Evaluation Tool of Clinical Teaching in Occupational Therapy - Desrosiers to be used by both the Fieldwork Student and Fieldwork Supervisor Marcel M. Desrosiers September 22 Reproduction of this assessment tool is forbidden without the written permission of the author, with the exception of the University of Ottawa for the 24 to 24 period.
Evaluation Tool of Clinical Teaching in Occupational Therapy Desrosiers Information Name of student: University: School Year: Fieldwork Experience # Name of supervisor: Location: Placement Date from: to Non-attendance: Lateness: Fieldwork Description: Intervention Types: Physical medicine Acute care Children Mental health Long term care Young adults Community Rehabilitation Adults Other: Older adults
Evaluation Tool of Clinical Teaching in Occupational Therapy - DESROSIERS This document is primarily a guide for the student and the supervisor to ensure a self-directed learning approach during clinical experiences. The evaluation tool is based on the Canadian Occupational Therapy Profile and on the Canadian Model of Occupational Performance 2. This document is divided into 7 Units and contains a maximum of 35 learning objectives or competencies. Most objectives are followed by descriptors that provide information about the context or aspects associated with each competency. Canadian Model of Occupational Performance(CAOT 997, adaptation) Example of item. of Unit : - Objective: Describe, in plain words, the conceptual and theoretical orientation of Occupational Therapy. - Descriptors: occupational therapy philosophy; theoretical models; occupational performance. The 7 Units of professional competency in Occupational Therapy are: Unit : Organization and Marketing of Occupational Therapy Practice. Unit 2: Demonstration of Professional Accountability. Unit 3: Identification of Clients and Assessment of Occupational Performance, Occupational Roles and Client Environments. Unit 4: Planning Goal-Directed Occupational Therapy Services. Unit 5: Implementation and Completion of Service Impacting Occupational Performance Potential Within the Context of Occupation-Person-Environment. Unit 6: Evaluation of Provision, Quality and Outcome of Occupational Therapy Services. Unit 7: Demonstration of Resource Utilization and Quality Management in Occupational Therapy. CAOT (996). Profile of Occupational Therapy in Canada. Canadian Journal of Occupational Therapy, 63(2), 79-95. 2 CAOT (997). Enabling Occupation: An Occupational Therapy Perspective. Ottawa, Ontario: CAOT Publications ACE.
Evaluation Tool of Clinical Teaching in Occupational Therapy - DESROSIERS Identification of learning objectives (boxes U and F in the 7 Units) A in the box U identifies objectives that the University has found appropriate for the student to learn, considering the level of the clinical experience. During the first week, the student and the supervisor will review all marked objectives by the university and distinguish, by putting a in box F (Facility), those that will be feasible in the placement. Formative and summative rating scale coding space for self-evaluation by student - + Final evaluation by the supervisor Mid-term evaluation by the supervisor - + This evaluation tool is unique in the fact that it allows both formative and summative functions by giving the student a coding space for self-evaluation and the supervisor a rating scale for mid-term and final evaluations. : : 2: 3: objective not achieved objective in progress objective achieved objective mastered The evaluation tool is used in partnership between the student and the supervisor; it aims at providing a context where the student can take responsibility for his/her own learning. Self-directed learning is defined as a process in which individuals take the initiative, with or without the help of others, in diagnosing their learning needs, formulating learning goals, identifying human and material resources for learning, choosing and implementing appropriate learning strategies, and evaluating learning outcomes. For this process to take place, specific roles and actions must be identified for the student and the supervisor. Roles and actions for the student. The student assumes an active role in the planning and decision-making related to his/her learning activities. 2. Once a week, the student completes a self-evaluation using the 4 points rating scale for each objective identified earlier (box F) by blackening one of the smaller boxes of the coding space. The self-evaluation allows the student to rate or to show his/her progress for each learning objectives. It is possible to identify the first self-evaluation of the placement by blackening the small box W (week ), and then at the second week of the placement by blackening the box W2, and so on to rate his/her performance.
