The OT Student Perspective

Fieldwork Wrap-Up

Andrea Vourtsis — Mon, 03 Aug 2009 16:27:00 GMT

Hi everyone! I know it's been a while, but I needed some time to catch my breath after finishing Level II Fieldwork a little over a month ago. Lots has happened since, but I'll get into that later. My second fieldwork placement was dramatically different...(read more)

Our true currency

Andrea Vourtsis — Tue, 02 Jun 2009 23:54:00 GMT

There is something about working a full-time job for free that makes you realize the value of what you're doing - especially when you are at a facility like the one I'm currently fieldworking at. This can go two ways. On one hand, in acute rehab you begin...(read more)

Some hospital ponderings

Andrea Vourtsis — Thu, 23 Apr 2009 02:05:00 GMT

One danger of working in the health care or medical field is that over time, you see so many sick people that you become somewhat immune to it all. Or perhaps you become burnt out, jaded, cynical, bored...the options are numerous and hard to avoid. Working...(read more)

Pediatrics Wrap-Up

Andrea Vourtsis — Thu, 09 Apr 2009 23:11:00 GMT

I've been meaning to write a little something about the conclusion of my pediatrics fieldwork for a while now. However, life got pretty busy and I'm only just able to sit down and do it now even though it has been over for nearly two weeks. I've had a...(read more)

OT Gifts

Andrea Vourtsis — Tue, 24 Mar 2009 02:00:00 GMT

Now that my first Level II placement is winding down, I'm faced with the prospect of finding the right gift for the supervisors that led me through. It would be easy to just spring for a few gift cards from Olive Garden. However, my brain wants to go about this in a decidedly OT manner. I want to give them something personal and useful.

So, with that in mind, I went searching for OT gifts. It took a lot of different search combinations, but eventually I found a decent amount of things that might tickle any OT's fancy.

Do you want to represent your profession? The clothing in this OTility online shop offers many clothing and gear options that support and poke fun at our great profession. My personal favorite is the shirt with the definition on it; it solves my dilemma from many months ago! If only we could all whip that out whenever someone asks us what we do. There are many other fun and great-looking options to be found here: www.cafepress.com/otility. There are several other cafepress stores devoted to OT, so a simple search can give you many options. Another similar option is Zazzle. You can browse through what other creative therapists and students have created at: http://www.zazzle.com/occupational+therapy+gifts.

The best slogans so far:

Beware, OT having out-of-chocolate experience
OTs are snappy dressers
Sometimes I'm glad I'm an occupational therapist. Other times I simply wish I had become a ninja. (what, you mean we're not healthcare ninjas?)
Top 10 reasons you should stay up late with an OT (I leave these to your imagination)

My other thought was to look into gift cards from therapy supply stores. It might please you to know that Therapro and Therapy Shoppe offer gift certificates. Our very own Advance also has gifts and gift certificates at http://shop.advanceweb.com! (Did you like that promotion? I sure did.)

On another note, those of you who haven't gotten the OT gift application on Facebook...you really need to just so you can have the amusement of sending your friends raised toilet seats and bra angels.

Go forth and give!

The Glove Conundrum

Andrea Vourtsis — Wed, 25 Feb 2009 13:29:00 GMT

Something I've noticed in my travels is that OTs outside of hospital or SNF settings rarely wear gloves when treating. Perhaps this is because there is a much slimmer chance of exposure to things that necessitate gloves. However, I'm coming face to face with the reality that I actually really want to wear gloves sometimes when others don't.

I'm not germ phobic. I should be with all the snot and saliva I'm seeing on a daily basis right now, but my hand sanitizer keeps my anxiety in check. In spite of this, I know that children don't really understand what is hygienic and what isn't and when you are working so closely with them, the probability of germ transfer is pretty high in spite of your best efforts.

I have always been very pro-glove, to the point that one of my previous jobs would get annoyed at me because I would go through boxes of them so quickly. In that case I was frequently dealing with bodily functions and would change my gloves in going form person to person. I ask you, who wouldn't elect to wear gloves in that kind of situation? Believe it or not, there were people who wouldn't.

