OT IN H IGHER ED

Addressing the process of fieldwork

preparedness
Laura Fahs, Stephanie Klotz, Angela Caldwell, Antonia Montefiori, Madalyn Kopmanis, Renee Swallow, and Joanne Baird, Volume 28 •
Issue 11 • November 2023, pp. 33–36 11/01/2023

Preparation for Level II fieldwork is a critical component of occupational therapy education, providing students with
vital opportunities to promote clinical reasoning and manual techniques (American Occupational Therapy
Association, 2013). Although occupational therapy programs provide students with the knowledge and skills for
fieldwork success, students may not feel confident or fully prepared to meet the challenges associated with
transitioning from classroom- to clinical-based performance (Bergstresser-Simpson et al., 2023; Snyder, 2018). This
need was discussed at a Pi Theta Epsilon (PTE) meeting, which included third-year students who had completed
their Level II fieldwork rotations and second-year students who would begin Level II fieldwork rotations the following
term. PTE is an honor society for occupational therapy students that recognizes scholastic excellence, contributes to
the advancement of occupational therapy, and promotes collaboration in scholarly activities (American Occupational
Therapy Foundation, 2023). As a result of these discussions, the third-year students proposed hosting an event to
provide the second-year students with a pre-fieldwork Skills Day—a day of hands-on skills review as an additional
opportunity to prepare for their upcoming fieldwork rotations.
Station 1: Second year students practicing managing lines/drains/tubes when transferring a patient out of bed to a chair

Event Planning

The University of Pittsburgh's Doctor of Occupational Therapy (OTD) curriculum provides optional
training for third-year students to be near-peer facilitators (NPFs). NPFs are more senior students who
have recently gone through an experience that a student a step behind will soon face, and they are
responsible for promoting skill development during simulations. Evidence supports many benefits of
NPFs, such as providing insight into relevant fieldwork experiences that often are not noted by faculty
(Khaw & Raw, 2016). Evidence also indicates that students feel more comfortable and are more apt to
test new ideas or try novel skills with a near-peer than with faculty (Burgess et al., 2020; Khaw & Raw,
2016). Based on this evidence, PTE leadership members concluded that NPFs would lead Skills Day.
This decision signified the beginning of a 3-month planning period to develop an event to increase the
second-year students' self-confidence and self-efficacy before their Level II fieldwork rotations.

PTE leadership members sent an informal, open-ended question survey to second-year students to
gauge interest and collect data about what skills they would like to practice the month before their
Level II fieldwork rotations began. Thirty-seven second-year students completed the survey, and PTE
leadership members and faculty advisors reviewed these results. Data supported the creation of clinical
simulations based on five customary practice areas:

1) acute care,

2) inpatient rehabilitation,

3) outpatient rehabilitation,

4) skilled nursing, and

5) pediatrics.

Each area had two corresponding lab stations with clinical scenarios based on learning objectives. See Table 1 for a
summary of the selected stations, corresponding practice settings, and objectives.

Table 1. Skills Day Stations and Objectives

Acute Care Station Objective

Managing Lines, Drains, & The student will independently manage

Tubes; Taking Vitals lines, drains, and tubes and accurately
take vitals on a patient for 2/3 trials.

Co-Treating The student will require minimal verbal

cueing to correctly identify three
potential fall risks during a co-
treatment with another health care
f i l
 professional.

Inpatient CARE Sets The student will independently

Rehabilitation complete all components of the CARE
Sets during a treatment session.

Adaptive Equipment for The student will correctly identify

Dressing appropriate adaptive equipment in 2/3
trials, and, with minimal verbal cues,
provide patient education for lower
body dressing.

Outpatient Splinting Essentials The student will accurately make 2

splinting patterns for a patient with a
wrist injury.

Outcome Measures The student will be able to

independently complete 3 outcome
measurements on a patient while
maintaining safety precautions.

Skilled Nursing Bed Mobility The student will utilize proper body
mechanics with minimal verbal cueing
to perform bed mobility tasks.

