Mary Morley

Supervision in Occupational Therapy: How are We Doing?

Occupational therapy has endorsed the practice of clinical supervision to promote high quality services and professional accountability, in line with the Governments governance agenda (Department of Health 1998, 2000). This opinion piece was prompted by a survey of London-based occupational therapists in autumn 2005, which highlighted inconsistencies in the practice and theory of supervision and in the provision of training. The authors argue that managers in health and social care settings should adopt a theoretical framework for supervision; make their expectations explicit; and build an infrastructure, including training and audit, to demonstrate the effectiveness of supervision in improving patient care as well as supporting staff growth.

Contextual Factors That Have an Impact on the Transitional Experience of Newly Qualified Occupational Therapists

Many newly qualified occupational therapists (NQOTs) experience difficulties when moving into practice, with limited opportunities to co-work with colleagues. In 2005, a preceptorship programme designed to ease these transitional challenges was piloted. The programme was evaluated using mixed methods within a realist framework in order to understand the contextual factors that have an impact on the transitional experience of NQOTs and their engagement with the programme. Semi-structured interviews were carried out with four pairs of NQOTs and supervisors at 6 and 12 months into the programme. The findings suggest that the demands placed on new practitioners are increasing, with early expectations of autonomy within an interprofessional context. Strategies that assist transition include co-working, role modelling and informal support. The preceptorship programme facilitates the provision of these. The study highlights the importance of situated learning theories and communities of practice as frameworks to prepare therapists to analyse the complexities of the workplace and to facilitate negotiated access to the multidisciplinary communities.

The Development of Care Pathways and Packages in Mental Health Based on the Model of Human Occupation Screening Tool

Purpose: Payment by Results (PbR) was recently introduced to mental health care in England. The system allocates service users to one of 20 clusters and will provide funding based on cluster membership, rather than on block contracts. Occupational therapists are challenged to define care packages for each of the clusters. Method: To facilitate their development, this study identified the occupational profiles of service users in each cluster based on measures offered by the Model of Human Occupation. The study used existing data from the clinical records of 625 service users from two organisations, collected through use of the Mental Health Clustering Tool and the Model of Human Occupation Screening Tool. Results: Across the sample, service users showed greatest problems with habituation, followed by volition and process skills. Qualitatively distinct occupational profiles were identified across the clusters. Service users with non-psychotic problems showed the least interference with occupational participation; those in clusters involving psychosis showed moderate levels of interference; and those in clusters involving cognitive impairment demonstrated the most difficulty with occupational participation. Conclusion: These findings provide an important evidence base for thinking about the occupational needs of service users within the various PbR clusters and the corresponding services that might be offered.

An Evaluation of a Preceptorship Programme for Newly Qualified Occupational Therapists

Following the introduction of preceptorship as a requirement for most newly qualified practitioners in the National Health Service in the United Kingdom, a preceptorship programme for occupational therapists was designed. This was the first of its kind within occupational therapy and was endorsed by the College of Occupational Therapists. Participation in preceptorship was intended to ease the transition of newly qualified occupational therapists. This paper offers a definition of preceptorship for the profession in the United Kingdom and reports on a small qualitative study that evaluated the extent to which the interventions of the preceptorship programme ameliorated the challenges of transition. The evaluation was conducted within a realist framework. Data were collected by semi-structured interviews from four pairs of newly qualified occupational therapists and preceptors during the pilot year. The findings suggest that the preceptorship programme was successful in supporting the development of new practitioners and that implementation was optimised through strong leadership, a learning culture and positive supervision. This paper contributes to the body of knowledge relating to the transitional experience of occupational therapists and recommends changes to the programme to optimise its effectiveness for practice.