I wasn't too bothered in this case until I recently started working with some lower-functioning children who need and like constant oral stimulation. They always have their hands in their mouths. When I'm working with them, I frequently have to do hand over hand for the tasks we're working on. The end result is that I am handling their saliva-coated hands with my bare hands for thirty minutes.

I don't find this pleasant. However, I see many others treat this way without being bothered. It's true that you can just wash your hands when you're done, but doesn't the adage ‘an ounce of prevention is worth a pound of cure' apply here?

It's not just me who is at risk from this. If I am carrying something, either my own or from another child I treated earlier, and these children are putting their hands in their mouths all the time, they are just as likely to pick something up as I am. But the majority of the people working with them don't wear gloves.

I can't fathom why people wouldn't want to put in a little extra effort to prevent bacterial or viral misery. Nobody likes being sick. For the sake of ourselves and the people we treat, can we glove up, please?

Who’s conditioning who?

Andrea Vourtsis — Thu, 05 Feb 2009 13:44:00 GMT

One thing that any therapist, pediatric or otherwise, will frequently come up against is that lovely word: behavior. Many have theorized about it and plenty think they know the best way to control, modify, or reduce it. Myriad techniques exist and on any given day in a pediatric setting, you can see several different approaches in action.

My question is, as a therapist, what level of responsibility do you have to carry over with behavioral strategies? If you have a student who refuses to participate or work during OT, what is the best approach for everyone involved?

Many would suggest a reward system; in other words, structured bribery. It usually works, because who wouldn't color or draw a shape or write a few sentences for some chips, candy, or some other type of prize? I know I would. However, coming from a psychologically based background, I know that this can lead to a child purposely refusing to do work just so that the incentive is offered to them. It's a solution in the moment, but it doesn't really solve anything in the long run because you are actually encouraging their non-productive behavior.

When confronted with a situation like this, I think of all the work that parents, teachers, other professionals, and children put in to implementing a behavioral program. Then I realize that we therapists can get stuck in a catch 22. We only see a child for a short period of time, maybe once or twice a week. In order to be able to bill (and possibly get paid ourselves), we need that child to work on the goals and objectives we've decided on. Because of this we may have to resort to strategies that sabotage a behavioral regime.

On the other side of the coin, many therapists routinely see their own recommendations ignored or incorrectly utilized. It's a frustrating element of our job. That is why I am hesitant to do the same thing to someone else, because that person put in just as much effort as I have.

Personally, I would rather sit there and wait out a child's poor behavior than reward it. However, the clock and the payment system are against me. I suppose I will have to find some kind of happy medium.

Any suggestions?

Treating without a diagnosis

Andrea Vourtsis — Fri, 23 Jan 2009 19:16:00 GMT

Perhaps I'm still stuck on the medical model, but am I the only one who finds it jarring to treat a client without full knowledge of what causes them to need treatment? I'm finding that in the school system, the occupational therapist isn't always provided with a full history of the child they are treating. I know that this is part of an effort to move away from allowing people to be defined by their disabilities. I agree with this 100%. Aside from the obvious fact that labels create stigma and a set of expectations that may be unrealistic, they travel with a person for the rest of their life. Every medical condition or disability presents a little bit differently in each person, so it is better to operate from a viewpoint of what they can do versus what a diagnostic category says they cannot.

Via our clinical judgment we can often figure out what the general issue is, anyhow. A child with ADHD is easy to identify, as is a child with motor planning problems. However, when diving into the nuances of cognitive differences or the autistic spectrum, things become fuzzier.

Seeing this play out in the school system has reminded me of one of the students I worked with in my previous job. All I was told was that she had a learning disability. She and her family didn't wish to discuss it beyond that and there was no information in her file. I respected and understood that, but then found myself in the position of trying to find a job for a person whose capabilities I didn't fully know. I had a hard time finding the right job because of this. Over time I got to know her and came to suspect that it was some kind of auditory processing disorder. Once I was able to piece that together on my own, I could shift the focus of my search and we did eventually find something. However, I wonder how much more quickly I could have accomplished that if I had known her diagnosis up front.

I foresee the same problem here. Without a diagnosis, how am I supposed to plan treatment for children I have only known for a short while and might see for a half hour a week? Therapists don't really have the time to feel out a person's cognitive abilities (unless it is an initial evaluation) - we can't bill for that, yet it is essential for the tailoring of our treatment.

