Stop, talk, roll: A framework for

students to manage challenging

situations in fieldwork
Ann Marie Marsico, Cara Lekovitch, and Ketki Raina, Volume 28 • Issue 11 • November 2023, pp. 22–25
11/01/2023

Some students experience challenging situations during fieldwork, such as

microaggressions, racist comments, and hate speech in patient treatment areas. A recent
study in health care found that disruptive behaviors (e.g., bullying, racial and ethnic slurs,
physical aggression) were reported in 97.8% of health care settings (Rehder et al., 2020).
Historically, there is evidence of indifference to disruptive behaviors in health care,
indicating that this problem is long standing and embedded in health care culture among
many organizations (Porto & Lauve, 2006). These disruptive behaviors and challenging
situations are widely recognized to negatively impact students, and may include
psychological stress, disengagement, and decreased coping with uncertainty (Ogunyemi et
al., 2020). These challenging situations also negatively impact the learning environment,
preventing the student from learning during the fieldwork experience.

Students in fieldwork report anecdotally that they do not respond to inappropriate behaviors
or challenging situations because they are caught off guard in the moment. They do not
consistently report these situations to the fieldwork educator or their academic fieldwork
coordinator (AFWC). When students do not report to faculty, there are multiple missed
opportunities: students do not learn how to manage challenging situations, they do not
develop resiliency, and are faculty cannot deploy efforts to mitigate the impact of these
challenging situations on the student. When students do not learn to navigate challenging
behaviors during the academic program, they often feel unprepared to face these situations
as novice therapists.

It is critical for occupational therapy programs to equip students with skills to address
challenging situations in the didactic portion of the program before students enter fieldwork.
Further, educators in the classroom and the clinic need a framework for navigating
challenging situations alongside the student. To address this gap in fieldwork education, we
adapted an existing tool to use as a framework: STOP, TALK, ROLL (STR).

A Framework for Challenging Situations

STR is a communication guidance tool designed by Georgetown University School of
Medicine (Chen, 2017). The tool suggests phrases and approaches for medical students and
residents to address uncomfortable situations and to diffuse tense communication. It also
provides pathways for seeking help and support to navigate challenging health care
scenarios.

We adapted the STR tool and materials to fit the needs of occupational therapy students and
taught them how to navigate challenging situations in fieldwork (Chen, 2017; Sandoval et al.,
2020). We introduce the STR framework to students before Level I fieldwork, and we provide
them with a broad introduction to the framework by highlighting the three core steps—Stop,
Talk, Roll (see Figure 1).

Figure 1. Stop, Talk, and Roll Framework Handout Provided to Students

Note. Adapted from Cheng (2017).

We then introduce each step of the framework in more detail. Each subsequent
step provides the students with actionable guidance on how to react to
challenging situations in the moment, as described below.

Stop

Stop directs students to stop the conversation and immediately consult with their fieldwork
educator. We provide prompts for how to stop an inappropriate conversation, along with
suggested wording and phrases for navigating the situation. There are two guidance
pathways provided in this step depending on who the challenging situation is occurring with:
1) a team member, or 2) a client.

Talk

Talk directs the student to talk through the encounter with their fieldwork educator. This
step provides guidance based on the context of the situation, including prompts for seeking
a private conversation with the fieldwork educator, being mindful of tone and body
language, and ensuring that students are hearing all perspectives during the conversation.

Roll
Roll directs the student to roll on out and email their AWFC. This critical step guides the
student to communicate with the AFWC for immediate, confidential, and psychologically safe
support and help for navigating the situation. The AFWC establishes an action plan using
their knowledge of the contextual factors related to the fieldwork environment, educator,
and student performance in fieldwork. The AFWC and student collaborate to finalize the
action plan, and role play practice occurs to ensure student readiness to return to fieldwork.
The student is directed to communicate with the AFWC if the issue remains unresolved. The
AFWC monitors the situation to ensure student safety at the fieldwork site.

Implementation in the Fieldwork Curriculum

We reinforce the use of the STR framework by scaffolding it in the fieldwork curriculum.
Students practice using the framework during role playing and problem-based learning
activities. Hence, students practice the use of the framework in four 5-week Level I
fieldwork experiences before transitioning into their Level II fieldwork placements.
Eventually, students generalize the information and need less guidance on how to react
during challenging scenarios in fieldwork and other contexts. This generalization of
knowledge impacts future classroom interactions, the capstone experience, entry-level
practice, and beyond.

Lessons Learned
We have learned that students apply the adapted STR framework in health care and
community-based settings across various client populations (see Table 1). Further, students
acknowledge that they feel supported by having a framework to rely on when responding to
challenging situations. As a result, students have the knowledge and skills to navigate these
situations and remain in fieldwork, whereas in the past, they may have been placed in an
alternate setting.

Table 1. Case Scenarios Using Stop, Talk, Roll Framework

Fieldwork Experience STOP TALK ROLL Outcome

Willa was at • Willa did not • Willa did not • Willa • The
her first feel feel scheduled fieldwork
Level I
psychologically psychologically an educator
fieldwork
safe in the safe to seek a appointment was
experience
at an environment to private with her supportive,
t th ti AFWC f dh d
outpatient stop the conversation AFWC for and had
hand conversation. to address the support. already
therapy comments with addressed
clinic. During
• Willa waited 24 • The AFWC
her fieldwork the
her second hours to reflect provided
educator. comments
day, she on the Willa with
with the
overheard a comments strategies to
conversation therapist.
made. approach a
between her conversation • The
FW educator
with the fieldwork
and another
fieldwork educator
therapist
where the educator was able
therapist regarding to educate
used a slur the Willa on
to refer to an inappropriate the
individual comments. strategies
with learning
she used
disabilities.
to navigate
that
interaction.

