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ADVANCE Outlook: OT

Conference Update: A Speed Bump in the Future of OT Education?

Published April 23, 2009 1:24 PM by EJ Brown

It's widely known within the profession that occupational therapy has an education "problem."  The issue isn't in the quality of its academics, nor in a lack of program levels or foci. The difficulty that is arising lies in how far and wide the scope of topics and skill sets can go in entry-level training.  That is, what should the basic OT curriculum teach in the 21st Century? What should it let go of? What should it add?

 This morning here in Houston, educators, clinicians and students filled a whole ballroom to talk about where OT education should be going in light of the Centennial Vision's goals for 2017. A panel of people who are researching the issue and have created AOTA's Blueprint for the Future of Entry-level Education in Occupational Therapy were presenting the preliminary results of four Zoomerang surveys of practitioners and educators on what should be taught and how. The results are eye-opening because they show just how much divergence of opinion there is within the profession as to what really matters most in OT practice. It reinforced evidence of the growing gap between education and practice that has arisen over the past 10 years as OT educators try to return practice to its roots. Many educators want to make occupation-based practice the standard, reimbursable methodology in the profession. But quite a few do not.

This is not a problem that appears in most other disciplines, who of course must maintain competence in their sciences but whose scopes of practice are well defined and all practitioners accept them. Nurses know exactly what it means to be nurses. Physical therapists know exactly what it means to be PTs. But OT is like the proverbial elephant that several blind men were asked to  describe. Touching different parts of the pachyderm, their descriptions ranged from a wall to a tree trunk to a snake to a spear to a rope. Just so, occupational therapists will describe and value therapy according to what they themselves do with it.

Just what is OT? The fact that no one seems able to define it has led to the idea that there is an identiity crisis going on in our industry. But I have come to believe that's not the problem. There are just too many ways to do it. AOTA has moved from formal definitions to sound bytes that try to capture OT's impact on people, such as "Skills for the Job of Living" or, currently, "Live Life to Its Fullest." But currently up on its Web site at www.aota.org is the association's latest attempt to define the profession. It reads: "By taking the full picture into account—a person’s psychological, physical, emotional, and social makeup—occupational therapy enables people to achieve their goals, function at the highest possible level, concentrate on what matters most to them, maintain or rebuild their independence, and participate in everyday activities that bring meaning to their lives."

For other health care professionals, even one such outcome would be what they hoped to contribute to through their own small part in the mission. For OTs, all of those outcomes actually are practice!  OTs and OTAs feel as though they're supposed to get them all done for every patient. But of course, that's impossible, and practice reflects that fact. Inevitably, clinicians focus on which goals are most important to the patient and to the third-party payer.

 The other issue is that OTs and OTAs can conceivably use the knowledge bases of medicine, psychology, cultural anthropology, technology, and/or arts and humanities as part of their interventional repertoire. They're not stealing. The broad brush of OT practice today reflects its founders' own association with different fields of health care. William Rush Dunton was a physician. In his day, well before the advent of antibiotics, holistic practice was part of medicine. Adolph Meyer, who advocated the balanced-life theory that still under girds OT, was a psychiatrist. Eleanor Clarke Slagle was a social worker at Chicago's famous Hull House. She worked with people in similar circumstances who were being trained to enter American society. Slagle made habilitation through habit training a significant part of occupational therapy. But as insurers and government increasingly set forth their own rigid parameters for reimbursing various health care providers, a discipline so broad-based is at risk. Competing professions want it carved down. They challenge occupational therapists to prove they have a curricular connection to all that they say they can do; yet the entry-level curriculum, even at a master's level, cannot possibly include all the foreseeable skills a practitioner might need.

Securing reimbursement for today's practitioners and tomorrow's is what AOTA's board of directors is currently prioritizing in its Vision goals. You can read them at www.aota.org on the home page. The Blueprint committee will press on. You can see the Blueprint there under educator resources. ADVANCE will report more fully on the preliminary results of the surveys after conference.

 

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