Category Archives: Critical Thinking

Learning IDEA for Level 3 students: Using the ACCR

Benefits of Having Students, Critical Thinking, Learning

It’s that time again for all OTs in BC to do the Annual Continuing Competence Review (ACCR) for your College renewal… and here is an idea from one of our most experienced preceptors! And a useful idea for students as they approach the NOTCE exam in the fall…

VCH Student Therapist Enhanced Program occupational therapist, Holly Hergesheimer, and her two Level 3B students, Ryan and Gabriela, have been working on the ACCR practice questions this week. They have been doing a few scenarios together every day and much discussion has ensued! They have even brought in a near by PT for team based consideration.

They’ve also carried on talking about the implications of the questions as they walked about from visit to visit in the community.

Student quote: I found the ACCR scenario questions to be a really helpful learning experience and provided a valuable opportunity for reflection and professional growth. I appreciated the chance to deepen my understanding and hearing the perspectives of others for each situation.  

Occupational Therapists

Also from the CHPCBC wesbite: https://chcpbc.org/registrants/occupational-therapists/resources/

The ACCR typically takes under an hour, and you can complete it at your own pace across multiple sessions. We’ve heard from occupational therapists that discussing their reflections and resources with peers is a valuable experience.

Why not extend these discussion to soon-to-be peers (i.e. students!)

Thanks for the great idea, Holly!
The UBC OSOT Fieldwork Team

Moving from OT Student Clinical Reasoning to OT Practitioner Critical Thinking

Critical Thinking, Learning, Learning Environment, Reflection, Teaching Tips, Uncategorized

This post comes from Kimberly Nguyen, MOT 2022 (edited by the OSOT Fieldwork Team)

Fieldwork is the perfect opportunity for students to problem solve and begin to move from explaining their clinical reasoning to moving towards critical thinking, defined as: Occupational therapists use critical reasoning and reflection approaches for safe, ethical, and effective practice (Essential Competencies of Practice, 3rd Ed), which will set them up to be effective occupational therapists. The question now becomes, how can fieldwork be a place that facilitates critical thinking? Read on!

Strategies: 

Reflections and debriefing

    • This can be a powerful way for students to critically think about their learning and brainstorm new ways of thinking. Equally as important, set out time to talk through the reflections with your student. Written reflection allows students to go deeper to into their thinking and solidifies learning.

    Allow for practice and independence

    • Students are often eager to get their hands in on the action and experiential learning has been proven to be an evidence-based method to critical thinking (Dvergsten & Haugen 2015). However, it’s important to not throw a student who doesn’t feel prepared into the deep end where their confidence suffers. Have a chat about levels of comfort.

    Ask don’t tell

    • It’s important to ask students questions, specifically open-ended questions, to promote active learning (Delić & Bećirović, 2016). This will allow them to practice problem solving for themselves.

    Inspire creativity

    • Often students come fresh with ideas and thoughts. Allow students to be creative in their thinking and approaches even if it’s not something that might be typically done where you work.

    Remember to have a conversation about what works for both parties and check in with each other. As we know, everyone is different in the way we all learn and think…

    Which method will you try?

    References:

    College of Occupational Therapists of British Columbia. (2011). Essential competencies of practice for occupational therapists in Canada, 3nd Edition. Victoria, BC: Author. Available at         https://cotbc.org/wp-content/uploads/EssentialCompetenies3rdEd_WebVersion.pdf

    Delić, H., & Bećirović, S. (2016). Socratic method as an approach to teaching. European researcher. Series A, (10), 511-517.

    Dvergsten, V., & Haugen, A. (2015). Experiential learning and its impact on critical thinking.

    Chronic Pain Learnings

    Critical Thinking, Interprofessional Education, Learning, Reflection

    This is a blog post courtesy of Evan Zhou, MOT student (MOT 2025), who wrote this as part of a reflection piece (adapted by the OSOT Fieldwork Team).

    This post highlights how much knowledge the MOT students often bring to placement, based on their prior experiences, as well as how much they learn during placement, which complements their classroom learning.

