ABSTRACT: This study aimed to document the process undertaken to incorporate project placements as an effective fieldwork option for second- and third-year occupational therapy students, by evaluating the experience of both students and supervisors and identifying areas for improvement. Project placements are full- or part-time placements where a project is completed by a student under the supervision of an occupational therapist. The study is primarily descriptive, and includes a prepost design using qualitative and quantitative data. The results indicate that the objectives of the study were achieved. Both supervisors and students expressed positive views about the placements. Students also identified changes that could improve the placements. Second- and third-year students gave similar ratings about aspects of the learning experiences during the project placements. The small cohort of third-year students and the low response rate from supervisors limited results. These project placements have shown an applicable model for students in earlier years of the course instead of the usual practice of non-traditional fieldwork being focused on final-year students. The project placements described are presented as one more potential fieldwork model in the range currently offered by curricula worldwide. Future research needs to concentrate on the longitudinal impact of these placements on the developing practice and attitudes of occupational therapy students.
Key words: fieldwork, occupational therapy students, project placements.
Introduction
Clinicians (Meyers, 1995; Huddleston, 1999a), academics (Jacobs, 1992; Alsop and Ryan, 1996; Banks et al., 2000) and students (Heath, 1996; Fleming et al., 1997; Hummell, 1997) recognize the important contribution of fieldwork in the education and training of occupational therapists. While accredited undergraduate occupational therapy programmes must adhere to the World Federation of Occupational Therapists' minimum requirement of 1000 hours of fieldwork experience (World Federation of Occupational Therapists, 1993), models of fieldwork education across educational institutions vary. There are many factors, both internal and external, that impact on the provision of fieldwork education for undergraduate occupational therapy students and on occupational therapy curricula. In response to these, fieldwork education needs to constantly evolve through a process of development and evaluation of new initiatives. The aim of this article is to describe the development, implementation, evaluation and outcomes of a project placement programme that was initiated at the University of Newcastle, Australia.
External impacts on fieldwork provision
There is an increasing international trend for flexible placement delivery in all types of health professional fieldwork education. Various models of flexible fieldwork education have been described over the past 15 years. Examples of these include role-emerging placements (Bossers et al., 1997; Huddleston, 1999b), group supervision (Jung et al., 1994; Mason, 1998, 1999), two Students to one supervisor (Tiberius and Gaiptman, 1985; Martin and Edwards, 1998, Huddleston, 1999b), four students to one supervisor (Zakrzewski and Salonga, 1997), split placements (Gaiptman and Forma, 1991) and long-arm supervision (Alsop and Ryan, 1996). Many Australian and international occupational therapy programmes are offering alternative fieldwork placements across different areas of occupational therapy practice.
This trend has also been experienced at a more local level where the flexible delivery of fieldwork placements has evolved in response to the increased demand for student placements. As there are four undergraduate occupational therapy programmes in NSW, clinicians receive constant requests to provide student placements. Therefore, initiatives that relieve some of the inevitable pressure that clinicians face in providing student placements are needed (Mackenzie, 1997). One such initiative has been the creation of a joint field-- work supervisors' workshop developed among the four university programmes (Mackenzie et al., 2001). Flexible and creative strategies are needed to provide sufficient numbers of high,quality student fieldwork experiences (Backman, 1994; Farrow, 1995; Westmorland and Jung, 1997). The initiative described in this article arose from a need to provide sufficient numbers of undergraduate student placements in the second and third years of the under-- graduate occupational therapy programme at the University of Newcastle, NSW, Australia.
Another external force in the evolution of the project placement stream was the climate of constant change occurring in the healthcare workplace and consequently in occupational therapy practice. An example is the trend for occupational therapy clinicians to be employed in public health or educational settings where they provide health promotion services at a population level rather than individual treatment (Poulden and Oke, 1990; Backman, 1994; Farrow, 1995). Therefore, it was important to continually evaluate fieldwork learning experiences provided to undergraduate students and supervisors, to adapt positively to such change (Alsop and Donald, 1996). Occupational therapy programmes have a central responsibility in preparing students for professional practice, therefore, they must keep pace with changes in the field and ensure graduates are equipped with the necessary knowledge and skills for current and future professional practice. As Westmorland and Jung (1997: 671) stated, 'new graduate occupational therapists will be expected to work in changing environments under challenging circumstances and must be prepared for these new and sometimes innovative roles'. Hummell and Koelmeyer (1999) reported that new graduates rated fieldwork experiences during their undergraduate training as a major source of the skills and knowledge that assisted their transition from student to graduate.
There may be some hesitancy in the profession to embrace placements that are perceived as less traditional (Alsop and Donald, 1996). However, according to Alsop and Donald (1996: 498), less traditional placements can be the placements that are 'most likely to enable students to develop relevant skills for future practice'.
Internal impacts on fieldwork
The undergraduate occupational therapy programme at the University of Newcastle experienced internal impacts on its fieldwork programme when, in 1998, the student intake was increased, thus creating greater pressure to meet the demand for student placements. It was anticipated that this would be a significant problem, particularly for the second- and third-year fieldwork programmes, due to the extensive and integrated fieldwork component in these years. Project placements were introduced as a strategy to address this.
