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Intraprofessional fieldwork education: Occupational therapy and

occupational therapist assistant students learning together


doi: 10.2182/cjot.06.05. This paper was published in the CJOT Early Electronic Edition, Spring 2006.

Bonny Jung n Penny Salvatori n Adele Martin

Key words
n Intraprofessional relationships n Collaboration n Occupational therapy education

Mots clés
n Relations intraprofessionnelles n Collaboration n Formation en ergothérapie

Abstract
Background. In the past 10 years, the use of support personnel in Canada has generated significant interest from occupational
therapists, professional associations, regulatory bodies, employers, educational institutions, and government agencies.
Purpose. The purpose of this study was to explore the impact of a combined collaborative fieldwork placement and weekly
tutorial as a teaching strategy for intraprofessional education. Methods. Seven pairs of student occupational therapists and
occupational therapist assistants were assigned to fieldwork placements. Tutorials were scheduled during the placements to
discuss intraprofessional issues and provision of occupational therapy services in the clinical setting. Journaling and focus
groups were used to collect data from students, tutors, and preceptors. Findings. Three key themes emerged from the data: (1)
developing the relationship, (2) understanding roles, and (3) recognizing environmental influences on learning. Implications.
Intraprofessional learning experiences prior to graduation can help prepare occupational therapy and occupational therapist
assistant students for future collaborative practice.

Résumé
Description. Dans les 10 dernières années, l’utilisation du personnel auxiliaire au Canada a suscité un intérêt chez les
ergothérapeutes, les associations professionnelles, les organismes de réglementation, les employeurs, les établissements
d’enseignement et les organismes gouvernementaux. But. Le but de cette étude était d’examiner les effets d’une stratégie
d’enseignement dans le domaine de la formation intraprofessionnelle basée sur un stage fondé sur la collaboration et un cours
hebdomadaire. Méthodologie. Sept paires formées d’étudiants en ergothérapie et d’aide-ergothérapeutes ont suivi des stages
cliniques. Des cours étaient prévus pendant les stages pour discuter de questions intraprofessionnelles et de la prestation de
services d’ergothérapie dans ce milieu clinique. La rédaction d’un journal et des groupes de discussion ont permis de recueillir des
données sur les étudiants, les superviseurs de stages et les tuteurs. Résultats. Les données ont permis de mettre trois thèmes en
évidence : (1) développer la relation, (2) comprendre les rôles, et (3) reconnaître les influences de l’environnement sur
l’apprentissage. Conséquences. Les expériences d’apprentissage intraprofessionnel avant l’obtention du diplôme peuvent
préparer les étudiants en ergothérapie et les étudiants aide-ergothérapeutes à collaborer dans l’exercice futur de leur profession.

n the past 10 years, the use of occupational therapy Willmarth (2005) reported that occupational therapists (OT)

I support personnel in Canada has generated significant


interest from occupational therapists, professional associ-
ations, regulatory bodies, employers, educational institutions,
and occupational therapist assistants (OTA) often struggle to
understand their roles and describe their own scope of prac-
tice to colleagues and the general public. Salvatori (2001) has
and government agencies. Although role delineation, super- suggested that “shared learning experiences for both profes-
vision, membership in professional associations, and accred- sional entry-level and assistant level students would facilitate
itation of educational programs remain issues that require collaborative relationships prior to entering practice”
further clarification and resolution, the use of (p. 226). Clearly there is a need not only to define roles and
support personnel is gaining national support as a viable and responsibilities of those involved in providing occupational
credible means of providing occupational therapy services therapy services but also to educate students at the profes-
(Canadian Association of Occupational Therapists [CAOT], sional and assistant level for future collaborative practice.
2003; Ferron, 2000). On behalf of the American This paper reports the findings of a qualitative study
Occupational Therapy Association, Yarett Slater and involving pairs of student OTs and student OTAs who partic-

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JUNG ET AL.

