Penny Salvatori

Reliability and Validity of Admissions Tools Used to Select Students for the Health Professions

The selection of students for the health professions is typically a very competitive multi-staged process that includes assessment of both cognitive abilities and personal qualities. The need for reliable and valid assessment measures is obvious. This review of the health professions literature examines the evidence to support the use of various selection tools. It is clear that pre-admission overall grade point average (GPA) is the best predictor of academic performance in all of the health professions; however, the relationship between pre-admission GPA and clinical performance is less clear. The Medical College Admission Test is a good predictor of performance of medical students in terms of in-course grades and licencing examination scores but a similar test does not exist in the other health professions. Controversy remains as to the value of personal interviews and written submissions as selection tools, although it is clear that training of assessors and explicit rating guidelines enhance their reliability and validity. Ongoing research is needed to find more reliable and valid ways of assessing non-cognitive characteristics of applicants.

The effect of defined violations of test security on admissions outcomes using multiple mini‐interviews

Introduction  Heterogeneous results exist regarding the impact of security violations on student performances in objective structured clinical examinations (OSCEs). Three separate studies investigate whether anticipated security violations result in undesirable enhancement of MMI performance ratings.

Development of a tool to measure clinical competence in occupational therapy: a pilot study?

Clinical competence is generally defined as a combination of knowledge, skill and professional behaviour. It is typically assessed using written tests, direct observation, chart audit, client satisfaction surveys and supervisor ratings. This paper describes the development and evaluation of a chart-stimulated recall (CSR) measure that combines the methods of chart audit and clinician interview to assess the clinical competence of practicing occupational therapists. The CSR tool was developed using the Canadian Guidelines for Client-Centred Practice and taps global domains of competence: use of theory, assessment, program planning, intervention, discharge planning, follow-up, program evaluation, clinical reasoning and professional behaviours. This pilot study involved two independent raters/interviewers who assessed twelve occupational therapy clinicians on two occasions using a random sample of client cases/records on each occasion Results indicate that the CSR tool is not only reliable and valid, but also sufficiently generic to be used in a variety of practice settings as a global measure of on-the-job performance.

Learning from today¿s clinicians in vocational practice to educate tomorrow¿s therapists

Background. In response to the demand for therapists and changes in vocational practice, a needs assessment was conducted to update an occupational therapy educational program. Method. Employing focus groups, interviews and questionnaires, 66 therapists from a wide range of graduating institutions working in vocational practice were asked to: a) identify the essential knowledge, skills and professional behaviours required for vocational practice; b) determine to what extent training is preparing students for vocational practice; and c) make recommendations for curriculum revision and/or for additional curriculum development. Participants and their jobs were profiled together with the challenges and issues of vocational practice. Results. There was strong agreement among participants regarding what is required to practice effectively but disparate views concerning the extent they were prepared for practice. Clinical Implications. Recommendations were given for entry and postgraduate level curricula. Findings were compared to a past community practice survey. Implications for practicums, professional integrity and ethical issues were discussed.

Comparison of Problem-Based Learning Curricula in Two Occupational Therapy Programmes

There is increasing interest in the use of problem-based learning (PBL) approaches in the education of health professionals. This paper compares the PBL occupational therapy programmes at McMaster University in Hamilton, Ontario and Shenandoah University in Winchester, Virginia. The first section of the paper offers some general comments about problem-based learning; the second section presents an overview of key components of the occupational therapy programmes at McMaster University and Shenandoah University. A description of the similarities and differences between the programmes is provided, and critical issues that have emerged in the process of implementing these programmes are discussed.

Meeting the Challenge of Assessing Clinical Competence of Occupational Therapists within a Program Management Environment

Background. Program management models have raised concerns among occupational therapists about professional standards related to clinical competence, performance review procedures, and quality improvement initiatives. Purpose. This paper describes how a chart-stimulated recall (CSR) peer-review process and interview tool was revised, implemented, and evaluated as a pilot project to assess the clinical competence of occupational therapy staff at a large urban health centre in southern Ontario. Methods. Fourteen pairs (n=28) of occupational therapists representing various practice areas participated in this project. Half served as peer assessors and half as interviewees. Peer assessors conducted an independent chart review followed by a one-hour personal interview with a peer partner to discuss clinical management issues related to the client cases. Each interviewer rated his or her partners clinical competence in eight areas of performance using a 7-point Likert scale. Findings. Results indicated that the CSR tool could discriminate among occupational therapists in terms of overall levels of clinical competence and also identify specific areas of concern that could be targeted for professional development. Feedback from participants was positive. Conclusions. The CSR tool was found to be useful for assessing clinical competence of occupational therapists in this large health centre as a quality improvement initiative within that discipline group. Further research is needed to establish the reliability and validity of the CSR tool.

Moral Development or Moral Decline? A Discussion of Ethics Education for the Health Care Professions.

Ethics education curricula in professional programmes are often confused and ineffective. They focus on traditional conceptions of professional ethics as rules supplementary to the law, and, it is claimed, contribute to tension and conflict in professional relationships, particularly with authority. This paper presents, first, a contemporary conception of the relationship between law and ethics that reinstates morality as a core component; it informs professional ethics and together they contribute to the law. Second, the paper describes the educational philosophy of two programmes in rehabilitation science where the ethics education component is being analyzed. Finally, research, that is currently under way, is described which will demonstrate the different effects of traditional and enhanced ethics education effort upon the moral reasoning processes that students use in reaching moral judgments.

The manpower shortage in occupational therapy: implications for Ontario.

A consistently increasing imbalance between the supply of and demand for occupational therapists has led to a critical manpower shortage in occupational therapy. Based on a review of various government reports and related literature, this paper provides an overview of the extent of this manpower problem, identifies factors affecting retention and attrition of occupational therapists and discusses strategies to improve retention and reduce attrition. To address the supply-demand imbalance, recommendations in relation to education, employment, immigration and service delivery for the occupational therapy profession in Ontario are proposed.

The History of Occupational Therapy Assistants in Canada: A Comparison with the United States

In the middle of the twentieth century, the role of occupational therapy assistant was introduced in North America. Although the role, utilization and training of assistant personnel have raised much controversy and debate within the profession, Canada and the United States have taken very different paths in terms of dealing with these issues. This paper focuses on the history of occupational therapy assistants in Canada, using the experience in the United States for comparison purposes. The occupational therapy literature and official documents of the professional associations are used to present a chronology of major historical events in both countries. Similarities and differences emerge in relation to historical roots; training model and standards of education; certification, regulation, and standards of practice; career laddering and career mobility; and professional affiliation. The paper concludes with a summary of issues which require further exploration, debate and resolution if the profession is to move forward in Canada.

Clinical Competence: A Review of the Health Care Literature with a Focus on Occupational Therapy

This paper provides a review of the health care literature on clinical competence with a focus on occupational therapy. A simple know-can-do hierarchical model provides a framework for understanding the concept of clinical competence and for exploring the issues related to its definition and assessment. While there is general agreement across the health professions regarding the broad meaning of competence, the profession-specific components have been more difficult to identify and measure. Much of the research on the assessment of clinical competence has focused on the validity of certification examinations, especially in medicine, or on the evaluation of student performance, as is the case in occupational therapy. Although a variety of evaluation measures have been developed, the evidence is clear that one comprehensive tool that provides a reliable, valid and cost-effective measure of clinical competence does not exist; therefore, a combination of evaluation methods is needed for assessment purposes. Defining and assessing competence remains a particular challenge for the profession of occupational therapy.