Coursework & Fieldwork Just drink the OT Koolaid...

[OTStudentSept2014]

I'm halfway through my first semester of OT school. I am finding many of my classes very obscure and theory based. I know from my experiences shadowing OTs that I would probably love the work unless I got burned out. I left each day with a big smile on my face. I know from my multiple experiences as a PT patient that I may not be able to physically do the work due to my own musculoskeletal issues. I preferred the OT holistic perspective over the PT work the muscle perspective. But I've heard PTs are becoming more holistic and getting more occupation based intervention programs in newer DPT grads. Encroaching on our areas.

I also know for multiple reasons that I'm not at the best school for me because of my learning style. I'm a visual learner and most of our classes are heavily aimed at auditory learners. We spend tons of time in class doing group projects/discussions, little time reading, and I view many of our assignments so far as busywork that people google the answers for. Most of the instructors are heavily anti-textbook. If I'm paying $10,000 for a semester's tuition, paying $200 for books in a semester is a good deal if they will help me understand things better.

In orientation and the first few weeks, they talked about how it is such a big problem that nobody understands what we do. Then in all the following weeks we've re-defined the word occupation and a bunch of other words. Then our heads are bashed in about occupation is what makes us special, occupation is superior to other methods, and we should never use theraband or theraputty. Based on some of the history we've learned, it sounds like OTs had to reclaim our emphasis on occupation in order to distinguish ourselves from PTs and be able to be reimbursed separately. If it weren't for the need for places like SNFs to have an additional area to justify charging insurance companies money, OT's might not still exist.

Anyways, I'm wondering if there are other new-ish OT students who are feeling like the theory and terminology are too isolated from the rest of the world's medical philosophies. One of my professors refers to PT's as "they who shall not be named", like the Harry Potter universe spoke about Voldemort.

Because of my stage in life and how difficult it was for me to get into school, I don't want to try dropping out of this program and going to a different one next year, or taking additional pre-reqs and applying to PT school. In an ideal world I'd be an dual OT/PT hybrid, but that doesn't seem to be an employment market for those.

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[Kidamnesiac]

I think that a problem comes in where modality-centered intervention doesn't have much evidence for long-term return to occupation. There is growing evidence that OT intervention leads to better long-term outcomes, and we ARE the experts when it comes to the realm of everyday life. All areas of medicine and Allied Health add to the continuum of care, and none could replace the other. Doctors, nurses, PT's, PA's...all of medicine is seeing the importance of holism, because the entire field is experiencing a paradigm shift concerning continuum of care. Preventative and long-term care are just as important as immediate care, especially when considering the frantic inflation of health-care cost.

 

[Kidamnesiac]

Also, it sounds like the professors aren't encouraging much collaboration with other professionals. I definitely think that collaboration is important in the field. PT's definitely serve an important role, and sometimes the most effective interventions occur in close collaboration with them!

 

[OTStudentSept2014]

Your phrase "Long term return to occupation" implies an OT-centric philosophy also. What does occupation mean? It doesn't mean the same to people outside the field. (I was going to write "outside the occupation" but that goes with the meaning the rest of the world thinks of.) Why is return to occupation important in layman's terms? Why should laymen or other health professionals care about a track record of interventions returning people to occupations if we are the only profession that know what occupation means? I think we would be far better off if we used the word "occupation" less in our own literature, and used "meaningful activity" or other similiar phrase that made sense to the rest of the world.

Granted, I'm coming from a viewpoint where I went through PT multiple times for the same/similar injuries. The PTs would ask vague questions about what I wanted/needed to do upon discharge (walk 15 minutes to the subway station without pain). However, they didn't follow up on whether I was able to do that at the end, or to encourage me to a) find alternate physical activities to keep in shape that wouldn't exacerbate/cause injuries or b) whether I was able to return to "normal activities" at the end.​

 

[Kidamnesiac]

I can understand that it seems like semantics, but unfortunately, the language is important in defining our domain. We can't say "everyday activities" because that might exclude other meaningful activities like driving (is that everyday for everyone), gardening or dancing (is that even necessary). But we can't just say meaningful activities because that might not include something like ADLs which are sort of taken for granted. It does seem like occupation is a bit arbitrary, but there actually is another field called vocational therapy that covers what we think of as jobs. I wouldn't call it all koolaid though, because most competent medical professionals actually desire more OT's in the field (as opposed to PT's or another profession) because of our importance in the continuum of care. Have you been on fieldwork 1 yet? I have found that to be especially useful in understanding the importance of language for advocacy and in documentation.

