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Educating Future Occupational Therapists Podcast

Educating Future Occupational Therapists Podcast
Erika Kemp, OTD, OTR/L, BCP, Dennis Cleary, MS, OTD, OTR/L
May 25, 2022

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Editor's note: This text-based course is a transcript of the Educating Future Occupational Therapists Podcast, presented by Erika Kemp, OTD, OTR/L, BCP,​ and Dennis Cleary, MS, OTD, OTR/L.

Learning Outcomes

  • After this course, participants will be able to:
    • Differentiate the four types of experiential rotations students are required to complete in entry-level rotations.
    • Analyze the purpose of clinical rotations in community practice locations.
    • Identify one benefit to OT practice when working with a student and/or academic program.

Podcast Discussion

Dennis: Hello, everyone. My name is Dennis Cleary. I'm a senior researcher at Cincinnati Children's Hospital Medical Center. I'm delighted to be joined today by Dr. Erika Kemp from The Ohio State University and a former coworker. Erika, could you introduce yourself and say a little bit about your background?

Erika: Hello, it's so lovely to be here and see you, Dennis, as always. I'm an occupational therapist. I graduated initially from The Ohio State University with my bachelor's degree, back when OT was a bachelor's degree, and worked primarily in pediatrics and acute care hospitals throughout the Midwest in Kansas, Wisconsin, and Ohio. I took fieldwork students and liked the experience. When I started working at a hospital in Sandusky and teaching as an adjunct in an occupational therapy assistant program, I decided that I also liked teaching. Eventually, I ended up back at Ohio State, where I was the fieldwork coordinator for many years and now am the doctoral capstone coordinator. I've worked in clinics, primarily in pediatrics and schools. Academically, I have taught in an OTA and an OT program. I've done a little bit of everything throughout the years.

Dennis: You're living a rich, full life.

Erika: I am.

Dennis: Then you got a master's degree, if I'm not mistaken, from Boston University?

Erika: I did. I was in their first cohort for their online post-professional master's degree, and now everyone has online degrees. At the time, I was working at the hospital and in the OTA program. I moved back to Columbus to work for the MOT program, and after my post-professional OTD from Indiana University, for the OTD program. So I have three different OT degrees.

Dennis: There you go. You've had a lot of fieldwork experience, taking students and placing students as a fieldwork coordinator and now as a capstone coordinator. The beauty of our profession is that we now have four different entry-level points to become occupational therapy practitioners. There is an associate's degree in occupational therapy for an OTA and some bachelor's programs for OTAs. There are about 15 of those programs that have either started or are in the process of developing. Now, it might be more programs than that. There are also master's and doctoral degree programs in occupational therapy to become an OTR. There are various doctoral degree options out there for OTs. Can you talk about the different types of experiential components, which is the fun word that ACOTE uses to talk about the different kinds of experiences that students need for hands-on learning in these various programs? 

Erika: I'm going to do my best on that one. First, I think multi-entry level points are good because everybody has different desires and end goals. For some, an OTA degree may be perfect for where they are in their life. They may not have to move from their families or incur significant expenses. Others may be more interested in a master's or a doctoral degree.

The first experiential requirement for most practitioners is observation or shadowing. This requirement is watching someone do therapy. However, with the pandemic, it has been harder to get observation and shadowing hours as clinics have shut down to outside visitors. We've also seen a lot of programs putting these requirements on hold and suspending them for at least the next couple of years.

Once someone is in an OTA or OT program, they have level one fieldwork requirements. Fieldwork is a shoulder-to-shoulder type of experience where the student can go and observe what they have been learning in the classroom. These experiences are usually about 40 hours long. As a practitioner, those are fun because the student is interested and excited to come out and see an actual patient. From a student's perspective, clinicians are the coolest thing in the world. Students usually bring a burst of energy to your practice. 

Dennis: When you were a student, did you watch a video about Level I fieldwork where it said that our role was to observe only and not interact with patients? I am significantly older than you, so maybe you didn't, but times have changed.

Erika: They have. I did see a similar video. Level I experiences are where we've seen the most change. Before, students were there to be wallflowers. Level I experiences are now more hands-on for the student in a safe way. We also need to reduce some of the drains in the clinics as there are four different types of experiential learning needs. Can we give students practice in some of these hands-on things like in a simulation lab with standardized actors, faculty-led clinics, or experiences with other professionals?