ipated in a unique intraprofessional learning experience that real world clinical practice by pairing student OTs and
combined a shared fieldwork placement with a small group student OTAs to provide client care, and (c) expanding
weekly tutorial. A review of the literature, methodology, find- opportunities for collaboration and teamwork (DeClute &
ings, discussion, and implications for the future are presented. Ladyshewsky, 1993; Higgins, 1998; Jung, Sainsbury, Grum,
Wilkins, & Tryssenaar, 2002). Mostrom, Ribesky, and Klukos
Literature review (1999) paired student physical therapists and student physi-
There is a paucity of literature on intraprofessional collabora- cal therapist assistants in clinical education placements and
tive practice and intraprofessional collaborative learning in identified similar benefits, such as peer support, enhanced
the health professions, particularly in the field of occupa- adaptation to the clinic, and increased knowledge of roles and
tional therapy. However, there is some emerging evidence responsibilities.
that collaborative practice makes a difference in patient/ In spite of the benefits of such placements, it has often been
client outcomes and that collaborative learning is useful to difficult to provide these collaborative learning experiences.
prepare therapists and assistant personnel for practice. Some of the challenges associated with collaborative learning
Valuable insights can also be gained from the burgeoning lit- include compromising individual learning needs because of a
erature on interprofessional collaborative practice and inter- group supervision model and difficulties associated with poorly
professional education that presents similar arguments. defined roles in some settings (Jung et al., 2002).
Problem-based learning (PBL) approaches that combine
Collaborative practice small-group tutorials with case-based learning in the educa-
According to Mickan and Rodger (2005), “the use of health tion of health professionals are now used worldwide
care teams to achieve quality and efficient patient care has (Salvatori, 2000). Studies show that these approaches facilitate
become widespread” (p. 358). Hayden-Sloane (2005) has the development of lifelong learners and are enjoyable for
identified the OTA as an important member of a collabora- both students and faculty (Maxwell & Wilkerson, 1990;
tive health team. Similarly, Blechert, Christiansen, and Kari Norman & Schmidt, 1992; Solomon, 1994; Steinert, 2004).
(1993) have discussed the importance of teamwork and team Visschers-Pleijers et al. (2006) have suggested that PBL
building for the effective delivery of occupational therapy approaches are consistent with the theory and research on col-
services. Roberts (2000) defines collaboration as the ability laborative learning. Salvatori (1999) concluded that “learning
“to work together, act jointly and cooperate” (p. 4). Key char- in a student-centred, problem-based curriculum constitutes
acteristics of collaborative practice are similar to those of ‘meaningful occupation’ for occupational therapy students”
effective teamwork and include a common purpose, profes- (p. 207). The role of the PBL tutor or facilitator is primarily to
sional competence, interpersonal skills, trust and respect, ask questions, promote problem solving and critical thinking,
effective communication, shared decision making, and a facilitate discussion among group members, and manage
shared value of interdependence (Hayden-Sloane, Mickan & interpersonal or conflict issues rather than lecturing, dissem-
Rodger; Rainville, Blechert, Christiansen, & Kari, 2005). In a inating information, and answering “content-related” ques-
qualitative study of 22 pairs of OT and OTA teams, Dillon tions as in the traditional role of teacher (Baptiste, 2003;
(2001) concluded that “effective intraprofessional relation- Barrows & Tamblyn, 1980). Tremblay, Tryssenaar, and Jung
ships enhance the quality of occupational therapy services (2001) have suggested that the role of the tutor is to act as a
provided” (p. 1). guide and an advocate, “challenging students to explore
depths and set standards of achievement” (p. 565).
Collaborative learning
Fieldwork experiences have long been used and highly valued Support from the
to bridge the gap between classroom preparation and entry to interprofessional literature
practice for both professional-level and assistant-level The rationale for more interprofessional education in the
students in occupational therapy. Blechert and Christiansen preparation of health care providers can also be used to
(1993) have discussed the importance of fieldwork in the support the need for more intraprofessional education. For
socialization process for occupational therapy support per- example, Freeth and Reeves (2004) attest to the value of col-
sonnel because it not only gives student OTAs opportunities laborative learning as a core aspect of professional practice.
to apply new knowledge and skills but also “to learn supervi- In a survey of occupational therapy and physiotherapy pro-
sory relationships” (p. 289). Pairing OT and OTA students in grams across Canada, Tryssenaar, Perkins, and Brett (1996)
collaborative fieldwork placements to explore these relation- reported a trend to maintain or increase levels of interdisci-
ships has not been common practice. Nevertheless, there is plinary educational activities at Canadian occupational ther-
increasing evidence that such collaborative learning experi- apy and physiotherapy programs and undergraduate levels.
ences can generate positive learning outcomes that include They add that educators need to make explicit in current
(a) learning about the roles of OTs and OTAs,(b) emulating educational practice what is anticipated for future clinical

