Factors Influencing Occupational Therapists’ Decision to Supervise Fieldwork Students

Abstract

The purpose of this study was to identify factors that influence the decision to supervise a Level II occupational therapy fieldwork student. A survey was sent to occupational therapists from licensure boards and alumni rosters, including those who have and have not supervised students (n=548). The results identified both positive and negative influences along with predictive factors of supervising a student. While positive factors included continuing education units, education on fieldwork expectations, their own fieldwork experiences, shared supervision, and access to educational resources, negative influences consisted of: job responsibilities, caseload, productivity standards, working part-time, and fear of failing a student. The discussion focuses on how to address the needs of the clinician and facilitate fieldwork placement.

Fieldwork, a required part of an occupational therapy curriculum, is the element of education that permits the student to develop competency by demonstrating appropriate clinical and professional skills under the direction of a qualified occupational therapy practitioner (Accreditation Council for Occupational Therapy Education [ACOTE], 2013). An occupational therapist must have a minimum of one-year experience and be adequately prepared before serving as a fieldwork educator for a Level II fieldwork student (ACOTE, 2013). Completion of Level II fieldwork experiences are near the end of the didactic course work and considered an extension of the academic program. To ensure students have sufficient time on fieldwork to develop professional competence, the World Federation of Occupational Therapists requires a minimum of 1,000 hours of clinical fieldwork (Holmes et al., 2010).

Over the last five years, occupational therapy has had a significant increase in students (American Occupational Therapy Association [AOTA], 2014). This growth created an increased need for fieldwork placements. According to the American Occupational Therapy Association (AOTA) (2014), a minimum of 54,050 Level II fieldwork placements were required based on 2014 enrollments. However, the number of sites available for students to complete their fieldwork experiences does not appear to be meeting the growing demand (AOTA, 2014).

Additionally, the job responsibilities therapists have in addition to treatment make finding qualified clinicians willing to take on the role of a fieldwork supervisor more challenging. Casares, Bradley, Jaffe, and Lee (2003) employed a survey to investigate how academic fieldwork coordinators and clinical educators from the southern United States (US), viewed the healthcare reform’s impact on student placements. Fieldwork educators (n=61) and academic fieldwork coordinators (n=17) were asked which factors they believed adversely affected student placements. Results included cost cutbacks and changes in reimbursement and increased productivity demands (Casares, Bradley, Jaffe & Lee, 2003).

According to the US Department of Labor (2014), “Employment of occupational therapists is projected to grow 29 % from 2012 to 2022: greater than the typical growth expected for any other occupation” (para 4). This increased interest in the field has led to more individuals entering programs, an increase in the number of schools, and a greater necessity for student fieldwork opportunities. Yet the marketplace still reflects a dearth of licensed therapists in all practice settings across the US. The shortage of licensed professionals has implications on available fieldwork supervisors in traditional practice areas and in emerging areas of practice. Emerging practice sites are important to consider when exploring potential fieldwork placements, as they are important to the development of the profession (ACOTE, 2013). All of these factors contribute to the shortage of fieldwork placements and make the issue critical to the future of the profession.

Issues related to fieldwork placement.

Clinician resistance to proctor students is not unique to occupational therapy; this is a noted phenomenon across healthcare disciplines (e.g. nursing, physical therapy). According to research (Casares et al, 2003; Davies et al, 2011; Hanson, 2011; Ilott, 1996; Ozelie et al., 2015), there are several reasons identified to explain why an experienced professional may decline supervision of a student including workplace stress, role strain, fear of difficult student interactions and limited resources. The workload and productivity demands of healthcare professionals create stress for practitioners and act as significant deterrents for willingness to accept a fieldwork student (Davies et al., 2011; Ozelie et al., 2015). A clinician’s perceived ability to maintain productivity, especially when asked to simultaneously fulfill multiple roles in his/her practice setting, may contribute to role strain. Therapists perceive the request for supervision as an additional expectation and responsibility to the practitioner’s workload (Barton et al., 2013).

Another reason to decline student supervision may be to avoid conflict. Ilott (1996) completed a study in Great Britain with 113 trained and experienced fieldwork supervisors. Results of a questionnaire indicated fear of a problematic situation or having to fail a student might affect occupational therapists’ willingness to accept a fieldwork placement. There is further support for this in a phenomenological study executed in Australia. Hunt and Kennedy-Jones (2010) used in-depth interviews to gain understanding of how new graduate therapists, those with less than five years of experience, perceived readiness to supervise a student. Similar to the results of Ilott’ s (1996) study, the need to provide negative feedback to struggling students was very concerning as the therapists hoped to avoid conflict and strain on the student-educator relationship. In addition, the participants expressed the need to feel comfortable with their own caseload and their own skills as a clinician before they could facilitate someone else’s learning.