 

[alg5443]

Did you guys start to go over the occupational therapy practice framework yet? It is a good model that shows just how much goes into an occupation and how much this can vary from person to person. Occupations provide people's lives with meaning, which is why our focus of occupations is so important. Occupation is what makes us special and it's definitely our roots. It's also what makes the profession fun.
Also, OT's are needed in so many areas besides SNF's and we are continuing to grow. There is talk of us being in primary care offices in the near future to provide immediate services and prevention services early in the stage instead of just doing interventions once a problem already arises and worsens. This might be a cool option if you are looking for more of the medical based side. I have professors that work with the homeless population and find it extremely rewarding. OT's were and are the pioneers of sensory integration. I could go on and on, but the main take away is that we have an abundance of settings in which we are needed and valued!
I'm in an outpatient rehab now for FW and work alongside PT's, nurses, and doctors. There is a lot of mutual respect and while OT and PT does work on similar things to meet a baseline of performance at first(which will be good for you since you seem to have an interest in both!), OT is clearly distinct in it's therapies and our holistic/psych approach is very evident. Our evals are different and include different goals. I've seen a lot of interdisciplinary care at this center and it was SO nice to see nurses and OT's helping each other out to make a patient's experience the best it can be, while still clearly having two different goals. OT is respected. Side note, if you like PT as well, check out hand therapy.
We are about to celebrate our 100 year anniversary in 2017 and one of AOTA's centennial goals is to get our name out there more and what OT means. It is very true that OT is not as well known to people, but hopefully that will be changing with all the growth in applicants at schools and our top spots on job rankings. We are moving towards being a more recognized profession but we need all OT's to chip in, advocate, and create awareness(and stop other professions from getting too into what our focuses is on).
I understand completely where you are coming from with the terminology and theories, it made me a little nervous at first, too. Thinking that maybe this was all just theory based rather than medically evidence based. But these theories are important and evidence based. Once they are applied, it becomes clearer and really shows the value about what we are learning.
I hope this helps alleviate your mind a little. You seem stressed! Don't fret, what we learn is very valuable and important, the theories are applicable, and we are an important part in many different settings. Stick with OT if you loved your experiences in the field and left smiling, that's all that matters at the end of the day. You will be smiling while you are changing lives. There's no better job than that.

 

[OTStudentSept2014]

No fieldwork yet, just been in school for 2 months now. Plus about 80 observation hours. I'm an older student changing careers from a very different field. I've got experience writing specialized documentation along with extensive experience with the medical field as a patient. I've got three theory-ish classes right now that are making me want more real life applicability. Along with two more difficult but substantive classes that are similar to ones I've taken before but that most other students are struggling with.

I've taken technical writing classes multiple times as well as have a couple friends who work as technical writers. The gift of writing on specialized subjects is not being able to explain a subject to people who are experts in a subject, but being able to explain difficult specialized concepts in a subject to people who have little experience in the subject in a way that they can understand.

While other medical specialties may see the need for OTs, if insurers don't see the need, or lawmakers who write therapy caps don't see the need, OT may have limitations in the future. In addition, if potential clients know about OT and what it could do for them, they might ask for OT services more readily rather than giving in to a surgeon who wants to operate right away, or a school psychologist who says your kid will grow out of it. I had handwriting and other fine motor issues as a kid, and could have benefited from OT services and possibly speech therapy if my parents had known to ask for it. They certainly advocated on my behalf when it came to getting into more advanced classes that met my needs.

My statement about "meaningful activity" is probably based out of some of the professors grand statements that the activities we choose as OTs need to be meaningful to a client, and we shouldn't just stick them with a sanding block for range of motion. For me, that actually *would* be a meaningful occupation.