    During a inclement weather day on my first placement (Level 1), I had the time to listen to a podcast titled “Tools to Reduce & Manage Pain” from the Huberman Lab Podcast and found it enthralling and transcendental. Below are my main takeaways and epiphanies.

    Evan’s Pain Psychoeducation Philosophy:

    • Providing tools and building emotional resilience are paramount for our clients when managing their pain.
      • I am a big believer in cognitive reframing and emotional regulation.
      • The main message that I want to teach my clients is that if we can increase one’s emotional well-being and provide ways to regulate the nervous system, perhaps one’s pain can be managed, and decreased.
      • And over time, the client can build greater repetitions to build up their pain tolerance.
      • My goal is not to cure their pain or fully alleviate it. But rather, to provide them the cognitive scaffolding to be able to contextualize their thought patterns and perceptions of pain in an accepting and non-judgemental way.
      • This is the message that I would love my clients to work towards – “Here it is again, I recognize it, I honour it, it hurts like hell, but I know that it won’t be permanent and that it will go away. I know what I can do to manage it, and reduce some of the hurt, and make myself feel a little bit better again.” “It will pass.”
    • Pain is a subjective and complicated experience and is pre-programmed into our brains to protect us, to keep us safe from injury or harm.
      • However, its not only a physical experience, it also impacts us both at a sensory and emotional level too.
      • After hearing Dr. Mackey’s experience, and witnessing this in my own clients I do believe that the emotionality piece gets lost in people with chronic pain syndrome (CPS) during their recovery.
      • Based on client reports during sessions, I’ve noticed that clients with CPS often hyperfocus on their physical pain experienced within their bodies. There seems to be this assumption that if one can alleviate their physical pain, all their pain will recede thereby improving their QOL.
        • This is 100% valid, and understandable but I do fear that this cognitive belief may potentially limits one’s ability to recover.
        • In my opinion, one’s own physical pain may often be a manifestation of one’s emotional pain that they have bottled up and stored not allowing oneself to address it.
        • Something that I’ve learned is that when OT’s provide psychoeducation regarding pain, we should explain it through a holistic lens, teaching our clients that pain is a combination of physical, emotional, psychological, and spiritual elements.
    • One tool that my preceptors constantly use in their work is Pacing.
      • Pacing is defined as breaking down an everyday activity into smaller, more manageable components.
        • Its function is to help achieve a desired outcome while reducing the potential of a pain flareup. Pacing can help with finding that “just right fit” for a client in managing the activities that they need to do or want to do, while also being mindful of their fatigue and pain.
        • Pacing can help clients balance between over-doing and under-doing, which is pivotal as the challenge with CPS is thatit waxes and wains. When you finally feel good it’s common for folks to try and do everything that on their to do list (things they weren’t able to do when they were in bed all day yesterday) so you do everything that you haven’t been able to do, but then you regret the next day.
        • What happens is you go into this rollercoaster of no activity – activity- no activity. Which creates reinforcement of avoidance of activity X. And reinforces the notion of fear “that going to my job, doing my physio exercises, or going to the gym will cause me more pain. And I don’t want more pain so I’m not going to do this.”
        • Unintentionally, clients who follow this line of thinking create a  negative reinforcement model which disencentizes participating in meaningful activities that could provide physical, emotional, or psychological relief because they are scared that these things will make your pain worse.
        • Therefore, folks experience occupational deprivation and reduce engagement in activities, which may negatively compound leading to greater atrophy, mood challenges, and ultimately greater disability. This totally makes sense and was a huge epiphany for me! 
        • So how do we to tackle this? Pacing – set small goals. If you can comfortably walk a block, add an extra 25m each day.  If you are having a great day don’t do 50 blocks. You’re training for a marathon. Not a sprint.
        • You are going to have good days and bad days. On your good days don’t overexceed it, or push yourself. Set a time on your watch, have a threshold time/distance and don’t exceed it.
        • On the bad days, recognize that you have bad days. Everyone has bad days. Give yourself some grace and self-compassion and let yourself get the rest that your body and mind need. Then, the next day, restart to where you were previously and build from there..