In another study, Hanson (2011) utilized electronic focus groups with 10 occupational therapists, who supervised at least one Level II fieldwork student, to explore the available incentives and barriers associated with student supervision. Shortages in staffing and physical resources, such as limited available computers and space to complete treatment and documentation, prevented clinicians from agreeing to supervise a student. The drawbacks identified within the role of fieldwork supervisor were the amount of commitment required on the part of staff and clients, the preparation time necessary, and the potential of having a student not adequately prepared for fieldwork. Many clinicians who participated in this study requested more support from the educational institutions including providing information regarding ACOTE standards, communicating regularly with academic fieldwork educators, and developing calendars and weekly newsletters from the academic fieldwork coordinator. Thomas et al. (2007) explored this topic with Australian occupational therapists (n=313) and reported the same concerns mentioned in Hanson’s work. In addition, the Australian therapists mentioned time constraints, workload pressures, and insurance reimbursement issues as barriers.

Gaps in the Research

While the availability of fieldwork sites is a recognized concern for the profession of occupational therapy, there is still minimal research available to identify influencing factors or viable solutions (AOTA, 2014). There is no current research available examining which factors affect a clinician’s decision to accept or not accept a fieldwork student. The studies previously mentioned investigated related topics, but were limited with small sample sizes and many were not completed in the US. This makes it difficult to determine the generalizability of the information to the practice of occupational therapy in the US, or if the differences of culture, healthcare and educational preparation have an impact on the factors identified. Many studies employed to explore the topic of fieldwork in the US, focus primarily on the reflective fieldwork supervisor opinions, the perspectives of the students, or the experiences of the students related to different practice settings (Kautzmann, 1990; Koski et al., 2013 Mackenzie et al., 2001; Michaud, 2010, Strong et al., 2003).

Finally, no research study actively sought the perspective of those who have chosen not to supervise a student. This information is pertinent in addressing the shortage of fieldwork placements and potential solutions. The perspectives of not only those who have supported a student, but also the perspective from those who have been hesitant or unwilling to support a student need to be understood. Identification of the needs and factors influencing the decision of occupational therapists may allow the needs of the clinician to be better addressed prior to student placement requests, and may even facilitate the placement of additional fieldwork students (Hanson, 2011; Davies et al., 2011; Thomas, et al., 2007). Without further research into this topic, appropriate and effective strategies to increase fieldwork placements will be difficult to identify.

If the interest in the field of occupational therapy continues to rise, as indicated by the 74% rise in the number of occupational therapy students from 2005 to 2014 (AOTA, 2014), there will be a clear need for increased number of fieldwork placements to meet the demands. Although fieldwork shortages are not a new problem, a comprehensive answer has not yet been identified. Thus, the purpose of this study was to explore factors affecting the decisions of occupational therapists that are asked to supervise Level II fieldwork students. The identification of these factors and what influence they have on the decisions of fieldwork educators may enable academic fieldwork coordinators and academic programs to address the precipitating factors and therefore increase fieldwork opportunities.

Methodology

Survey/Questionnaire Research

A cross-sectional survey research design was used to collect information on the nature of the current perceptions of occupational therapist in regards to providing supervision for Level II fieldwork students. This design allowed access to a large sample, was time and cost effective, and explored a variety of variables. This design also allowed participation to be convenient and timely.

Participants

Ethical approval for this study was obtained from the Institutional Review Board and completion of the survey served as informed consent. Non-probability and snowball sampling were used to obtain participants for this study. Participants were identified through the alumni rosters of the two universities; in addition, the state licensing boards of North Dakota and Florida were used. Originally, requests for emails of licensed occupational therapists were made to several state licensing boards in order to have a diversified selection of potential participants. However, not all states had an available email listing as part of their database. Of the requested states, the only email lists available were in North Dakota and Florida.

To meet the inclusion criteria for this study, participants were required to be licensed occupational therapists with at least one-year experience (per ACOTE requirements for a Level II fieldwork educator), English speaking, and willing to complete the survey. Perspectives of both clinicians who have supervised a student and those who have not were sought for this study. Exclusion criteria included certified occupational therapy assistants, occupational therapists not currently active in practice, individuals working less than 10 hours a week and those who have not yet practiced for one year.