Clinical expertise: Learning together through observed practice

The popularity of inservice training programmes and short courses, as well as clinically related MSc courses in higher education, suggest that manual therapy practitioners are only too aware of a need to enhance clinical effectiveness and efficiency. While national professional bodies may consider continuous professional development (CPD) activity as obligatory, practitioners themselves have long been driven by a strong moral responsibility to improve what they do for their patients, investing both their time and finances in their learning. But what sort of learning do they do and is it effective to develop clinical expertise? Typically, CPD activities involve in-service training in the workplace and short courses away from the workplace that focus on relevant literature and research and hands-on skill. Practitioners perform techniques on each other with guidance from someone with expertise. Practitioners then go back into clinical practice and apply their new knowledge and skill to patients. Over time, practitioners see numbers of patients and gain experience and ‘patient mileage’ (Richardson, 1996, 1999). Will this CPD diet of patient experience, in-service training and short courses, result in enhanced clinical practice; will it lead to clinical expertise? To address this question, the literature related to professional learning is briefly reviewed. The notion that patient mileage automatically leads to clinical practice expertise is not supported by the literature (Boud et al., 1993; Stathopoulos and Harrison, 2003; Conneeley, 2005). There may be a number of reasons for this:

Moving from Student to New Practitioner: The Transitional Experience:

Preceptorship is now a requirement for all newly qualified occupational therapists joining the National Health Service (Department of Health 2005). This is intended to ameliorate the difficulties experienced by new practitioners when moving from the role of student into clinical work. A number of studies confirm the importance of providing both support and challenge in the first year of practice. This opinion piece presents the case for the introduction of preceptorship, building on the expertise of clinical supervisors. This role of preceptor could improve the transitional experience of new practitioners and support the development of their skills and their confidence.

Developing a Preceptorship Programme for Newly Qualified Occupational Therapists: Action Research:

This action research study used three focus groups and one interview to explore the experiences of five recently qualified occupational therapists, four supervisors and five occupational therapy managers. The participants were asked to identify the perceived development needs of new practitioners and the mechanisms that supported or hindered these being met. The findings showed that the recently qualified occupational therapists experienced satisfaction at making a difference in their first posts. However, for some, their first post had fallen short of their expectations because they faced challenges when moving from student to practitioner, sometimes with limited support. The participants identified development needs that they felt were common to other new practitioners and also the factors that constrained or enabled the meeting of these needs. These findings informed the second phase of the action research study to design a preceptorship programme that was compliant with the revised National Health Service employment contract (Department of Health 2005) and would improve the transitional experience of occupational therapists. This paper presents the focus group results and the rationale for the preceptorship programme, which was launched as a pilot evaluation study with occupational therapy staff from over 20 organisations in Autumn 2005.

Building Reflective Practice through Preceptorship: The Cycles of Professional Growth

A preceptorship process for newly qualified occupational therapists is presented, highlighting the importance of reflective practice within the preceptorship period to extend the skills of new practitioners and to promote professional growth. Models drawing on the learning cycle (Kolb 1984) are used to explore links between the processes of reflective practice, continuing professional development and preceptorship. This opinion piece introduces the National Health Service Knowledge and Skills Framework (Department of Health 2004) as a development tool and summarises the findings of a pilot study to show how preceptorship supports graduates in maintaining good habits of reflective practice and continuing professional development.

Professional doctorate: combining professional practice with scholarly inquiry

Professional doctorates in occupational therapy and physiotherapy in the United Kingdom offer a practice-based qualification equivalent in status to a PhD. Their aim is to develop professional practice and contribute to professional knowledge. Two doctorate journeys illustrate how applied research added both to each professions knowledge base and to practice. Their learning was enhanced by interprofessional peer support. It is argued that the professional doctorate is an attractive option for a senior practitioner in clinical practice, management or higher education who wants to influence practice.

Occupational Therapy can Flourish in the 21st Century — A Case for Professional Engagement with Health Economics

The view that the profession of occupational therapy will flourish in the 21st century was expressed before the banking system and financial market collapse in 2008. The profession now competes for scarce resources as austerity measures take effect. A summit meeting at the College of Occupational Therapists, in May 2013, discussed how to improve the professions understanding and use of health economics. At this meeting, short-, medium-, and longer-term approaches were discussed, with the aim of improving the quality and quantity of publications on economic evaluations in occupational therapy. Despite an increasing number of publications on health economics across professions, occupational therapy lags behind. This focus is now vital for the profession.