Competant, Proficient or Expert

image: St Pancreas Station statue
One of our recent posts has been discussing the issue of what undergraduates need to know. I did consider leaving this thought as a comment on this post - but decided to create a new post instead and would be keen to know your thoughts.
I really like what Creek(2009) has to say in her letter "Achieving a higher level of expertise". In this letter she discusses the nature of expertise in practice and states that within education, students are "taught that using a model for practice represents the highest level of skill" of the OT - a point she refutes by using Benner and Tanner's (1987) work on how expert nurses work and her own description of expert practice "the context of the intervention modifies the occupational therapy process and the therapists thinking, negotiation and action" (Creek 2003 p17).
The point she is making in this letter is that undergraduates are taught how to be competant and not proficient or expert in occupational therapy- therefore undergraduates need to understand that their approach to models of practice tends to be limited to an acceptable yet limited standardised and routine approach. Only with practice and experience can this be moved forward. Therefore those practitioners that are flexible, responsive and 'eclectic' with their use of models and interventions could be said to be practicing at a proficient and/or expert level.

References:
Benner P, Tanner C (1987) Clinical Judgement: how expert nurses use intuition AmJ Nursing Jan 23-31
Creek J (2003) Occupational Therapy defined as a complex intervention London:COT
Creek J (2009) Letters to the Editor: Achieving a higher level of expertise BJOT 72(2) 90

what do undergraduates need to know?

Here at Salford we are constantly reviewing our programme to ensure that we are enabling the students to gain the necessary skills that they will need in order to be more than capable clinicians and hopefully to further develop the profession in the future. We have thoughts and ideas about what's currently working and not working for us but I'd be interested to know what others think about what skills you think a band 5 'should' have. We are told fairly regularly by a small (I think) number of clinicians that our students don't have enough knowledge of anatomy and physiology. Is this important? Do we need this knowledge as OTs? I would also be interested to see what others think about theoretical frameworks that we teach students. They seem to be getting and understanding generic models (MOHO, CMOP, Kawa River) but getting confused about what we called intervention models (CBT, Neurodevelopmental, Psychodynamic, Biomechanical etc.) We're wondering whether this is because we're not teaching it in quite the right way and find that students talk about referring on to others regularly and don't seem to be able to articulate what they're doing as on OT....we want more on therapeutic activity rather than using a CBT approach for example. All thoughts and ideas greatfully recieved.

MSc Advanced Occupational Therapy -online

Just a reminder that the admission cycle for the MSc Advanced Occupational Therapy -online has opened for intake September 09.

Study in the comfort of your own home, share, compare and contrast your experiences with a virtual community of like-minded occupational therapists potentially from all over the world. Deepen your knowledge base, develop your thinking and become a leader within your profession. Not only will you gain academic award, but through negotiating your assessments you will also have the option of using your learning to enhance and develop your current and future work roles. Don't just take our word for it - here's some things that our students have to say about the course so far:

"I've really enjoyed being in contact with other students, in particular the student I worked with on the Model's formative assessment. It was great to talk and share experiences re: learning and the course. I've occasionally ventured into the social aspects of the course, and found it useful to be in contact with people in this way."

"It has facilitated my confidence in trying out new approaches with clients and has made me re-focus my understanding of what it is to be an Occupational Therapist. Fellow colleagues have also commented on the new terminology i now use in both my verbal and written communication....Thank you."

"Having just completed the PatBot module i have started questioning the way we do things here at work, which I suppose is only a good thing! I found the module really interesting and it has been a good introduction to the masters. At times the technology is frustrating but my skills have improved and I am now getting used to computer technology which has even made me learn how to put songs on a i-pod! Forward thinking hey!!!"

and finally - a student sharing their thoughts on one of the social wiki spaces for the cohort - talking to fellow students:

"Every now and again I start wondering why I ever started this journey, especially at the moment with work commitments, xmas, students and assessment deadlines looming. I have also commented recently, that sometimes I feel I am doing this on my own. However, after having 'one of those moments' recently, I have just trawled through blackboard and read some of the posts on the various wikis etc which you have all contributed to and they have left me feeling really inspired and excited and priviledged to be doing this and has made me realise that actually I am not doing it on my own and there is support out there in cyber space! So, if anyone else has 'a moment' of doubt ....try reading through some of our comments!"

So, if you want to know anything further about the programme, or would like to send in your application for our next intake please follow the link to our website that should give you all the information you need. Please contact us of you have any queries.

Core Values or Core Skills ?........... You decide

Here is a post that is long overdue - I have been meaning to share these thoughts with you before now - I guess I am finding it hard to "verbalise" my thoughts but then I decided that I would just write them down and offer them for discussion and debate.
It stems from a session I was running with our third year undergraduate students, preparing them to go off to their role-emerging placements before Xmas. The session was discussing how one might offer explanation of what OT is and what an OT might offer the new team to a potentially brand new audience. Of course this seems to be an everlasting debate and one that has proved difficult for as long as I've been an OT (25 years) and before that too.
Anyway, I was offering the idea of using our core skills to define ourselves by and to identify those things that make us unique and asking students to offer their understanding of our core skills. Many were suggesting such things as client-centred, holistic, collaborative, groupwork etc and I jumped in with the view that these are not core as they could be said to be practiced by many other health and social care professions and offered my own understanding of core skills being the use of graded activity as a therapeutic tool, activity analysis , focus on occupational performance etc.
The wind was quickly taken out of my sails when a student pointed out that COT, in their briefing of 2006 (Definitions and Core Skills for OT) identify core skills as " expert knowledge and abilities shared by all OTs" and uses Creek's (2003- OT as a complex intervention) definition that states that our core skills are built around occupation and activity but then lists collaboration, assessment, enablement. problem solving and groupwork as part of these. Teach me to keep upto date with my reading I thought. However, I have since reflected on this and I do have some concerns that maybe, in order to end this debate we need to identify what is meant by "core" does it mean unique to a profession, or does it mean core as in the fundamental values of a profession? These may seem similar and possibly a pedantic exercise, but I believe that they are different and cause confusion when establishing the unique contribution and value that an occupational therapist can bring to a client and/or an organisation (see current discussions on our blog for another post discussing similar issues).
Maybe we need to talk about Core Values and Core Skills - I'd be interested to hear your views on this - please feel free to press the comment button and add to the discussion.


image created using Crappy graphs