Wheelchair Management The student will independently operate

a manual and power wheelchair.

Pediatrics School-Based Essentials The student will correctly identify an

appropriate school-based intervention
in 2/3 trials.

Pediatric The student will independently identify

Inpatient/Outpatient and trial 3 games that can be used
Essentials during a pediatric outpatient/inpatient
intervention session.

The goal of the event was to provide second-year students with an opportunity to practice a manual
skill embedded in a clinical scenario common to its specific practice setting; skill proficiency was not
expected or anticipated. Thus, the stations were designed to prepare students for day one of fieldwork
with an initial level of readiness, based on the experience of the NPFs. The use of stations allowed
second-year students to complete the task with an NPF guiding them through the clinical scenario to
promote a safe learning environment.
Station 6: Third year NPFs demonstrating how to complete manual muscle testing for the upper extremity

Event Preparation
Several support documents were created to guide NPFs to lead activities with consistent use of best practices. Each
station had learning objectives, a learning outcome, a materials list, and a description of the simulation. PTE
leadership members collaborated with fellow third-year students to develop the clinical scenarios and station
designs. As a result, stations included common assessments and relevant skills needed to succeed in each practice
area. Third-year students designed each station based on their experience to simulate how a student would
incorporate skills into a treatment session. Faculty members with expertise in the respective clinical area reviewed all
the drafted supporting documents and clinical simulation scenarios. Faculty provided verbal and written feedback,
and final documents reflected the recommended changes for the event.

Each station had a materials list that included all supplies and equipment needed to set up and reset the station.
These ranged from hospital beds to adaptive equipment to paper towels. NPFs used these equipment lists before
and during the event to ensure that all stations had the necessary materials. The event occurred from 10:00 am to
2:00 pm on a weekday after scheduled classes to provide an extended time convenient for students. NPFs signed up
to volunteer for either a morning session from 10:00 am to 12:00 pm, an afternoon session from 12:00 pm to 2:00 pm,
or both. They signed up for the stations where they felt they had the most fieldwork experience. During each
session, one to three NPFs supported each station.

Station 7: Second year students practicing proper body mechanics when performing bed mobility tasks
Second-year pre-fieldwork students received an email about each station and instructions to sign up for stations of
preference based on their upcoming Level II placements. Second-year students signed up for 20-minute time slots
for each station and created a personal schedule for the stations based on these 20-minute rotations, allowing 18
minutes to participate in the station simulation and 2 minutes to transition to a new station. A maximum of three
students were permitted to sign up for each time slot to ensure enough time to provide an overview of the station,
allow each student to engage in the skills, leave time for questions, and transition to the next station. The ratio of
NPFs to participants was small, to encourage second-year students to be as hands-on as possible.

Station 9: Second year students working on how to implement a common game into a pediatric treatment session that targets age-appropriate

skills

Event Implementation
PF volunteers set up each station the day before the event. A handout outlining where each station would go
ensured that each station had the optimal space needed and that the required materials were present. Stations were
set up in classrooms, hallways, and the student lounge. On Skills Day, the NPFs arrived 15 minutes before the event
to review any final instructions and to ask questions. Each rotation began with a brief overview of the station's
objectives provided by the NPF, followed by a demonstration. Second-year students were encouraged to engage in
hands-on learning as much as possible and would often be part of the demonstration to ease into their facilitated
skills-based task. They received verbal feedback as they practiced completing each task. After practicing the skills
at each station, they had an opportunity to ask questions, and the NPFs shared tips for success based on their
fieldwork experiences. At the end of the 20-minute time slot, the NPFs reset the station's materials to prepare for the
next group.

After Skills Day, second-year students received a post-event survey via email. The survey included multiple choice
questions about scheduled Level II fieldwork settings, sessions attended at Skills Day, and four open-ended
questions. The responses provided information regarding what students found helpful, what things stood out to
them, and what suggestions they had for improving this event in the future.
Station 10: A third year NPF showing second year students how to upgrade and downgrade school-based interventions

Results
In total, 21 of 53 third-year students (40%) served as NPFs during the event, and 45 of 60 second-year students
(75%) participated in Skills Day. Of the 45 second-year students who attended Skills Day, 37 (82%) responded to the
post-event survey. The stations that attracted the most students covered skills needed for acute care and inpatient
rehab settings (see Figure 1).