Instruments

The survey was developed based on the information from the literature and focused on the views, attitudes, and beliefs affecting the willingness of occupational therapists to supervise Level II fieldwork students. An online survey was constructed to enable electronic distribution and administration, eliminate printing and postage costs, and to facilitate organization of the data for further analysis. The anonymous survey was developed using Research Electronic Data Capture (REDCap) a secure, web-based application designed to support data capture for research studies (Harris et al., 2009). The survey was piloted with two occupational therapy academicians, and two occupational therapy clinicians. Revisions were made based on the feedback from the pilot sample. The survey design included a combination of multiple choice demographics, mark all that apply, and two open-ended responses. In questions that asked about factors that positively influenced, negatively influenced, or did not influence their decision to accept a Level II student(s), participants were given the opportunity to “mark all that apply”. The open ended questions asked participants: 1) What 3 factors from the list do you feel have the most influence on your decision of whether or not to supervise? 2) What factors could increase your likelihood of supervising a student? This area allowed participants the ability to elaborate on or clarify a specific response and identify additional factors that may not be mentioned in literature, therefore not included when the survey was developed.

Procedures

An email providing information about the purpose of the study, the confidentiality process, a link to access the electronic survey, and a request to forward email to other practicing occupational therapists was sent to all intended participants. A total of 548 surveys were completed of the estimated 6,000 sent. A true response rate cannot be determined because of the request to forward the survey. From the surveys returned, a total of 48 did not meet the inclusion criteria, so were excluded from data analysis. These included participants working less than 10 hours a week (n=21) or having less than one-year experience (n=27). Therefore, a total of 500 completed surveys were reviewed and analyzed for this study.

Data Analysis

Descriptive statistics (means, SD, IQR ranges, n and proportions as indicated by variable type) were performed for all survey questions, demographic variables and characteristics of respondents. Participants were asked “Have you ever taken a Level II student in the past?” Based on the response, individuals were divided into two groups; those who have always taken a fieldwork student versus those who never or only sometimes take a fieldwork student. The makeup of this second grouping was based on the sample size of each group. This allowed us to compare the strongest group (those who always take students) to the others since the goal of identifying influencing factors is to make changes that would encourage practicing therapists to accept fieldwork students. Survey questions were also ranked by positive, negative and no influence on the decision to always accept a fieldwork student. A chi square test or Fisher’s exact test (for sparse data) was used to test for difference in proportions between the two groups based on survey questions and respondent characteristics.

A multivariable logistic regression model was performed using investigator selected survey items and demographic/workplace variables as predictors for the two-level response of always accept fieldwork student versus sometimes or never. Results are presented as adjusted odds ratios, 95% confidence intervals and corresponding p values. In this multivariable model the adjusted odds ratios examine the odds of the given predictor after controlling for all other predictors in the model. All analyses were conducted using SAS version 9.4 (Cary, NC). The alpha level for statistical significance was 0.05. Survey questions were tested individually, so the p values have not been adjusted for multiple comparisons. In addition, corresponding open-ended questions used within the survey strengthened the credibility and accuracy of the findings, and clarified information gathered.

Results

Four hundred and fifteen participants reported working 30 hours a week or more (83%), the majority had greater than 10 years of experience (62%), and many had direct input into the potential to accept supervision of a fieldwork student at their facility (67%). Table 1 offers detailed demographic information on the participants, further categorized by whether the participant always, sometimes or never accepts a Level II student.

Table 1:

Descriptive Summaries

Demographic or Work Characteristic of Respondent	Ever taken/refused to Take FW student?
	Always		Mixed		Never		Overall
	N	Col. %	N	Col. %	N	Col. %	N	Col. %
Years experience
Less than 1 year	.	.	.	.	1	0.7	1	0.2
1-5 years	34	18.4	9	5.2	70	49.6	113	22.6
6-10 years	31	16.8	23	13.2	19	13.5	73	14.6
11-15 years	35	18.9	35	20.1	18	12.8	88	17.6
16-20 years	25	13.5	32	18.4	11	7.8	68	13.6
20+ years	60	32.4	75	43.1	22	15.6	157	31.4
Currently work?
+40 hours a week	95	51.4	79	45.4	53	37.6	227	45.4
40-30 hours a week	65	35.1	68	39.1	55	39.0	188	37.6
30-20 hours a week	15	8.1	18	10.3	18	12.8	51	10.2
20-10 hours a week	10	5.4	9	5.2	15	10.6	34	6.8
Feel prepared to supervise a Level II FW student
	172	93.0	162	93.1	67	47.5	359	71.8
Have input re Level II FW student is accepted
	116	62.7	134	77.0	78	55.3	328	65.6
Participated in ed. opp. to prepare for a Level II FW student?
	84	45.4	95	54.6	17	12.1	196	39.2
Ed. resources at your facility to be a Level II FW supervisor?
	72	38.9	69	39.7	40	28.4	181	36.2

Within the survey, all participants were asked how specific factors influenced fieldwork supervision decisions (Figure 1). The respondents had the ability to choose all items that apply; therefore, if a factor has the potential of being both a positive and a negative influence, the individual was able to mark both. This process was chosen to ensure the survey could capture all of the therapists’ experiences.