Dennis: Many programs use these options for Level I experiences, including Simucase, which we used. When teaching an undergraduate program for students interested in becoming OTs or PTs, I utilized the free student membership on OccupationalTherapy.com. With this online membership, they completed some of their observation hours during the height of the pandemic. As you've said, it was just impossible to place Level II students, let alone students that needed observation hours, to apply for school.

Erika: Observation hours determine if it is the profession you want to pursue, and video or podcast interactions make a lot of sense in these cases.

Dennis: Yes. As you said, some of these experiences are now not necessarily with live patients. They can be with simulations. The nice thing about this is that often patients would call in sick, and the students would spend a lot of time cleaning the mat tables or whatever. You have a little more control with simulations.

Erika: Sure. We also now have more medically complex patients. For example, when I went through OT school, there wasn't a thing called an ECMO, extracorporeal membrane oxygenation. This level of severity is almost too much for a Level I experience. We want students to be comfortable talking, transferring, touching, and performing basic range of motion and ADLs with clients. We do not want them to worry about pulling out an important cord or wire. There are a lot of advantages to simulation and actors.

Dennis: Yes. Every program will be a little bit different in terms of its Level I expectations. And hopefully, they're doing an excellent job of communicating that with the sites they're using for those fieldworks.

Erika: I think that's the challenge as a clinician. When you take students from multiple programs, a Level I fieldwork may mean different things as they are course-driven by the instructor and the program, more so than Level IIs. We need to know the objective of Level I because it's very common for some clinicians to expect students to treat, but they're not yet to that point. We have others who don't let them touch or talk to a patient. The clinician needs to know the program expectations and the developmental sequence the student falls. At Ohio State, we have three different Level Is that are developmental, and they span practice settings. We have a mental health one, an adult physical function one, and a pediatric one. Having that conversation with the program will help guide you as a clinician.

Dennis: OTA and OT programs will have different ways to set those up. Do you want to talk about Level II fieldwork and how this is different from an OTA and an OTR standpoint?

Erika: Sure. A Level II is what we think of as traditional fieldwork. This is full-time immersion in the clinic with the end goal of creating a generalist with entry-level competency. While there may be some differences, most OTA students do two eight-week rotations for 16 weeks of full-time fieldwork. These rotations should occur in two distinctly different settings. One rotation might be in a skilled nursing facility, and the second in an outpatient. Or it might be pediatrics and mental health. There should be two different settings. The glorious thing about occupational therapy is that we have like 16 to 18 different settings from which to choose. The OT student needs to complete 24 weeks of fieldwork. Most programs will do two rotations that are 12 weeks, each focusing on entry-level competence. There is a new fieldwork evaluation tool called the FWPE or Fieldwork Performance Evaluation. That has been normed and studied as a valid tool which is a significant step forward.

Dennis: Which is a change of pace.

Erika: It is!

Dennis: Yes, that's great.

Erika: ACOTE allows flexibility so that programs can adapt their own tool should they desire to do that, but there is the validated option aimed at entry-level competence. It goes through the OT process, according to the OTPF, from screening, evaluation, treatment, discharge, communication, and professional behavior. These are all sections of the FWPE for both OTA and OTR students. We often forget that OTAs can play a role in the evaluation process, as delegated by the OT. Thus, some items are the same for OT and OTA students on that Level II rotation. Fieldwork II placement is vital, which is why we are always trying to ensure we have enough rotations for students. I think there's an excellent opportunity for clinicians to reconnect to their alma mater or local school and take some fieldwork students.

Dennis: Absolutely. Especially in some areas of the country, there's a real shortage of Level II fieldwork placements. What are some of the unique models they're using to meet unmet needs in the community and create opportunities for Level II students?

Erika: I think the most critical place we see a lot of innovation is behavioral health. OT started in behavioral health, and that's where our roots are. Over the years, we've lost ground because of reimbursement and other issues. I think that with the focus again on mental health in society. We're seeing a lot of great opportunities for us to step back into this area. We are putting students out with these community partners to serve mental and physical health needs. Examples include homeless shelters, after-school programs, and addiction recovery services. Schools often pair students so that they have someone else to share ideas, and supervision is provided. ACOTE requires at least eight hours per week of supervision. Supervision will start heavier in the first couple of weeks as students get their feet wet, and then this will taper off to the minimum requirement with consultation provided. Let's take the example of nursing. Many nurses work on traditional medical floors for three to five years. Still, they move on to places like homeless shelters, churches, and schools or move to different roles in the medical setting like case managers or quality improvement. These emerging professional practice settings might also be a way for us to think about that transition.