(Optional) It is also possible for the student to further discriminate the self-evaluation by using, instead of just the black square, the symbols, and in rating objective in progress of the rating scale. With these three symbols, the student can identify progression towards the achievement of an objective. 3. For a full-time placement, the student is granted half a day to: - complete a self-evaluation on all tagged objectives in order to set or modify priorities for the placement, to evaluate the general process or development of the placement; - plan the weekly meeting with the supervisor by reviewing his/her notebook (where student writes pertinent observations, thoughts, interventions and progress made with all clients); - organize learning objectives for the following week by writing a plan of specific activities to be conducted, the human and material resources required, establishing participation in committees, etc.; - discuss with supervisor at a one-hour formal meeting, the self-evaluation, thoughts, and the development of the placement in terms of learning objectives to be worked on, and the plan of learning activities for the coming week. This half-day is essential to the student to be a self-directed learner. To assist in the self-evaluation process or to develop reflections during therapeutic interventions, the student completes his/her notebook where observations, reflections and interventions are noted. The self-test of efficacy 3 is a simple tool to identify strengths and behaviours in interpersonal relationships, and to improve reflections of actions during the action. It could be simplified to the usage of the colours green, yellow and red in order to establish if the student s therapeutic interventions or intentions are or are not producing the desirable effect to the client. Colours green yellow red Effect produced to the client The student codes him/herself green (effective) if the effect of the therapeutic intervention occurs within the client, without undesirable secondary effect. The student codes him/herself yellow if the effect of the therapeutic intervention did not occur within the client, but there is an opportunity for progress or advancement towards the desirable effect; or the effect of the therapeutic intervention occurs within the client, with undesirable secondary effect. The student codes him/herself red if the client s reaction is opposite to the desirable 3 St-Arnaud, Y. (995). L'interaction professionnelle: efficacité et coopération. Montréal: Les presses de l'université de Montréal.
effect and a redefinition of the therapeutic intention is required. 4. The student plans or elaborates personal learning objectives using the learning contract 4 found in each of the 7 Units of the evaluation tool. With or without the assistance of the supervisor, the student ) formulates his/her learning needs and transforms them into measurable objectives, 2) lists all available resources, 3) identifies criteria that can demonstrate objectives are achieved, and 4) selects an appropriate evaluation method. Learning objectives Resources /strategies Evidence Validation What do you want to learn or develop? What will you utilize to achieve your learning objectives? Where can you find information? How can you show to yourself and your supervisor that you have met your learning objectives? What proof will you offer and when? How do you want your evidence to be evaluated? By whom? When? What are the criteria for evaluation? 5. The student participates to the mid-term and final evaluations by completing the section Comments from student, at the end of the evaluation tool. Roles and actions of the supervisor. The role of the supervisor 5 is to facilitate the acquisition of Occupational Therapy practice skills by the student. It is highly recommended that the supervisor: - invites full participation of the student in the design, implementation, and evaluation of learning experiences; - creates a supportive, non-threatening environment that fosters free raising of questions by the student; - aims to provide meaningful learning experiences for the student; - helps the student develops problem-solving and decision-making skills; - helps the student consult other clinical experts and utilizes alternative learning resources like libraries and audio-visual aids to supplement learning; - actively listens and observes the student and then communicates his/her understanding back for validation; 4 Knowles, M. S. (975). Self-Directed Learning: a guide for learners and teachers. Chicago, USA: Association Press/Follet Publishing Company. 5 Manley, M. J. (997). Adult Learning Concepts Important to Precepting. In J. P. Flynn (Ed.), The role of the preceptor: a guide for nurse educators and clinicians (pp. 5-46). New York: Springer Publishing Company, Inc.
- is genuine with the student and demonstrates congruence in his/her words, actions and feelings. 2. The supervisor formally meets with the student once a week, for one hour. They discuss the self-evaluation, thoughts, development of the placement in terms of learning objectives to be worked on, and the plan of learning activities for the coming week. 3. The supervisor grants half a day to the student to complete the self-evaluation, to plan the weekly meeting and to self-direct his/her learning. 4. The supervisor formally evaluates the student twice on the rating scale: - First, at the mid-term of the placement, where the supervisor indicates with a - the level achieved by the student for each learning objective identified (box F). The supervisor then completes the section Evaluation Mid-Term of the evaluation tool where strengths and competencies to improve are described and presented to the student. - The second evaluation is summative and takes place at the end of the placement. The supervisor indicates his/her final appreciation of the student s achievement with a + in one of the boxes,, 2 and 3. The supervisor subsequently completes the section Final Evaluation of the evaluation tool. 5. The supervisor recommends in writing, to the university, a pass or a fail of the student upon the completion of the placement. To assist the supervisor in this decision, the evaluation tool suggests to calculate a percentage of learning objectives attained by the student. This percentage is not a mark but primarily an indicator to guide the supervisor in a final decision.