Figure 1:

Rank ordering of items that influence decisions to take fieldwork students

Factors such as degree difference (88%, n=435), nomination for awards (78%, n=383), university swag (i.e. pens, lanyards, etc. from the universities) (77%, n=379), placement during winter months (71%, n=347), and reimbursement guidelines (69%, n=335), were the factors most often cited as having no impact on the decision to accept or decline fieldwork supervision.

Regression Analysis

The results of a univariate analysis about factors that positively or negatively influence the decision to supervise a fieldwork student identified several predictors (Table 2). Out of the 163 participants who always accepted fieldwork students, 104 (63.8%) identified Onsite Mentorship as a positive influence to take a student. This is compared to 125 (46.6%) out of the 268 who never or only sometimes accepted students (p<0.001). The majority of participants who always take a student, 125 (76. 7%), identified Past Experiences as a Fieldwork Student as a positive influence on the decision to take students versus 152 (56.7%) of those who only sometimes or never take a student (p<0.001). Prior Experience Supervising a Student was identified as having a positive influence by 127 (77.9%) of those who always take a student, and 131 (48.9%) of those who never or only sometimes accept (p<0.001). Lastly, Support from a Supervisor was identified by 88 (54%) of those who always accept a student and 100 (37. 3%) of those who never or only sometimes do (p<0.001).

Table 2:

Univariate Test for difference in proportions all Influence questions

Univariate Test for difference in proportions all Influence questions (N=431 answered all items)		Accepted Fieldwork student?
		Always N=163	Never/Sometime N=268
Item	Response	N/Col. %	N/Col. %	P value for Chi square test (*indicates Fisher’s exact test was used).
AFWC provides in-service	Neg/None	55 / 33.7%	90 / 33.6%	0.973
	Positive	108 / 66.3%	178 / 66.4%
Assignments to be completed	Neg/None	120 / 73.6%	221 / 82.5%	0.029
	Positive	43 / 26.4%	47 / 17.5%
Availability of work space for student	Neg/None	128 / 78.5%	209 / 78%	0.895
	Positive	35 / 21.5%	59 / 22%
Awareness of ACOTE guidelines	Neg/None	121 / 74.2%	216 / 80.6%	0.121
	Positive	42 / 25.8%	52 / 19.4%
CEUs for supervision of a FW student	Neg/None	21 / 12.9%	41 / 15.3%	0.488
	Positive	142 / 87.1%	227 / 84.7%
Challenge caseload provides	Neg/None	82 / 50.3%	146 / 54.5%	0.400
	Positive	81 / 49.7%	122 / 45.5%
Current job responsibilities	Neg/None	131 / 80.4%	224 / 83.6%	0.396
	Positive	32 / 19.6%	44 / 16.4%
Degree difference	Neg/None	155 / 95.1%	261 / 97.4%	0.207
	Positive	8 / 4.9%	7 / 2.6%
FW placement summer	Neg/None	146 / 89.6%	252 / 94%	0.091
	Positive	17 / 10.4%	16 / 6%
FW placement winter	Neg/None	124 / 76.1%	201 / 75%	0.802
	Positive	39 / 23.9%	67 / 25%
Fear failing a student	Neg/None	161 / 98.8%	261 / 97.4%	0.493*
	Positive	2 / 1.2%	7 / 2.6%
If student projects are determined by you	Neg/None	86 / 52.8%	140 / 52.2%	0.916
	Positive	77 / 47.2%	128 / 47.8%
Interactions with co-worker FW student	Neg/None	83 / 50.9%	156 / 58.2%	0.140
	Positive	80 / 49.1%	112 / 41.8%
Nominated for award as FW educator	Neg/None	121 / 74.2%	212 / 79.1%	0.242
	Positive	42 / 25.8%	56 / 20.9%
Onsite mentorship	Neg/None	59 / 36.2%	143 / 53.4%	<.001
	Positive	104 / 63.8%	125 / 46.6%
Past experiences as a FW student	Neg/None	38 / 23.3%	116 / 43.3%	<.001
	Positive	125 / 76.7%	152 / 56.7%
Prior experience supervising a student	Neg/None	36 / 22.1%	137 / 51.1%	<.001
	Positive	127 / 77.9%	131 / 48.9%
Productivity standards	Neg/None	140 / 85.9%	241 / 89.9%	0.205
	Positive	23 / 14.1%	27 / 10.1%
Regular meetings with AFWC	Neg/None	90 / 55.2%	152 / 56.7%	0.761
	Positive	73 / 44.8%	116 / 43.3%
Reimbursement guidelines	Neg/None	142 / 87.1%	240 / 89.6%	0.440
	Positive	21 / 12.9%	28 / 10.4%
Relationship with the University	Neg/None	68 / 41.7%	116 / 43.3%	0.750
	Positive	95 / 58.3%	152 / 56.7%
Share supervision with another OT	Neg/None	64 / 39.3%	103 / 38.4%	0.864
	Positive	99 / 60.7%	165 / 61.6%
Support from your supervisor	Neg/None	75 / 46%	168 / 62.7%	<.001
	Positive	88 / 54%	100 / 37.3%
Swag incentives	Neg/None	125 / 76.7%	211 / 78.7%	0.620
	Positive	38 / 23.3%	57 / 21.3%
University offered ed. resources	Neg/None	59 / 36.2%	116 / 43.3%	0.146
	Positive	104 / 63.8%	152 / 56.7%
Work less than full time	Neg/None	148 / 90.8%	250 / 93.3%	0.347
	Positive	15 / 9.2%	18 / 6.7%
Your caseload/census	Neg/None	107 / 65.6%	194 / 72.4%	0.139
	Positive	56 / 34.4%	74 / 27.6%
Univariate tests for difference in proportions for demographic/workplace variables (N=431 answered all items)		Accepted Fieldwork student?
		Always	Never/Sometimes
Item	Response	N/Col. %	N/Col. %	Pvalue for Chi square test
Ed. resources at your facility to be a Level II FW supervisor?	No	99 / 60.7%	173 / 64.6%	0.426
	Yes	64 / 39.3%	95 / 35.4%
Feel prepared to supervise a Level II FW student	No	10 / 6.1%	72 / 26.9%	<.001
	Yes	153 / 93.9%	196 / 73.1%
Have input re Level II FW student is accepted	No	59 / 36.2%	83 / 31%	0.263
	Yes	104 / 63.8%	185 / 69%
Participated in ed. opp. to prepare for a Level II FW student?	No	89 / 54.6%	170 / 63.4%	0.069
	Yes	74 / 45.4%	98 / 36.6%
Work Hours/Week	10-39	81 / 49.7%	155 / 57.8%	0.100
	GE 40	82 / 50.3%	113 / 42.2%
Years Experience	10 or less	61 / 37.4%	107 / 39.9%	0.606
	11 or more	102 / 62.6%	161 / 60.1%

We chose to do the multivariable logistic regression on pre-specified variables that were, in the experience of the researchers, most often cited during the fieldwork placement process. Therefore, Table 3 represents only a portion of the survey, demographic and workplace variables. Adjusted odds ratios are reported which are the odds ratios after accounting for all other variables in the model.

Table 3:

Full Logistic Regression Model with demographic and workplace variables

Testing Effect of:	Always Accept N = 163	Never/ Sometimes N=268	Adjusted† Odds Ratio	Lower 95 % CL	Upper 95 % CL	P value
Influence Items selected by Investigators
N/% reporting as Positive Influence
CEUs for supervision of a FW student	142 / 87.1%	227 / 84.7%	1.067	0.564	2.019	0.84
Fear failing a student	2 / 1.2%	7 / 2.6%	0.400	0.066	2.428	0.32
Productivity standards	23 / 14.1%	27 / 10.1%	1.128	0.547	2.326	0.74
Your caseload/census	56 / 34.4%	74 / 27.6%	1.223	0.724	2.064	0.45
AFWC provides in-service	108 / 66.3%	178 / 66.4%	0.917	0.559	1.504	0.73
Awareness of ACOTE guidelines	42 / 25.8%	52 / 19.4%	1.051	0.596	1.852	0.86
Challenge your caseload provides	81 / 49.7%	122 / 45.5%	0.918	0.567	1.486	0.73
Current job responsibilities	32 / 19.6%	44 / 16.4%	0.902	0.487	1.671	0.74
Onsite mentorship	104 / 63.8%	125 / 46.6%	2.181	1.351	3.520	0.001
Reimbursement guidelines	21 / 12.9%	28 / 10.4%	1.143	0.527	2.479	0.74
Regular meetings with AFWC	73 / 44.8%	116 / 43.3%	0.944	0.595	1.500	0.81
Share supervision with another OT	99 / 60.7%	165 / 61.6%	0.984	0.629	1.539	0.94
Support from your supervisor	88 / 54%	100 / 37.3%	1.766	1.119	2.789	0.015
Work Place or Demographic Factors
N/% at first level listed
Years experience
11 or more vs 10 or less	102 / 62.6%	161 / 60.1%	1.090	0.684	1.736	0.72
Work Hrs. / Week
GE 40 vs 10-39	82 / 50.3%	113 / 42.2%	1.523	0.979	2.370	0.06
Feel prepared to supervise a Level II FW student
Yes vs. No	153 / 93.9%	196 / 73.1%	7.333	3.389	15.865	<0.001
Have input re Level II FW student is accepted
Yes vs. No	104 / 63.8%	185 / 69%	0.571	0.352	0.926	0.023
Participated in ed. opp. to prepare for a Level II FW student?
Yes vs. No	74 / 45.4%	98 / 36.6%	1.139	0.715	1.816	0.58
Ed. resources at your facility to be a Level II FW supervisor?
Yes vs. No	64 / 39.3%	95 / 35.4%	0.815	0.515	1.289	0.38

^†Adjusted for all other variables in the model. Bolded items indicate statistical significance

Subjects for this analysis were the respondents who answered all items (n=431), the significant predictive factors influencing the odds of whether or not to accept a fieldwork student were: if the therapist felt adequately prepared to supervise a student (OR=7.333, 95% CI: 3.389 to 15.865, p< .001), if there was available onsite mentorship (OR=2.181, 95% CI: 1.351 to 3.520, p=.0014), and if the therapist felt the decision was supported by a supervisor (OR=1.766, 95% CI: 1.119 to 2.789, p=.015). These results are interpreted as having a positive influence on the decision to supervise a student meaning if any of these factors were present the therapist is more likely to accept the responsibility of supervising a student. A fourth factor in the logistic regression model, having input into whether or not a fieldwork student was accepted, was also identified as significant (OR=0.571, 95% CI: 0.352 to 0.926, p=.023), but the reason for this is not as clear. This factor indicated that therapists who have input into the decision were more likely to not take a student. Since the survey did not ask the participants to clarify these answers, we assume this is related to if the therapist or if their supervisor is the one making the decision if a student should be accepted e.g. if the facility had a temporarily high caseload, the therapist may want to decline a student whereas the supervisor might accept a student regardless.

Discussion

While several recent studies related to fieldwork have explored the alternative solutions to meet the growing need of fieldwork placements (Evenson, Roberts, Kaldenberg, Barnes, & Ozelie, 2015; Hamilton et al., 2015, Ozelie, Janow, Kruetz, Mulry, & Penkalabragge, 2015), this study sought to identify factors influencing an occupational therapist’s decision of whether or not to accept the responsibility of supervising Level II fieldwork students. Addressing the items that impact this decision process related to fieldwork supervision may improve the effectiveness of recruiting methods when seeking Level II fieldwork placements.

The top five factors identified by the participants as predominately positive influences included: continuing education units (CEUs) offerings (85%, n=421), if the Academic Fieldwork Coordinator offers educational resources discussing fieldwork requirements and expectations (65%, n=322), the educators’ past experiences as a fieldwork student (63%, n=310), if there was an opportunity to share student supervision with another occupational therapist (60%, n=299), and if the university offered access to education resources (59%, n=293).

The top five factors identified as having a negative influence on the decision of whether or not to supervise a Level II fieldwork student were mostly related to job expectations and included: current job responsibilities (47%, n=234), number of clients on caseload/census at the educator’s facility (46%, n=225), productivity standards (42%, n=205), working less than full time (33%, n=159), and a fear of having to fail a student (32%, n=160). The open ended questions allowed participants to identify additional influences and revealed several negative influences that were not provided as options in the survey. The following includes these additional factors with supporting comments:

• Student preparedness- “I feel like this is impossible, but if we could get assurance the student is capable, willing, and motivated to put in the time to learn I probably could have used that to accommodate more students by sharing that with my boss.”