So often, therapists are inheriting clients from other therapists who may have known them better. Without the pass-down of information like diagnoses and test results, how can a new set of eyes know how to best treat the client? I would rather have the very general guideline of a diagnosis to let me know what I might expect. Any good health professional knows that a diagnosis is just for the sake of eligibility and billing. How that diagnosis presents is variable. But is there really any harm in having some idea of what one might see?

With this I have to acknowledge that diagnoses are often wrong, outdated, or misrepresentative of a person's ability to function in their world. Again, any good health professional would know this and be careful not to assume that just because someone is diagnosed with something, they will present that way. It is proven time and time again that people grow and change and sometimes leave their diagnoses behind altogether.

The medical model dominated for many years in spite of its faults, but perhaps we are being a little too quick to reject it. We still use it to define eligibility for services yet we want to shy away from it. There is a paradox inherent in this attitude. As an OT I want to look at the whole person. A disability is a part of that person, so does it behoove me to operate in ignorance of what that is?

I hope that this has come out logically. I have graciously been given the first of many colds I will surely receive while working with children (Flintstones vitamins, you have failed me!) and I have taken a fair amount of decongestants to combat that. While decongestants clear the nose they sometimes cloud the mind. If that's the case, my apologies - I shall reduce the amount of methamphetamine precursors I consume before writing the next blog.

Groups in OT

Andrea Vourtsis — Mon, 19 Jan 2009 12:45:00 GMT

Something I've observed in many different treatment settings is the grouping of clients for the sake of being able to see and bill for more at one time. I understand the necessity of this, and oftentimes it works to the advantage of both the therapist and the client. Group treatment is great for social interaction and allows the therapist to consolidate his or her time when treating people with similar conditions and needs. However, at the same time, I've seen a few examples of this grouping working against both the therapist and the client.

In certain settings groups are absolutely essential. For children on the autistic spectrum, the social interaction provided by a group is a key to their treatment. The same often goes for psychiatric settings. I know these types of groups can be tremendously successful and provide excellent treatment to our clients.

Nonetheless, I still wonder how often people's needs are not met by group treatment. For example, if two children are grouped for their therapy time, but one requires substantially more attention, prompting, and follow-through by the therapist, is the other child being shortchanged? Is the benefit of social interaction cancelled out by the disparate amount of treatment? Also, if a person is too shy, inattentive, or unmotivated to participate fully in group activities, what benefit are they receiving?

What other options do therapists have in a situation like this? It seems like a case of too many clients to fit into an already jam-packed schedule. With the pressure from agencies, insurance companies, and school districts, who push for group treatment because it is frequently less costly to them, do therapists have to compromise their treatment?

Stress Relief, OT Style

Andrea Vourtsis — Thu, 08 Jan 2009 13:01:00 GMT

I've probably mentioned in other blogs that graduate school has been one of the most difficult, trying experiences of my life. This isn't a bad thing; I like to be challenged. However, challenges often bring with them unprecedented levels of stress. I'm sure that any grad student can attest to the strain that comes along with furthering one's education.

So what are we to do? Everyone has at some point compiled lists of generic stress relievers, so I won't do yet another one of those. Instead, I will try to pull my suggestions from the practice of OT, so you can receive therapy as you devote so many hours to giving it!

Theraputty is one of my favorite ways to expel excess tension. Who doesn't love essentially playing with Silly Putty? Those blue foam blocks used for hand strengthening also make excellent stress relievers.
Con one of your PT friends into giving you a massage.
Play with assistive technology. If trying to eat your lunch or giving a coworker a wedgie with a reacher doesn't make you laugh, you should just go home.
Clean or sanitize everything. I'm not a huge fan of cleaning, but it's a mindless task that really dispels a lot of tension, and helps to prevent the spread of infection, too.
Recount your favorite moments from the week before. Often, things that seemed disastrous at the time are hilarious in hindsight.
Give yourself some sensory or vestibular treatment. Have someone smoosh you with a mat or spin you around in a chair. Just be careful who you ask. If no one can be trusted, go in the closet and brush yourself.
Practice all your ADLs, including the sleep and sex ones. (can I endorse that? If not just delete this one)
Since OT is considered a holistic profession, do something else that's labeled holistic. Try some aromatherapy, start taking vitamins, or talk to your patients about home remedies they might know about. You always learn something interesting this way. (On a side note, I am entirely convinced that my slavish devotion to Flintstones gummy vitamins since August is solely responsible for me not getting sick YET. Of course, after advertising that I will now catch a cold tomorrow.)
Modalities can be fun, too. Just don't get in trouble for using up all the paraffin.
Exercise is always a great stress-buster, and can be built in to many of the activities you do without even realizing it.