Unit : Organization and marketing of occupational therapy practice Occupational therapy practice is organized and marketed consistent with occupational therapy philosophy. It is important for occupational therapists to develop, monitor and review the organization and marketing of practice, both on entering a new practice and at regular intervals as professional practice continues. Organizing and marketing extend well beyond managers and are viewed as shared responsibilities of every occupational therapist. Rating Scale: not achieved ; in progress ; 2 achieved ; 3 mastered U F Item Rating. Describe, in plain words, the conceptual and theoretical orientation of Occupational Therapy: occupational therapy philosophy; theoretical models; occupational performance..2 Communicate to the client (or audience) the broad purpose and scope of occupational therapy practice in terms appropriate to age, cognition and culture: occupational performance; client-centred practice; modalities..3 Identify what occupational performance needs require occupational therapy services: types, age and needs of clients; taking into account family, team members and involved agencies..4 Promote occupational therapy services: using the language of occupational performance; developing materials marketing occupational therapy services. Learning objectives Resources/strategies Evidence Validation
Unit 2 : Demonstration of professional accountability Occupational therapists practice as autonomous professionals in a variety of settings in both the public and private sectors and work within the parameters for client-centred practice. Professional competence is achieved through education and assimilation of the profession's values, philosophy, and theoretical models. Occupational therapists are committed to life long continuing professional education, the preparation of future health.professionals as well as the development of the profession through research. Advocacy for social justice at both an individual client level and at the societal level is well evidenced. Rating Scale: not achieved ; in progress ; 2 achieved ; 3 mastered U F Item Rating 2. Practice in accordance with the professional code of ethics for occupational therapy: confidentiality; client s values and beliefs; regulatory statutes; application in practice situations. 2.2 Comply with record keeping policy and procedures: progress notes; interventions plan; demonstrate problem solving and decision making; participate in audit of record keeping. 2.3 Demonstrate application and transfer of information from current literature and professional standards to practice: participation and development in life-long continuing education;, professional accountability; evidence-based practice. 2.4 Participate in research activities: recording data; collaboration to the evaluation of outcomes/data. 2.5 Participate in developing and carrying out educational policies and procedures for students. Learning objectives Resources/strategies Evidence Validation
Unit 3 : Identification of clients and assessment of occupational performance, occupational roles and client environments This stage clarifies referrals and requests for service. Negotiations then can occur to reach agreement about whether or not to proceed to actual assessment. Assessment involves information gathering about characteristics or components of occupation-person-environment interactions that are relevant to the situation. Priorities are identified in relation to the occupational profile and occupational performance goals of the client. Assessment is carried out at initial, interim, ongoing, and final points within the service agreement. Rating Scale: not achieved ; in progress ; 2 achieved ; 3 mastered U F Item Rating 3. Establish a professional relationship with the client: interview; share decision-making; empowerment; define expectations; identify potential conflicts of interest; communicate the parameters of service; build rapport. 3.2 Determine suitability of available services with the client: review chart, information from other sources; clarify conceptual and theoretical orientation; document client and therapist expectations; accept, refuse or redirect client based on available services; terminate services. 3.3 Determine theoretical model and orientation for assessment: with client involvement; define purpose of assessment to the client. 3.4 Assess areas of client s occupational performance (or group): evaluation of self-care, productivity and leisure within the context of roles, demands, expectations, goals, and settings of client; select tools and methods; strengths, limitations, environmental supports and barriers; document reasoning, methods, findings and analysis. 3.5 Assess occupational performance components with client (or group): affective, cognitive and physical components; values, beliefs, assumptions, motivation, abilities and sense of purpose and meaning; select tools and methods; strengths, limitations, environmental supports and barriers; document reasoning, methods, findings and analysis. 3.6 Assess elements of the environment as they impact on occupational performance with client (or group): obtain information on physical environment; social, cultural, organizational, geographic, physical, economic, political and legal conditions; in a context of occupation-person-environment, information gathered by interviews, visits to settings, community/organizational assessment. 3.7 Assess opportunities and barriers for supporting client s occupational potential in a context of occupation-person-environment: document reasoning, methods, findings and analysis.