• Factors which may impact the quality of the experience- “Census at my facility, space as it is an intimate/small environment, since I work for myself it may vary and I would like to have enough clients to provide adequate exposure to students interning with [company name] rehab”.

The most noteworthy information from Table 1 is the fact that of those who reported no experience supervising students, only 26% had actually ever declined the opportunity, implying the other 74% had never been asked. Also, many therapists who have accepted fieldwork students have also not accepted students at one time. For those reasons, requesting placements at sites that have declined in the past or seeking out sites that have not previously supervised a Level II student could result in eventual placement.

In response to a follow-up question asking participants to identify factors that could increase the likelihood of accepting a student, common responses emerged including the desire to receive CEUs, ability to share supervision responsibilities, and a process to assure student preparedness, such as interviews prior to placement. One participant indicated:

“… it is a very significant time commitment and can be stressful if the student is not fully aware of expectations or if that student is not a great fit for the clinical situation. Social skills and professionalism are a huge factor in reluctance to accept students blindly. If a student is lacking in either one of those it can be stressful and at times embarrassing to have them interacting with patients and students that you have built rapport with”.

The factor reported to have the greatest influence was the receipt of CEUs for supervision. Awarding CEUs for supervision of a fieldwork student validates the therapist’s efforts and compensates them for the time spent. Many states offer this benefit currently, however there are still 19 states that do not offer CEU credit toward state licensure requirements. The participants of this survey and the state in which they practice were anonymous, however the states from which the email addresses were obtained all currently provide CEU credit for fieldwork supervision. This makes it difficult to ascertain if the participants as a whole desire a greater CEU credit, if they have moved to a different state, or if there is a lack of knowledge because many states have only recently begun to recognize CEUs for fieldwork supervision. The value of CEUs is determined at the state level; therefore, it would be beneficial if therapists and state associations worked with state licensing agencies to increase awareness about CEU provision for fieldwork supervision. Remarkably, although CEUs were identified as having the greatest motivating factor related to fieldwork supervision, they did not show statistical significance as a predictive factor.

This research indicates additional fieldwork specific education is a key solution to impacting practitioners’ willingness to accept Level II fieldwork students. Although most therapists reported feeling adequately prepared to supervise a fieldwork student, both those who have supervised a Level II student and those who have not, requested additional information and ongoing training. In fact, two of the five most influential factors of accepting a fieldwork student were if the academic fieldwork coordinator or university offered educational resources. Many participants discussed the provision of education on how to supervise a Level II student as a potential positive influence and uncertainty in their ability to provide an excellent educational experience was often identified as a negative influence.

“The biggest factor influencing my reluctance to take a Level II student is my insecurities about being able to provide a student with the experience they need to grow and learn from. I still feel as though I am a recent grad learning how to navigate school-based practice” and “Not confident in my own skills as an OT, due to being isolated from other OTs in my current setting. Not sure I would be providing an example of best-practices all the time.”

Through education on topics related to learning styles, facilitated learning, and fieldwork expectations, clinicians can be better prepared to offer students an enhanced learning opportunity and address difficult student issues (Rodger et al., 2014; Towns & Ashby, 2014). Academic institutions could offer practicing clinicians in-services and online courses on fieldwork accreditation requirements and skills for student supervision. In order to reach a large number of clinicians, this information could also be included in the entry-level curriculum, so practitioners enter the field with this knowledge. Additionally, academic fieldwork coordinators could provide support by helping sites develop weekly schedules, provide information on how to manage difficult students, and create plans of remediation (Evenson, Roberts, Kaldenberg, Barnes, & Ozelie, 2015).

Supportive education for fieldwork educators and validation of student preparedness may alleviate fear of student issues and help the clinician feel more equipped to deal with a struggling student (Hunt & Kennedy-Jones, 2010; Ilott, 1996). As suggested by several of the participants, a simple way to address the concern of preparedness is to recommend student interviews prior to accepting Level II students. A pre-placement interview would allow the site to determine if the student seems qualified and a suitable match for the particular demands of the site. This can create a better experience for both the educator and the student. The fieldwork educator’s past experiences as a student, along with his/her perceptions, influence the way fieldwork education is approached (Delany & Bragge, 2009). This is important because this study’s results indicate that an educator’s past experiences as a fieldwork student can also have a positive influence on the decision to provide supervision for a student and influence the way fieldwork education is approached (Delany & Bragge, 2009).