The OT Framework, 3rd ed says occupation = “Daily life activities in which people engage...”

If we have specialized OT documentation, it needs to be readable for other health professionals and for medical insurers. And so we should strive for a reasonable amount of commonality of language.

So much of what I have heard is something to the effect of occupation therapy is therapy through occupation and occupation is better because occupational therapists do it. To me, this sounds like circular reasoning as opposed to logical language.

However, I'd better stop writing now because I have an exam in 9 hours and I also have come up with some ideas for a paper that I haven't written yet so I'd better stop before I post something that I can be accused of plagiarizing later.

 

[alg5443]

After reading this...they are always editing the OTPF and YOU sound like a perfect person to contribute to this! haha. Good luck on your exam! I'm studying for one too!

 

[OTStudentSept2014]

Did you guys start to go over the occupational therapy practice framework yet? It is a good model that shows just how much goes into an occupation and how much this can vary from person to person. ................... There is talk of us being in primary care offices in the near future to provide immediate services and prevention services early in the stage instead of just doing interventions once a problem already arises and worsens.
.

We got a copy of the Framework, but haven't gone over it exclusively, more referred to it as we are doing other classes. I actually like it. I'd prefer to have gone over the Framework in more detail before going over all these models. And according to the theory classes the OT framework isn't a model, it's an overarching document which goes over the models, which then go over frames of reference.

We aren't going to go into primary care offices unless there is reimbursement for it, which requires a lot more awareness of the profession and more OTs to do that work.

 

[alg5443]

Yes! The framework definitely changed my opinion on the theories once we delved into it. The best things I have learned from my professors is just how much goes into an occupation(that I didn't even consider), how each person does an occupation differently that there are endless endless variations, and how much meaning occupations bring to people's lives. When conditions disrupt that..it's just so defeating. I couldn't imagine not doing some of my favorite occupations. So I let this be my drive for OT.
And yeah it's going to take huge work on our part. USC is currently doing a fantastic job at it, we just need more interest from OT practitioners to get in there and show PCP's what we can do. Small steps. But would be a really cool area for OT.

 

[Sunny324]

OTStudentSept2014, If you are concerned about OT being visible and understood by lawmakers, make sure to check out AOTPAC.

Becoming a member of AOTA and donating to AOTPAC are the easiest ways to contribute to advocacy for our profession. Consider that only about half of OTs are members of AOTA while almost 100% of PTs and SLPs are members of their professional organizations - they can lobby much more effectively than us that way! This is crucial for things like reimbursement, medicare, etc.

p.s. if anyone is curious why PT and SLP have higher membership rates:
- It is practically an unwritten rule in the PT world that you are a member of APTA.
- It is a requirement to be a member of ASHA to keep an SLP licence

 

[futureOTRL]

OTStudentSept2014, If you are concerned about OT being visible and understood by lawmakers, make sure to check out AOTPAC.

Becoming a member of AOTA and donating to AOTPAC are the easiest ways to contribute to advocacy for our profession. Consider that only about half of OTs are members of AOTA while almost 100% of PTs and SLPs are members of their professional organizations - they can lobby much more effectively than us that way! This is crucial for things like reimbursement, medicare, etc.

p.s. if anyone is curious why PT and SLP have higher membership rates:
- It is practically an unwritten rule in the PT world that you are a member of APTA.
- It is a requirement to be a member of ASHA to keep an SLP licence

I second Sunny324. I have a lot of moments when I feel like the OP, but I also have a lot of moments where I intuitively and see get the importance of OT (why I wanted to become one in the first place). Donate to and/or join AOTA. We need those people to lobby for us while we do our parts of becoming great practitioners and continuing to educate the public. We are only making our jobs and lives easier as OTs or future OTs by doing this. This can only contribute to our own security about our professional identity.

 

[RedHeadOT]

For a second I thought we might be going to the same school, but nope. My school is very heavily theory based at the moment. A lot of models, the framework, understanding culture and communication, etc. I'm kind of tired of this type of stuff and can't wait until we get to the interventions and assessments! Luckily, my school does a nice job incorporating the other healthcare disciplines, like PT, SLP, MD, etc.

