Accommodating Students with Disabilities: Fieldwork Educators’ Experiences

Abstract

Background. Fieldwork is an essential part of experiential learning in occupational therapy education. Fieldwork educators identify limits on reasonable accommodation and difficulty implementing disability-related accommodations. Student occupational therapists with disabilities report discrimination from within the profession, including inflexible fieldwork environments. Purpose. To understand the experiences of occupational therapy fieldwork educators in Canada in accommodating students with disabilities and to develop action-oriented practice recommendations. Method. In this interpretive description study, we interviewed 11 fieldwork educators about their experiences accommodating students with disabilities. Interviews were recorded, transcribed, and analyzed using a constant comparative approach. Findings. Educators emphasized a meta-theme of “Learning” when asked about disability-related accommodations. Three subthemes about student learning emerged: 1. Educators focused on “Student Learning in Preparation for Professional Practice” rather than their fieldwork setting only; 2. Educators were “Using Occupational Therapy Skills for Student Learning” in fieldwork; and 3. Educators recognized that their professional and personal “Context Influences Student Learning.” Conclusion. Fieldwork educators can work with students to align their accommodations with required learning outcomes for professional practice and use their occupational therapy skills to assist with implementation. Fieldwork educators require time and other supports to work effectively with all students.

Introduction

Changes in legislation and increased disability awareness are enabling more students with disabilities to access post-secondary education (Hargreaves & Walker, 2014; Jung et al., 2014; Newsham, 2008; Ozelie et al., 2019, 2022). However, students with disabilities are underrepresented in health professional programs (Lindsay et al., 2023). They have higher attrition rates compared to their non-disabled peers (Sharby & Roush, 2009). Further, students with disabilities report challenges accessing appropriate accommodations (Ozelie et al., 2019). It has been argued that stakeholders in health professional programs perpetuate barriers for students with disabilities through ableist practices (Bulk et al., 2017; Easterbrook et al., 2019), and that addressing ableism in professional programs will improve justice, equity, diversity, and inclusion (Lindsay et al., 2023).

There is a breadth of literature describing the student experience in professional programs. A recent systematic review of 48 studies by Lindsay et al. (2023), summarized the literature on ableism in the workplace for health providers and students with disabilities in health professional programs. They listed several types of ableism, including institutional, inaccessible environments, insufficient supports, and stigma and discrimination. As a result of ableism, students and professionals experienced difficulty disclosing their disability and asking for accommodations, which impacted their perceived career prospects and well-being. While there were methodological concerns in many studies, the findings were very similar. Lindsay et al. recommended further research to improve the entry and retention rates of students with disabilities in professional programs.

Educators in professional programs must partner with health organizations to find sufficient fieldwork hours for students. Organizations are not required to offer fieldwork opportunities, although it is an expectation for many teaching hospitals. Sites providing fieldwork opportunities must meet the needs of their patients and students (Rankin et al., 2010). Providing accommodations to students with disabilities in fieldwork can be challenging due to the limited availability of educators and sites, educators’ capacity to accommodate student needs, balance them with patient care, and ensure students meet fieldwork learning objectives (Stier et al., 2015).

The fieldwork educator and their organization's perspective are less well understood. In Australia, Rankin et al. (2010) conducted an exploratory qualitative study in which they held focus groups with representatives from 50 organizations that provide fieldwork opportunities to student nurses with physical disabilities. Findings indicate that representatives were committed to providing learning opportunities; however, they relied on timely disclosure of the student's disability for safety and their relationship with the student and university to facilitate the process. They also identified that the process can be more challenging with staff shortages and if the right mix of staff skill sets is not available.

Occupational therapists advocate for the inclusion of people with disabilities in meaningful activities (Dhillon et al., 2010; Ozelie et al., 2022). However, these values do not appear to be upheld within the profession, as occupational therapists with disabilities report experiencing discrimination from managers, educators, and colleagues (Bevan, 2014; Chacala et al., 2014). Student occupational therapists with disabilities describe accommodations as forced disclosure and indicate that fieldwork settings lack the flexibility needed for their learning (Jung et al., 2014).

