The Experience of OT Students During Fieldwork: What Fieldwork Educators (FWE) Should Know

Personally, my fieldwork A and B experiences were vastly different in terms of setting and the support I received from fieldwork educators, with the first being a frustrating time and the second a supportive experience. During my first fieldwork experience, my Fieldwork Educator (FWE) and I did not have a clear and consistent stream of communication. I made repeated mistakes because I wasn't given clear instructions on how to approach a new situation. There was also a lack of trust and understanding between us because I didn’t feel ready to handle a full caseload, and my FWE felt I wasn't as competent as she had hoped. Although I often leaned on the resources provided to us at school, it wasn't as helpful as I would have liked due to the constant changes in the environment, such as new management, clients, and expectations. During my second fieldwork experience, my FWE and I communicated frequently through email, text, and face to face. She would go into detail about the interventions she planned for the therapy session, even if she thought I had learned it in school. She learned about my learning style and incorporated it into daily therapy so that I could learn hands-on and engaged in my professional interests. I felt challenged, but was reminded to take breaks as needed. My second FWE felt more like a mentor than an educator, which I needed and appreciated after my first fieldwork experience.

For occupational therapy students, the fieldwork portion of their education is a pivotal experience. It's a time wrought with challenges, emotions, and opportunities for growth as students transition from textbook concepts to real-world clinical practice. It is a crucial part of the development of future occupational therapists. For fieldwork educators, it's important to understand the student experience during this time to better support their learning and growth. Here are some key aspects of the OT student fieldwork experience that fieldwork educators should keep in mind:

Stress and Anxiety

Doing fieldwork for the first time can be incredibly stressful and anxiety-provoking for students. They are entering a new environment, meeting new people, learning new systems, and being evaluated on their clinical skills - all while trying to apply what they've learned in school. As fieldwork educators, being aware of this and providing reassurance can help students manage these feelings.

For example, during fieldwork, I struggled to complete documentation on time, and one reassuring comment that my FWE said to me was that everyone struggles with documentation, and it is a skill that I will improve as time goes on. This was reassuring to me because it made the issue less personal to me and made me feel more confident that I would improve in the future. Other reassuring statements that can be reassuring could be: 

  • I know starting fieldwork can feel overwhelming, but I'm here to support you every step of the way.

  • You're doing great so far. I can see you have strong clinical skills and a passion for this work.

  • Don't stress if you need to ask lots of questions. Inquiring minds lead to great therapists!

  • It's ok to feel overwhelmed but remember we are a team. I'm here to collaborate and guide you.

  • You've got this! Take things one day at a time and trust the preparation you've had.

All of these simple but reassuring phrases help students manage expectations and normalize anxiety as part of the process to build confidence to master new skills needed during fieldwork.

Confidence and Self-Doubt

Along with stress, students often experience swings between confidence and self-doubt about their abilities. After mastering a new skill in one session, they may feel on top of the world. But confusion or mistakes in the next session can send their confidence plummeting. Bolstering students' self-assurance and focusing on progress is important. Fieldwork educators can do so by suggesting the student reflect on and write down their accomplishments and growth throughout the experience, by helping them set small, achievable goals for skill development they can build on. Also check in regularly about how the student is feeling and offer encouragement; don't minimize their doubts. Assigning tasks and responsibilities that are appropriately challenging but not overwhelming will help fieldwork students build confidence in their skills. Remind them of the knowledge and skills they bring from their education and previous clinical experiences and encourage them to lean on that knowledge. Finally, suggest peer support and sharing stories with other students in fieldwork to boost their self assurance of the learning process of their fieldwork experience.