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practice. Similarly, Gilbert et al. (2000) have argued that educational strategies to facilitate effective team building
“increasing emphasis on the delivery of integrated, interdisci- within the fieldwork setting while attempting to address
plinary, client-centred health care services in Canada some of the student concerns identified in the former study
demands that health care professionals have a sound knowl- by Jung et al. (2002). Ethics approval was obtained through
edge of the services provided by their colleagues as well as the the McMaster University Occupational Therapy Program
knowledge and skills to work effectively with them as a team” Education Committee and the Mohawk College
(p. 223). The interprofessional education literature also sup- Rehabilitation Science Advisory Committee. At the time of
ports the use of interactive problem-based learning the study, Mohawk College offered a 42-week certificate pro-
approaches to enhance future collaboration in practice gram for a combined Occupational Therapist Assistants and
(D’Eon, 2004; Solomon, Salvatori, & Guenter, 2003; McNairn, Physiotherapist Assistants (OTA and PTA) role, which
Stone, Sims, & Curtis, 2005) included 18 weeks of fieldwork placement. McMaster
In summary, there is some evidence in the literature that University offered a 24-month master’s-level entry program
collaborative fieldwork educational experiences and small- in occupational therapy, which included 28 weeks of field-
group, problem-based tutorials can enhance learning for work placement. This study was conducted in March and
student OTs and OTAs. However, no occupational therapy April in two consecutive years because it was the only time
program to date has used a combination of these two educa- when students from both programs were doing a full-time
tional strategies to foster intraprofessional education. fieldwork placement at the same time.

Purpose and objectives of the project Participants


The purpose of this study was to explore the impact of a Seven pairs of student OTs and OTAs participated in this
collaborative fieldwork placement combined with weekly study. The usual procedures for fieldwork placement selec-
small group tutorials on intraprofessional learning for OT and tion and assignment were followed, that is, these placements
OTA students. It builds on the previous work of Jung et al. were listed along with other placement options for student
(2002) that paired student OTs and student OTAs in fieldwork review. The students had opportunities to express their inter-
placements. Although Jung et al. reported positive outcomes est, and the fieldwork course coordinators used this informa-
in terms of intraprofessional learning and collaboration, they tion to assign the students to the placements. The fieldwork
also identified several challenges that the students faced, course coordinator then asked the students if they wanted to
including limited understanding of assignment, delegation, participate in the study, and all but one pair agreed. Students
and supervision issues; lack of awareness of current national were given the option to withdraw from the study at any time
guidelines re OT and OTA roles; minimal awareness of edu- with no consequences to their learning experience or evalua-
cation programs and skills training for OTs and OTAs; and tion. The student pairs were assigned to six in-patient hospi-
limited student commitment to equal learning partnerships. tal fieldwork settings in the southern Ontario region where
The combined fieldwork–tutorial experience in this OT and OTA roles had been established. One site offered the
study was designed to provide more opportunities for stu- placements during both years. The client populations served
dents to discuss these problematic issues in a tutorial setting through these placements were adults and older adults, and
while learning to work together during a fieldwork placement the practice areas were in mental health and physical health.
to provide occupational therapy services to clients. There The tutors and student preceptors (often referred to as
were two learning objectives in this program: (1) to learn fieldwork supervisors or clinical educators) served as sec-
about the roles and responsibilities of OTs and OTAs includ- ondary sources of information in this study. As Berg (2004)
ing supervisory relationships, and (2) to share knowledge and and Steinert (2004) have suggested, a comparison of student
work collaboratively in pairs to deliver occupational therapy and teacher perceptions adds an important research perspec-
services to individual clients. Essentially, the small group tive and serves to create a more comprehensive picture of the
tutorials were designed to enhance fieldwork learning and student experience.
thus strengthen the process of students’ acquiring knowledge, The preceptors were experienced fieldwork educators
developing skills, and building relationships in the placement and they agreed to participate in the study because of their
setting. interest in this unique educational model. In each clinical set-
ting, one OT preceptor ultimately was responsible for and
Methods supervised both the student OT and student OTA. The OTA
Context contributed to this learning model by supervising the student
Two educational institutions, McMaster University MSc OTA and actively facilitating the learning of both students.
(OT) Program and the Mohawk College occupational thera- Two educators with tutoring experience, one OT affili-
pist assistant/physiotherapist assistant certificate program, ated with McMaster University and one OTA affiliated with
continued their collaboration in this study to further explore Mohawk College, were recruited as co-tutors for the two-year