Ozelie et al. (2022) surveyed occupational therapists and occupational therapist assistants about their perceptions of “reasonable” accommodations in fieldwork. They identified the most reasonable accommodations as using adaptive equipment and missing fieldwork activities due to disability-related needs. Unreasonable accommodations included involving an intermediary person to carry out a task and use of American Sign Language interpreters because the intermediary's tasks were considered essential and required another staff member to complete and interpreters were expensive. However, this descriptive exploratory study was limited by a small sample size in the United States, generated through snowball sampling of participants who potentially share similar biases.

In a qualitative pilot study conducted in Australia (Hirneth & Mackenzie, 2004), six occupational therapy fieldwork educators reported struggling with the balance between providing disability-related accommodations and ensuring students met practice competencies. They relied on the university program to support them and the students. They also struggled with maintaining the role of fieldwork educator and instead found themselves taking on the therapist role to meet students’ needs. The study is limited by the pilot design and was conducted nearly 20 years ago.

There is a need for more research about occupational therapy fieldwork (Jung et al., 2014). The perspectives of occupational therapists and students with disabilities indicate challenges with this component of professional programs (Bevan, 2014; Jung et al., 2014). The existing literature in occupational therapy primarily examines the perspectives of fieldwork educators in the United States and Australia and is limited to two studies, one of which is almost 20 years old (see Hirneth & Mackenzie, 2004; Ozelie et al., 2022). Given the regional and temporal influences on accessibility legislation, policies, and practices, there is a need to understand accommodation in the local context. Understanding the experiences of occupational therapy fieldwork educators can aid in the development of practical recommendations to improve the retention of students with disabilities in occupational therapy programs and the profession. The purpose of this study is to explore the experiences of occupational therapy fieldwork educators in Ontario, Canada, providing accommodations to students with disabilities and generate action-oriented recommendations for practice.

Method

We applied Thorne's interpretive description methodology to understand the experiences of occupational therapy educators providing fieldwork opportunities (Thorne et al., 1997). This methodology borrows from known traditions such as phenomenology, grounded theory, and ethnography and is flexible in its application (Thorne, 2016). Interpretive description is theoretically driven by the health discipline in which the research is being conducted (Thorne, 2016). This naturalistic approach recognizes that knowledge is constructed between researcher and participant and contextualized by the influence of the local environment (Hunt, 2009; Thorne et al., 1997, 2004). The outcomes of an interpretive description study are explanations about individuals’ experiences that are action-oriented for practice (Thorne et al., 2004). Interpretive description is a good fit for this study about occupational therapy fieldwork educators’ experiences as it emphasizes application and will result in practical suggestions for accommodating students with disabilities.

The foundational underpinning of interpretive description studies includes acknowledging “a socially ‘constructed’ element to human experience that cannot be meaningfully separated from its essential nature” and recognizing “that in the world of human experience, ‘reality’ involves multiple constructed realities that may well at times be contradictory” (Thorne, 2016, p. 82). Thus, while researchers aim to find patterns in the experiences of participants, they also anticipate and seek variations to present a robust description of their experiential knowledge. In this study, we used purposive sampling with maximum variation to recruit fieldwork educators from different practice settings, varying years of experience and geographical areas, anticipating that these factors may impact the educators’ experience of providing disability-related accommodations. All fieldwork educators worked in the catchment area of the same mid-sized university in Ontario, Canada, offering an entry-level occupational therapy program. The faculty member responsible for fieldwork in this program compiled a list of email addresses of educators who had provided at least one fieldwork experience for a student with disability-related accommodations in the last five years. This resulted in the identification of 96 educators who were sent an email inviting them to participate in an interview about their experience(s).

Eleven educators responded to the email invitation. Data were collected through in-depth interviews lasting between 30 and 90 min. One was conducted by phone, two virtually over Zoom, and eight in-person (seven of the in-person interviews occurred at the educators’ workplaces and one at the University). Interview questions focused on the educators’ experiences of accommodating students with disabilities and included questions such as: (1) How did you come to know that the student in fieldwork with you required accommodations? (2) What do you do in the accommodation process? Field notes were also taken during each interview for context and to make links between the educator's comments and the ideas emerging from the data (Thorne et al., 1997). Data were collected until new data no longer improved the understanding of the topic to a great extent (Hunt, 2009).