Figure 1. Skills Day Station Attendance

Lessons Learned
In response to the open-ended questions, students reported that the first-hand experiences shared by the NPFs and
the ability to focus on hands-on practice were most helpful. Many students said they would prefer more time in each
station and more time to break between sessions for future events. Specific recommendations included more time to
review materials, practice hands-on skills, and ask questions before transitioning to other stations. They also
reported that some stations (e.g., CARE sets, splinting) might require more time than others.

Suggestions also included specific station modifications. For example, one student indicated that having common
pediatric assessments available to review would have been helpful. Students also preferred that pediatric stations
cover broader practice areas, including medically based settings. Recommendations included adding a tracheostomy
k d h tt b f th t i B d th lt ld di i
mask and chest tube for the acute care scenarios. Based on these survey results, we would recommend increasing
the amount of time for each station, combining the pediatric stations, and adding additional equipment to the
managing lines, drains, and tubes station.

Conclusion
Second-year students reported that Skills Day was a helpful, hands-on supplement to existing curriculum-based
fieldwork preparation. Students shared sentiments of appreciation both in the survey and throughout the event.
Students recommended that the event occur on an annual basis. The documents created will allow for easy
replication, and student feedback can improve materials for future Skills Day events.

References

American Occupational Therapy Association. (2013). COE guidelines for an occupational therapy fieldwork
experience—Level II.
https://www.aota.org/education/fieldwork//-/media/corporate/files/educationcareers/educators/fieldwork/levelii/coe-
guidelines-for-an-occupational-therapy-fieldwork-experience-level-ii-final.pdf

American Occupational Therapy Foundation (2023). Pi Theta Epsilon: Student membership handbook.
https://www.aotf.org/Portals/0/PTE/PTE%20Membership%20Handbook%206_17_20_2[1]%20copy%202.pdf?
ver=OQOJLsKx17t8ZhcNDotwYA%3d%3d

Bergstresser-Simpson, R., Sweetman, E., Maloberti, C., Hall, M., Hermes, F., & Worl, B. (2023). OT graduate students'
perceived preparedness for Level II fieldwork: Traditional, nontraditional and mixed fieldwork I experiences. Journal
of Occupational Therapy Education, 7(1), 1–27. https://encompass.eku.edu/jote/vol7/iss1/15

Burgess, A., van Diggele, C., Roberts, C., & Mellis, C. (2020). Key tips for teaching in the clinical setting. BMC Medical
Education, 20(Suppl. 2), 463. https://doi.org/10.1186/s12909-020-02283-2

Khaw, C., & Raw, L. (2016). The outcomes and acceptability of near-peer teaching among medical students in clinical
skills. International Journal of Medical Education, 7, 188–194. https://doi.org/10.5116/ijme.5749.7b8b

Snyder, K. (2018). Exploring students' use of feedback during occupational therapy Level II fieldwork experiences.
Journal of Occupational Therapy Education, 2(2), 1–20. https://doi.org/10.26681/jote.2018.020204

Laura Fahs, OTD, OTR/L; Stephanie Klotz, OTD, OTR/L; Madalyn Kopmanis, OTD, OTR/L; Antonia Montefiori, OTD,
OTR/L; and Renee Swallow, OTD, OTR/L; were students at the University of Pittsburgh who served as the leadership
team for Skills Day.

Joanne M. Baird, PhD, OTR/L, CHSE, FAOTA; and Angela R. Caldwell, PhD, OTR/L, CLT, are faculty in the Department
of Occupational Therapy at the University of Pittsburgh who supported Skills Day.
 © 2023 American Occupational Therapy Association, Inc. All Rights Reserved

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