    Interventions for Pain Medicine & Management from Dr. Mackey:

    6 Broad Categories: The idea is to not necessarily solve their pain using one modality but to slowly chip away at their pain experience using various interventions and tools.

    1. Medications
    2. Nerve blockers, spinal cord stimulators, drug deliver pumps
    3. Psychological and behavioural therapies
    4. Physical and occupational therapy approaches to pain (ex. Pacing, diaphragmatic breathing, MSBR, MBCT, AROM)
    5. Complimentary/alternative medicines (ex. Chiropractor, Acupuncture, Trauma-informed Yoga, TCM, Qi-Gong, Tai Chi, Breathwork)
    6. Self-empowerment – reading stories, books, blog posts, evidence based podcasts, learning coping skills.

    Feel free to share examples of topics you’ve learned about from your students, that have been enhanced while on placement…

    Student Evaluation: formative assessment & CBFE quick tips

    Critical Thinking, Learning, Placement Evaluation & CBFE Tool

    ~This is a combined post of two previous posts by Donna~

    Formative assessment is the ongoing day to day observations you are gathering when you have an OT student. It allows you to gather evidence  for the purpose of providing feedback (the formative assessment or impression you have of the student) in order for them to  improve learning. The aim of formative (ongoing) assessment is to improve students’ mastery of the content and to equip and empower them as self-regulated, life-long learnersFree Rental Property Evaluation – Property Savants

    Students should be actively participating in this formative process. They should be doing this through self -assessment. They should be asking themselves these  three questions: 1) Where am I going? 2) Where am I now? and 3) How can I close the gap? (Chappuis, 2015; Sadler, 1989; Wiliam, 2011). This process should allow students to reflect on the expectations of the placement, what their strengths are and what they should continue to focus on to enhance their knowledge and skill acquisition.

    Strategy: Two things I did well, two things I need to continue to work on

    This technique works far better than asking students: “How did that go for you?” The above technique requires students to critically reflect on not just their knowledge & skills but also their behaviours of how they came across in the encounter. Having to “name” one’s strengths is often very difficult for students, but great to help build their confidence.

    Your role: engage in discussion with the student to confirm and/or correct their self -assessment. Often students are very hard on themselves. It will also open up the dialogue for you to anticipate what opportunities you could provide to assist the students to develop the areas where they feel they are weaker.

    Don’t just rely on the Summative CBFE-OT evaluation. Every discussion, dialogue and conversation you have with an OT student is formative assessment and is what students can really attend to throughout the placement to show change in their knowledge, skills and behaviours!

    Quick tips for the CBFE and preparing for the final evaluation meeting: 

    • Send in only one form that has the mid term, final comments and numbers
    • If students have completed a self evaluation using the CBFE you can send that in too or combine their self eval onto your one form
    • PLEASE ONLY EMAIL your form to: osot.fieldwork.ubc.ca

    Here are some points to think about when completing the evaluationSelfassessment, peer Assessment, selfconcept, Critical thinking, selfesteem, educational Assessment, evaluation, quiz, Self, skill | Anyrgb

    • Review the student’s learning objectives
    • Examine your own attitudes toward the student; try to differentiate between knowledge, skill and personality issues
    • Review any and all documentation that the student completed
    • Ask the student to complete self-evaluation (optional)
    • Request input from colleagues
    • Make sure you have discussed with the student the evaluation procedure, including date, time and meeting place
    • Ensure there are no surprises on the written evaluation- they should have heard everything
    • Discuss the rationale behind your comments, and clarify by providing examples to support the feedback
    • Maintain a positive approach to  the evaluation – provide areas of improvement balanced with areas of strength—

    References:
    Chappuis, J. (2015). Seven strategies of assessment for learning (2nd ed.). Hoboken, N.J.: Pearson Education, Inc.

    Sadler, D. R. (1989). Formative assessment and the design of instructional systems. Instructional Science, 18, 119-144.

    Wiliam, D. (2011). Embedded formative assessment. Bloomington, IN: Solution Tree Press.

    How do we (UBC OSOT) check in with students during placement? (i.e. ever wondered what T-res is really all about?)