Dennis: Sometimes, the university provides that supervision for the Level IIs. Other times, it's an agreement between a university and the fieldwork setting, where the setting does that in exchange. It's an excellent way for them to try to explore some new areas of practice. Some places are even writing grants for that. 

Erika: I get excited about that sort of thing, especially with capstones. I think capstones are ripe for unique and pushing-the-boundaries types of experiences.

Dennis: Do you want to talk more about capstones and what they mean? 

Erika: The OTA at the bachelor's level has a capstone, but it is a didactic project with no experiential piece required as of now. At one point, the experiential component was in the draft standards, but they redacted that. The word capstone is used across multiple professions, and it helps students pull together the threads of what they've been learning in an area of interest. It is conceptualized at the OTR level through experience with a clinical community partner. The OTD capstone includes both a project and experience and should map back to the program's curriculum somehow. It should match the site's needs and the student mentor's expertise. The possibilities are endless as there are eight areas of focus for the OTD capstone. They include clinical practice, advocacy, leadership, administration, program and policy development, education, and theory development. I knew I'd forget one.

Dennis: I thought you would forget theory development as that is one typically not done.

Erika: Yes, developing a theory in 14 weeks would be hard. Did I say research? That was the one I missed.

Dennis: Look at you forgetting research and working at Ohio State. You are going to be in trouble.

Erika: While our capstone design has a research piece, we have very few focused on research. Writing a protocol, going through an extensive IRB, executing a study, and analyzing takes way more than 14 weeks. However, research capstones are more common than theory development.

Dennis: I think many occupational therapists get confused about the difference between a clinical doctorate (OTD) versus a doctor in philosophy (PhD)? Could you talk a little bit about that?

Erika: Each student needs to make an informed decision. A dissertation for a PhD creates new knowledge to fill a gap in the literature versus a clinical doctorate that improves clinical practice at the OTD level. At Ohio State, we have focused on implementing evidence into practice to achieve better clinical outcomes and improve practice using data-driven decision-making. We use an implementation science framework for our capstones. We need to figure out what the student is interested in and then match them with somebody external to the faculty with expertise in that area of interest. This gives the clinic exposure to students earlier and vice versa. For example, somebody in the past may have had difficulty getting hand therapy experience. For our current students, we're able to give them a roadmap while they're in school.

Another example is a person interested in becoming a manager, an administrator, or a hospital leader. A capstone allows them to figure out how to get that exposure. This is the same thing for an advocacy or research track. They may be able to partner with an academic program to move into academia eventually. The project is clinically relevant, and it is not new knowledge that must be created. It is all about improving outcomes. The OTD capstone is mentored, individualized, and independent. I use the word "clinical" loosely because it could be in the community versus the traditional medical setting.

Dennis: Right. I've mentored several capstone students from Ohio State and several other universities. This is part of what we're looking to do at Project Search, which is the group that I'm part of at Cincinnati Children's. We focus on the transition to employment for young adults with intellectual disabilities. These are students that often have "graduated" from occupational therapy. These capstone students are not necessarily providing occupational therapy currently to these students. Still, with the expansion of license reportability with the OT compact, that is one thing that I'm looking to do. I want to help support some of our capstone students who want to do occupational therapy with this population. I want to thank NBCOT and AOTA for working together to help that happen. This provides an excellent opportunity for OT capstone students. For example, I had a student create a 50-page document on adaptations and accommodations for job coaches who are either high school or college prepared but don't necessarily have a ton of external training to support people in employment. It has a ton of great resources. I don't know if you have any specific stories about unique capstones that are an excellent synergy between a therapist and a capstone student.

Erika: There are so many things I can discuss. I think hand therapy is an excellent example of where you can get a specialized set of skills and exposure that may not be appropriate for Level II fieldwork. It's beyond that of just a generalist and what a generalist would know to do. Similarly, we've had students do things in ICUs, early mobility, communication, wheelchair seating, and mobility clinics. These are more specialized niche areas.