Fieldwork in the undergraduate occupational therapy programme at the University of Newcastle has been integrated into the problem-based learning (PBL) design of the curriculum. PBL curricula are characterized by learning tasks being presented in the context of a case study or scenario designed to trigger learning needs (Alvani, 1995). Students identify their own learning objectives to progress through their learning tasks, and co-operative learning takes place in small groups (Barrows and Tamlyn, 1980; Jacobs and Lyons, 1992; Sadlo et al., 1994). There is an emphasis on student self-directed learning (Jacobs, 1992). In keeping with this philosophy, fieldwork is timed as an extension of the learning that occurs through the case scenarios (Jacobs, 1992). Thus, students study a scenario related to an area of practice and follow this with a fieldwork placement in that area of practice. Placements are at least three weeks in length. The curriculum schedule presents students with occupational therapy practice scenarios around predominantly physical dysfunction topics in their second and early third year of study. These scenarios or learning units are broadly labelled as general physical, neurology, paediatric and occupational health areas of practice. The project placements were applied in the context of the fieldwork components of each of these learning units. Similar project placements in mental health have only recently been offered and are not included in this study.
Project placements defined
Project placements are defined as full- or part-time placements where students complete a piece of work initiated by a fieldwork site - for example, an intervention programme or a quality assurance project - under the supervision of an occupational therapist. The project placements are self-directed in nature. Students are required to negotiate their own learning objectives and activities. They are expected to work independently and co-operatively with another student and with minimal supervision. Project placements are therefore consistent with the problem-based nature of a PBL occupational therapy programme. In addition, they are a reflection of the changing nature of field-- work placements in general, from an apprenticeship model to a model that encourages greater student-directed learning. An exploration of such models of fieldwork has developed in the literature (Gaiptman and Anthony, 1989; Jacobs, 1992; Heath, 1996). The project placement model calls for students and supervisors to work collaboratively to set learning objectives, plan, undertake and evaluate student placements and student performance.
Some unique tailored fieldwork placements were tested in our fieldwork curriculum prior to developing the project placements. These were developed in response to individual requests from students or clinicians in the community. For example, some students were placed in mental health settings with long-arm supervision (off-site supervision) provided by local occupational therapists and/or academic staff (Mackenzie and Drake, 1997). Other students have been placed in a special school and have received part-time occupational therapy supervision from a paediatric therapist, also under a long-arm model of supervision. The feedback from students and supervisors involved in these placements was both positive and negative. A carefully designed project placement programme was initiated that incorporated the positive features of student autonomy and supervisor recruitment, and optimized student access to supervision and provided a standardized placement protocol.
Examples of project-style fieldwork placements offered by other occupational therapy programmes include role-emerging placements (Bossers et al., 1997) for predominantly final-year students who developed innovative community-based programmes with little on-site occupational therapy supervision. Other examples in Australia include a video production project for learning materials (Zakrzewski and Chan, 1995), community-based project placements for third-year students (Zakrzewski 1997), and self-directed practica for final-year students where projects such as developing specific programmes, pieces of equipment, brochures and manuals or evaluating programmes were undertaken (Mackenzie and Drake, 1997). These project-style placements were conducted for varying lengths of time (mostly eight weeks) with differences in levels of direct client contact, use of occupational therapy-- specific skills, numbers of students placed together, and models of occupational therapy supervision.
The project placement model occurs earlier in the occupational therapy programme, beginning with second-year students, and over a shorter fieldwork period of three weeks. On-site supervision is provided by an occupational therapist to accommodate the needs of students. Placements are recruited by an academic staff member in the same way as other fieldwork placements and individual student allocations to project placements are negotiated between students. The placements can be hospital-based or community-based. Students work in pairs and must produce a specific outcome by the completion of the placement. Projects must have a client-related focus but may not necessarily involve direct client contact.
The major aims of this study were to: (1) document the process that was undertaken, (2) report on the evaluation of the experiences of students and supervisors who undertook and supervised project placements respectively during 1999, (3) identify ways to improve the process and outcomes for students and supervisors, and (4) inform fieldwork supervisors about the variety of fieldwork opportunities they can provide and the benefits of these.
Method
The procedures used to develop and then evaluate the project placements are described separately, under the headings of phase 1 and 2.
Phase 1: Implementation of project placement programme
The aims of this stage of developing the project placements were to:
(a) Identify fieldwork placements that would meet both the fieldwork experience needs of the undergraduate students and the needs of clinicians as supervisors;
(b) Develop effective strategies for administering these fieldwork placements; and
(c) Pilot the project placement programme over the course of one academic year.
Figure 1 outlines the six-stage process of implementation of the project placements. The needs assessment at the start of the process involved all the clinicians working in NSW who were on the University of Newcastle fieldwork mailing list (n=250). A questionnaire was distributed asking respondents to rate their approval of each type of alternative fieldwork model using dichotomous ratings (yes/no). Fieldwork models rated were: (1) parttime placements, (2) long-arm supervision, (3) two students to one supervisor, (4) project placements, and (5) group supervision. A total of 140 clinicians returned the questionnaire, giving a response rate of 56%. Project placements were identified by survey respondents as the preferred model.
A planning committee was established to develop detailed procedures prior to the implementation of the project placement programme. A student performance assessment form was developed specifically for project placements as an outcome of the planning phase. This was introduced to students and clinicians in the pre-project briefing (stage 5). Promotional activities were carried out to inform students and clinicians about the programme (stage 3).
