OT Education

Update: Please read this in relation to the comments attached!!

OK lets cut the crap, this article isn’t going to help you make you a better OT student, its not going to give you constructive advice on how to best use your limited practice time and its not going to be pretty. It is, however, going to give you the powers to bullshit your way to the best grade possible and have hypnotic control over your educator. After only a few weeks you will see results. By the end of your placement your practice educator will be waiting patiently by your desk, on all fours, drooling from the mouth and asking for ‘another MOHO biscuit’.

Always carry a black pen – When everything is going well and there are no significant flaws in your work practice educators tend to regress to Freud’s anal stage, in which the smallest details are highlighted to you, ostensibly returning the educator to the position of authority.

Go for a drink with them – As Oscar Wilde recognizes it is not what one does in work that makes one successful but what one does outside of work. Quite

Feign ignorance – Of course you know what a functional split is or errorless learning or CBT or solution focused therapy. You know because you are aware of current evidence base and NICE guidelines. Thing is your practice educator graduated from a Women’s Institute craft school in the 1930’s and have held on to the one or two stands of knowledge that dementia has not whittled away. Just say, “oh how interesting, I really did not know that…well done”.

Furnish their Ego’s – Don’t be fooled into thinking the Educator is an altruistic in nature. The educator resents being legally obliged to have a student and will moan about the inconvenience at every opportunity. Instead the educator wants to be both admired and loved. Love them and admire them.

Ask them to be an accomplice - At your midway interview say how you are aiming for the best possible grade and would like their assistance in pushing you that bit harder. Demand criticism! (Reverse psychology works every time)

The anti COPM – Don’t be fooled into thinking that it is a student-centred relationship - The educator is the main problem definer.

Flirt – If you fail to win them over with your clinical reasoning skills try blinding them with more primitive influences (please refer to Maslow’s hierarchy of needs). This will subvert the balance of power and make it more equal (only in a smutty way, not in a professional capacity).

Threaten – If your final review didn’t go quite as planned the ‘final solution’ is the good old-fashioned ultra violence. You can employ many techniques including verbal and non-verbal behaviour. Borrowing lines from famous films is recommended if your mind goes blank from the anticipated sadism that you are about to create – “I’m gonna make you an offer you can’t refuse” is a good one. Counting backwards with a threat at the end is always intimidating too. The last tip is to slowly walk over to the door and lock it, then walk behind the educators back laughing nervously, like a James Bond baddy.

Quote Kielhofner - If all else fails just spout some Kielhofner rubbish. Showing your practice educator MOHO is like showing a monkey an ipod: It doesn’t understand it yet it will look puzzlingly at it for hours on end.

Go forth and succeed!

(Image Courtesy of epc @ flickr - Licensed under Creative Commons)

I’m sitting at my computer trying to write a presentation for a conference later this week but struggling to keep focused. Why? Its because I’ve been introduced to another social-networking site - this time its facebook. I figured that instead of wasting work time on it I would turn it into a reflective piece for meta-ot - so enjoy!

Now I had heard of it for ages - but largely I thought that the majority of contributors were students and I simply figured it was another myspace - full of unending tedious messages from friend to friend and random media that would have no interest in anyone other than the intended audience*. But recently I was introduced by an old school friend and on a bored Saturday afternoon I signed up. For about a week I became obsessed - I have had the amazing pleasure of “bumping” into old friends and stalking old workmates. Put simply its what friends reunited was meant to be. So then why am I writing about it on this site? Well typing in “occupational therapy” brings up a staggering 83 groups - some not actively written on but that’s beside the point. And the most interesting thing is this: they aren’t all (so it seems) students using them. But what are the discussions? Lets take a quick look at a few:

• “Bored Of Fluffy Occupational Therapy” (55 members)
• “Collaborating & Sharing Ideas With Other Occupational Therapists” (71 members)
• “I’m tired of having to explain what Occupational Therapy is!” (2108 members)
• “I wish i didn’t choose Occupational Therapy as a career” (20 members) (has the amusing address of 77 Kielhofner way) This one has, somewhat ironically, the BAOT logo as the groups logo.
• “Yes, I am a Occupational Therapist and no we don’t wipe bums!!” (366 members)
• “British OT’s” (83 members)
• “LOOKING FOR A MAJOR? NOT SURE WHAT TO DO? O.T. is the way to go!!” (15 members)
• “My OT professor wants me to do what….?!?” (57 members)
• “Booze Drinking Occupational Therapy Students (B-DOTS)” (89 members)
• “OTs are hot” (260 members)
• “Why do physio’s think they are god’s gift (applies to vast majority)” (126 members)

And a whole load of “OT’s [some-college] [some-year]” which are usually specific to a particular college/university and graduation year.

Now some thoughts. If I was a recruiter I could just as easily use it for work reasons as well as social reasons and look up a potential candidate. Would a candidate who has joined “I wish i didn’t choose OT as a career” be a potentially wise choice for a post? This potential danger is not unheard of - anyone can google your name and come up with a posting from 5 years ago where you may have belittled a previous boss - but facebook makes the whole process a little easier - and, by its nature of being one of the largest social networking social sites - entirely likely that your candidate is on the site.

It is this general concern that someone I recently spoke to stated as to why they didn’t want to contribute to putting things online in such a public way. I would argue this fact shouldn’t scare OTs away from joining in with discussion. Lets put it another way, in comparison to my above recruitment problem: would someone who has posted to “Bored of fluffy Occupational Therapy” and trying to change the profession actually strengthen their position for a post?

Purely because your view may not be the same as others is not a reason to not join in with debate. For example, reflection - in whatever form you decide to use it, may involve discussing difficulties of working with colleagues, or dare I say it - clients. But in the same way that you were trying to talk to your boss about a potential working-relationship problem you would (I hope) try to be professional. Its in your own interest, and ultimately the professions (remember these groups are public! Imagine you are a potential client and find out that your OT doesn’t believe in what they are doing? what kind of image does that give?). Although I realise, more than anyone, that there are times that you just want to go “aarrgh I hate this!” doing it so publicly may be a tad dangerous. Just be careful - that’s all.

Conversley, facebook - along with blogging etc, is a easy way of getting to know your online peers. Facebook is, by its very nature, good at finding others who have your same interests and background. It can be a little stalkerish in a way - but I would be interested to see how it develops as a social-networking cum-working tool.

* myspace suffers somewhat from multiple-design-failure which doesn’t help my hatred for the service.

Yesterday I had the pleasure of attending London South Bank University’s Learning & Teaching Conference. I was asked to speak about my experiences of the learning process and in particular how I found the teaching of research within the 2-year Post-Graduate Course. I wasn’t entirely sure how to tackle this subject but in the end I think it worked out OK, even though it turned into a discussion of Problem Based Learning & its Pro’s and Con’s rather than research per se. The following may be useful to those struggling to come to terms with the whole PBL concept as well as those who attended the conference. Find attached the original slideshow as a PDF and below a text version of the talk (with some extra content which I can add with hindsight). Hope its useful! Read on for the full article..

Please find on this site a concise listing of all Current OT Courses as of August 2006. These course listings are different from those listed as on the various country OT associations websites/publications however they are far easier to navigate and with the option to provide feedback on the courses. We welcome feedback from ex-students and the like and moderate all comments. Please realise that courses are constantly changing and are updated frequently.

UK Courses http://metaot.com/ot-courses-uk
USA Courses http://metaot.com/ot-courses-usa

I have finally had five minutes to make live the OT Courses list of USA Courses. It has been a nightmare to be honest - If you are from the US and can spare some time to help improve the data please step forward - Im hoping this will be a useful resource but it will only be if the data is accurate!

See here for the BIG list http://www.metaot.com/ot-courses-usa

Please feel free to comment but once again note that the list will be moderated!