That's certainly not a comprehensive list. What are your suggestions for what works best to calm you down?

Already?

Andrea Vourtsis — Tue, 06 Jan 2009 13:04:00 GMT

The fateful day has come: today I began my Level II placements. In a way it was good that there wasn't a long, drawn-out break beforehand, because more waiting would lead to more nerves. Basically, I haven't had the time to become insanely worried! That, however, makes me wonder if I should be more worried, and I get worried that I'm not worried, and frantically delve into my textbooks...again. Because the only reason I am allowed to not be worried is if I: a) know everything or b) am delusional and know nothing but think I know everything. It's obviously not choice a.

I'm sure that none of us have ever felt truly ready for something as important as Level IIs. It's when you really learn if you will sink or swim in the profession, and that's a scary prospect to come up against. While I'm certain that for every person who sinks, there are 100 who swim, it's still frightening to think that you might be the one who goes straight to the bottom.

More than anything else, I think that Level II fieldwork exists to train our minds. Books, theories, facts, and statistics create a foundation upon which we need to build. We have to train ourselves to consolidate all that information through the lens of action and intervention. That is the skill you can't teach in any classroom, because the permutations you'll see out in the field are too numerous to cover in any semester-long course. It's also the skill that is hardest to master.

I taught swim lessons for a year when I was younger. I remember telling every petrified child to think of the water as a friend, not an enemy, and to go with it rather than fight it. When all else fails, the instructor is always there spotting you, even if you can't feel them. I think this advice carries over to many learning experiences, especially fieldwork. It's my hope that in time, like so many of my young swimmers, I'll be able to cross the pool without even realizing that the instructor has let me go.

Busywork Order & Rank, Inclusive of Non-Graded Materials for Education (BORINGME assessment tool)

Andrea Vourtsis — Fri, 19 Dec 2008 19:34:00 GMT

The following is a new assessment tool developed by myself and several colleagues (also known as me) in conjunction with Temple University (also known as I hope I don't get sued for making that up). The BORINGME assessment tool observes and evaluates the approximate level and skill of busywork tasks frequently encountered in day-to-day life in graduate school. Items are ranked in several ways, including graded or non-graded, in class versus out of class, group or individual, involving presentation or not, etc. Areas covered include:

Wiki posts. Add an extra point if at least five people post the same journal article and an extra two points if everyone posts in a different place, making it impossible to actually tell who did the assignment and who didn't.
Anything involving an assessment that doesn't actually require giving or practicing the assessment. Add five points if the assessment is outdated and hasn't been used in 10 or more years.
E-mail responses to events or lectures. Add three points for every response you receive that discusses the lecture in vague terms which causes you to suspect that the student doesn't actually know what they are responding to.
Out of class activities that have no foreseeable relation to in class material. Add fifteen points if it includes forcing students to wake up early, spend money they don't have, carpool with people they don't like, or feign interest in the things that only you are interested in.
Using scratch-offs to go over exam answers. Add five points if the scratch-off material is found to be carcinogenic in the state of California and fifty if students already resent you for giving a difficult test.
Anything involving Disney princesses. Add ten points for each time you forget that your students are all over the legal drinking age. Add one hundred if your students resort to drinking in class.
Unnecessary group activities. Add two points for each time you overhear groups talking about other things. Subtract five points each time a group successfully presents their findings to the class even though they did not actually do the activity. Add twenty for each student who gets up and walks out, if applicable.
Assessments of stress, wellness, or quality of life. Add 15 points for each student who actually states that they did not previously realize they are inhumanly stressed, bordering on grievously unwell, or living below the poverty line and means it.
Portfolios. You receive no points and may God have mercy on your soul. (One point if you recognize what movie that is from)
And many more!!!