As part of the recruitment process (stage 4) for obtaining project placements for students, a form was used which asked clinicians to outline the details of projects they were considering offering students. This included, for example, a detailed description of the project, potential learning objectives for the students, proposed time line of activities for the length of the placement, and resources required. This was sent to clinicians at the end of 1998 with the regular package requesting student placement offers for 1999. Clinicians returned the form to the fieldwork academic who discussed and refined with clinicians the details of the projects being offered. The information was made available to students when they were selecting their placements.
Academic staff members with expertise in the area of practice related to each of the project placements were matched with the supervisors and students undertaking the project placement, in order to provide support for both students and supervisors.
Before each project placement, the supervisors and students were asked to complete surveys asking them to reflect on their personal aims for the project placements. At the conclusion of each placement, supervisors and students were asked to complete evaluation surveys about their experience of the project placements (stage 5).
Phase 2: Evaluation of the project placement programme
Exploratory methods designed to gather information about the experiences of supervisors and students were used to evaluate the project placements. The aims of the evaluation were to:
(1) Identify the attitudes and expectations of students and supervisors prior to the project placements;
(2) Measure the attitudes of students and supervisors about their experience of the project placements; and
(3) Determine the capacity of project placement experiences to enhance skills needed to develop occupational therapy competencies.
Measurements and data collection
Several measurements were devised to formally evaluate the placements
(a) Pre-placement questionnaires
These consisted of open-ended questions, and were distributed to students and supervisors to be completed about one week prior to the placements. Unstructured responses were sought in order to allow the respondents to give their own opinions about the process as freely as possible, which is an appropriate method for an exploratory educational study (Tuckman, 1978). Participants were asked about their reasons for having offered or selected a project placement, what they hoped to gain from the project placement, their perceptions about student and supervisory roles during a project placement, and what their concerns were.
(b) Student debriefing sessions
Following the placements, information was gathered from student debriefing sessions related to students' perceived benefits and challenges of undertaking a project placement. The sessions were organized in the form of a structured focus group (Reiskin, 1992) for the six to eight students who undertook a project placement in each placement period. The nominal group technique (Delbecq and Van de Van, 1971) was adapted to elicit student responses, using the following process:
* Seated in a circle, students listed on a piece of paper two things they found beneficial about their experience.
* They passed their list (clockwise or anti-clockwise) to the person next to them.
* Each participant added another two items to their newly acquired list, which were different from the items already listed by themselves or the previous student.
* The process was continued until no new responses were being generated.
* Participants individually ranked the importance of responses contained in the final list each person had in front of them.
* As a group, participants discussed and came to a consensus about the group ranking of the whole range of responses generated by the group.
This technique was repeated to determine the key challenging aspects of all the project placements. Strategies for overcoming some of the problems associated with the project placements identified during these debriefing sessions were brainstormed by the students in collaboration with the fieldwork coordinator. The strength of the nominal group technique was that students could create their own categories of feedback about the project placements, rather than having the categories interpreted by an external facilitator. This method also allowed student creativity in problem solving and maximized the generation of ideas (Delbecq and Van de Van, 1971).
(c) Post-placement questionnaires
At the end of the project placements students and supervisors each completed a post-placement questionnaire. In order to ensure face validity, drafts of the student and supervisor post-placement questionnaires were reviewed by clinicians, students and academics who were members of the project placement committee. The student questionnaires consisted of a 25-item attitudinal scale, and open-ended questions asking students to identify the specific and generic skills they acquired during the placement. The supervisor questionnaires consisted of the same 25-item attitudinal questionnaire items. However, these were phrased to ask them to rate their perceptions of the student's experience of the placement as well as their own. An additional seven items were included that were specific to the supervisor's attitudes towards the placement. The attitudinal scales included statements derived from the literature about the value of non-traditional fieldwork (Backman, 1994; Alsop and Donald, 1996; Bossers et al., 1997; Mason, 1998). Respondents were asked to rate their agreement with the statements on a five-point Likert scale including 'strongly disagree', 'disagree', 'undecided', 'agree' and 'strongly agree' (Stone, 1993; Bowling, 1997; McGibbon, 1997). The 'undecided' category was retained in order to detect any ambivalence or uncertainty about any aspects of the project placements (McGibbon, 1997).
Six subscales that contributed to the overall dimension of attitudes towards the project placements were identified in the 25 items developed for the questionnaire (De Vaus, 1990). These were: personal issues (for example, `Overall, I enjoyed my experience while on this placement'); occupational therapy issues (for example, 'This placement enabled me to further define the occupational therapy role'); learning (for example, 'I was able to learn from all my experiences whether positive or negative'); environmental factors (for example, 'This placement has allowed me to engage in a variety of roles not usually experienced during a traditional placement'); and supervision (for example, I had adequate time with my supervisor').
Data analysis
Written responses to open-ended questions used in each of the administered questionnaires were transcribed. Items were coded independently by two coders and categorized according to emerging themes. Final categories were identified and agreement was reached on any initial differences in coding through consensus between the two coders (Fowler, 1984; Pope et al., 2000). Frequencies of responses for each category were then calculated, and transformed into percentages in order for comparisons to be made between the categories.
Responses to the attitudinal scales were numerically coded from 1 to 5, with 1 representing strong disagreement, 3 representing a neutral opinion and 5 representing strong agreement with each statement, allowing summary scores to be calculated (Bowling, 1997; Ballinger and Davey, 1998; Murray, 1999). Coded data were entered into a statistics computer program for analysis (StataCorp, 1997). Descriptive statistics were used to summarize the responses to the questionnaire (Gissane, 1988). The subscales in the attitudinal questionnaire were evaluated using correlation matrices to determine whether the subscale items were sufficiently correlated with one another, and Cronbach's alpha was used to determine the internal consistency of the items in each subscale, and the scale overall (Bowling, 1997).