We've also done some incredible things with the Columbus Zoo. The zoo administration wanted to increase their accessibility, and several capstone students worked on this with them. We have an excellent continuing partnership with them, and they consistently have sensory-friendly events at the zoo. There are sensory maps and social stories for individuals, and they have also looked at adult accessibility with adult changing tables in the bathrooms. There are benches throughout for rest breaks for the elderly. Last year, another student developed tactile maps within the zoo for the low-vision community. This is an example of partnering with a community entity and using universal design to increase access for the disability community.

We've also had people do things with refugees and resettlements. There is a lot of stress and cultural adjustments within this population. They must learn to use public transportation, meal prep, et cetera. There has also been work done in addiction recovery and the juvenile court system. These areas are ripe for picking. Also, adaptive fitness like adaptive kayaking, paddling, and those kinds of activities are very popular within community centers. Project Search is another area that would be a great capstone area where students could help high schoolers transition to independent community living. The list goes on and on.

Dennis: Some of those things can be difficult to figure out billing. I was at the Canadian OT meeting last week, and it's a different system in terms of flexibility and delivery of care. The zoo, refugee resettlement, Project Search, and others are not about range of motion, transfers, manual muscle testing, and other core meat and potato OT activities. How does the student benefit from these experiences?

Erika: I think the biggest thing the students love is the opportunity to explore an area of interest on which they would've only had a 1-hour guest lecture. What is their three-to-five-year goal in practice and a niche area they would like to explore? I think these specialty capstones have helped them see past traditional one-on-one, fee-for-number-of-minutes types of service. It expands their ideas of where they can work and what they can do. They also gain independence in these settings compared to traditional fieldwork, where they are assigned a one-on-one supervisor. In these capstones, they have more of a peer mentoring type of relationship. We've also seen these students increase their ability to advocate and communicate what OT is to other OTs and outside of the profession. How many times have you explained what OT is? This is vital as there is still a mystery about what we do. 

Dennis: That's great! When we were at Ohio State, physical therapy found out what these capstones were and wanted students. Physical therapists are wonderful mentors, but we were trying to offer capstone students to occupational therapists interested in taking them on as mentors first. I don't know if you remember that or not.

Erika: I do. We have had successful capstones with PT mentors. However, it takes the right PT willing to support our scope of practice. Pelvic health and maternal health are great examples where OTs have expanded, which have traditionally been a PT realm. If you think about all the mental health needs of a new mom, it makes total sense that an OT should be in there. We can do both the mental and physical pieces needed for pelvic postpartum care.

Dennis: What types of different folks can mentor all of these experiences? Do you want to go through and talk about Level I, Level II, and capstones? What are the qualifications for the mentors for each of these different types of experiences?

Erika: Level I fieldwork depends on the state. Here in Ohio, you do not have to have a year of experience to be a Level I fieldwork educator. And Level I fieldwork, as we alluded to, can be outside of the profession. Again, someone with expertise in that population that the student is observing. We see a lot of variety with Level I fieldwork, and it's a great way to get started. If you're like, "I can't commit to taking a whole student for all those weeks," take a Level I student. They're usually with you for one week or maybe once a week for five or six weeks. And again, it's exposure for the student with very discrete objectives and what they should get out of the experience. The only preparation is reaching out to your local academic partner.

There is a little bit more stringency with Level IIs. If you are an OT or OTA, you need to have one year of experience before taking a Level II student, but most practitioners prefer two or three years. I have had successful first-year-out educators because I think they remember what the experience is like and create a welcoming environment. Educators with upwards of 25 years of experience may have a more challenging time breaking things down. They may not even realize how advanced their thinking is. I want to encourage new people that if you are a year out, you probably know more than you think you do. And the first time you take that student, it makes you realize how much you've grown and what you have to offer.

Dennis: Absolutely. And I think there's also a shout-out to be given to our occupational therapy assistants to encourage them to be fieldwork educators. Again, each state is different in terms of its supervision. An OTR may need to be involved in that supervision, but the OTA can take the lead. One article showed that OTRs were supervising maybe 60% of OTAs in their Level II fieldwork instead of OTAs. We need OTAs to mentor the next generation of OTAs as well.

Erika: I agree. I haven't looked at those numbers, but anecdotally in my experience, having done fieldwork at an OTA, I would say it was probably close to 60% were OTRs, and I don't know why. In some cases, the OTAs were only part-time and vice versa. We need to have confidence in our OTAs as they know what they are doing, and it is a great way to stay involved.