Scoring is on a scale of 0-200. Interpretation is as follows:

151-200: You are in imminent danger of being poison-darted by your students.

125-150: That look in their eyes isn't stress. Consider soothing aromatherapy or a gift of food.

100-124: When you think your students are talking about you, they probably are, and it isn't to compliment your outfit.

75-99: You need to reconsider your use of busywork. It may turn your previously vivacious and intelligent students into disgruntled drones.

50-74: You're pushing it, professor.

1-49: Busywork levels are tolerable. Your students probably like you.

Test booklets, scoring sheets, and other educational resources for the BORINGME are available at the following website: http://en.wikipedia.org/wiki/Satire.

Portfolio of Doom

Andrea Vourtsis — Wed, 17 Dec 2008 12:41:00 GMT

Okay, at the risk of sounding like a complainer, I have to tell you all that I really don't enjoy portfolio assignments. As with the group projects, I know I'm not alone in this. This may just be due to the fact that I recently had to complete a THIRD one...

I can understand the necessity and utility of such things for artists. I also understand the basic rationale behind a portfolio. And lord knows, as a former counseling major I can reflect on just about anything. Ask me to tell you my in-depth feelings on dryer lint and you'd get a coherent, if brief, response.

But really, people, talk about a drain of time and paper! If you don't know what you've been doing over the course of a semester, there is a problem. If you need a lengthy, repetitive assignment to remind you, then you probably didn't do very well in the first place. And if that's the case, why would you want to "showcase" that in a portfolio?!

I would estimate that my class alone probably took out a significant portion of the Amazon rainforest with our three portfolios each. That's 96 portfolios! At an average of 30 pages each, sometimes more...well, math is not my forte, but you get the idea!

And on the other side of things, instructors, do you REALLY want to sit there and "grade" these things? I can tell from the diligent scoring sheet that you are bored to tears because...guess what...you already read and/or taught everything in that portfolio! Also, what is there to grade when it's all subjective? Everything in there is my subjective thoughts and reflections, which aren't right or wrong, so how can you realistically grade that?

I can guarantee you that with so many students and so many pages, these portfolios don't get read beyond a glance or a skim to make sure they were actually completed. So we spend entire weeks putting these things together, making them beautiful and professional-looking, for someone to give it a passing glance and slap an arbitrary 98% on it.

Funny story. In my second portfolio, one item had to do with learning about various forms of assessment. So, I chose to include an assessment project we had completed for one professor, where literally 50 assessments were analyzed via a series of questions and compiled by our groups. So, this was a long, thorough document on nearly every psychosocial assessment tool under the sun. When I got the portfolio back, 10/10 was written for that particular section, then crossed out and rewritten as 8/10...and the comment said "Needs more detail." There's your arbitrary 98% and a healthy shot of irony.

Perhaps I should keep my sarcasm in check. I know what many of you will say: portfolios are valuable learning tools, you should do them for yourself, etc. etc. Perhaps if I was doing a portfolio of things I didn't already know or hadn't already completed, this would be the case. Not so, my friends. I'm pretty sure I'm operating at Allen Cognitive Level 6 (or 5 in my most sleep-deprived moments). With this in mind, please cut me a break and assume that I grasp what I am learning without the aid of end-of-semester busywork!

I know that complaints aren't constructive without the presentation of a possible solution, so here you go: 5 ways to make portfolios more useful and a more pleasant experience overall.

1. E-Portfolios. There's no reason to kill trees, waste ink from a $40 cartridge, or be saddled with a bulky binder.

2. Don't make it an assignment full of reiteration. Instead of proving we've met a competency, ask us to find an item that supports that competency, like a journal article, website, or product. That way, we actually learn something new and there will be some variety in what the instructor has to sit and look at (and the instructor might actually learn something new, also!)

3. Don't structure it so that a student HAS to wait until the end of the semester to start putting it together. Currently, students do have to wait until the last minute because they haven't accumulated enough "artifacts" until that time (and even then it doesn't feel like we have enough to choose from). Some of us would actually like to do it sooner - we aren't all procrastinators.