Trustworthiness
The data for this study were collected consistently over the period of a year, so that consistent patterns of student and supervisor responses could be assessed alongside any potential 'outliers' or isolated extreme ratings (positive or negative) about the fieldwork experiences. Furthermore, as the sampling procedure for the evaluation involved the entire cohort of students and supervisors who participated in a project placement, sampling errors were reduced and the transferability of findings was enhanced. The findings can therefore be viewed as typical of the student and supervisor groups (Krefting, 1991).
The use of the nominal group technique was one method to ensure an authentic participant perspective in the data analysis (Maxwell, 1992). Possible internal errors in the questionnaire or nominal group technique data, where students may have given what they thought were desired responses rather than their true responses, were minimized by the discussion that followed in the focus group debriefing. Discussion was facilitated to confirm and explore the data provided by the student participants so that any inconsistencies in responses or the interpretation of their responses would be detected (Krefting, 1991 ).
The use of a variety of methods in data collection (focus group, structured debriefing sessions, questionnaires, discussion with staff involved in supervising project placements and the role of the committee members) enhanced the quality of the data collection and the data analysis (Krefting, 1991; Abott-- Chapman, 1993).
Results
The project placements undertaken during the study period are summarized in Table 1. Twenty-six project placements were undertaken, 20 for second-year students and 6 for third-year students.
Pre-placement questionnaires
Reasons given by supervisors who offered project placements included: 'I think it's a good idea'; ' I would have enjoyed it as a student'; and it will be 'more rewarding for both students and myself given that, in an occupational health setting, it is difficult to provide students with client contact'. By offering a project placement, supervisors hoped to gain resources, ideas, information, additional support and programmes, while at the same time providing a positive experience for students. Supervisors anticipated that they would provide less face-to-face supervision and not be 'shadowed' by the students as much during a project placement. However, they were concerned about not being able to adequately evaluate student performance given that they would not be spending as much time with the students.
Student responses indicated that most students had multiple reasons for selecting a project placement. Some actively sought to undertake a project placement, whereas others were more passive participants in the selection process and expressed no strong preferences. Reasons for undertaking a project placement rather than other fieldwork placements being offered included a belief that it would be a valuable learning experience, because it was a 'different' experience, or because students liked the idea of producing a useful end product. Other students selected the project placement for logistical reasons -- for example, the locality of the placement was convenient for them. Specific project placements were also selected because of an interest in the particular practice area or topic - for example, multiple sclerosis. Four students thought that a project placement in occupational health would provide a better learning experience than a traditional placement in occupational health.
The personal objectives for the project placement that were identified by students were related to the project outcome (for example, 'to successfully research and complete the project'; 'to develop a programme or tool that would be useful'), the anticipated learning process (for example, 'learn to work as part of a team'; 'be able to plan and set goals and tasks'), and both general and specific content learning relate to the area of practice (for example, 'reinforce what we have learned in class'; 'learn more about child development'; 'understand more about multiple sclerosis'). Specific gains that were anticipated from the project placement included the development of skills, knowledge and independence, along with the completion of a valuable project.
Students thought that their role as a student would differ from traditional placements because they would have greater independence and opportunity for self-directed learning. Some suggested that they would have more responsibility and control over their placement activities and that their contribution would be more important. A few students expected to have more of a collaborative working relationship 'with' their supervisor rather than working 'under' their supervisor. Seven out of 26 students did not identify any concerns about undertaking a project placement. The remainder expressed concerns that the placement would limit their learning experience, that their level of knowledge would not be enough to successfully complete the placement, and that they may not have enough time to complete the project.
Student debriefing sessions
Results from the second-year debriefing sessions are provided in Table 2 and those from third-year debriefing sessions are in Table 3. The aspects of under-- taking a project placement that were ranked positive and those that were ranked as challenging, as perceived by the second- and third-year students during their debriefing sessions, are summarized in these tables.
All the debriefing groups ranked the opportunity to work independently as either a 1 or 2. Both second-year groups ranked the opportunity to learn about one area of practice in depth as 1 or 2. Third-year students also thought this was a positive aspect of their experience, but ranked this lower than the second-year students. All groups thought that producing a tangible outcome was valuable. One second-year and one third-year group rated working with another student as a positive experience, whereas one of the second-year groups also rated working in collaboration with their supervisors as positive. This group felt that they had a partnership with their supervisors rather than a subordinate-type relationship as they had experienced in other placements; however, this was not the case for all students. Third-year students reported feeling like a qualified therapist because people listened to, were interested in, and respected them. One of the second-year groups reported having more responsibility than they had experienced on other placements. All groups reported having practised professional skills such as presentation skills, time management and organizational skills and resource skills.
Both second- and third-year students reported issues related to supervision as being challenging aspects of the project placements. Second years felt that they needed more time with their supervisors and that their supervisors were unclear about the student evaluation procedure. Third-year students reported limited feedback from supervisors during the course of, and at the completion of, the placement. Both second- and third-year students reported lack of direction or unclear expectations from supervisors. Both student groups reported limited opportunity for client contact/hands-on therapy, with second-year students ranking this high on the list, as opposed to third-year students, who ranked this last. Second-year students were concerned about learning about only one aspect of practice and were dissatisfied when they perceived that their project was undervalued by the supervisor or department.
