several health professions includes the development of residency programs and the implications these developments have on occupational therapy. The analysis across health professions includes medicine, pharmacy, physical therapy, speech-language pathology, and occupational therapy. This thorough analysis can help guide the development of occupational therapy fellowships. This background provides a foundation to focus on the implications for emerging fellowships within occupational therapy. The findings can be utilized to assist in the development of new successful fellowship programs.

Meeting Global Rehabilitation Needs: The Development and Evaluation of an International Visiting Rehabilitation Student Program.

Collaboration to increase capacity for healthcare professionals requires careful planning, open communication, implementation, formative and summative evaluation, and sustainability. International collaboration to meet the rehabilitation needs of China requires a supportive structure of faculty and staff implementing the program. The purpose of this article is to explore the development of a collaborative international rehabilitation education program and illustrate outcomes as they relate to professional development, cultural competency, and healthcare team skills. A retrospective analysis of program assessment data was completed including pre and posttest survey results and focused interviews. Results indicate that program participants had a significant positive change in values and beliefs towards cultural diversity and increased awareness of interdisciplinary team skills which contributed to overall professional development as future rehabilitation practitioners. The description and assessment of the program also serves as a framework for the development of future collaborative international rehabilitation education programs. Future research could explore institutional growth and faculty development of collaborating educational institutions.

Occupational and Physical Therapists' Perception of Evidence-Based Practice.

BACKGROUND: The significance of evidence-based practice (EBP) cannot be overstated. However, literature on the perception of occupational and physical therapists toward EBP is scarce. METHODS: This survey study was intended to examine occupational and physical therapists' perceptions of EBP. A total of 47 of 261 practicing therapists in a health care system in the Midwest U.S. responded to the questionnaire previously developed by Rubin et al. RESULTS: The results of the study showed that therapists reported familiarity with the EBP process and maintained an overall positive attitude toward EBP. Of the five subscale measures of EBP, familiarity with EBP process had the greatest average score (3.82±0.48) followed by attitude about EBP process (3.73±0.37). The smallest mean subscale score was found on the measure of current engagement in EBP process (2.93±0.55). Therapists reported intent to engage in the EBP process but were less favorable to engage in EBP and only reported engagement in EBP a little less than "some of the time." Barriers to engaging in EBP included time, access, and the constraints of the responders' practice setting. Implications of this study resulted in recommendations for clinical practice and educational programs.

Impact of an interprofessional community-based educational experience on students' perceptions of other health professions and older adults.

Caring for older adults has become increasingly complex due to multiple health and societal factors. The purpose of this study was to evaluate the impact of an interprofessional community-based educational project on students' attitudes toward other health care professions and older adults. A pretest and posttest quasi-experimental research design was implemented with 64 participating students from four health care professions (nursing, occupational therapy, physical therapy, and pharmacy). These students completed the Interdisciplinary Education Perception Scale (IEPS) and Survey of Attitudes on Aging Scale (SAAS) before and following an educational experience with older adults. Qualitative data were collected through student reflection journals and focus groups with participating students. The results of the study showed that interprofessional community-based learning had a significant impact on some students' attitudes toward older adults. The difference between pretest and posttest reached a statistically significant level on the SAAS in occupational therapy (p = 0.013) and physical therapy students (p = 0.044). No significant differences, however, were found between the pretest and posttest in pharmacy (p = 0.097) or nursing students (p = 0.144). Similarly, the experience also had a positive impact on some students' perceptions of other health care professions as measured by the IEPS. A significant difference was found between the pretest and posttest in occupational therapy (p = 0.000) and physical therapy students (p = 0.028). This study indicates that interprofessional community-based learning can be an effective method for some students to increase their understanding and respect toward other health professionals and older adults.

Preventing practice errors and improving patient safety: an examination of case studies reflecting common errors in occupational therapy practice.

Like other health care professionals, occupational therapists make errors in clinical practice. Only recently have we systematically studied errors in occupational therapy practice. In this report, key findings from two grant projects in occupational therapy practice errors are further examined. Specifically, this report includes an in-depth analysis of five examples of occupational therapy practice errors in physical rehabilitation and geriatric settings. These examples from the five most commonly reported causes of errors found in a national survey study on occupational therapy errors are misjudgment, lack of preparation, lack of experience, lack of knowledge, and insufficient communication. For each of the five examples, hypothesized causes of errors and their implications for professional education training and current occupational therapy practice are explored. It is hoped that this report helps to better inform practice and educational approaches to contribute to the prevention and reduction of occupational therapy and other health care practice errors.