“Well at least she’s prettier
than the last OT I had”

Around 12,000 years ago in a stone aged settlement in central Europe, a tribal elder made a decision that would change the course of civilization forever, and eek mankind one notch further on the evolutionary scale. This man decided to unleash the family goat from the nearby tree, and guide it to the warmth and protection of the hut. From that moment on, the history of animal domestication began. 10,500 years later, on the battle fields of the Crimea, Florence Nightingale reflected on this giant leap for mankind, and its potential benefits to the disabled; “a small pet is often an excellent companion for the sick, for long chronic cases especially”. For maximum pleasure Ms. Nightingale suggested a small “caged bird”. Decades earlier the Moral Managers of the York retreat in England envisioned that animals could become an important part of psychiatric treatment, helping lessen the need for medication and restraint. Since then animals have consistently been used in health care from guide dogs to helper monkeys. Can animals continue to play a role in the 21st century healthcare system, or should they be consigned to the history books? ”¦And what’s it all got to do with OT anyway?

Over the last decade, a wealth of studies have emerged to support the widely held anecdotal views that animals can be ”˜therapeutic’. A large proportion of these have looked at the benefits of animal assisted therapy (AAT) or therapy involving a trained (furry) animal and its owner, as opposed to a ”˜service animal’ such as a guide dog. A common finding between the studies is that animals have an intrinsically therapeutic effect on patients. Studying the benefits of a companion dog for patients with schizophrenia, for example, Barker, and Dawson (1998) found that the caring human-canine relationship helped ground the patient in reality. In another study Arnold discovered that for patients with dissociative disorders, a dog was a calming influence, which not only relaxed the patient but also gave the patient confidence to interact more with the healthcare professionals. Similarly, Holcomb and Meacham (1989) found that AAT was most effective in engaging patients who were most isolated on the ward. The conclusion made by Arnold (1995) is that interacting with the dog posed fewer demands than other traditional therapy groups that may have otherwise caused states of increased anxiety.

Although this evidence clearly expounds the comforting qualities of AAT, some critics have suggested that there needs to be more task-focused research in order to make it more clinically relevant for professions such as OT’s.

A study by Oakley and Bardin (1998) highlights the measurable effects of AAT on children recovering from traumatic brain injury. In treatment sessions at St Mary’s hospital for children in New York, the OT’s incorporate a dog into therapy sessions in order to satisfy specified goals. If, for example, a child has difficulty dressing and grooming due to decreased function on one arm, the therapist will get the child to reach out with the affected arm and stroke the dog. The child then becomes motivated and excited to participate in the task, and eventually attains the goals quicker than anticipated without the dog. According to Davies (1998) this is not only a fun activity for the child on a psychological level, but one that operates on a biological level too. Tests show that when stroking dogs, the blood pressure of children, and adults, decreases, even when performing an unpleasant task simultaneously.

The potential benefits of AAT to peoples physical health has more resonant implications for older adults. Recent studies have confirmed that pet owners experience greater longevity than their non-pet owning counterparts. A recent Australian study, for example, involving 5,741 participants found that pet owners had significantly lower blood pressure and triglyceride levels compared with non-pet owners (Anderson, Reed, Jennings, 1992). These findings could not be explained by other influencing factors such as smoking, alcohol consumption and social status. The exact causal link between animals and good health however is still unclear, ranging from the intrinsic anxiety reducing qualities of animals to, simply, the benefits of dog walking.

How can these findings relate to OT practice? For a start many OT clients are pet owners, and each has or could have a responsibility of care for that animal. The demands of looking after that animal such as feeding, cleaning andexercising the animal all rely on complex co-ordinated movements, exercise tolerance and even social interaction. This will help embed a structured routine into the client’s day. So, next time you are on a home visit, don’t just step over the dog or pat it on the head, think how the animal can be incorporated into an achievable and measurable goal for the client in his or her rehabilitation. Dr Albert Schweitzer, a leading expert of animal therapy, believes that animals have an important role to play in the future of health care “as we except animals as potential healers and major contributors to our health, wellness and vitality”¦we need a new wiser concept of animals’. In order for this vision to be fully realised, however, more evidence is needed that looks at specific, task related, AAT interventions and outcomes.

If OT’s fail to keep on top of the developments in the world of AAT then we are potentially leaving the door wide open for helper monkeys to take over our jobs. This monkey (above) is already working as a Senior I in Basingstoke ICT.