Post-placement questionnaires
Results of the evaluation of the post-placement questionnaire items indicated that each of the scales had acceptable internal reliability, as measured by Cronbach's alpha, of between 0.65 (environmental factors) and 0.83 (occupational therapy issues) for this type of survey (Bowling, 1997). The items for each of the scales correlated highly with each other, with the exception of two items on the supervision scale (`adequate time with supervisor' and 'positive teaching-learning relationship with other staff'). This suggests that one of these items should be deleted from the scale to improve its reliability and validity.
Table 4 presents the student and supervisor responses to the post-placement questionnaire items. Supervisors were generally more positive than students in their ratings of most items. Some differences in ratings were expected. For example, students reported feeling less confident, whereas supervisors ranked students more highly on their perception of how confident they were. Supervisor ratings were also more positive about students having developed a greater understanding of occupational therapy as a result of undertaking the project placement, whereas student ratings were undecided. Lower student ratings for this item might be expected as the students were in the earlier years of their course, when an understanding of occupational therapy practice is usually in the early stages of development. Supervisors consistently rated projects as being a reflection of future occupational therapy practice, while the students were undecided on this. Nevertheless, it is a positive endorsement of the project placement model that supervisors regarded project placements as an experience that should assist students to further understand occupational therapy practice and that project placements can meet the learning needs of students regarding changing trends in health care. Ratings were similar for both supervisors and students about the project placement, allowing students to engage in a variety of roles not usually experienced in a traditional placement. This suggests that project placements can meet learning needs that may not be met by other placements in the programme.
There was a mixed response in student ratings about the supervision that they had experienced during the project placements, especially related to receiving adequate time with their supervisor. However, supervisors provided ratings that indicated that they thought students were provided with adequate supervision time. At the same time, students consistently rated their supervisors as approachable and supervisors rated themselves as approachable. So, it would seem that while students felt their supervisors were approachable, they were not able to negotiate more time when they felt they needed it.
Table 5 provides a comparison of the ratings given by second- and thirdyear students about their project placement experience. Generally, all items were rated relatively highly; however, there were differences for most items between second- and third-year students.
The differences in student ratings of items related to their confidence and learning (for example, understanding of occupational therapy, level of skills and knowledge) were to be expected; however, there were two items that second-year students ranked higher than third-year students. First, second-year student ratings indicated that they felt their contributions were more valued during their placement than did third-year students. Second, second-year students indicated higher levels of satisfaction with the time they had with their supervisors compared with third years. It is possible that third-year students had higher expectations of their placement and supervisors overall than second-year students because they had experienced more placements than second-year students, or their previous placements in the second year had been characterized by a higher level of supervision.
Table 6 presents supervisor responses to the post-placement questionnaire regarding their experience of the project placement. Results show that supervisors felt positive about their experience of supervising students on a project placement and felt their service benefited from the students' contributions. While most supervisors responded that they were adequately prepared and supported by the university, a few were undecided. Results about supervisors' feelings of adequacy in being able to evaluate students were consistent with their concerns about student evaluation prior to the placement.
Discussion
Meeting the needs of students and supervisors
Overall, both students and supervisors gave positive feedback about their own project placement experiences. However, the perceptions that supervisors expressed about the students' experiences were generally more positive than the feedback given by the students. These differences related to the personal issues scale and the occupational therapy issues scale, such as the overall enjoyment of the placement, developing confidence, defining the occupational therapy role, gaining experience useful on graduation and gaining further understanding of the nature of occupational therapy. This may be related to supervisors spending less face-to-face or informal time with the students, and as a consequence being less aware of how students were perceiving their placement experience. Furthermore, supervisor ratings on this item may have been influenced by their own positive views about the project placement, because they anticipated and experienced a placement that placed fewer supervisory demands on them, while at the same time providing them with a useful outcome. This is in contrast to supervisors of a traditional fieldwork placement who have reported challenging aspects of fieldwork supervision in the literature, such as an increase in workload, financial implications, a reduction in clinical output and more personal demands (Proctor and Tompson, 1990; Meyers, 1995; Paterson, 1997) as a result of taking a student.
The less positive student ratings may be explained by the importance placed on fieldwork experiences by students (Hummell, 1997). This may lead to higher student expectations, a personal investment in the placements and therefore more critical evaluations of their placement experiences. Meyers (1995) has suggested that students experience considerable stress associated with fieldwork placements, such as being watched by supervisors, managing time, fearing failure, meeting financial costs, and adjusting to the role of worker. Some of these stressors were mitigated for most students during the project placement, as indicated in the student feedback, such as having more opportunity for autonomy, gaining skills in time management by conducting their project independently, and contributing something of value to the placement setting.
The relationship between expectations and experiences of project placements
The experiences of both second- and third-year students generally matched their personal objectives for the placement. The students' expectation of and desire to work independently and to produce a tangible and useful product were met. Second-year students reported, after their placement, that the expected collaborative relationship with their supervisors was a positive aspect of project placements. The quality of this relationship has been strongly advocated in the fieldwork literature. The role of fieldwork supervisors has been described as a facilitator, a coach, a mentor and a collaborator in student learning, underpinned by a sense of mutual respect (Backman, 1994; Ladyshewsky, 1995; Hummell, 1997).