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project. The researchers thought that this co-tutoring the previous week. Each pair of students was also responsible
approach would serve as a model of collaborative practice for for preparing one case scenario from their clinical setting for
the students. See Table 1 for information on study partici- group discussion each week. Group discussions often focused
pants and learning experiences. on issues concerning role overlap, role conflict, assignment of
tasks, supervision, accountability, report writing, and collab-
Learning experiences orative planning.
During their placements, the OT and OTA students were
expected to meet the fieldwork objectives prescribed by their Data collection
education programs. In addition, the OT and OTA student A qualitative design was used to explore how this educational
pairs were expected to meet the specific intraprofessional model contributed to the students’ learning experiences.
learning objectives outlined for this study. During the five Student journals were the primary data collection tool.
weeks when placements overlapped, the students spent some Journaling is an effective tool that encourages self-reflection,
time working alone and some time working together in the critical thinking, and professional growth (Perkins, 1996:
clinical setting under the supervision of their preceptors. In Solomon et al., 2003). The students submitted reflective jour-
addition, student OT/OTA pairs from all fieldwork sites nals at least twice a week throughout the placement period
would meet together for a small group tutorial. Tutorials were and were asked to provide comments on any thoughts, feel-
scheduled once per week for two-and-a-half hours and took ings, concerns, or issues arising from the placement and tuto-
place at the Institute for Applied Health Sciences, the acade- rial experiences. The students were encouraged to address
mic setting which housed both the OT and OTA/PTA pro- some guiding questions: What do you hope to gain from this
grams. Each student received a resource binder with journal experience? Do you anticipate any difficulties? What did you
articles and documents published by professional associa- learn about yourself, the client, OT/OTA team, or the role of
tions and the provincial regulatory body that addressed cur- the health care team this week? What critical events had an
rent issues facing support personnel within the profession in impact on you and why? How could you apply what you have
Canada. During the tutorials, students had the opportunity learned to another population/situation in the future?
to discuss and debate these readings and to share any critical The students also participated in a post-placement, focus
incidents or key learning experiences that had occurred in group discussion. Those students who could not attend
received a questionnaire with the same questions used for the
focus group discussion: What were the strengths and weak-
TABLE 1
nesses of this placement experience? Did you benefit from
Study participants and learning experiences
the tutorial experience in terms of your clinical performance
and increased knowledge? Did you feel adequately prepared
Participants
and Learning for this supervision model? Were the binder resource mater-
Experiences 2003 2004 ial and pre-placement orientation session helpful? What are
your recommendations for future placements? Would you
Students • 4 OTA/PTA Year 1 • 3 OTA/PTA Year recommend this type of learning opportunity for your class-
Certificate Students 1 Certificate Students
mates/students in the future?
• 4 MSc OT students • 3 MSc OT students
• ( 2 Year 1 & 2 Year 2) • ( 1 Year 1 & 2 Year 2) The tutors submitted reflective journals throughout the
placement and had weekly debriefing meetings with one of
Preceptors • 1 OT and 1 OTA for • 1 OT and 1 OTA for the study investigators. The preceptors participated in a post-
each pair of OT/ each pair of OT/OTA placement focus group to share their perspectives on the stu-
OTA students students
dent placement experience. The preceptors were not asked to
Tutors • 2 (1 OT & 1 OTA) • 2 (1 OT & 1 OTA) journal because of the extensive time commitment involved
in this process, and it was felt that the focus group discussions
Fieldwork • Adult physical • Adult physical health would yield sufficient data to inform the study.
Sites health (n=3) (n=2)
• Adult mental health • Adult mental health
(n=1) (n=1)
Data analysis
The journals and audiotaped focus group discussions were
Placement • OTA - 7 weeks • OTA – 7 weeks transcribed. The three authors initially read the student jour-
Duration • OT - 5 weeks • OT - 5 weeks nals using a retrospective content analysis. Major topics were
clustered into codes and categories were developed. The tutor
Tutorials • 1 per week for 3 of 5 • 1 per week for 5 weeks
weeks (2 cancelled
and preceptor data were then reviewed to further refine the
because of SARS) categories that were developed from the student data. To
strengthen the trustworthiness of the data, the students