Unit 3 : Identification of clients and assessment of occupational performance, occupational roles and client environments (continued) Rating Scale: not achieved ; in progress ; 2 achieved ; 3 mastered U F Item Rating 3.8 Integrate assessment information into an occupational profile of an individual (or group): share outcomes and analyses with client (or group); determine a course of action with client (or group) centred on occupation-person-environment. Learning objectives Resources/strategies Evidence Validation
Unit 4 : Planning goal-directed occupational therapy service In some instances, services are developed with individual clients based upon identification of their priorities, goals and objectives. In other situations, the occupational therapist plans and designs the service as a manager, programme developer, educator or as part of other professional roles. Rating Scale: not achieved ; in progress ; 2 achieved ; 3 mastered U F Item Rating 4. Clarify the conceptual and theoretical orientation with client: select theoretical model to the client s goals and available resources; gain client understanding of the chosen orientation; involve client in decisions. 4.2 Establish expected outcomes with client: identify outcomes in terms that are measurable, observable and achievable; assist client in understanding the risks and responsibilities of the decision-making; develop short-term goals that define ways to achieve the long-term goals; clarify client s priorities. 4.3 Involve the client in the organization and implementation of intervention: considering home, vocational and leisure environments; consistent with identified outcomes and selected theoretical model; considering benefits, risks, responsibilities and costs; considering client s abilities. 4.4 Determine resources required for service: human resources; supplies, equipment and environment(s); financial resources. 4.5 Determine location, timing, frequency and duration of service. Learning objectives Resources/strategies Evidence Validation
Unit 5 : Implementation and completion of service impacting occupational performance potential within the context of occupation-person-environment Services, implemented in collaboration with clients, promote, develop, maintain and/or restore occupational potential. With individual clients, implementation may refer to the use of diverse intervention approaches such as occupational, biomedical, psychosocial, neuro-developmental, rehabilitative or environmental. With agency, community, corporate or other clients, implementation may take different forms, for example, workshops, research projects, educational sessions, or the development of healthy community policies, projects and initiatives. Rating Scale: not achieved ; in progress ; 2 achieved ; 3 mastered U F Item Rating 5. Choose implementation options which are meaningful for the client: activities supporting occupational potential; consistent with client and service plan; safe environment; adapt or grade occupations to achieve desired outcomes. 5.2 Implement processes that promote change in (or maintain) occupation-clientenvironment: communicate regularly with client and pertinent others; consultation; lobbying. 5.3 Conduct continuous assessment of the implementation against desired outcome: record client s observations and reflections; client s satisfaction with outcomes; changes in identified goals and desired outcomes. 5.4 Modify implementation plan, process and environment as needed: record changes in implementation and reasons for changes; discuss changes to client and others. 5.5 Plan completion of occupational therapy intervention: identify completion criteria; communicate completion plan to client and others; finalize follow-up; record outcome of implementation, future plan and recommendations. 5.6 Refer client to other resources as needed: based on current resources and their availability. Learning objectives Resources/strategies Evidence Validation
Unit 5 : Implementation and completion of service impacting occupational performance potential within the context of occupation-person-environment (continued). Learning objectives Resources/strategies Evidence Validation
Unit 6 : Evaluation of provision, quality and outcome of Occupational Therapy services Occupational therapists carry out evaluation of services in collaboration with clients. Service evaluation is closely related to quality improvement activities. Qualitative and quantitative methods must be relevant to goals, processes and outcomes of occupational therapy service. Rating Scale: not achieved ; in progress ; 2 achieved ; 3 mastered U F Item Rating 6. Identify purpose of evaluation: formulate; identify people in the evaluation and types of data to be collected. 6.2 Participate in the evaluation: based on methodology; collaborate with relevant persons; data gathering and analysis. 6.3 Communicate evaluation results to identified recipients: verbal communication to peers; review or collaborate to the writing of the final report. Learning objectives Resources/strategies Evidence Validation
Unit 7 : Demonstration of resource utilization and quality management in Occupational Therapy Occupational therapists are accountable for safe and effective resource utilization and quality management. This responsibility spans all occupational therapy roles and encompasses planning, development, administration and impact analysis of human, financial and material resources. Rating Scale: not achieved ; in progress ; 2 achieved ; 3 mastered U F Item Rating 7. Record data that reflects activities of the client, of services and outcomes. 7.2 Participate in maintaining inventory, safe storage and maintenance of materials and equipments. 7.3 Follow principles of business practice: operate within budget guidelines; cost-effective utilization of materials. 7.4 Implement recommendations on quality of service and service provision. Learning objectives Resources/strategies Evidence Validation
Learning contract (extra spaces) Learning objectives Resources/strategies Evidence Validation
Evaluation Tool of Clinical Teaching in Occupational Therapy - DESROSIERS Mid-Term Evaluation Comments from supervisor on the fieldwork process in general, on achieved objectives, and on objectives to be worked on. Comments from student on the fieldwork process in general, on achieved objectives, and on objectives to be worked on. Supervisor signature: Date Student signature: Date
Evaluation Tool of Clinical Teaching in Occupational Therapy - DESROSIERS Final Evaluation a = total number of + in boxes 2 and 3 of the 7 units = b = total number of + in boxes and of the 7 units = The supervisor recommends: pass of the placement fail of the placement. % of objectives achieved a x = a + b Comments from supervisor on the fieldwork process in general, on achieved objectives, and on objectives to be worked on in the future. Comments from student on the fieldwork process in general, on achieved objectives, and on objectives to be worked on in the future. Supervisor signature: Date Student signature: Date