Stakeholders' priorities in the development of evidence-based practice competencies in rehabilitation students: a nominal group technique study.

PURPOSE: Clinically integrated teaching (CIT) is an effective approach for promoting evidence-based practice (EBP) competencies among medical students. Challenges towards the implementation of CIT in rehabilitation curricula include educators' different conceptualizations of EBP, the perceived complexity of EBP and the boundaries between the academic and the clinical setting. This study aimed to identify tailored strategies to implement in rehabilitation programs and their affiliated clinical sites to support the development of EBP competencies among students in occupational therapy (OT), physical therapy (PT) and speech-language pathology (S-LP). MATERIALS AND METHODS: Nominal group technique (NGT) with stakeholders from three rehabilitation programs in Canada, offering the professional master's in OT and PT (n = 35 participants) and in S-LP (n = 8). RESULTS: The top two strategies identified in the OT/PT NGT were: 1) Developing a flexible definition of EBP that recognizes its complexity; 2) Providing clinicians with more access to the teaching content by pairing faculty with preceptors. The top two strategies identified in the S-LP NGT were: 1) Providing students with opportunities for decision-making with experienced clinicians; 2) Increasing interactions between faculty and preceptors using formal group meetings. CONCLUSION: Findings laid foundations for future integrated knowledge translation projects to collaboratively implement, and test identified strategies.

Rehabilitation professions including occupational therapy, physical therapy and speech-language pathology acknowledge the importance of evidence-based practice (EBP).Current challenges in the teaching of EBP among rehabilitation students include educators' different conceptualizations of EBP, the perceived complexity of EBP, and the boundaries between the academic and the clinical setting.This study shows that increasing interactions between faculty and preceptors, for instance through an online community of practice, constitutes a stakeholder-endorsed priority to advance EBP education in rehabilitation.

Socially Accountable Canadian Occupational Therapy Fieldwork with Indigenous Peoples: Where Are We At?

In an increasingly globalized world, there have been mounting calls for social accountability with respect to recognizing Indigenous and nonwhite human rights within nation states. Thus, this perspective paper reflects on the Canadian occupational therapy journey for social change with a specific focus on Indigenous fieldwork experiences. First, we describe the importance of cultural safety in occupational therapy practice and partnership development. Then we profile a unique and successful fieldwork experience as a guide for facilitating transformative learning during an Indigenous fieldwork placement. The results of a national portrait evaluation of Indigenous fieldwork across Canada and considerations for future actions are also presented. The time is right to create further opportunities to develop creative, constructive dialogue and strategic thinking to engage in and evolve occupational therapy fieldwork education in forward-looking partnerships with Indigenous stakeholders, services and communities.

Building evidence-based practice competencies among rehabilitation students: a qualitative exploration of faculty and preceptors' perspectives.

Medical education literature suggests clinically-integrated teaching may be the most effective approach to teach evidence-based practice (EBP). Before implementing this educational best practice in rehabilitation curricula, it is imperative to better understand the current context, barriers and facilitators to teach EBP in rehabilitation from the academic to the clinical setting. The aim of this study was to explore faculty and preceptors' experiences and perceptions of teaching EBP in rehabilitation professions, namely occupational therapy, physical therapy and speech-language pathology. We gathered data from seven focus groups and an individual interview with a sample of 24 faculty and 15 preceptors, i.e., clinical supervisors. Data collected were subjected to inductive thematic content analysis. We identified three overarching themes and corresponding strategies. First, "Recognizing EBP as a multifaceted concept" denoted participants' lack of consensus regarding the meaning and scope of EBP, and their awareness of such discrepancies. Second, "Complexity of EBP is at the core of teaching practices and experiences" referred to participants' perception of EBP as a complex process involving high-level cognitive skills, which influenced their teaching practices and challenged students and themselves. Third, "Connections and divides between research and practice" represented the limited and delicate connection between faculty and preceptors, the factors either bridging or maintaining the gap between them, and the impacts of such connections and divides on teaching. Improving collaboration between faculty and preceptors constitutes an essential first step towards more effective EBP training programs in rehabilitation that could be facilitated through online communities of practice or integrated knowledge translation research projects.

An integrated knowledge translation project to develop, implement, and evaluate a train-the-trainer program at a community rehabilitation program in Tamil Nadu, India.