References

Anderson WP, Reid CM, Jennings GL: Pet ownership and risk factors for cardiovascular disease. Medical Journal of Australia 157:298-301, 1992 [Medline]

Arnold JC: Therapy dogs and the dissociative patient: preliminary observations. Dissociation 8:247-252, 1995

Barker S, Dawson K: The effects of animal assisted therapy on anxiety ratings of hospitalized psychiatric patients Psychiatric Services 49:797-801, June 1998

Beck A, Katcher A: A new look at animal-assisted therapy. Journal of the American Veterinary Medical Association 184:414-421, 1984 [Medline]

Davis JH: Animal-facilitated therapy in stress mediation. Holistic Nursing Practice 2:75-83, 1988

Holcomb R, Meacham M: Effectiveness of an animal-assisted therapy program in an inpatient psychiatric unit. Anthrozoös 2:259-264, 1989

Oakley D, Bardin G: The potential benefits of animal assisted therapy for children with special needs, 1998 (www.kidneeds.com)

10 minute guide to Activity Analysis
Activity Analysis: What is it?
The ability to analyse activity in minute detail is one of the unique skills of an OT (Hagedorn 1992). Activity analysis or "the exploration of the typical contexts, demands and potential meanings that could be ascribed to activity" (Crepau 2003 p191) has two main purposes - to identify difficulties and problems experienced by the individual in activities and provide specific interventions that are meaningful and purposeful to the individual.

How?
The content of the activity must be analysed and evaluated. Note that there is no one set way to achieve activity analysis - different authors vary in their approach and terminology. The first stage in any method however is to understand what is required of an individual to perform the activity competently. Items to consider should include (Hagedorn 1992):

• Performance components required (e.g. cognitive, motor, interpersonal - the headings for each may depend on the model being used)
• Degree of complexity
• Positive or negative social or cultural aspects
• Structured or Unstructured activity?
• Familiar to a person?
• Tools and environment required to perform the activity
• Safety and risk concerns
• Potential for engagement of patient interest and participation
• The tasks that make up the activity:
• sequence and flexibility of order
• task components (some define this as "task analysis")

Remember this first stage is to investigate activity - which remember is context-free (See box). Think of it as how someone would 'normally' perform the task*.

The next stage is to investigate the activity in context and discover how the person in question performs the required elements. Although often innately achieved by a therapist, there are a number of formats to achieve this. Lamport, Coffey and Hersch (2001) give some suggested forms to discover expected performance and for therapeutic intervention. The AOTA (in Crepau 2003) suggest one format that breaks down performance components into motor skills, process skills and communication/interaction skills (Crepau 2003 p193). A form that investigates expected and actual performance for a activity can be downloaded to use for your own use here (word, pdf). This is largely based on the Lamport et al text and you will need to refer to descriptions of the performance components to understand this form although its relatively straightforward. Note that some elements are missing from the form; these are mainly the performance contexts and should be taken into account within any activity analysis.

What now?
With the understanding of normal function and ability and being able to highlight those areas of difficulty seen by the individual it is possible to combine the two and formulate meaningful treatment plans. This will typically involve the use of graded activity - sequentially increasing the demands of an activity on a person to stimulate improvement in their functional ability (Crepau 2003). This will differ depending on the nature of the identified problems and theoretical approaches being taken (including Model, Approaches and Frames of Reference). Adapting the activity may also be required. Both adaption and grading requires modification and planning of not only the activities steps but also the context (e.g. environment).

* Im not keen on the word 'normal' but for clarity it is used here.

References
Lamport N.K., Coffey M.S, Hersch G.I (2001) Activity Analysis & Application, 4th Edition, NJ: Slack
- A nice text. Its slightly unrealistic to expect a practitioner to carry out all 5 forms suggested in the book but note that it has been designed to facilitate learning rather than for practice. What is useful is that the authors have gone to some effort to create steps to perform activity analysis and use terminology that is common - making full use of the AOTA Uniform Terminology; repeated for reference in the appendix of the book. If you buy it you also get access to the forms for downloading (once only).