Both the second- and third-year students felt that, in their experience, one of the challenging aspects of the placements was the limited opportunity for client contact and learning about only one aspect of practice. A number of students had this concern before the placement. However, this challenge may also be true for some more specialized traditional placements. In order to con, trol any potentially negative effects of a specialized project placement, steps were taken at the beginning of the project placement programme by establishing a policy that students would undertake only one project placement during the course. In any case, the results of this study would indicate that any challenges of participating in a project placement are usually outweighed by the benefits of the placement experience for student learning and development. Benefits include the development of broad professional skills, which have been identified as essential for future practitioners. These include time and resource management, working with minimal supervision, and self-directed learning (Schell and Slater, 1998). Such benefits need to be promoted to students as essential elements of future clinical practice alongside the more obvious learning opportunities arising from direct client contact.
Supervisors' expectations that they would provide students with a positive experience were matched by their perceptions that they had achieved this at the end of the project placements. The stated desire by supervisors to gain resources, ideas and information as a result of the project placement was accomplished, as all supervisors indicated that they had benefited from the students' contribution. The balance of costs and benefits of student supervision has been explored in fieldwork literature (Meyers, 1995; Paterson, 1997). A sense of mutual satisfaction and benefit as a result of these project placements seems to be a good recipe for a successful placement model.
The expectations stated by supervisors that they would have less direct supervision time with the students seemed to have been met by supervisors agreeing or strongly agreeing that they could meet other commitments during the placement compared with the demands of more traditional placements. Pressure on clinicians with increased demand for placements makes this type of placement a positive option for clinicians. In some instances, time availability has been identified as a factor that may deter some clinicians from offering a placement (Proctor and Tompson, 1990). Initial concerns expressed by supervisors about their capacity to adequately evaluate student performance seemed to be overcome, with 67% of supervisors agreeing that they were able to evaluate student performance adequately. However, one-third of supervisors remained undecided. Student evaluation is one of the aspects of fieldwork supervision that is consistently identified as an important topic for supervisor education in general (Cohn and Frum, 1988; Seale et al., 1996; Mackenzie et al., 2001), indicating that supervisors can be expected to have concerns about student evaluation (Ilott, 1996). However, it is unclear from the study findings whether these concerns are specific to project placements. As the project placements demand less face-to-face time with students, this may have impacted on the supervisors' ratings of their ability to evaluate student performance. There seems to be a paradox in that the project placements are attractive because less direct supervision is required; yet, because of this, there is the potential for more concern with student evaluation.
Application of project placements to earlier stages of the course
The project placement programme was designed for students at the secondand third-year stages of the course. Therefore, demands are being placed on students to acquire professional skills, and to be self-directed during a placement at a much earlier stage of the course than is commonly reported. To some extent, students are already prepared for this by their experiences of a PBL teaching and learning programme, which also included earlier general placement experience than most curricula. Therefore, this evaluation of the use of project placements with less experienced students was critical.
From the debriefing sessions and the post-placement questionnaires, the evaluation revealed that second-year students expressed less satisfaction with most aspects of the project placement experience than did third-year students. They also listed a wider range of challenging aspects of project placements in their debriefing sessions compared with third-year students. This could be accounted for by a fundamental difference in the expectations of placements, the learning needs and previous experience of second- and third-year students. Second-year students expressed a need for more hands-on placement experience in preference to the emphasis on gaining professional skills during the project placement. They seemed to be less able to value and transfer the skills acquired during a project placement to other more client-related activities. In their debrief, second-year students ranked the following challenging aspects of their placement the highest: not enough client contact and being exposed to only one area of practice.
Mason (1999) described a collaborative group supervision model for second-year students and suggested that supervisors needed to be more explicit about the learning that was taking place during fieldwork, and to make links between the professional skills being acquired and their application to practice. In this study, second-year students valued exposure to specific treatment techniques more highly than building generic skills, such as communication skills and time management. Hummell (1997) also found that second-year students rated environmental influences more highly than other years as a limitation on effective fieldwork supervision. Clearly, second-year students in a project placement setting may also require specific guidance and a more structured environment from their supervisors in order to identify what generic skills they are acquiring and the relevance of them for future practice.
Student contribution
Student contributions, including the project outcome, were consistently valued by supervisors. Second-year students ranked the value of their contribution to the workplace as a challenging aspect of the placement, but agreed that they perceived that their contribution had been valued by their supervisors. Second-year students stated during the debrief that they needed to believe that their projects would be used by the workplace; otherwise, they were less likely to be motivated to complete the project. Third-year students rated their perception that their contribution had been valued lower than the second-year students, and some students were undecided about whether their project was valued or not. Clearly, supervisors need to make sure that the student project outcomes are sufficiently recognized in the workplace, and that the value of the projects is communicated to students.
Supervision
Second-year students were more satisfied with the degree of time and the relationship they had with their supervisors than were third-year students. It is possible that second-year students were more closely supervised because supervisors were aware of their placement inexperience. Conversely, students may have been provided with a similar level of supervision but third-year students had greater expectations of supervisors. Perhaps, in previous placements, students had more time with their supervisors. However, third-year students ranked independence as the most positive aspect of project placements.
The supervision issues raised by the students on project placements are similar issues that have been documented in the literature regarding supervision of traditional placements. These included dealing with unclear supervisor expectations, limited time with supervisors and supervisors not being aware of the evaluation procedure (Backman, 1994; Hummell, 1997). It is important to note that, prior to the project placements, supervisors expected to gain resources at the same time as provide less supervision. There is a danger that supervisors might believe that offering a self-directed project placement means not having to spend time with students. However, self-direction is effective only when it is supported; therefore, the amount of time spent with students needs to be negotiated according to the individual needs of both supervisors and students (Heath, 1996).