The education of fieldwork supervisors does not have to fall solely on academic programs and fieldwork coordinators. Educational opportunities on fieldwork topics are already available. The problem is, they are underutilized because many clinicians are not aware they exist. According to AOTA (2014), of 150 occupational therapists surveyed 55% of fieldwork educators have not utilized any training and 61% were not aware of the resources that are available for fieldwork education. A greater focus is needed to determine the most effective way to strengthen and promote the educational opportunities that are already available and if additional options are needed to provide better utility (AOTA, 2014). This education will help occupational therapists feel prepared to be fieldwork educators.

One available resource, the Fieldwork Educator Certificate Program (FWECP), offers formal training to occupational therapists on effective teaching strategies, models of supervision, and learning theories in order to support successful fieldwork experiences (Baird & Baker, 2010). However, this program has a limited number of qualified trainers making the frequency of the trainings limited. Also, this program is relatively expensive. Since this training does not directly increase clinical reimbursement it may be difficult to market to management as a necessary program for paid education.

Another option is for fieldwork educators to use published resources for self-education. These include published books and journal articles that offer current evidence on the teaching strategies and supervision skills necessary for successful supervision of a Level II fieldwork student. Continuing education articles, such as “Becoming a Fieldwork ‘Educator’: Enhancing your Teaching Skills” provide information on specific teaching strategies and student-learning (Provident et al., 2009). However, according to Hanson (2011), utilization of literature and a self-taught approach in preparation for fieldwork supervision is perceived as overwhelming and time intensive. Clinicians reported limited time to seek out literature and concerns about evaluating the resources.

Potential fieldwork supervisors are concerned about how the additional responsibility of supervising a fieldwork student might affect job responsibilities and performance. Although research indicates that supervision of a Level II Fieldwork student will not negatively affect productivity (Ozelie et al., 2015), many therapists believe that it is difficult to provide a “good fieldwork experience” when contending with high productivity standards. Several participants of both this study and a previous study by Barton et al. (2013) reported that the time and effort spent providing a Level II fieldwork experience were not perceived as valuable by management. This sentiment was corroborated by several participant comments and is often considered a contributor to greater stress within the role of clinician (Barton et al., 2013). In light of this information and the fact that supervisor support was identified as a predictive factor, a significant benefit could arise from academic institutions educating sites, including managers, about the benefits of fieldwork education, the need to support fieldwork supervisors, and the research addressing Level II fieldwork supervision and productivity (Ozelie et al., 2015).

Limitations of the study

This study represents only a portion of practicing occupational therapists and is representative of limited geographical locations. Thus, geographical specificity is a significant limitation of this study. Although participants forwarded the survey to other practicing occupational therapists, the results represented the experiences of therapists mostly from two state licensure boards and the alumni of two universities. Another limitation of the study included the lack of clarity in questions. Based on the instrumentation used, it is unclear how recent the experiences were or if these factors would influence future decisions about student supervision. Additional data could have been collected such as frequency of acceptance of fieldwork students, specific experiences with most recent student, and precipitating factors about students who were declined. The analysis method did not differentiate the between those who did not accept students and those who sometimes accept students because the response categories were collapsed into the two groups for comparison. The use of self-reported surveys created a limitation because the answers represent the opinions of the participants and may present with bias or be influenced by social desirability. Although we identified limitations and aspects we would design differently, this study represents an important step forward in understanding those factors that influence the decision of whether or not to supervise fieldwork students.

Recommendations for further research

Given that work factors were frequently mentioned in the comments of this study, a larger, more extensive investigation into the job related factors that affect the decision of whether or not to accept supervision of a Level II fieldwork student would be beneficial. Open ended questions in this study revealed that this issue is complex and not easily revealed through survey alone. Therefore, future studies could use focus groups to provide greater insight into the workplace factors that may affect the decision-making process. Further query is also needed to explore the best ways to evaluate a student’s readiness for fieldwork and the best methods of ensuring a good fit between student learning needs and fieldwork educator qualities.

Conclusion

In order for the professional vision of occupational therapy to be actualized, academic programs must be able to foster a diverse workforce prepared to meet society’s shifting needs. This goal can only be obtained through collaborative efforts between clinicians, facilities, and academic institutions. Currently, many occupational therapists are hesitant to accept supervision of a Level II fieldwork student. The reasons cited relate to workplace factors and uncertainty in the provision of fieldwork education. Further advocacy and education about the value of providing fieldwork supervision are required to increase the availability of fieldwork placements. Employers of occupational therapists would benefit from further education on what a student program can offer their facility. Additional education for occupational therapists can better prepare them for supervising a fieldwork student and increase understanding of the academic fieldwork coordinator role in supporting fieldwork educators.