Crepau E.R. (2003) Analyzing occupation and activity: A way of thinking about occupational performance in Willard & Spackman's Occupational Therapy pp 189-198

Hagedorn R (1992) Occupational Therapy: Foundations for Practice, Edinburgh UK: Chuchill Livingstone

Trombly, C.A (1995) Occupation, purposefulness and meaningfulness as therapeutic mechanisms (Eleanor Clarke Slagle Lecture), American Journal of Occupational Therapy 47, 960-972

Just a quick one (more to come next week) but just to let the world know about another freebie book chapter that is available on the net. Titled "Leading and Managing Occupational Therapy Services: An Evidence-Based Approach" It looks like another one to add to the pile about bringing the evidence world into practice (what some may define as scholarship in practice). The sample chapter available here (pdf) is titled "Introducing others to evidence-based practice". Haven't had time to have a decent look myself yet but the full book details are available at the publishers FA Davis and Amazon for a bargain price (??) of $44 (not yet available in the UK it seems).

There are a lot schools using the Problem Based Learning (PBL) approach to educating health professions - including OT which now has a number of courses that are highly PBL focussed.

The theory behind PBL is that education should allow students to "learn how to learn". i.e. rather than teaching reams of facts parrot like fashion, students are given problems - or in Occupational Therapy - cases (e.g. referral information). These are then discussed in groups in a free-form fashion. Sessions are then broken down how the group decides to investigate and problem solve.

In short this method of teaching suits some students and not others. Some, often who traditionally "enjoy" tests and exams or are just used to the assessment approach can find this method of learning painful - "I can't see what we are learning?!" often being the response. Others it works well for. Some would argue that it suits a profession such as OT where questions are rarely known by any one person - a good clinician will be able to find the answers and best approach - that's what matters.

Evidence is for PBL is mixed with a large amount of research investigating as to how competent students feel they are in a given subject post-PBL teaching(see refs below and this page for a list of abstracts). Some new research (6th March 2006) from Washington University suggests that testing students is not only useful to assess a level of skill but also to improve learning and memory:

"Students who self-test frequently while studying on their own may be able to learn more, in much less time, than they might by simply studying the material over and over again," says Henry L. Roediger III, Ph.D. "Incorporating more frequent classroom testing into a course may improve students' learning and promote retention of material long after a course has ended."

( see here for the full press release via bb)

So perhaps a new middle line should be taken? Perhaps PBL teaching needs to highlight that students should self-assess themselves regularly with clear goals to attain. Note that Im stating "self-assess" - not self-evaluate which is commonly used in PBL teaching already. Evaluation of student involvement from a educator is also done. My argument is that you cannot evaluate until you have assessed your own skills - and not just "fact finding skills". This piece of evidence seems to suggest that not only is the assessment worthy but also may improve learning. Surely that's a good thing all round?

Refs:
"Repeated test-taking better for retention than repeated studying, research shows" at : http://www.eurekalert.org/pub_releases/2006-03/wuis-rtb030606.php

de Witt P, Franzsen D (1999) Evaluation of the Students' Experience and Their Learning Approaches in the Problem Based Learning (PBL) Component of the Occupational Therapy Course at the University of the Witwatersrand, South African Journal of OT 29(1):7-9

McCannon R, Robertson D, Caldwell J, Juwah C, Elfessi A (2004)Students' Perceptions of Their Acquired Knowledge During a Problem Based Learning Case Study, Occupational Therapy in Health Care 18(4):13-27

See also: "The PBL Handbook" http://meds.queensu.ca/medicine/pbl/pblhome.htm

Just a quick one - if anyone needs a "nice"* diagram of the stress-vulnerability model see attached. Its an adapted version from the very nice Mental Health Handbook by Trevor Powell. So citation to read something like "The Stress-vulnerability model adapted from Powell, 1992,p103, metaot.com 2005"

Update: If anyone wants a nice image of something for your case study see this page which is the online parts of "Abnormal Psychology by Nolen-Hoeksema"

* NB: its not perfect. far from it - I couldn't get my graphics package to do a arrow round the outside!