Interviews were audio recorded and transcribed verbatim. To begin the data analysis, the first and last authors immersed themselves in the data before beginning the coding process to encourage conceptualization (Thorne, 1997; Thorne et al., 2004). Then both authors coded five transcripts independently and met to discuss their codes and links within and across transcripts (Robinson et al., 2015). This process facilitated a “stable” coding framework such that a qualitative software program, Dedoose, could be used by the first author to code the remaining transcripts (Robinson et al., 2015). Then, the analysis involved searching for patterns in a constant comparative method (Robinson et al., 2015). These patterns were examined in comparison to one another to determine the overarching themes in the data, which led to considerations for the accommodation process. In keeping with interpretive description, the research team focused on results that could improve the process for both educators and students.

The research team includes five educators, three of whom teach in professional rehabilitation programs. The first author is an occupational therapist and university-based educator, with fieldwork education experience. She has published research about the experiences of student occupational therapists in their professional programs (Jung et al., 2014). This research study is part of her doctoral work. She conducted all interviews and wrote reflective journal entries after interviews and throughout the analysis process to optimize reflexivity (Thorne et al., 1997). Since she knew several of the participants as fellow occupational therapists, reflexivity was important to consider implications, such as potential power differences. The first author did not hold any leadership positions, nor did she have the same employer as any of the participants. In addition to journaling, she met regularly with the last author/thesis supervisor to discuss these issues. Ethics approval was received from the university's research ethics board.

Findings

Educators

All 11 educators were practicing clinically with individuals across the life span. Their clinical foci spanned: neurology, cardiovascular health, complex care, mental health, and/or general physical health. Table 1 provides an overview of the educators’ experience and practices.

Table 1.

Educators’ Experience and Practices

	n
Experience in Practice
• <11 years	1
• 11–20 years	3
• 21–30 years	5
• 31–40 years	2
Experience as Educator
• <11 years	1
• 11–20 years	8
• 21–30 years	0
• 31–40 years	2
Practice Settings
• Inpatient Hospital	4
• Outpatient Hospital	2
• Inpatient Community	1
• Outpatient Community	4
Geographical Location
• Northern Ontario	2
• Southern Ontario	9

Eight educators supervised one student with disability-related accommodations, another supervised two students, and a third supervised three students. One educator spoke more generally about their accommodation experiences. Table 2 provides information about students’ disabilities and their accommodations.

Table 2.

Students’ Disabilities and Their Accommodations.

	n
Students’ Disabilities
• Educator did not identify	4
• Learning disabilities	3
• Mental health/illness & trauma	3
• Neurological conditions	2
• Metabolic conditions	1
• Sensory deficits	1
When Accommodations were Identified
• Prior to fieldwork beginning	8
• At the beginning of fieldwork	4
• As fieldwork progressed	4
Students’ Accommodations
• Space for rest, medication/service animal or reading documentation	5
• Absence from fieldwork for medical/technology appointments	2
• Modifications to eliminate work on the floor	2
• Modifications to the fieldwork schedule	2
• Excuse themselves from triggering clinical interactions	2
• Breaks throughout the day	1
• Software program	1
• More feedback	1
• Reduced workload	1
• Involvement of support personnel	1

The meta-theme of Learning was evident across the 11 educators’ interviews, even though they were asked mostly about disability-related accommodations. There were three prominent subthemes: (1) Student Learning in Preparation for Professional Practice, (2) Using Occupational Therapy Skills for Student Learning, and (3) Context Influences Student Learning. Each theme is described below with representative quotations attributed to educators using pseudonyms.

Meta-Theme: Learning

Overall, educators identified that their primary focus in fieldwork was student learning. It was often unclear whether the educators were referring to their experiences with disabled students, or students in general, because of the value they placed on learning in fieldwork, irrespective of the learner. Educators reported that while some students have formal accommodations, all students had learning needs. Alka emphasized the importance of working with each student individually to address those needs:

…I’m sure other students I’ve had in the past have maybe not had accommodations, but they have…ways of learning, different learning styles. So, I think you have to accommodate everybody in some way, it's just this one is more a formal accommodation…I think every student, you don’t know…how they are going to interact, how their documentation is going to be…their strengths and weaknesses. So, just making sure that you can work within…their needs.