PURPOSE: This project aimed to develop, implement and evaluate a train-the-trainer initiative for community rehabilitation workers (CRWs) and rehabilitation specialists within a community rehabilitation program for children with delayed development in Tamil Nadu, India. METHODS: Guided by the Knowledge to Action framework, non-governmental and academic partners collaboratively developed two 2-day workshops for (1) rehabilitation specialists and (2) CRWs. Outcomes were evaluated using mixed methods, with pre and 2.5-months post surveys (59 participants) and three focus groups (17 participants) involving trainers and trainees (including rehabilitation specialists and CRWs). RESULTS: There were significant increases in the CRWs' self-perception of their capacity to assess comprehension, provide explanations, respond to questions, adjust teaching, motivate learners, communicate effectively, and provide feedback. Significant changes were noted for rehabilitation specialists in five of seven domains, and for rehabilitation specialist leads in six of seven domains. Participants appreciated the interactive training style, and the use of immersive methods such as role play, though noted challenges when instructions were unclear or when they felt that material was more theoretical. CONCLUSIONS: This collaboratively developed train-the-trainer project demonstrates the value of such an intervention, provides an example of how a tailored program can be developed, and suggests the importance of stakeholder-driven design processes.Implications for RehabilitationThe ability to provide effective training is a core skill set for people engaged in community-based rehabilitation (CBR) programs, yet examples of initiatives to train trainers are lacking, as is their evaluation.This project demonstrates the value of a collaborative and tailored train-the-trainer program to support community rehabilitation workers and rehabilitation specialists in their training roles within a CBR program in India.A stakeholder-driven design process supported by a collaboration between non-governmental organization and academic partners enhanced the capacity to develop, implement and evaluate the train-the-trainer program.

1000 fieldwork hours: analysis of multi-site evidence.

BACKGROUND: Internationally, the World Federation of Occupational Therapists has established a minimum of 1,000 hours as the fieldwork standard. PURPOSE: To examine student development in fieldwork across placements to determine if students achieve entry-level competence after completion of 1,000 hours of fieldwork. METHODS: Archival data (N=400) from six occupational therapy programs were analyzed to examine the acquisition of fieldwork competency over time as measured by the Competency Based Fieldwork Evaluation Scale. FINDINGS: Competency scores increased with each fieldwork placement, the majority of students achieved entry-level scores upon completion of their final fieldwork placement. While, on average, some competency scores exceeded entry level by 1,000 hours, Practice Knowledge, Clinical Reasoning, and Facilitating Change fell just short. IMPLICATIONS: The identification of a plan for addressing the lower ratings in these three competencies should be considered.

Practice style traits of student occupational therapists and physical therapists.

BACKGROUND: Intensive efforts are aimed at understanding student attributes in anticipation that this will lead to effective knowledge translation (KT) strategies. One attribute of interest is practice style trait: four have been identified ranging from the seeker, who is driven by scientific evidence, to the pragmatist, who is driven by practicality. PURPOSE: To identify the prevalence of the four traits among student clinicians and explore associations between these traits, clinician characteristics and practice behaviours. METHODS: Ninety-two occupational therapy and 86 physical therapy students completed a survey that elicited information on traits, clinician characteristics, and practice behaviours. FINDINGS: The most prevalent trait was pragmatic, the least, seeker at <1%. The most prevalent reason for choosing an intervention was "it was used by my clinical supervisor". IMPLICATIONS: Educators should carefully reconsider the implication of using KT strategies that cater primarily to seekers. Research is warranted to explore the impact of matching educational strategies to traits.

Creation and pilot testing of StrokEngine: a stroke rehabilitation intervention website for clinicians and families.

OBJECTIVE: There is a gap in the translation of knowledge about stroke between researchers and clinicians. This paper describes the creation and pilot testing of an evidence-based stroke rehabilitation intervention website, StrokEngine (http://www.strokengine.org), which was designed to close this gap. DESIGN: A within-subject design was used to compare the usability and navigability of StrokEngine vs other search strategies/sites. Each participant searched a well-known stroke website, searched StrokEngine, and performed a free search, with the order of search randomized. A standard questionnaire was used to elicit information on usability and navigability across the 3 searches. SUBJECTS: A purposive sample of 19 rehabilitation clinicians from Montreal, Quebec, with varied stroke-related treatment experience. RESULTS: All 19 clinicians gave the highest usability score to StrokEngine (p<0.05): StrokEngine usability score (mean 43, SD 4) vs the Cochrane Library (mean 26, SD 8), the Royal College of Physicians website (mean 20, SD 5) and a general Internet search (mean 26, SD 7). CONCLUSION: This preliminary study on StrokEngine's usability and navigability suggests that it has the potential to be an asset for clinicians who wish to keep abreast of information on intervention effectiveness.

WebCT in occupational therapy clinical education: implementing and evaluating a tool for peer learning and interaction.

As occupational therapy expands into new practice arenas such as wellness, driver rehabilitation and ergonomics, educators are challenged to revise the curriculum as well as change educational technology. One of the changes in occupational therapy educational programmes is the utilization of on-line teaching. The purpose of this study was to evaluate the learning experiences of 42 occupational therapy students who were involved in a virtual learning environment during their six-week fieldwork placement. The results indicated that the majority of students enjoyed participating in this web-based learning environment (WebCT). A vast array of themes emerged from the on-line discussion and these themes reflected different levels of learning. Participation in WebCT during fieldwork appears to have a beneficial effect on student learning and achievement of stage 1 learning objectives by supporting students in peer learning. Other benefits include improving student autonomy during fieldwork, supporting self-directed learning and stimulating higher order thinking. Although the results of this study were positive there is still a need to further evaluate the effectiveness of web-based learning as an alternative to traditional educational methods during fieldwork education.