Improving the process and outcomes
The need for university support for both students and supervisors was recognized prior to the placement stream being implemented. Feedback from supervisors suggested that the university support of the placement may not have met their needs. One strategy would be the provision of additional training to assist with the evaluation of students and with specific aspects of supervision of a project placement. One strategy to assist students might include more student preparation prior to a project placement, including what to expect in a self-directed fieldwork placement, and ensuring regular academic support. Another strategy would be guidelines for supervisors about (1) explicitly communicating the relevance of the generic skills that students can acquire during the project to students, (2) planning sufficient time for supervision, and (3) recognizing the contributions of the student projects.
This study has underlined the importance of selecting appropriate projects for placements - for instance, projects that will provide relevant learning experience, be of interest, and have some degree of client/consumer contact, particularly for second years.
Limitations
Findings need to be interpreted in the light of smaller numbers of third-year students (n=6) participating in the project placement programme, compared with second-year students (n=26), and a response rate of 75% for the postplacement questionnaire from the participating supervisors (n=9). This means that overall student feedback may have been biased in favour of second-year students, and it is unclear whether there were any differences in the characteristics of the supervisors who returned the questionnaire or those who failed to return it that may have influenced the results. However, the response rate is at an acceptable level for most surveys (Bowling, 1997). There may also be a possible bias in students' responses to the questionnaires and debriefing sessions as they were aware that project placements were a new programme, and most of the data collection was conducted by the fieldwork supervisor who was also administering and evaluating the programme.
Conclusion
The authors have outlined the design, implementation and evaluation of a new project placement programme as part of fieldwork for second- and third-year occupational therapy students. Students were generally satisfied with their learning experience, and supervisors gave positive feedback about their experience of the project placements. Recommendations have been made for further refinement of the programme. It is hoped that the information in this article will assist other university programmes and clinicians providing fieldwork, to trial project placements in their own settings, to create new fieldwork options and to continue to develop the range of occupational therapy fieldwork offered.
References
Abott-Chapman J (1993). Is the debate on quantitative versus qualitative research really necessary? Australian Educational Researcher 20: 49-61.
Alsop A, Donald M (1996). Taking stock and making changes: Creating new opportunities for fieldwork education. British Journal of Occupational Therapy 59: 498-502.
Alsop A, Ryan S (1996). Making the Most of Fieldwork Education: A Practical Approach. London: Chapman & Hall.
Alvani C (1995). Problem-based Learning in a Health Sciences Curriculum. London: Routledge.
Backman C (1994). National perspective: Looking forward to innovative fieldwork options. Canadian Journal of Occupational Therapy 61: 7-10.
Ballinger C, Davey C (1998). Designing a questionnaire: An overview. British Journal of Occupational Therapy 61: 547-9.
Banks S, Bell E, Smits E (2000). Integration tutorials and seminars: Examining the integration of academic and fieldwork learning by student occupational therapists. Canadian Journal of Occupational Therapy 67: 93-100.
Barrows H, Tamlyn R (1980). Problem Based Learning. New York: Springer.
Bossers A, Cook J, Polatajko H, Laine C (1997). Understanding the role-emerging fieldwork placement. Canadian Journal of Occupational Therapy 64: 70-81.
Bowling A (1997). Research Methods in Health. Investigating Health and Health Services. Buckingham: Open University Press.
Cohn E, Frum D (1988). Fieldwork supervision: More education is warranted. American Journal of Occupational Therapy 42: 325-7.
Delbecq A, van de Van A (1971). A group process model for problem identification and program planning. Journal of Behavioural Science 7: 465-92.
De Vaus, D. (1990). Surveys in Social Research. Sydney: Allen & Unwin.
Farrow P (1995). Power for the profession: Quality graduates and more therapists. Australian Occupational Therapy Journal 42: 27-9.
Fleming J, Gilbert J, McKenna K, Heath T (1997). First year occupational therapy students: Profile and perceptions. Australian Occupational Therapy Journal 44: 107-18.
Fowler F (1984). Survey Research Methods. Beverly Hills, CA: Sage Publications.
Gaiptman B, Anthony A (1989). Contracting in fieldwork education: The model of self-directed learning. Canadian Journal of Occupational Therapy 56: 10-14.
Gaiptman B, Forma L (1991). The split placement model for fieldwork placements. Canadian Journal of Occupational Therapy 58: 85-8.
Gissane C (1998). Understanding and using descriptive statistics. British Journal of Occupational Therapy 61: 267-72.
Heath L (1996). The use of self-directed learning during fieldwork education: The students' perspective. British Journal of Occupational Therapy 59: 515-29.
Huddleston R (1999a). Clinical placements for the professions allied to medicine, part 1: A summary. British Journal of Occupational Therapy 62: 213-19.
Huddleston R (1999b). Clinical placements for the professions allied to medicine, part 2: Placement shortages? Two models that can solve the problem. British Journal of Occupational Therapy 62: 295-8.
Hummell J (1997). Effective fieldwork supervision: Occupational therapy student perspectives. Australian Occupational Therapy Journal 44: 147-57.
Hummell J, Koelmeyer L (1999). New graduates: Perceptions of their first occupational therapy position. British journal of Occupational Therapy 62: 351-8.