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received the categories for review. They were asked to com- We have been getting quite a lot accomplished due to our
ment on the information relative to their experiences and great working relationship and respect for each other. I
subsequent changes were made. This member checking hope that everything continues this great until the end of
ensures that the information has been translated as accurately the placement (student OT).
as possible and decreases the chances of misinterpretation I enjoy being around the OT student. This allows me to
(Creswell, 2003; Krefting, 1990). Overarching themes were see how she works. We were told that she would be
then developed from the identified categories. assigning me tasks by week 4 and at first I was a bit taken
aback but realize that is her job and my job is to go
Findings through those tasks (student OTA).
Data gathered from students, tutors, and preceptors sup- I don’t know if it’s [only] my third day, but I don’t really feel
ported the benefits of intraprofessional learning for OT and like I take orders from her. In fact, it doesn’t seem to be that
OTA students. Three key themes emerged: (1) developing the way with the OTs and the OTA either (student OTA).
relationship, (2) understanding roles, and (3) recognizing
environmental influences on learning. Understanding roles
Defined OT and OTA roles in the clinical setting as well as role
Developing the relationship modeling by the tutors in the educational setting, affected stu-
The students identified the importance of developing their dent collaborative learning. As students learned to work
relationship through activities that required shared learning, together, they began to understand their own roles better and
communicating effectively, and building trust and respect. A then to describe their roles in relation to their student partners.
number of strategies facilitated the peer/shared learning At times I feel as though they [OT students] are looked
process. For example, at the beginning of their placements, on as being much more intelligent and superior and this
students developed learning objectives that involved some sometimes makes me feel not so important; however,
joint activities. They also worked together on projects and over the last week I realized that my job is important and
client interventions in the clinical environment. In addition, at I play a big role in occupational therapy. (student OTA)
their weekly tutorials each student pair presented a case study I think that every OT student should have at least
to illustrate their complementary clinical teamwork. The one opportunity to work alongside OTAs [student or
nature of the student supervision model promoted graduates] so that they may learn the value of their role.
peer/shared learning within the clinical environment as evi- (student OT)
denced by this student’s comment: “I have been able to teach I have had the opportunity to work with the OT stu-
[my student partner] what we have learned in our OTA classes dent on a module for the mentally ill. This I think has
and she taught me what they have learned” (student OTA). been a turning point in our relationship because it gave
The importance of communication in client service us the opportunity to actually see what the other was
delivery between students and practicing clinicians surfaced capable of doing. (student OTA)
early in both the clinical and tutorial settings. Students dis- Students were able to articulate the differences and the
cussed profession-specific literature, consulted with each similarities in their respective roles. Many expressed some
other about client cases, resolved conflicts about caseloads, surprise at the other’s knowledge and skills.
and clarified terminology and methods of documentation. It was interesting to learn that they (OTA students) were
Communication is the key among all team members and familiar with concepts that are widely used in the OT pro-
the OT and OTA need to be on the same page for all clients gram (like client-centredness) and that they have to know
to be able to chart their progress and report at team meetings a lot of the same things that we learn about. (student OT)
(student OT). While we worked together with this client through-
We actually resolved [the issue of] too many people out the past two weeks, we would have a small discussion
putting responsibility on the other person. I was getting after each intervention, and we would discuss the
a lot of directions from two OTAs and the OT preceptor difference in our roles as OT and OTA. It was a very
and the OT student. I didn’t know whose work to do interesting experience, and really clarified our roles to
first. I actually worked it out by the end of the placement both of us. (student OTA)
but think that’s something you need to talk about right Finally through understanding each other’s roles and
away from the beginning (student OTA). effective communication there emerged a sense of teamwork
Building trust and respect were promoted early on starting and genuine interest in collaborating on a very comprehen-
with the pre-placement orientation session at which students sive client plan that ultimately complemented the delivery of
were encouraged to begin to develop relationships with their occupational therapy services. This sense of team compe-
peers, preceptors, and tutors. This initial step in the process was tence was evident in these student comments.
paramount in enhancing clinical service partnerships. So far within this week, I have been brainstorming with