    Critical Thinking, Placement Preparation, Reflection, UBC Fieldwork Portfolio- Updates & Goings On!

    This post is edited and updated from a previous post by Donna.

    T-what? T-res is a web and mobile application that allows the UBC Occupational Therapy students to track  and record  all of their clinical experiences on the go- using smart phones, or the internet. Students are able to actively record their learning experiences and sync them to a hosted (Canadian) server which the OSOT fieldwork team can login to and assess student progression throughout their academic program. It also allows for electronic submission of reflections. which helps us to assess how students are developing their clinical skills, including self-reflection. 

    T-ResUBC OSOT Fieldwork has been using T-res since 2013 when Donna heard about it during an Interprofessional Practice Education Committee meeting. The idea of being able to track placement activities with accuracy was very appealing so that a) the placement matching process could  be strengthened (only one example of its use) and (b) provide an easy-to-use tool to support students’ personal reflection. The OT template tracks: client diagnosis, practice area; the level of “independence” to which the student participated in the encounter; the actual encounter (direct client care, indirect client care, non- client care), what they did (activity) and linking that activity to the PEO Model (Person-Environment-Occupation). Additionally, there is also a section for private notes for students to voluntarily jot down thoughts or notes and then a separate reflective writing section which gets submitted periodically during the placement.

    The OSOT Fieldwork Team reviews all of the T-Res reflections- we divide up the cohort list each year so we have about 20-25 students per cohort to provided feedback to while they are on placement. Depending on the student’s level, they submit reflections weekly (Level 1A) or else 3x throughout the placement ((Levels 2A, 2B, 3A & 3B). Many of the other health programs at UBC now use T-Res too so it has been tried, tested and has proven it’s true value for many disciplines.

    So what does this mean for you? Well, if you happen to see a UBC student actively using their smart phone on placement, they most likely are NOT texting, they are reflecting! If you are able to, please allow the students some time during or at the end of the day to record their reflections and clinical encounters. If you are interested in more information about what the students are actually recording, or are curious about the reports that T-Res can generate, please contact us at osot.fieldwork@ubc.ca 

    OT Fieldwork Educator, Student & Client Relationships: Making relationships intentional

    Critical Thinking, Learning Environment, Relationship & Relationship Building, Uncategorized

    This post comes courtesy of Cayla Douglas, UBC MOT Class of 2022 (edited by Donna Drynan)

    A wise OT once described some secret tips for clinical reasoning. They said “every interaction I have with a client I make it intentional”. This phrase also invites students to engage in critical reflection of the importance of simply being present.

    Engaging in intentional relationship building is so important, not only with your client’s but with the students you take under your wing. Interactions that are Intentional have the potential to truly foster enhanced learning in many fast paced placement settings.

    Here are four (4) examples of intentional relationship building:

    • Together with your student engage in 1-2 minutes of post intervention reflection. Name one thing that you did well and one thing you could improve upon.
    • Have lunch or coffee breaks with your students, get to know them as individuals to increase your understanding of who they are and how they might learn best. Giving students your time helps them feel valued and a real member of the team.
    • Taylor (2020) describes building an interpersonal skill base by “checking in and acting as an emotional buoy” (p.248). This is a great reminder that even the best of students may be struggling with an inner or external conflict.
    • To increase your intentional relationship building, the following book listed below is very insightful and always a good tool to look back upon.

    References

    Taylor, R. R. (2020). The intentional relationship: Occupational therapy and use of self. FA Davis.

    Student Occupational Therapists and the ‘just right’ challenge

    Critical Thinking, Learning, Teaching Tips, Uncategorized

    This post is courtesy of Lisa Odland MOT Class of 2021 (Adapted by Donna Drynan)

    So What is the Just Right Challenge?

    No it is not the cereal, it is a “balance between the inherent level of difficulty in the occupation and the client’s level of developmental competencies”. In other words, to optimize the therapeutic benefit of an occupation, the task must be difficult enough to provide a challenge to the person attempting it but must not be so difficult that the person surrenders in frustration (Nelson and Jepsen-Thomas 2003).