4. Make them pass/fail. You shouldn't be grading our subjective feelings and reflections because they can't be wrong. This will also encourage more honesty and better reflection.

5. For the love of all that is holy, do not make us present our portfolios in class. This may scientifically be the most boring thing possible (I'm propositioning the NIH for funding to study whether this is, in fact, true) and is comparable to Chinese Water Torture. Why? Well, first of all, it's supposed to be personal reflection and we might not want to share that. Secondly, 75% of the artifacts being presented are things I've already seen and done. I probably have the same exact thing, or something similar, in my portfolio. If there are more than eight people in the class, this "sharing" becomes incredibly monotonous and meaningless. Spare us! Or, if you really want us to talk about our portfolios, divide us into small groups of four or five and have us discuss them that way, for no more than 20 minutes. I don't mind hearing a few peoples' perspectives, but 30+ is too much and it ends up being a huge waste of time.

There - Andrea's complete portfolio overhaul. Embrace it if you dare. (Please?)

I See Dead People

Andrea Vourtsis — Mon, 08 Dec 2008 16:52:00 GMT

One thing that I can say I've done in the course of my program that most OT students do not get the opportunity to do is cadaver anatomy. For some reason, this isn't required for many OT programs. I don't quite understand the logic behind that. As OTs, we deal with just as much physical and anatomical detail as the other professions who do require cadaver anatomy and dissection. Perhaps we aren't discussing a specific muscle or bone as often as another professional, but that doesn't diminish our need to understand the physical structure of the body.

Those who have not participated in cadaver anatomy probably find the idea somewhat repulsive. Dissecting a cat or a fetal pig is one thing, but a person? And I have to admit that when you first walk into that lab, it can really freak you out.

I can't really explain the transition that takes place. I don't know when, where or how you go from being unable to look at the person's face to dissecting that same face. I can tell you that it involves a lot of humor, and to be honest, the fumes might have something to do with it.

I never thought I'd say this, but cadaver anatomy was a great experience. There are times, a year later, when I actually miss it. Not the smell, or the body juice, or the scraping of adipose tissue off the structures you want to see, but the joy of discovery, of connecting a structure to an action, and of really knowing what lies beneath. It gives you a tremendous understanding of how your body works that just isn't possible from a book.

The other great thing about it is that you can see the impact of disease and other conditions on the body. Want to know what a knee or hip replacement looks like? One of the cadavers in your lab will probably have one. Want to see what cancer does to your insides? Find a body with a chemo port. How about cirrhosis of the liver? Rheumatoid arthritis? Heart disease? Osteoporosis? Blunt force trauma or TBI? I was able to see all of those and their direct impact on physical body structures, which I think is an invaluable experience.

Of course, the other good part was being able to work on this with fun classmates and a knowledgeable, good-humored professor. Without those two ingredients, it could have been a (more) unpleasant experience.

So what do you guys think? Have you had cadaver anatomy? Love it or hate it? Do you wish you had been able to dissect a cadaver? Should OT students have to do this? Weigh in if you're so inclined.

Evidence-based practice

Andrea Vourtsis — Thu, 04 Dec 2008 16:53:00 GMT

In the last few years, the occupational therapy profession has made large and purposeful strides towards becoming evidence-based. We have known all along that what we do works. However, we don't have very much scientific, quantifiable evidence to back it up. As a result, students like me find themselves barraged with evidence-based assignments - and oftentimes, there isn't yet any evidence to report on!

I don't mind research, as long as the topic interests me. However, not so long ago I found myself doing a paper on handwriting interventions, which didn't interest me in the least, solely because there were evidence-based articles written on the topic. Other people found themselves in the same boat, writing papers on alternative seating in the classroom just because there was actually some research to be found on that. While it was a good experience and the articles were mildly interesting, it certainly didn't spur my desire to do more research.

Isn't there a better way to do this?

Here's an idea for a project. Someone research why students don't like research! I'm certain the answers would be enlightening. While it's true that there will always just be some people who detest the slow, scientific process of research, I think the way it is being thrown at us chases some people, those who are on the fence, away.

OTs are creative. So let's figure out a way to make backing up our profession with statistics FUN. If they can make watching bacteria grow in a Petri dish interesting, studying OT interventions should be absolutely enthralling. Right?