Fieldwork helps the practitioners grow as well. You don't have to have all the answers as the educator or the site mentor. You may often think, "Wow, that is a question that I do not have an answer to."  You can say, "let's go look for that answer," or "let me get back to you on that." There are lots of ways to handle that line of questioning. However, most of the time, you have an answer to questions and don't realize you do.

Dennis: Great. You talked about Levels I and II fieldwork. What about capstone mentoring?

Erika: First, if a mentor is outside of the profession of OT, which probably 50% of the capstone mentors are, the requirement is that they have expertise in that content area. For example, someone working with refugees has content expertise in that area, whether it's a social worker, a case manager, or a licensed professional clinical counselor. Content expertise is determined on a case-by-case basis. Depending on the OT program's curricular threads and the student's interest and project, we need to make sure that the mentor has something to offer in the way of guidance. And if it isn't going to be an OT, you need to check your state licensure laws to ensure that there are no additional criteria, such as one year of practice or something like that. 

Dennis: Sure. I know in some places, if the mentor is not an occupational therapist, they'll have an OT familiar with the content in some capacity. The program will also have faculty involved, either as a capstone mentor or a faculty member with some expertise in that area.

Erika: Right. The OT involved may vary from program to program. It might be the capstone coordinator, or it might be a faculty mentor. In these nontraditional settings, it is essential to have an OT involved so that they can tie everything back to our scope of practice. The student is not learning how to be a social worker. Instead, we're thinking about interprofessional education and interprofessional collaborative care. We know that the more brains you get around a client, the better outcomes you will have; thus, utilizing this interprofessional model is for the better.

Dennis: If someone is interested in being a fieldwork educator or a capstone mentor, how do they get training? Do you have any ideas on that?

Erika: There are many great resources out there. OccupationalTherapy.com has some webinars and podcasts to gain those skills.

Dennis: I have heard some good things.

Erika: Yes! AOTA also has a fieldwork educator certificate program that is two days long and yields a certificate. There are also some resources available for capstones. Ohio State has a website with some training videos for our local state mentors. I am the chair of the DCC, the Doctoral Capstone Coordinators, on the Academic Leadership Council. 

Dennis: Is that a group of AOTA folks?

Erika: Yes, individuals like myself at all the different programs are loosely called the Academic Leadership Council. The capstone coordinators get together and think about current issues. It is an amazing collaborative group. There's a mentoring program if you're a new doctoral capstone coordinator. If you're a site mentor, some tremendous continuing education things have been offered at AOTA and state conference meetings. So, keep an eye out on your state meetings and national conferences for some capstone-specific training.

Dennis: Sadly, I don't live in Ohio anymore.

Erika: We miss you.

Dennis: I miss you guys too. Still, I am a member of the Ohio Occupational Therapy Association. Are the Ohio fieldwork coordinators and capstone coordinators still having continuing ed at the state conference every year as well?

Erika: Right. There are often fieldwork and capstone consortiums by the state as another resource. We make sure that we do something at the state meetings every year. Depending on your region, AOTA has a list of what those fieldwork consortiums are. 

Dennis: Yes. In terms of productivity, is there any evidence about how fieldwork affects productivity for an occupational therapist or an occupational therapy assistant?

Erika: There was a study in 2015 that showed that taking a student has no impact on productivity for the OT. A more recent study from physical therapy showed that there was no impact on productivity for those that took students across settings. I know physical therapy is not OT, but their model is similar to ours. There have been a lot of interesting ways to think about productivity impacts. If you use a collaborative model, whereas you have one educator to two students, sometimes you can recoup that productivity that may be lost in the first couple of weeks after showing them what to do, and they are deemed competent.

Dennis: We're not going to talk much about student billing and those sorts of things, but students can bill. Billing changes regularly and is dependent on insurance. There are things that we would direct you to your local university or community college to talk about how to mentor and supervise students ethically. How would you like to add to that?

Erika: I think it's essential to look at your local laws for that.

Dennis: You talked about one mentor with two students, but there's also the possibility of two mentors to one student. Do you want to talk about this, especially now that we have many occupational therapists who are job sharing or working part-time?

Erika: I think student mentorship is one of the things that gets lost when you go to a part-time job. Having two part-time therapists share with a student works well. It gives the student two perspectives on the same caseload and allows the practitioners to stay connected. For example, students often have to look up current evidence on the patient's condition. Often, we don't realize what updated research is out there. Students today know how to research things and go into PubMed, CINAHL, and other sites. They still have access to the medical libraries from their school and can pull articles. This can be an added benefit to the educator.