    As occupational therapists, we strive to provide clients with the ‘just right’ challenge.  The same concept can be applied to students on fieldwork placements.

    Why the Just Right Challenge?

    Consider the following:

    • Too much observation leaves the student feeling a lack of confidence, not trusted, and questioning their abilities to perform the task themselves.
    • Too much task independence may have the student wondering if they are doing the right thing, missing a key consideration, or offering the most evidence-based or client-centred care.

    That ‘just right’ challenge where student-client encounters are complicated enough to challenge the students’ clinical reasoning, while supporting the student enough to instill confidence will maximize student learning outcomes.

    How Do We Achieve the Just Right Challenge?

    • Accept that it will be unique to each and every student
    • Remember the three levels of the placement continuum
    • Ensure there is clear respectful communication between preceptor and student;
    • Consider constant check-ins, reflection, and two-way feedback.
    • Keep the lines of communication honest and open.
    • Collaboratively develop a roadmap that advances along a continuum from observation towards independent work from the student.
    • FInd the “sweet spot” which will require the preceptor to provide feedback after periods of independence.

    As occupational therapist Ann Christie (1999) says, providing that ‘just right’ challenge stimulates the inner drive to succeed. Isn’t that what we all want for students, the next generation of occupational therapists?

    References

    Christie, A. (1999), A meaningful occupation: The just right challenge. Australian Occupational Therapy Journal, 46: 52-68. https://doi.org/10.1046/j.1440-1630.1999.00178.x (Links to an external site.)

    Nelson, D., & Jepsen-Thomas, J. (2003). Occupational form, occupational performance, and a conceptual framework for therapeutic occupation. In P. Kramer, J. Hinojosa, & C. Royeen, Perspectives on human occupation: Participation in life. Philadelphia: Lippincott.

    Clinical Reasoning in 1, 2, 3!

    Critical Thinking, Learning, Uncategorized

    This post comes courtesy of Nicole Gingrich MOT class of 2020 (edited by Donna Drynan)

    Fieldwork placements are the primary opportunity for student occupational therapists to develop clinical reasoning skills. On placement, students, are aware of the many technical skills they are expected to learn – administering assessments, writing various styles of chart notes, and carrying out treatment plans. However, just learning those skills  on their own does not make them feel confident in their ability to treat clients of all different ages, conditions, and needs in a variety of settings. With their quickly approaching transition to the working world their  priorities begin to shift towards transferable clinical reasoning skills.

    How can you help?

    1. Ask them… to make treatment plans, verbally justify their decisions, and brainstorm solutions to hypothetical situations. These are a few examples of helpful questions: “What’s your plan with Ms. M?”, “Why did you decide to do x?”, “What might you do if x happens while working with her?”.
    2. Explain your own reasoning. As a student, this is more helpful than you might imagine (and no, not just justifying your decisions with a theoretical framework). Practical information such as  “I’m going to assess Mr. T first because he tends to have more energy in the morning” provides them with information that they likely would have never thought to ask about.
    3. Create space for them to make mistakes. One outstanding preceptor stated that the motto for the placement would be “Take chances, make mistakes, get messy” (from Ms. Frizzle -The Magic School bus). “  It’s hard for students to come up with plans and ideas for treatment  if they are not encouraged to jump in and take the lead. Sitting on the sidelines doesn’t push them to develop our own clinical reasoning.

    We hope  that this post highlights the importance of assisting students in developing their clinical reasoning skills, and provides some suggestions for how to practically support students in doing so. Remember, even you as a preceptor, should  take chances and get messy! Its ok, after all you too are human!

     

     

    OT student perspective on fostering clinical reasoning: Are questions always warranted?

    Critical Thinking, Teaching Tips, Uncategorized

    This post comes courtesy of Jory Campbell, MOT class of 2020 (edited by Donna Drynan)

    Brown, Bannigan, and Gill (2009) propose that Socratic questioning is an essential skill OT’s must use in post‐modern health‐care service delivery. It probably follows then that questioning a student’s perception of their performance and/or observations is an effective way to gain access to their internal thought processes while providing the opportunity to model clinical reasoning. Although most students would agree that questioning is undoubtedly an important and effective tool, some might argue that it may not always be the best teaching tool for everyone.