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the student OT and the OT, concerning different clients For one student, supervision issues became much clearer
and possible activities and devices for them. I have found after reviewing some of the information in the tutorial.
we all tend to be on the same wavelength with our ideas. The clarification in one of our first tutorials of assigning
Except we will all have a different spin on the idea. . . . vs. delegating really helped me when working with the
This is a major example of how each discipline and edu- OTA student and realizing the power sharing between
cation level may have different views, levels of knowl- us. (student OT)
edge, and reasoning but still can come together as a team The tutor played an important role in the learning
respecting these differences and form a very complete process, as the student OT stated, “The tutors were quite
and creative plan for a client. (student OTA) helpful in stimulating the group with discussions and helping
It is kind of a relief to know that I may get to work us phrase out our thoughts so that they would be meaningful
with an OTA after graduation, as I have seen how large a to the groups’ learning.” Another task that the student pairs
caseload can be in a hospital setting. I think that having had was to present client cases for discussion in the tutorial
the assistance of an OTA would make the workload less groups. The students benefited from this exercise as evi-
overwhelming, especially for new grads! (student OT) denced in this comment:
In support of the student comments on understanding Our [tutorial] group worked together to come up with
roles, the occupational therapist tutor stated: “Reading is not the idea to ask the client what was wrong and then make
enough. The experience of sharing and collaborating [in the a list about how the client could solve that problem or
clinical and tutorial setting] was the clinching factor to make the problem better. Overall, I think that these pre-
improved relationships and appreciation of each others’ roles.” sentations really do bring out some interesting discus-
sions and very helpful solutions that as OT/OTAs we can
Recognizing environmental influences definitely apply in the future. (student OTA)
The students identified the impact of the clinical (hospital) This tutor made an interesting observation reporting
and educational (tutorial) environment on their learning that the OT and OTA students who were pairs exchanged
process. The clinical environment presented the students more information and interacted more closely during these
with both opportunities and challenges to their learning as tutorials than with their own respective classmates at school.
individual learners and as learning pairs. Students enjoyed They appeared very comfortable together like old
the client interactions, preceptor relationships, and wealth of friends; they laughed, looked at and touched each other
learning opportunities that their clinical settings offered. frequently. They complimented one another and spoke
They began to have an emerging sense of self in relationship of their mutual respect. They indicated that they did not
to their learning partners and to their own professions. have similar working relationships with other staff and
However the students also were immersed in the health care students. They were all very positive about their experi-
culture and experienced the real-life work dilemmas that ences and recommended that this working model be
challenged their notions of ideal practice. Increased work- mandatory. (OTA tutor)
load and stress, staff attrition driven by salary scales, reduced In addition, the scenarios brought up in the student dis-
client services, team conflict, limited preceptor role apprecia- cussions evoked in this OTA tutor a personal and powerful
tion by the institutions were some issues raised. On the topic reaction based on her own past experiences. She reflected on
of workload, one student suggested that efficiency could be this: “I was reminded of similar situations in my working
improved through better use of the services of an OTA. experience and the depth of stirring by the events. I was also
The assistants do absolutely no charting on clients at this encouraged by their idealism and resolve.” Her confidence in
facility. I am really surprised. I don’t see the harm in hav- their ability to influence the future was heartening.
ing assistants do some SOAP notes if the actual therapist
did not see their patient that day. I think that would take
Discussion
a load off the therapists from not having to write down Our findings in the area of peer learning, communication,
their interpretation of the verbal report from the assis- and respect have been consistent with the existing literature.
tant and it would save them some time. (student OTA) Others have discussed the emergence of peer learning as a
One tutor explicitly noted that the clinical environment, benefit of a cooperative or group placement (Farrow,
despite the available learning opportunities, plays a powerful Gaiptman, & Rudman, 2000; Jung, Martin, Graden, & Awrey,
role in supporting or hindering the building of relationships. 1994; Mason, 1998). According to Ladyshewsky (2000),
It appears that despite the stated goals of [our] research learners use each other as sources for mutual discovery, reci-
study, the [hospital] organization structure determines procal feedback, and exchange of ideas.
the students’ ability to work collaboratively by control- Communication is critical in the development of a col-
ling the frequency, duration. and quality of their interac- laborative relationship between the OT and OTA. Dillon
tions. (OTA tutor) (2001) has discussed the importance of communication,