Educators understood that they were required to implement disability-related accommodations and because accommodations are needed for the broader goal of learning, the formal process often fit seamlessly into their work.

The participants described their views on disability through their accommodation experiences as “normalizing” disability. They did not view disability as a problem in fieldwork, nor did they require specific details. Zoya explained that the students’ diagnoses are irrelevant. Rather, Zoya's focus was on reducing students’ experiences of disablement through accommodations so that students could achieve their learning goals:

…I went through never knowing what her diagnosis was or what the medical condition was…and at the end of the day it doesn’t really matter…because we are looking at accommodations so it's kind of reducing any disability that might arise…regardless of the diagnosis, its neither here nor there…It really is about how they are functioning and what needs to happen in order for them to meet their school requirements.

Participants not only identified how helpful disclosure of functional impacts was in the accommodation process but they also understood the risks related to disclosure.

Most often educators discussed student learning, however, they also reported learning about themselves as practitioners and educators. They learned about disability-related accommodations and their own knowledge gaps in this area. Educators reflected on their assumptions and the need to challenge them. After meeting a student with a physical disability while teaching in the occupational therapy program at the University, Meenal invited her to have a fieldwork experience, thinking that the student may be interested in “mentoring” young clients at work:

I thought she would be able to share quite a bit…with our adolescents…I thought…it would be good. It wasn’t good for a number of reasons…there was no expectation at all that she would do that, so it wasn’t sort of part of the placement. And it became very clear, very early…she indicated that she did not want to do that, she wanted to do nothing that related to mentoring someone who had a physical disability…

Meenal recognized that it was inappropriate to assume that the student would engage in a mentorship role because she had a disability. This experience underscores the importance of recognizing that each student is unique and will determine their own place in the profession. The following three subthemes focus on student learning and how educators engage in their learning process.

Subtheme 1: Student Learning in Preparation for Professional Practice

Educators identified that their goal was to help students prepare for occupational therapy practice and that accommodations facilitated this process. Educators commented on important skills (e.g., problem-solving, prioritization, work–life balance, and ensuring safety) students needed to learn for practice; some of these skills intersected with the accommodations being implemented. Gyan supervised a student who struggled to complete documentation in the organization's electronic health records system because the student did not have access to the computer software they used at the university:

…you are making all these accommodations for her in school so she can do well on her assignments but there needs to be that transition for that to work for her in the working world as well…she is applying for jobs…I think it will make a big difference for her success in the workplace…having the tools that she already knows will help her…

Gyan worked with the student to access the required software and encouraged the student to speak to Human Resources about the accommodation process during employment. Amanat also discussed preparing students for practice but emphasized helping students and occupational therapists consider different models of employment:

…it might mean [that occupational therapists practice] individual psychotherapy with further training and [see] patients and/or clients once a week. That way [they are] taking on as many [clients] as [they] can handle at [their] own pace…I think sometimes we get tunnel vision and I think that we forget that…there is really inventive, creative models for working as an OT that I think as a profession, we haven’t gone there really.

Most educators commented on how students’ learning incorporated managing their disability while in fieldwork. For example, students learned about the impact of medication adjustments on their performance, how to manage mental health issues triggered by client interactions, and who to reach out to for disability-related support while in fieldwork. In some instances, the learning involved adjusting their accommodation to facilitate skill development. The student in fieldwork with Alka had an accommodation to bring scripts with her to client visits:

… she’d try to take that script with her…which I think is good to have some direction but also trying to…say okay, it's not just a script, we need to talk with [clients] and then base questions off what they say…I tried to have her not bring in the script but that she could still write down…responses and then I could jump in, as needed…and trying to work with her…so she gets all the information.

Alka reported that the student agreed that she was missing information and learned to gradually use the script less as she became more skilled at interviewing. Educators were future-oriented in their work with students, encouraging them to maximize learning in their fieldwork experience to help them prepare for professional practice.