Development of the Sensory Processing Measure-School: initial studies of reliability and validity.

OBJECTIVE: The history and development of the Sensory Processing Measure-School are detailed, and findings of initial pilot studies are reported. METHOD: Multiple reviews, focus groups, case studies, and two pilot studies were used to develop the early versions of the tool. Internal consistency and discriminatory ability were examined. RESULTS: Internal consistency measured with Cronbach's alphas ranged from .93 to .99 in the first pilot study and .70 to .99 in the second pilot study. Children who were typically developing were correctly classified 92.3% of the time, and children with sensory issues were correctly classified 72% of the time. CONCLUSION: Initial results suggest that the tool is reliable and valid and discriminates children with and without sensory processing issues. Further research is under way with larger samples.

Occupational therapy practice errors in physical rehabilitation and geriatrics settings: a national survey study.

OBJECTIVES: The purpose of this survey study was to investigate occupational therapy practice errors in physical rehabilitation and geriatric practice settings. METHOD: Two hundred and forty-five (245) out of 994 surveyed occupational therapists who have practiced or currently practice in physical rehabilitation or geriatrics settings responded to a self-developed questionnaire. Descriptive statistical analysis was used to describe practice errors as to the types, causes, impact on, and responses of occupational therapists and work sites. Inferential statistical analysis was used to explore the relationships among different variables of interest including: the effect of the number of years of practice experience on the perceived impact of making errors on practice; the relationship between disclosure or nondisclosure of errors; and the types of coping strategies used by occupational therapists and work site administrators' responses to errors. RESULTS: The vast majority of practice errors occurred during the intervention phase of the occupational therapy process. Misjudgment, lack of preparation, and lack of experience were reported as the top three causes of practice errors. Various coping strategies-such as compensating for the errors by voluntarily devoting additional time for care of the patient, making and following a corrective plan, concentrating on the next step, or not letting errors interfere with daily work-were used by the occupational therapists when errors occurred. The types of coping strategies and work site responses appeared to be associated with the disclosure or nondisclosure of errors. CONCLUSION: Errors occur in occupational therapy practice. Making errors has considerable impact on occupational therapists as well as their future practice. However, disclosure of errors can often lead to positive outcomes.

The entry-level occupational therapy clinical doctorate: The next education wave of change in Canada?

BACKGROUND: Currently, Canada and the United States are the only two countries that mandate entry to the occupational therapy profession at the master's level. There was a recommendation considered by the American Occupational Therapy Association that by 2025 all education programs would move to the clinical doctorate level. In August 2015, the Accreditation Council for Occupational Therapy Education made the formal decision that for now, the entry-level qualification for occupational therapists in the United States will remain at both the master's and clinical doctorate levels. PURPOSE: This article presents an overview of the types of doctorates available, the pros and cons of moving to the clinical doctorate, and some potential questions that will need to be considered. KEY ISSUES: Is the next step in the educational progression of occupational therapy in Canada the entry-level clinical doctorate? What are the potential implications for the profession, our clients, and funders? IMPLICATIONS: Further discourse and investigation of this issue is needed.

CHIP: Facilitating Interprofessional and Culturally Competent Patient Care Through Experiential Learning in China.

Health care professionals have advocated for educating culturally competent practitioners. Immersion in international experiences has an impact on student cultural competency and interprofessional development. The China Honors Interprofessional Program (CHIP) at a university in the Midwest is designed to increase students' cultural competency and interprofessional development. From 2009 to 2013, a total of 25 professional students including twelve occupational therapy students, ten physical therapy students and three nursing students were enrolled in the programme. Using a one group pre and posttest research design, this study evaluated the impact of CHIP on the participating students. Both quantitative and qualitative data were collected in the study. Findings of the study revealed that CHIP has impact on students' cultural competency and professional development including gaining appreciation and understanding of the contributions of other healthcare professionals and knowledge and skills in team work. The findings of the study suggested that international immersion experience such as CHIP is an important way to increase students' cultural competency and interprofessional knowledge and skills. Limitations of the study included the small sample in the study, indirect outcome measures and the possible celling effect of the instruments of the study. Future research studies should include a larger and more representative sample, direct outcome measures such as behaviour observation and more rigorous design such as prospective experimental comparison group design. Future research should also examine the long-term effects of international experience on the professional development of occupational therapy students. Copyright © 2016 John Wiley & Sons, Ltd.