Jake was at • Jake said • Jake asked • Jake felt that • Jake
his second to the his fieldwork the situation completed his
Level II
patient, “I educator for was resolved second Level II
fieldwork
would like a private and did not fieldwork
experience in
an inpatient
to discuss conversation, notify his experience
rehabilitation your care and told the AFWC. without
hospital. with my educator, “I’m difficulty.
• One week
During an supervisor.” feeling upset
initial
later, Jake • · In the Level II
by a
evaluation, a • Jake told his Fieldwork
comment
patient assessed AFWC about Performance
that Mr. X
refused to that the the situation Evaluation,
work with made to me,
patient was in casual Jake’s
Jake and told and I’d like
safe, then conversation. fieldwork
him to go your advice
contacted educator
back to his on how to • The AFWC
his commended
own country. handle it.” told Jake that
fieldwork him for his
even if the
educator. • They
situation was
superior
discussed communication
resolved,
the skills and
Jake should
comments ability to
have notified
and navigate
the AFWC
strategies to difficult
that the
navigate the situations.
behavior
situation.
occurred
 occurred.

Faiz was • Faiz was • Faiz • Faiz emailed • The

completing stunned by immediately the AFWC to fieldwork
their second
the patient’s notified the notify them of educator
Level I
disclosure fieldwork the situation closely
fieldwork
experience in of possible educator that occurred monitored
a pediatric abuse. about the during future
outpatient patient’s fieldwork. treatment
• Faiz
clinic. On the disclosure. sessions
last day of
assessed • The AFWC
They with the
the the situation requested a
reviewed the patient.
placement, a and brief meeting
details of the
6-year-old determined to ensure full
comments. • Faiz was
patient told that the understanding
Faiz that her
able to
patient was • Faiz and the of the events
complete
parents hit
not fieldwork that took place.
her with a the Level I
currently in educator
belt. The • Faiz and the fieldwork
patient distress. went to a
AFWC met to experience
showed Faiz private space
review the having
a bruise on and
events and the followed all
her leg. contacted
report that was proper
child
made to child procedures
protective
protective as a
services to
services. mandated
make a
reporter.
report.

Faculty also find the framework helpful in delivering consistent guidance to

students who experience difficult situations in fieldwork. The instructor reviews
the student’s experience sequentially through each step of the framework to
better understand the student’s perspective and psychological safety in
responding to the situation. Subsequently, students receive an individualized
approach from the instructor that is guided by the framework.

Follow up in the fieldwork environment is required by the student after they meet with the
instructor to review the difficult situation and receive guidance. As we gain more practice
with the framework, we will consider adding another component to ensure that the student
will respond based on the guidance provided by the instructor. Opportunities also exist for
the instructor to follow up with the fieldwork educator within or outside of the fieldwork
environment based on the needs of the situation.
Empowering the fieldwork educator with knowledge of the framework increases their buy-in
for responding to the situations experienced by the students. Familiarizing fieldwork
educators with the steps of STR allows them to anticipate the types of conversations they
may have with students related to challenging situations in the fieldwork environment.
Eliminating the unexpected aspect of having an uncomfortable conversation allows for a
more open dialogue related to difficult situations in health care and community-based
contexts.

Conclusion
The adapted STR framework equips occupational therapy students with skills to address
challenging situations during fieldwork. Through these important teaching and learning
opportunities, students learn how to respond in a healthy way. Minimizing psychological and
physical cost, they grow stronger in the process and become more resilient in the workplace
environment.

References

Cheng, S. M. (2017, May 10). Stop, talk, roll: How to deal with tough communication
exchanges in the medical workplace.
https://som.georgetown.edu/diversityandinclusion/studentorganizations/stoptalkroll/

Porto, G., & Lauve, R. (2006). Disruptive clinical behavior: A persistent threat to patient
safety. Patient Safety and Quality Healthcare. http://www.psqh.com/julaug06/disruptive.html

Ogunyemi, D., Clare, C., Astudillo, Y. M., Marseille, M., Manu, E., & Kim, S. (2020).
Microaggressions in the learning environment: A systematic review. Journal of Diversity in
Higher Education, 13(2), 97–119. https://doi.org/10.1037/dhe0000107

Rehder, K. J., Adair, K. C., Hadley, A., McKittrick, K., Frankel, A., Leonard, M., … Sexton, J. B.
(2020). Associations between a new disruptive behaviors scale and teamwork, patient
safety, work-life balance, burnout, and depression. Joint Commission Journal on Quality and
Patient Safety, 46(1), 18–26. https://doi.org/10.1016/j.jcjq.2019.09.004

Sandoval, R. S., Afolabi, T., Said, J., Dunleavy, S., Chatterjee, A., & Ölveczky, D. (2020).
Building a tool kit for medical and dental students: Addressing microaggressions and
discrimination on the wards. MedEdPORTAL, 16, 10893. https://doi.org/10.15766/mep_2374-
8265.10893
 Ann Marie Marsico, CScD, MOT, OTR/L, is an Assistant Professor and Academic Fieldwork
Coordinator at the University of Pittsburgh.

Cara Lekovitch, CScD, MOT, OTR/L, BCG, is an Assistant Professor at the University of
Pittsburgh.

Ketki Raina, PhD, OTR/L, FAOTA, is an Associate Professor and Vice Chair of Academic
Affairs at the University of Pittsburgh.

© 2023 American Occupational Therapy Association, Inc. All Rights Reserved

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