Subtheme 2: Using Occupational Therapy Skills for Student Learning

When asked how they knew how to implement disability-related accommodations, educators identified that they used their skills as occupational therapists. Their response to accommodation needs was based on the student's report and their knowledge of how to improve occupational participation. For example, Raaina worked with a student who identified challenges working on the floor with babies due to mobility limitations. The student did not have formal accommodations:

Of course, I’m not seeing her as my client, but I have to use some of those OT skills…when she starts saying that something wrong with her knee then I start asking, so that's where the OT part comes in. So, what can you not do functionally or what you can do functionally…I don’t expect a student on the first week of a placement…would know what is available…So, I think I’m using my OT skills to do compensation and adaptation…

Raaina used a strengths-based approach to work with the student to facilitate the goal of learning in fieldwork.

Educators identified that engaging with students was essential to understand their needs and address them in a way that was helpful for their learning. This engagement required communication and collaboration. Daksh emphasized communication and listening to students’ expertise, in particular:

[The student is] the one who knows best what she needs or what has worked for her in the past and she was able to tell me enough about her condition and what happens and what the response should be and all that, that I felt comfortable just with that.

Shlok emphasized collaboration to determine the best way forward in her work setting and was open to various possibilities that suited the student:

… we identified the barriers…very quickly within the first few days and then we just sort of brainstormed together, like what are we going to do to…help this work for [the student]… if we needed to take extra time to do some things then that's fine…if we needed to use other methods to record information or to gather information or to move around in the school, then that's fine too.

Occupational therapists are required to be competent in communication and collaboration, which were also identified by educators as important for implementing disability-related accommodations.

Most educators stated that implementing accommodations was an iterative process, where they responded to the student's changing needs and engaged others if needed. Kudrat supervised a student with accommodations in a combined traditional and role-emerging fieldwork opportunity, in which they prepared in advance since Kudrat was not on-site full time:

I think what I was prepared for was if this goes sideways, we adjust…let's do this and adjust as necessary based on what happens…I knew that there could be a time where just in terms of managing all of this, [the student] may have to tap out completely.

The student had recently been diagnosed, and therefore, was in the process of adjusting to a new lifestyle while also trying to complete the final requirements of the occupational therapy program. As a result, Kudrat prioritized check-ins with the student and mobilized support as needed. If required, educators consulted others in the accommodation process, including work supervisors, colleagues, staff, and university-based educators. Overall, educators were solution-oriented and used their knowledge and skills as occupational therapists to accommodate students and ensure learning.

Subtheme 3: Context Influences Student Learning

Educators discussed how the experience of accommodating students depends on their context, specifically the employment demands/requirements, the social environment, and the educators’ personal responsibilities. Many educators commented on whether their work setting was conducive to taking students in fieldwork. Zoya worked in an outpatient community mental health setting that she said was a good fit for many students, including students with physical disabilities:

…if, for example, I had…a student with a physical disability, that's not going to be as much of a barrier to him or her than if…they were in acute medicine or in geriatrics or something like that where they have to do transfers and things like that. That's just not part of my job here. So, it's not going to be part of the students’ job.

Both educators working in mental health settings felt their workplace was flexible and accommodating for student learning as compared to other settings. Mahi works with people who have complex neurological injuries and was initially concerned about their ability to manage a clinical caseload and teaching responsibilities with limited information when asked to take a student with disability-related accommodations:

I was hesitant mainly because I know that my job is such a fast-paced job and because I know that [university-based educators] can’t really divulge a lot of information…and this is an accommodation [the student] need[s]. So, for me it's not knowing what is coming my way is a little nerve wracking.

After speaking with university-based educators, Mahi felt they could adequately fulfill both roles and proceeded with the fieldwork opportunity.

Some educators commented on the importance of support from managers and colleagues. Shlok felt supported in her current role, but identified that this has not always been the case:

Where I work right now…my supervisor [is] an occupational therapist and so in going to her and saying…we are going to need a little bit more time for this…she was very accommodating but one thing I found from my own experience over the years is that not all employers appreciate the amount of time that goes into having a student and being a [fieldwork educator].

While not speaking specifically about students with accommodations, Shlok highlighted that support from the employer is essential for facilitating student learning.