Brains rule! fun = learning = neuroscience literacy.

Brains Rule! Neuroscience Expositions is a project designed to improve neuroscience literacy among children and the general public by applying a model where neuroscience professionals transfer knowledge and enthusiasm about neuroscience through fun, engaging hands-on activities. This educational model draws strength from many national and local partnerships of neuroscience professionals to coordinate expositions across the country in a variety of local communities. Brains Rule! Neuroscience Expositions uses a flexible science fair-like format to engage children in the process of science and teach about neuroscience concepts, facts, and professions. Neuroscience literacy is important to everyday life and helps individuals better understand themselves, make informed decisions about health and drug use, participate knowledgeably in governmental and social issues, and better understand scientific advancements. In this study, children's ratings of Brains Rule! Neuroscience Expositions activities were analyzed both quantitatively and qualitatively. Analysis of the responses revealed that overall the children perceived the learning activities as fun and interesting and believed that they learned something about the brain and nervous system after engaging in the activities. The Brains Rule! Neuroscience Expositions education model can be an effective tool in improving neuroscience literacy for both children and adults.

Occupational therapists' responses to practice errors in physical rehabilitation settings.

OBJECTIVE: Errors occur in all health care professions. Practice errors, however, have not been systematically examined in occupational therapy. The purpose of this study was to examine occupational therapists' responses to practice errors in physical rehabilitation settings. METHOD: A qualitative focus group research method was used in this study and a total of 35 occupational therapists from four different states who had practice experience in physical rehabilitation settings participated in four focus groups. Focus group discussions were transcribed verbatim and analyzed by two investigators of the study. Qualitative software program, NUD*IST Vivo was used to aid the data analysis process. RESULTS: Five major themes were generated from the data regarding practice errors, which included (1) Concept of practice error: It is against our standards; (2) Perceived causes of practice error: Not just an individual matter; (3) Emotional responses: I felt horrible; (4) Impact on practice: Doing things differently; and (5) Management of practice error: Being honest and taking initiative. Occupational therapists perceived practice error from a broad perspective and identified physical and psychosocial issues as practice error. CONCLUSION: Most practice errors described by participants appeared to be preventable. Despite the tremendous emotional distress in reaction to making an error, participants valued the learning in the experience and made constructive practice changes. Findings of the study have implications for current educational training programs and practice such as the development of clinical reasoning related to patient safety and assertiveness training for hierarchical situations.

Interprofessional vs. interdisciplinary services in school-based occupational therapy practice.

Interdisciplinary or transdisciplinary service is strongly advocated in school-based occupational therapy practice. The terms, interdisciplinary and transdisciplinary, however, are not accurate in their use. This paper examines the difference between the terms of discipline and profession and recommends the more precise and appropriate use of interprofession and transprofession related to school-based occupational therapy practice. Occupational therapy is a profession, not a discipline. Using the terms of interprofession and transprofession can benefit the occupational therapy profession by increasing language use precision, facilitating professionalism, and improving interprofessional interactions and collaborations based upon accuracy.

Stability of tactile defensiveness across cultures: European and American children's responses to the Touch Inventory for Elementary school aged children.

Screening and assessment for single and discrete sensory systems, such as screening for tactile defensiveness, can provide valid information for identifying sensory processing dysfunction of children. Tactile defensiveness may be considered to be a specialized type of what was previously called a sensory integrative disorder and now is termed a sensory modulation disorder. The current study was designed to examine further the phenomenon of tactile defensiveness, particularly the stability of the concept, across different cultures. In this study, the test scores of 28 European children (16 girls and 12 boys of three different nationalities) on the Touch Inventory for Elementary School Aged Children (TIE) were collected and analysed (Royeen and Fortune, 1990). The TIE scores of the European sample were compared with that of the American sample in the original TIE study (Royeen and Fortune, 1990). Results revealed that the mean test scores on the TIE between the American sample and European sample were very similar (n = 415, M = 41.0 vs. n = 28, M = 39.5) and no significant difference was found between the two samples (t = 0.99, p < 0.05). Internal consistency of the TIE on the European sample was found to be good and close to that obtained from the American sample (0.78 vs. 0.89). The current study provides evidence that tactile defensiveness is a stable phenomenon across different cultures as measured by the TIE. Limitations of the study include use of a small and convenient sample of European children. Further studies are recommended to examine tactile defensiveness as a clinical phenomenon.