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mutual respect, and trust as key characteristics in establishing trust are central to the process, and if a learning system is
effective working relationships between OTs and OTAs. He going to maintain integrity, it is critical that the partners
coined the term “intraprofessional unity” to reflect this basic respect one another. Once there is respect, trust can begin to
element in the ongoing daily practice of occupational ther- grow. It appeared that the tutorial experience in conjunction
apy. Mickan and Rodger (2005) and Tjosvold (1997) have all with the placement provided the opportunity for the OT and
discussed the similar concept of “interdependence.” In a sim- OTA students to consolidate and enhance the different parts
ilar vein, Hayden-Sloane (2005) has suggested that “commu- of their learning.
nication is the essential factor in successful partnerships” Lessons learned in relation to the following educational
(p. 30) and Rainville et al. (2005) have stated that effective and organizational issues may provide food for thought for
teamwork and team building are essential processes within other OT and OTA educators.
the profession of occupational therapy.
Student participants all agreed that working together in a 1. Curriculum development
clinical setting not only enhanced their understanding of each With current credentialing shifts taking place, as OT pro-
other’s roles, including similarities and differences, but also grams make the transition to the master’s degree level and
fostered the development of competence and confidence in OTA programs to the diploma level, this is an opportune time
one’s own skills and abilities as well as one’s partner. DeClute to work together to develop complementary curricula and
and Ladyshewski (1993) reported that the achievement of clin- enhance collaborative learning experiences for both groups of
ical competence in patient evaluation, program planning, students. Although it would be ideal to have students enter a
implementation of treatment, communication, and profes- collaborative placement with some knowledge of each other’s
sional behaviours was enhanced through a collaborative clini- roles, this may not be feasible given differences in curriculum
cal education model. Mickan and Rodger (2005) have sug- design and organization. However, it is critical to stress the
gested that “to communicate well and build up a sense of com- significance of communication, respect, and trust and the
mitment, individuals need a certain level of self-knowledge building of relationships in the respective curricula.
and confidence in their own professional role and skills”
(p. 359). They also purport that good teamwork results in 2. Site selection and preceptor preparation
improved coordination of care, efficient utilization of services, In planning fieldwork experiences, it is important that
increased patient satisfaction, and improved health outcomes. selected sites have defined OT and OTA roles in order to cre-
The tutorial, as the unique aspect of the learning experi- ate learning environments that illustrate collaborative prac-
ence, appeared to play a key role in facilitating and enhancing tice relationships. Education for clinicians about the OT and
learning. Students could debrief and work through their OTA educational programs and student expectations is nec-
thoughts and emotions and gain new knowledge in a safe essary to garner their support and develop their confidence
environment. They found the intraprofessional case discus- to serve as preceptors in such a collaborative fieldwork edu-
sions useful because of their practical focus on real clients. As cational model.
Steinert (2004) recommends, the clinical relevance and inte-
gration of scenarios are important characteristics for effective 3. Tutorial planning and tutor training
small group functioning. The resource binders with current and selected documents
The tutor notes revealed that the students also used the and journal articles proved to be a useful resource for stu-
tutorials to discuss personal experiences that were uncom- dents and preceptors. Tutors need to be experienced or at
fortable, for example, issues of role overlap and role conflict least receive training on how to facilitate small group learn-
that they had observed in their fieldwork settings or experi- ing. The role of the tutor is important in facilitating and guid-
enced themselves. One student OTA stated, “No one held ing student learning, promoting collaborative interactions,
anything back. We all said what was on our minds.” Blechert and resolving conflict when it arises.
and Christiansen (1993) have suggested that “despite all of
the positive aspects and efforts of teaming, it is inevitable that Limitations
conflict sometimes will arise” (p. 292). However, if managed There were several limitations to this study. The most impor-
well, conflict can often be productive and result in people tant perhaps is that the students participated in a combined
feeling more powerful, efficacious, and interdependent collaborative learning experience (fieldwork placement plus a
(Tjosvold, 1997). It was clear that students appreciated the weekly tutorial) and the results speak to this combined expe-
opportunity to discuss sensitive issues in a supportive envi- rience. Data were not collected separately on the learning that
ronment, which served to help them bridge the gap between occurred in the fieldwork placement and in the tutorial. This
their impressions of ideal practice and the realities of work. means that it is not possible to know which component con-
Baptiste (2003) states that within the tutorial experience, the tributed the most learning and in what way.
principles of partnership, honesty and openness, respect, and The first set of students (four pairs) was in the middle of