Gyan reflected on the personal context of the educator and their roles and responsibilities outside of employment and teaching. Gyan identified that not all educators are able to support student learning, as needed:

other people, if they have small children, they may be, ‘I got to be out the door at four o’clock because I have to pick up my kids’, but I’m…happy to stay longer and spend more time with the student because my kids are older, and I can be flexible that way. So, I think it would be harder for someone who…has other commitments if [they] have a student who…needs a bit more time if it's a busy placement.

Educators were cognizant of their personal context that either facilitated or challenged their ability to ensure student learning. Overall, educators recognized that the student's learning is influenced by the context of their own employment setting and personal circumstances.

Discussion

The purpose of this study was to understand the experiences of fieldwork educators when accommodating students with disabilities and develop action-oriented practice recommendations. The findings indicate that educators prioritize learning in the fieldwork setting. They use their occupational therapy skills to implement disability-related accommodations and facilitate student learning in preparation for professional practice. Educators report that their workplace and personal context are important factors in students’ learning. While not surprising, these findings lead to several practice recommendations explored below.

In this study, educators focused on learning. Their standpoint was that of educator and thus, their descriptions of accommodating students in fieldwork followed from this perspective. Studies about students with disabilities in professional programs typically focus on disability discourse, human rights, and their implications for students and other stakeholders in the accommodation process (Bulk et al., 2017; Easterbrook et al., 2019). Discourse about disability can explain why challenges exist and potentially offer solutions to these challenges (Gabel & Miskovic, 2014). Similarly, a human rights lens ensures that students have access to accommodations that remove barriers to their learning (Roberts, 2013). A discourse about learning forefronts this aspect of fieldwork, rather than disability or accommodations, which could help normalize accommodations rather than perpetuating the “othering” effect that disabled students may experience.

However, the risk in this approach is that educators may not provide accommodations if they are perceived as more than “typical” learning needs. Educators are legally required to implement disability-related accommodations in fieldwork (Ontario Human Rights Commission, n.d.). When they adjust the students’ prescribed accommodations or implement accommodations they determine as most appropriate, educators are potentially interfering with the students’ legal right to reasonable accommodations because developing disability-related accommodations falls within the purview of the student disability office on campus. Ideally, fieldwork accommodations should be determined by this office in collaboration with the student, program representative, and fieldwork educator. However, this may be a cumbersome process.

Also, by educators foregrounding learning, disability is moved to the background or minimized in the fieldwork setting. Some students with disabilities may strongly affirm their identity as a disabled person for sociopolitical reasons, in which case normalizing accommodations as part of learning, may diminish this identity. Previous research recommends disability awareness and legislation training for educators (Botham & Nicholson, 2014; Brown et al., 2006; Calloway & Copeland, 2021). However, occupational therapists are educated in understanding disability and its impact on occupation (Townsend & Polatajko, 2013). Given the competing discourses, this study highlights the ways in which a learning discourse can provide an alternate framework for discussions about disability-related accommodations in fieldwork, while considering the potential limitations of such an approach.

Further, a discourse focused on learning does not negate the importance of occupational therapists considering their own social position and its implications for their work. The educators in this study identified their assumptions related to disability and accommodations, signaling that they are also learning. Ongoing critical reflexivity by educators is needed to understand and appreciate differences, including disability, within the profession (Chacala et al., 2014; Taguchi Meyer, 2014). The opportunity for educators to learn may be a benefit of supporting students with disabilities in fieldwork such that educators can then interrogate the biases that arise for them with their support system, as this would not be an appropriate role for students. In addition, the implementation of accommodations in a “real world” context may reveal opportunities for flexibility in employment that could be helpful for the organization to reflect on when considering hiring and accommodation practices. We recommend that professional programs emphasize both the importance and value of offering fieldwork opportunities to clinical sites.

In this study, the tasks of accommodating students and assisting them with meeting professional competencies were combined under the purview of learning. Educators leveraged accommodations to assist students in working toward achieving professional competencies. In previous fieldwork research, occupational therapy educators separated these tasks, and they reported difficulty achieving both concurrently (Hirneth & Mackenzie, 2004). One difference may be that educators in this study did not perceive fieldwork to be a separate and static entity in which students had to learn to function. Rather, they described a fluid situation in which the student's accommodations aligned with their learning goals and the fieldwork opportunity was one part of the student's journey to becoming an occupational therapist. We recommend this future-oriented approach as part of fieldwork educator training and support to enable flexibility when working with students to address accommodations and learning needs.