 

[abm00029]

which schools do you all attend?

 

[c2902]

My program is similar in that the first year, we mostly talked about OT theory and beat the OTPF to death, etc, and everyone was wondering "when we will begin treatment"? As a Y2 (second year) who is now 4 weeks into fieldwork, I can tell you that knowing the theory is absolutely ESSENTIAL to being a good practitioner. My fieldwork site this first semester is a little bit non-traditional in that I have a lot more autonomy (which is fine), and I can tell you that I wouldn't have had a clue as to what to do if I hadn't had that first year of theory, etc. As people have mentioned, knowing the theory behind the profession is vital to fulfilling the goals of the Centennial Vision, and identifying the profession as unique, and hopefully allowing us to push into emerging practice areas.

 

[c2902]

Consider that only about half of OTs are members of AOTA while almost 100% of PTs and SLPs are members of their professional organizations - they can lobby much more effectively than us that way! This is crucial for things like reimbursement, medicare, etc.

My program requires us to sign up for, and maintain registration with AOTA while we're in the program.

 

[OTStudentSept2014]

I don't know that AOTA membership is required in my program, but it is strongly recommended. We are expected to have access to all the journal articles, etc on the website. I do plan on contributing to AOTPAC once I am out and making money again.

I'd love to have more information on cultures and communication, and I think the OT Practice Framework seems more key to understand early on than some of the models. I did decide that the Occupational Adaptation model that I just learned about yesterday appeals to me more than some of the others.

 

[lcs2074]

My program requires us to sign up for, and maintain registration with AOTA while we're in the program.

We are required to be members of AOTA for our program as well as our state OT association (especially since one of our professors is the president of our state OT association!) Advocacy for our profession is so important and all of our professors emphasize this, and that is directly what our dues go towards. So its definitely worthwhile!

 

[HopefulOT17]

This is not exactly relevant to the full discussion at hand, but something stuck with me from the initial post. Why is the use of theraputty highly discouraged? Both of my shadowing experiences (hand therapist and pediatric) both used it and said they had success with it.

 

[c2902]

This is not exactly relevant to the full discussion at hand, but something stuck with me from the initial post. Why is the use of theraputty highly discouraged? Both of my shadowing experiences (hand therapist and pediatric) both used it and said they had success with it.

Theraputty and other preparatory methods and PAMs (physical agent modalities like heat, ice or paraffin) can and are used by OTs, but my guess is that the OP's faculty members want to stress that if OT's focus of intervention gets too far outside modalities that don't look like occupations, then we run the risk of not differentiating ourselves from PTs (as they seem to be very anti-PT, which isn't really good for professional collaboration). For hand therapy and peds, theraputty is definitely run of the mill, BUT it's not the only method being used, and should be used in conjunction with purposeful or occupation-based activity.

 

[OT1188]

I agree with theory based topics in OT school. It's abundant and confusing! I am finishing up my second year of OT school and I realized through fieldwork and observing OTRs that models and theory aren't that important. Most/all (except professors) of the OTRs I spoke with say they forget about that stuff. Yes it builds a foundation but I found it very confusing and I only understood PEO and Biomechanical and NDT approaches.

 

[c2902]

I agree with theory based topics in OT school. It's abundant and confusing! I am finishing up my second year of OT school and I realized through fieldwork and observing OTRs that models and theory aren't that important. Most/all (except professors) of the OTRs I spoke with say they forget about that stuff. Yes it builds a foundation but I found it very confusing and I only understood PEO and Biomechanical and NDT approaches.

PEO is a theory. Biomechanical is a frame of reference. They are similar things, but not the same. You use theories and FORs together, and you can be operating under more than one FOR at a time, but our professors said that for an OT to say "oh, well I'm eclectic" is lazy. Yes, you may not think about what you are using, but if someone asked you which FOR you were operating under (as one of my professors recently did in a case assignment), you should be able to answer based on how you developed your treatment plan (and yes, I was able to answer her with more than "I don't know"). In certain settings, you are going to be implicitly working under certain FORs, to an extent - for example, if you work in a peds clinic that operates under the Ayres Sensory Integration principles, your default FOR is going to be SI, with other things added as needed, even if you don't say "hmm...today, I think I will use the SI approach". Does that make sense?