The Learning Curve

There is a steep learning curve for students as they transition from the controlled classroom environment to the real-life clinical setting. They will make mistakes and need time to build competency with new responsibilities and skills. Understanding this learning curve and allowing a reasonable adjustment period is essential. Some ideas that fieldwork can do to support a students learning curve during fieldwork is by first starting with observation and shadowing before having the student begin hands-on work. Explain your reasoning and decision making process out loud so they can comprehend your clinical reasoning. Make time for a debrief after a treatment session to evaluate what went well and areas of improvement. Help them build a toolkit of techniques, phrases, and best practices they can reference before or during treatment session. Adjust the pace accordingly if they are struggling with a particular skill or concept, provide additional coaching. Provide opportunities for them to observe or collaborate with a peer to learn different techniques and approaches.

The Need for Feedback

Feedback from fieldwork educators is extremely valuable for OT students, as it helps shape their clinical skills and thinking. However, make sure feedback is supportive rather than overly critical, which can be discouraging. Students need guidance on what they are doing well in addition to areas needing improvement. Utilizing the sandwich approach is a beneficial method for effective feedback. It is a common method used in the professional setting as it is easier for people to hear and accept negative feedback when it comes with positive feedback.

To use the sandwich method open on a positive note. Starting with praise or appreciation helps put the recipient in a more receptive frame of mind to accept feedback, and builds confidence. Next, provide constructive criticism the student needs in order to close. Finally, positively, ending feedback with praise.  Reiterating strengths, skills, or values that are appreciated.it cushions negative feedback. Constructive criticism is easier to swallow when couched between two positive comments, and the recipient will feel encouraged rather than defeated. The recipient will focus on growth areas but also feels recognized. 

Feeling Like an Outsider

Entering a new facility with established routines and relationships among staff can initially make students feel like outsiders. Making efforts to integrate them into the occupational therapy team and larger facility community can help them feel welcomed and engaged. 

Some ways of making your students feel welcome are:

  • Introduce them to staff and provide a tour of the facility. Make sure to show them where important things are located like bathrooms, break rooms, supply rooms, etc.

  • Explain their roles and responsibilities clearly so expectations are set. Provide training if needed.

  • Include them in meetings and discussions relevant to their work so they feel part of the team.

  • Send a welcome email to co-workers announcing the student's arrival and providing some background on their schooling and interests. Encourage others to introduce themselves.

  • Set up a workspace for them, even if it's just a desk or shared office space. Make sure they have the supplies they need.

  • Ask for their input on projects or processes as appropriate since they bring a fresh perspective.

  • Have them shadow another team member if possible, invite them to an office outing if that's an available option.

  • Check in regularly to see how they are adjusting and address any concerns. Be open to feedback.

  • Plan a celebration like a lunch or happy hour when they complete their clinical rotation.

Relationships and belongings

Between our educators, fellow staff members, and patients, new relationships emerge during fieldwork. Though initially intimidating, these connections enable students’ growth. It is important to make them feel welcome and supported by the rehab team.  By understanding the student mindset and experience during this pivotal learning phase, fieldwork educators can provide the empathy, support, encouragement, and direction needed to guide occupational therapy students into skilled, confident professionals. A thoughtful approach to fieldwork education benefits both students and the occupational therapy field.

Guest Blogger: Anne Momgbet, OTS

Sources:

Aota.org (2024). https://www.aota.org/publications/ot-practice/ot-practice-issues/2023/role-emerging-placements-expand-opportunities

Lau, M., & Ravenek, M. (2019). The Student Perspective on Role-Emerging Fieldwork Placements in Occupational Therapy: A Review of the Literature. The Open Journal of Occupational Therapy, 7(3), 1–21. https://doi.org/10.15453/2168-6408.1544

Rezaee, M., Rassafiani, M., Khankeh, H., & Hosseini, M. A. (2014). Experiences of occupational therapy students in the first fieldwork education: a qualitative study. Medical Journal of the Islamic Republic of Iran, 28, 110. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301239/

What Is Sandwich Feedback? (With Pros, Cons and An ..., au.indeed.com/career-advice/career-development/sandwich-feedback. Accessed 13 Feb. 2024.