Dennis: There isn't an occupational therapy program within a couple of hours of my current location. While there is a program that will be putting their first Level I fieldwork students out there this summer, I've noticed that practices that do not have access to students regularly have a more challenging time keeping things fresh and new. Continuing education opportunities through universities or community colleges is a good way for all of us to stay on our game.

Erika: It is. Which is essential for us here. The one thing that's always bothered me is the gap between academia and practice. I have heard some educators say to my students, "Forget everything they taught you in the classroom. I'm going to teach you real OT out here." If that were true, you would take observation students and turn them into therapists. We have to get people to stop saying those things because the two cannot exist without each other. We cannot make practitioners without fieldwork, but we cannot make practitioners without the academic side. I love the capstone and fieldwork so much because they are the bridge. What works on both sides, and how do we bring those together?

Dennis: We changed Ohio State's curriculum to make it more pragmatic and hands-on. Part of that process was bringing fieldwork educators into the classroom as paid assistants to support the core competency types.

Erika: I think that is an excellent thing for therapists. Those in the classroom love having an extra set of hands. When you're trying to teach transfers to 50 students, it's hard to get around to everyone. If you're interested in that experience, reach out to your local OT program. You could be an assistant in the class or lab or a guest lecturer. 

Dennis: Yes. Could you talk about some changes since you first started practicing? I've been out for 25 years. 

Erika: Twenty-one for me.

Dennis: What are some changes you've seen in that time in terms of how fieldwork? There wasn't a capstone 21 years ago.

Erika: I think the most significant change that I can think of is that it is not required that one of your Level IIs be a mental health rotation. It is necessary that at least one experience be focused on behavioral health and that every fieldwork experience, no matter what, have at least one objective considering how we address the psychosocial needs of clients. Even in acute care, we're considering meeting that client's psychosocial needs. It also seems more complicated to find spots for our students to go. An article recently said there was a decrease in the number of educators taking students. But there are more certificates out there than there are students, so there is a mismatch. There has also been a change in onboarding students. Some sites are controlling what schools and students they take. We've had hospitals say, "I'm only taking students from these schools here in Ohio." Educators also need a little more time with their students, especially in those first couple of weeks. That's been a little bit harder with, as you mentioned, the number of hours you're face-to-face with your client.

Dennis: Yes. I remember my Level II experience at St. Rita's Hospital in beautiful, sunny Lima, Ohio. They put my mentor (Jeff) and me in an LTAC area that didn't have a ton of patients. They did it intentionally so that we would get everything done by lunch. Then, we spent a lot of time going to other areas like inpatient and outpatient doing hands. The two of us would go and fill in. It was a great experience to see many different areas of the hospital. I just think this would be harder to do now than it used to be with current productivity requirements. Sometimes settings can reduce productivity for the first couple of weeks. Still, I think there is more financial pressure on healthcare organizations, schools, and community settings than there used to be.

Erika: There's also much more specialization than we realize. A therapist may be a specialist in heart and lung transplants which is hard to bring down to entry-level. Due to this specialization, it is harder to give those more comprehensive experiences.

Dennis: Can you describe the interaction between a fieldwork educator and the academic person for someone who's never taken a student? Do they drop a student off and pick them up eight or 12 weeks later?

Erika: This is another thing that has changed in fieldwork education. Many of us have been practitioners for a long time and remember leaving for 12 weeks. I think ACOTE standards have changed to eliminate that "see you later" mentality, and fieldwork coordinators are a little more involved than they used to be. Each site should have a timeline for its eight or 12-week placement, depending upon if it is an OTA or OT. What are the objectives? How do they ladder these students from zero to 60? The fieldwork coordinator usually is in contact with that educator ahead of time with information about the program's curriculum so that they know what the student has learned to help them build that timeline and student program manual. Your academic fieldwork coordinators are your friends. You need to reach out as we are here to help develop educators and sites. If you don't have a coordinator in place or do not have these materials, that shouldn't hold you back. Know that we have templates and will work with you to help create those things wherever you are.

Dennis: Yes, there are lots of different supports that you offer to programs.

Erika: Absolutely. There is also usually a midterm visit. We love coming out and seeing or doing a Zoom call to check-in. This is an opportunity for you and the student to answer questions, get resources, and ensure you're on the right track. The school should be involved, especially if you are worried about anything.