 

[OT1188]

Yes I understand, I replied to a post from weeks ago when I was browsing. What I meant to say was that the models of theory were confusing and in the "real world" it seems like only frames of reference are what is used to guide intervention, which makes sense. Although, right now as a second year OT student I do feel like those models make some sense of what OT is based on and analyzes but it was a bit discouraging when in fieldwork of different settings/populations, models are completely forgotten.

 

[Kidamnesiac]

PEO is a theory. Biomechanical is a frame of reference. They are similar things, but not the same. You use theories and FORs together, and you can be operating under more than one FOR at a time, but our professors said that for an OT to say "oh, well I'm eclectic" is lazy. Yes, you may not think about what you are using, but if someone asked you which FOR you were operating under (as one of my professors recently did in a case assignment), you should be able to answer based on how you developed your treatment plan (and yes, I was able to answer her with more than "I don't know"). In certain settings, you are going to be implicitly working under certain FORs, to an extent - for example, if you work in a peds clinic that operates under the Ayres Sensory Integration principles, your default FOR is going to be SI, with other things added as needed, even if you don't say "hmm...today, I think I will use the SI approach". Does that make sense?

It's also helpful to know that approaches like SI have very little research to back them up.

 

[OT1188]

In addition to that, I have met many OTs who have been practicing for 30+ years that believe that SI confuses the sensory system as opposed to organizing it. Anyway, about the models and theories vs. FOR, I too in class always have to rationalize my treatment plan assignments with a model and a FOR. Models aren't used for billing rationalizations of treatment nor intervention planning as an OTR. I haven't met one OTR that uses models after school except models professors. Are there any?

 

[c2902]

Yes, theory is just that - theory. You aren't going to find them on a list of billing codes, and that wasn't what I implied. Same with FORs. However, if you looked at a general intervention plan, you could probably affix it with the label of a certain FOR or two, based on the approach. Theories and FORs, not just in Occupational Therapy, but in other disciplines, are merely lenses through which we view our work. They are not to be expressly stated, and are often relegated to subconscious processes, but all I meant was that it doesn't mean they aren't worth learning, or keeping in mind. My original point when I first posted to this thread was that many students, like the OP, fail to understand that you have to do the "boring" foundational work before you can grasp the surface material. This is true with any discipline, and yes, it's not fun or interesting to have to read about stuff and not "do" stuff (as in OT, we are all about the "doing"), but it's necessary, I believe, in order to be not just a good practitioner, but an advocate for the profession.

 

[Kidamnesiac]

Yes, theory is just that - theory. You aren't going to find them on a list of billing codes, and that wasn't what I implied. Same with FORs. However, if you looked at a general intervention plan, you could probably affix it with the label of a certain FOR or two, based on the approach. Theories and FORs, not just in Occupational Therapy, but in other disciplines, are merely lenses through which we view our work. They are not to be expressly stated, and are often relegated to subconscious processes, but all I meant was that it doesn't mean they aren't worth learning, or keeping in mind. My original point when I first posted to this thread was that many students, like the OP, fail to understand that you have to do the "boring" foundational work before you can grasp the surface material. This is true with any discipline, and yes, it's not fun or interesting to have to read about stuff and not "do" stuff (as in OT, we are all about the "doing"), but it's necessary, I believe, in order to be not just a good practitioner, but an advocate for the profession.

Absolutely agree. It's what separates subpar practitioners from good practitioners. It's like learning to read...you need the rudiments before you can read, even if you're not referencing them while you read.

 

[affa]

Honestly, the only way I got through what felt like a tedious and not very helpful alphabet soup of theory and jargon was to go above and beyond the required fieldwork. I found seeing OT's in action --almost none of whom had real high opinions on the theory or jargon either, BTW-- helped keep me focused of what I wanted to get out the program. My suggestion is don't make waves, and just keep jumping through hoops.