Educators identified using their occupational therapy skills, such as communication and collaboration, when providing accommodations. Similar studies also cite the importance of communication between educators and students (Ozelie et al., 2019; Rankin et al., 2010). Hirneth and Mackenzie (2004) found that fieldwork educators were taking on the role of therapist to fulfill students’ needs. This may be a potential boundary crossing if educators are providing treatment to students while also assessing their learning. Students can benefit from educators’ knowledge and skills in altering the task or environment to facilitate their participation in learning, which does not require the educator to become their therapist and cross boundaries. We recommend university programs help differentiate between the therapist role and educator role to better support educators and students in fieldwork.

Educators provided insights on how their context including, job requirements, work supervisors, and personal responsibilities could influence their ability to facilitate student learning. Mental health settings were identified as the most flexible for disability-related accommodations due to limited physical demands and the pace of work, while previous research demonstrates that rehabilitation settings are perceived to be most flexible for students with disabilities (Hirneth & Mackenzie, 2004; Ozelie et al., 2022). Several educators in this study specified that time is needed to develop implementation plans with students for their accommodations. However, time can also be an issue for educators for a variety of reasons, including when students are not meeting minimum performance requirements. Similarly, while providing accommodations may be challenging due to the limited availability of educators, the skills of the educators and their ability to provide client services simultaneously (Rankin et al., 2010; Stier et al., 2015), these factors are not unique to working with students with disabilities. Educators need support from their supervisors because the role of fieldwork educator requires resources. The extent of those resource needs will vary depending on factors such as the nature of support the educator must provide, the complexity of the student's accommodation/learning needs, etc. We recommend that education policies and memorandums of understanding with fieldwork sites acknowledge the varying amounts of resources that may be needed due to a multitude of reasons in fieldwork, not specifically due to disability-related accommodations.

Strengths and Limitations

The strengths of this study include the application of interpretive description methodology, which has led to practical considerations for fieldwork education. Further, two members of the research team coded half of the transcripts independently to build a coding tree and ensure rigour in the analysis process. Also, the educators in the study represent a breadth of practice and teaching experience across varied practice settings.

The limitations of the study include using interviews as the only data source collected at one point in time. All participants were employed in the catchment area of one Canadian occupational therapy program and recruitment occurred through the fieldwork education department. Knowledge claims from this study are limited to 11 educators who worked with students with disability-related accommodations, had generally positive experiences, and felt comfortable discussing these experiences.

Conclusion

Previous research indicates that students with disabilities in professional programs report experiencing ableism within their programs and educators in these programs express challenges with finding adequate fieldwork opportunities and difficulty accommodating students with disabilities. Rather than focusing on challenges, the findings in this study demonstrate opportunities. Educators prioritized learning and used their knowledge and skills to create flexible accommodation options for students to progress in their individual journeys to becoming occupational therapists. The accommodation process can be complex as reasonable accommodation in one fieldwork setting may not be reasonable in another setting. Overall, educators require support to do this work. While this study provides the perspective of Canadian occupational therapy fieldwork educators from one university program, future studies need to involve fieldwork educators across the country from different healthcare professions, including educators who struggle with implementing disability-related accommodations.

Key messages

• Being open and flexible to learning with and from students with disabilities can enhance practice for both the student and the therapist.

• Adopting a future orientation and engaging students about their learning needs can enrich learning and preparation for occupational therapy practice.

• Fieldwork educators require support from supervisors, particularly time, to fulfill this role well and in addition to their clinical role.

Author Biographies

Shaminder K. Dhillon, PhD(c), OT Reg. (Ont.) is an assistant professor in the School of Rehabilitation Science at McMaster University, Canada.

Sandra E. Moll, PhD, OT Reg. (Ont.) is an associate professor in the School of Rehabilitation Science at McMaster University, Canada.

Magda Stroinska, PhD, is professor emeritus in the Faculty of Humanities at McMaster University, Canada.

Patricia E. Solomon, PhD, is professor emeritus in the School of Rehabilitation Science at McMaster University, Canada.