Ilott 1 (1996). Ranking the problems of fieldwork supervision reveals a new problem: Failing students. British Journal of Occupational Therapy 59: 525-8.
Jacobs T (1992). The academic-fieldwork interface. Australian Occupational Therapy Journal 39: 33-7.
Jacobs T, Lyons S (1992). `Give me a fish and I eat today: Teach me to fish and I eat for a lifetime'. The Newcastle program. Australian Occupational Therapy Journal 39: 29-32.
Jung B, Martin A, Graden L, Awrey J (1994). Fieldwork education: A shared supervision model. Canadian Journal of Occupational Therapy 61: 12-19.
Krefting L (1991). Rigor in qualitative research: The assessment of trustworthiness. American Journal of Occupational Therapy 45: 214-22.
Ladyshewsky R (1995). Enhancing service productivity in acute settings using a collaborative clinical education model. Physical Therapy 75: 504-10.
Mackenzie L (1997). An application of the model of human occupation to fieldwork supervision and fieldwork issues in NSW. Australian Occupational Therapy Journal 44: 71-80. Mackenzie L, Drake V (1997). Innovative fieldwork options - finding out how non-traditional
practice setting can make a difference in fieldwork. Paper presented at OT Australia 19th National Conference, 29 April-3 May, Perth, Australia.
Mackenzie L, Zakrezewski L, Walker C, McCluskey A (2001). Meeting the educational needs of fieldwork supervisors: A collaborative workshop developed by New South Wales occupational therapy fieldwork co-ordinators. Australian Occupational Therapy Journal 48: 1-10.
Martin M, Edwards L (1998). Peer learning on fieldwork placements. British Journal of Occupational Therapy 61: 249-52.
Mason L (1998). Fieldwork education: Collaborative group learning in community settings. Australian Occupational Therapy Journal 45: 124-30.
Mason L (1999). A co-operative inquiry study to identify strategies for group supervision in occupational therapy fieldwork placements. Occupational Therapy International 6: 224-42.
Maxwell J (1992). Understanding validity in qualitative research. Harvard Educational Review 62: 279-300.
McGibbon G (1997). How to avoid the pitfalls of questionnaire design. Nursing Times 93: 49-51.
Meyers S (1995). Exploring the costs and benefit drivers of clinical education. American Journal of Occupational Therapy 49: 107-11.
Murray P (1999). Fundamental issues in questionnaire design. Accident and Emergency Nursing 7: 148-53.
Paterson (1997). Clinician productivity with and without students. Occupational Therapy Journal of Research 17: 48-54.
Pope C, Ziebland S, Mays N (2000). Analysing qualitative data. British Medical Journal 320: 114-16.
Poulden D, Oke L (1990). Occupational therapy in Australia - Where are we going and how do we get there? Australian Occupational Therapy Journal 37: 147-9.
Proctor L, Tompson M (1990). Factors affecting a clinician's decision to provide fieldwork education to students. Canadian Journal of Occupational Therapy 57: 216-22.
Reiskin H (1992). Focus groups: A useful technique for research and practice in nursing. Applied Nursing Research 5: 197-201.
Sadlo G, Piper D, Agnew P (1994). Problem-based learning in the development of an occupational therapy curriculum, Part 1: The process of problem-based learning. British Journal of Occupational Therapy 57: 49-54.
Schell B, Slater D (1998). Management competencies required of administrative and clinical practitioners in the new millennium. American Journal of Occupational Therapy 52: 744-50.
Seale J, Gallagher C, Grisbrooke J (1996). Fieldwork educator training: Design and evaluation of an education package. British Journal of Occupational Therapy 59: 529-34.
StataCorp (1997). Stata Statistical Software: Release 5.0. College Station, TX: Stata Corporation. Stone D (1993). Design a questionnaire. British Medical Journal 307: 1264-6.
Tiberius R, Gaiptman B (1985). The supervisor-student ratio: 1:1 versus 1:2. Canadian Journal of Occupational Therapy 52: 179-83.
Tompson M, Proctor L (1990). Factors affecting a clinician's decision to provide fieldwork education to students. Canadian Journal of Occupational Therapy 57: 216-22.
Tuckman B (1978). Conducting educational research (2nd edition). London: Harcourt Brace Jovanovich.
Westmorland M, Jung B (1997). Educational partnerships: Student and faculty involvement. British Journal of Therapy and Rehabilitation 4: 671-5.
World Federation of Occupational Therapists (1993). Minimum Standards for the Education of Occupational Therapists. Geneva: WFOT.
Zakrzewski L (1997). Community projects in occupational therapy fieldwork. Paper presented at AAOT-NSW conference, Sydney, Australia.
Zakrzewski L, Chan P (1995). Expanding fieldwork options. Paper presented at the Australian Association of Occupational Therapists 18th Federal and Inaugural Pacific Rim Conference, 12-15 July, Hobart, Australia.
Zakrzewski L, Salonga R (1997). A different approach to fieldwork supervision in mental health. Paper presented at OT Australia 19th National Conference, 29 April-3 May, Perth, Australia.
ALISON PRIGG Discipline of Occupational Therapy, University of Newcastle, Australia
LYNETTE MACKENZIE Discipline of Occupational Therapy, University of Newcastle, Australia
Address correspondence to Alison Prigg, Lecturer, Discipline of Occupational Therapy, Internal Box No 19, Hunter Building, University of Newcastle, Callaghan, NSW 2308, Australia.
Email: [email protected]
Copyright Whurr Publishers Ltd. 2002