Dennis: As a capstone coordinator, you think fieldwork and capstones are a fantastic way for occupational therapists and occupational therapy assistants to interact with their local university or academic programs. I'm sure you and your fieldwork coordinator are going out and doing training for your clinical partners as an excellent way to give back to the sites. What are some other ways that an occupational therapist or assistant can interact with a community college or a university?

Erika: Other than taking fieldwork and capstone students?

Dennis: Yes. Other than the thing that you want them to do.

Erika: Yes, my usual is, "Please call me, and I will send you a student." Otherwise, it depends on the curriculum. There may be some opportunities in the standardized patient labs that we discussed earlier. Guest lectures are another great example. Service-learning is another thing that we do. We go out to community partners and provide a service that helps them learn about occupational therapy. There are many ways to get involved. Lastly, there are specializations, like pediatrics, aging, or research. This is an opportunity for students to gain exposure to a clinical area over and above the didactic curriculum, but not so in-depth that it's a capstone.

Dennis: I think it's also an excellent way for assistants and therapists interested in moving into academia. I'm helping to mentor a young man who will be teaching his first course in an OT program. Last night he asked, "How do you get students to read?" I said, "If it doesn't have points attached to the assignment, they are less likely to do it." Educators are competing with other faculty for their time. Additionally, they have their family and perhaps a job. Trying out new things can help one figure out where they want to work as an OT.

Erika: Yes, definitely, as there is currently a faculty shortage due to the rapid expansion of programs. Taking a student in your practice, doing a guest lecture, or being an adjunct are great ways to test the water.

Dennis: If someone wants to connect to an academic program, what's the best way for them to find where an occupational therapy or occupational therapy assistant program would be?

Erika: The website ACOTEonline.org has a list of programs that are in all phases of accreditation. The fully accredited programs are the ones that have been through the whole self-study, onsite visit process, candidacy, and applicant phase. And so that will have, at ACOTEonline.org, contact information for each program. And so that's a great way just to get on ACOTE. You can sort it by the state to find out who's near you. I think you'll find you'd be very welcome at any program you contact. I love when people reach out to me. I'm like, "Yes, I will connect with you."

Dennis: There are advisory boards. As you said, it might be a little niche area of practice. It could even be that maybe you've had a Level II or a capstone student, and you feel like you have something to offer that program. Call and offer. We are usually thrilled to talk with folks and work with the local practitioners because we're an applied science. Living in the high ivory tower doesn't work for our profession. This is another huge change I've seen in the last 25 years of practice. I think academic programs are working hard to collaborate better with the programs.

Erika: Yes, and the other area is the admissions process. Many schools are moving to holistic admissions and thinking beyond the GPA and GRE. At Ohio State, we recruit practitioners to review and read every application submitted. We also do interviews. Getting the input from practitioners makes a lot of sense, as who do you want the practice's future to be?

Dennis: Thank you so much, Dr. Erika Kemp, for spending some time with us. We look forward to seeing what you're doing in the future and how fieldworks and capstones may evolve.


Please refer to the outline and handout.


Kemp, E., and Cleary, D. (2022). Educating future occupational therapists podcast. OccupationalTherapy.com, Article 5512. Available at www.occupationaltherapy.com

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erika kemp

Erika Kemp, OTD, OTR/L, BCP

Erika Kemp is the Doctoral Capstone Coordinator and Director of Clinical Education for The Ohio State University’s entry-level occupational therapy doctorate program.  She has experience as a clinician in pediatric outpatient and school-based settings as well as adult acute care.  She has been the academic fieldwork coordinator for an OTA program as well as MOT and OTD programs and is passionate about shortening the gap between practice and academia.

dennis cleary

Dennis Cleary, MS, OTD, OTR/L

Dr. Dennis Cleary has over 25 years of experience as an occupational therapist.  Dennis’ clinical practice has been primarily with children and adults with intellectual disabilities to encourage their full participation in all aspects of life at home, work, and in the community. He has had faculty positions at The Ohio State University and Indiana University. As a researcher, he has been on teams that have received over seven million dollars in grants from state and federal agencies, including a National Institutes of Health multisite trial of the Vocational Fit Assessment, an age-appropriate transition assessment, which he co-created. He has numerous publications and national and international presentations. Dennis is passionate about increasing the role of Occupational Therapy in transition-age service with the goal of improving outcomes and quality of life for all. 


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