    For some students,  things can “click” for them when they are encouraged to discover on their own. Being given room/time to come to their own conclusions, or formulate their own questions, can be integral to furthering their clinical reasoning skills. Although they may  not always be correct in their assertions, this process allows them to learn in a safe environment as you are their safety net.  It may seem counter intuitive to shape minds by not posing questions; however, here are a few potential reasons to avoid an over reliance on questioning your students:

    • It can put them on the spot:

    When asked directly how something went, it sometimes distracts them from their natural thought process, as it put pressures them to come up with an answer on the spot. Students report that their best work doesn’t usually come under pressure.

    • It has the potential to hijack their  own thinking:

    Asking questions might be deemed a good way to frame a formula for how to think like an OT; however, it can take away from the development of their  own thinking patterns. Students as individuals,  might rely on different kinds of questions, in a different order.

    • Leaving room will allow them to question you:

    The questions students have for you may encompass the question you have asked of them but leaving room for them to ask a question, fosters their own process of discovery. At times these questions are usually paired with the reflective observations students have about their own performance. ­

    • Sometimes it just takes time:

    We all think differently; some require a bit more time to digest what  was just experienced. Learners reasoning might not become evident to them until much further along, but once it does, they will be excited to bring it up with you.

    To summarize, as preceptors you should always continue to provide students with feedback and instill the notion of life long reflective practice through questioning.  Students are certainly in need of and thankful for your guidance, but I challenge you now to think about leaving room for students  to come to you with their own reflections/questions,  as they may just surprise you.

    References:

    Brown, C. A., Bannigan, K., & Gill, J. R. (2009). Questioning: A critical skill in postmodern healthcare service delivery. Australian Occupational Therapy Journal, 56(3), 206-210. doi:10.1111/j.1440-1630.2008.00756.x

     

     

    Evidence-Based Practice: Encouraging the Development of Scholarly Practitioners

    Critical Thinking, Teaching Tips, Uncategorized

    This post comes courtesy of Emily Miller MOT class of 2020 (Edited by Donna Drynan)

    As scholarly practitioners, occupational therapists are expected to use high quality research, clinical expertise, and client values to inform their decisions. This process, also known as evidence-based practice, is complex, requiring occupational therapists to consider a variety different sources prior to making clinical decisions. (For more information on evidence-based practice, click here).

    Students are well acquainted with the concept of evidence-based practice. It is a topic that is thoroughly taught throughout their education. Students are skilled at conducting literature searches, acquiring information, and appraising evidence. Applying these skills in placement, however, is a different ball game. For students, fieldwork is a period of intensive learning over a short span of time. Students are constantly processing and storing new information, making it challenging to keep evidence-based practice at the forefront of their minds.

    While practicing from an evidence-based perspective may be habitual to preceptors, students likely need additional guidance to apply this skill to practice. Here are some suggestions to support your student in doing so:

    1. Attend in-service learning events with your student: In-service learning events, or “lunch and learns”, are a convenient and fun way for both you and your student to stay up to date with relevant and current research.
    2. Encourage your student to use their library access: Students have unlimited access to online library databases. Utilizing downtime to engage in research is a great way for your student to build on their knowledge of the current evidence.
    3. Debrief with your student: Discussing the evidence that was used to inform clinical decisions can assist students in developing and maintaining evidence-based clinical reasoning skills.
    4. Connect with colleagues: Conversing with colleagues can be a good way for you and your student to discuss emerging evidence, as well as the application of new evidence, while encouraging inter-professional collaboration.

    Incorporating evidence-based activities into your student’s placement encourages the development of a student’s clinical reasoning, while increasing their knowledge. You may also learn a thing or two!

    Do you have any tips for maintaining an evidence-based practice?

    For more resources related to evidence-based occupational therapy please visit: https://www.theottoolbox.com/evidence-based-practice-for-occupational-therapy/