Effects of interprofessional rural training on students' perceptions of interprofessional health care services.

Interprofessional training has been advocated in the education of students in health care professions to facilitate collaboration and cooperation among health care providers. This study reported on one facet of the outcomes of a larger grant project funded by the Department of Health and Human Services HRSA grant #1-D36 AH 10082-03, which aimed to develop a new and innovative model for interprofessional student training. Over the 3-year period of the project, a total of 111 students from allied health professions including occupational therapy, physical therapy, and pharmacy participated in the project training. Participants' perceptions on interprofessional service were assessed before and after they participated in the project by the Interprofessional Education Perception Scale. Results of a univariate repeated measures two-way analysis of variance revealed a significant increase in participants' positive perceptions regarding interprofessional practice after they participated in the project (p < 0.05), and the significant increases were independent of the duration of the training (p < 0.01 for short-term and long-term training). A significant interaction between the duration of the training and pretest and posttest scores of the participants was found (p < 0.05) and students who participated in long-term training reported more positive attitudes on the posttest. These encouraging findings are supported and strengthened further by the qualitative data of the study, suggesting the training project has a significant impact on allied health students' perceptual attitudes toward interprofessional service delivery. Findings of the study are discussed related to the improvement of quality care and to the recruitment and retentions of health care providers in rural and underserved areas.

Teacher education professionals as partners in health science outreach.

Medical school and other health science outreach programs to educate and recruit precollege students always have relied on successful collaborative efforts. Creighton University shares the value, significance, and strategies of involving teacher education professionals in several of its current outreach programs, including HPPI, Brains Rule! Neuroscience Expositions, and HHMI Build a Human Project. The education department partner serves as an essential team member in the development, implementation, assessment, and dissemination of these projects to promote science and mathematics achievement and interest in medical careers. Specific examples and mistakes to avoid are included.

Comparison of on-campus and hybrid student outcomes in occupational therapy doctoral education.

We compared the graduate outcomes of doctoral students in a traditional on-campus occupational therapy program with those in a hybrid program. Participants were 81 students from an on-campus program and 13 students from a hybrid program. Graduate outcomes were measured with student grade-point average (GPA) at the end of each academic year, cumulative GPA, Fieldwork Performance Exam, National Board for Certification in Occupational Therapy (NBCOT) practice exam scores, and final NBCOT pass rate. Consistent with previous research, our results revealed no significant differences on most outcome variables, suggesting that hybrid programs are an effective delivery model for postsecondary higher education. These findings may provide guidance to occupational therapy programs in curriculum design, content delivery, and program refinement and development. Replication of this study is needed with a larger sample and inclusion of qualitative data. Future studies should compare the affective domain of graduate outcomes in on-campus and online or hybrid programs.

International practice experiences in pharmacy education.

OBJECTIVES: To identify reasons for inclusion of international practice experiences in pharmacy curricula and to understand the related structure, benefits, and challenges related to the programs. METHODS: A convenience sample of 20 colleges and schools of pharmacy in the United States with international pharmacy education programs was used. Telephone interviews were conducted by 2 study investigators. RESULTS: University values and strategic planning were among key driving forces in the development of programs. Global awareness and cultural competency requirements added impetus to program development. Participants' advice for creating an international practice experience program included an emphasis on the value of working with university health professions programs and established travel programs. CONCLUSION: Despite challenges, colleges and schools of pharmacy value the importance of international pharmacy education for pharmacy students as it increases global awareness of health needs and cultural competencies.

Fostering cultural competency, clinical reasoning, and leadership through international outreach.

ABSTRACT The Centennial Vision of the American Occupational Therapy Association (AOTA) has called for occupational therapy to be globally connected. Students can gain cultural competency, clinical reasoning, and leadership from attending didactic coursework and participating in discussions and clinical simulations. Immersing oneself in international settings, however, tends to have a greater impact on learning. The authors describe the outcomes of two international outreach programs: China Honors Immersion Program (CHIP) and Institute for Latin American Concern (ILAC). The outcomes of these programs indicate that students believe that such international experiences greatly affect their development, both professionally and personally. Implications of the program outcomes to current professional education are discussed. Future research directions are also proposed.