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JUNG ET AL.

their placements when Severe Acute Respiratory Syndrome standing roles, and recognizing environmental influences in
(SARS) became a major health care issue in Ontario. The stu- the delivery of health care provide an important message for
dent and preceptor experiences were altered because they had better preparation of students for the realities of clinical prac-
to deal with disruptions in their caseloads, drastically changed tice. The perceptions that the student OTs and OTAs
roles, and the anxiety of coping with an unknown and lethal reported in this study suggest that they gained new knowl-
syndrome. As a result of SARS, the placements were discon- edge and developed new teamwork skills that have helped
tinued because of directives from the Ministry of Health. The prepare them for collaborative practice in the future.
last two tutorials were cancelled as well. Although the stu- Since completion of this study, the intraprofessional field-
dents’ collaborative learning experiences were more limited work placements and tutorials have continued. In a recent
than planned, all four student pairs submitted journals for a placement, a student OT provided this optimistic comment.
four-week period and also participated in post-placement This process definitely helped foster the relationship
focus groups. Interestingly, some of the students identified the between OTA and OT for me, and I am now much more
desire to continue the tutorials because they saw them as an comfortable with the idea and position of working with an
oasis of stability within a period of confusion in the health OTA in the future. I now am aware of what our roles are,
care system. In some ways this crisis might have helped the how they are different and how they are similar. I can work
students see how much of a bond they had developed in a with an OTA to determine the best use of our abilities.
short period of time. One OTA student stated, “When we were
told that we had to leave our placement because of SARS….we
Acknowledgements
all just kind of looked at each other in a shocked state. We had We wish to thank the students, tutors, and preceptors for gen-
all become so close working together, depending on each erously sharing their thoughts and time. This study was sup-
other, and now for a brief time it is over.” ported by joint funding from McMaster University, School of
In addition, the participants were recruited from only Rehabilitation Science, and Mohawk College of Applied Arts
one OT and one OTA/PTA educational program. Therefore, and Technology, Health Sciences and Human Services,
the findings are limited to the experiences of students from Occupational Therapist Assistant/Physiotherapist Assistant
these two programs and may not be transferable to other Program. Parts of this paper were presented at the CAOT
educational programs. Annual Conference in Vancouver, British Columbia, May
Finally, because of the malfunction of the audiotape 2005.
equipment during one of the preceptor focus group discus-
sions, no transcript was available. To ensure that the written
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Teamwork and team building. In A. Wagenfield and J. format) any material published in CJOT.There is a per page,per table or figure charge
Kaldenberg (Eds.), Foundations of pediatric practice for the occu- for commercial use.When referencing this article,please use APA style,citing both the
date retrieved from our web site and the URL.For more information,please contact:
pational therapy assistant (pp. 539-548). Thorofare, NJ: Slack.
copyright@caot.ca.

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