Efficient and effective occupational therapy curricular and course design is essential to develop competent and reflective practitioners. The intentional use of metacognitive strategies could improve the development of higher-order thinking and learning outcomes. The study explored the use of metacognitive strategies to improve learning and higher-order thinking in students within occupational therapy higher education. A targeted search for occupational therapy journals only was the primary method to identify studies. Arskey and O’Malley’s (2005) five-stage framework guided this scoping review. All studies demonstrated some aspects of metacognition, this included thinking about their learning, reflection, self-assessment, or sense-making. Through the PRISMA process, the initial search yielded 260 studies; 27 duplicates were removed for a remaining total of 233 studies. Thirteen articles were included in the final study. The identification of the studies’ purpose, pedagogy, metacognitive strategies, and the level of Bloom’s taxonomy for the strategies was included in the analysis. Written reflection, peer-to-peer debate, self-directed learning, critical thinking, self-assessment, and reflection observation were the metacognitive strategies described in the articles. The metacognitive strategies were not specific to a pedagogy. Rather the strategies varied in use; however, all focused on learning outcomes to develop higher-order thinking skills and life-long learners. The selected studies reported improved learning outcomes and described metacognitive strategies. Transparency and intentionality in occupational therapy higher education related to metacognition may improve learning outcomes leading to practitioners whose self-reflection and critical thinking improve client and system outcomes.

A primary objective of occupational therapy education is to facilitate development of clinical reasoning skills. These skills are complex and difficult to cultivate in classroom settings, therefore educators often use experiential learning activities to support clinical reasoning development. Most of the literature about experiential learning activities aimed at developing clinical reasoning focuses on activities occurring in-person, with individuals in physical disabilities settings. This research addresses the gap in the literature by evaluating the impact of a group based, psychosocial focused experiential learning activity that occurred virtually and in-person on entry-level occupational therapy students’ perceived clinical reasoning. Students (n=36) completed the Self-Assessment of Clinical Reasoning and Reflection (SACRR) before and after engaging in a six-week experiential learning activity. The mean total score for the SACRR increased after the learning activity (Z=-4.92, p=.00). Mean scores on 25 of 26 subtests increased and the change on 19 of the 26 items was statistically significant. Items about applying theory to practice increased the most, indicating that students’ perceived abilities increased related to applying theory. Additionally, the learning activity occurred on virtual platforms, demonstrating the potential role of virtual platforms in experiential learning for clinical reasoning development. Overall, this study found that an experiential learning activity designed to address psychosocial needs of groups, using in-person and virtual delivery, increased occupational therapy students’ perceived clinical reasoning. Results add to the literature about clinical reasoning development in students by providing evidence for the use of group based, psychosocial focused learning activities delivered virtually and in person.

Life skills are the basic skills required to function in everyday life. Occupational therapy assistant (OTA) students may struggle with life skills, and as a result experience challenges in academics and practicum. The purpose of this phase of a multiphase study was to identify the life skill needs of OTA students from multiple perspectives. This study used a pragmatic qualitative design. Students in the second year of a 2-year therapy assistant diploma program, graduates, instructors, and preceptors participated in interviews or focus groups to discuss OTA students’ life skill needs. Interviews and focus groups were recorded and transcribed. Applied thematic analysis was used to analyze the interview and focus group data and draw conclusions. Common themes were identified: contributors to student success; impact of students’ life skills on clinical encounters; and life skills training needs. These themes were identified across all participant groups. Findings suggest that OTA students with lower confidence or abilities in life skills may also have lower confidence and success in clinical encounters. Life skills training tailored to OTA students may help students develop foundational skills to enhance their confidence and competence in relevant life skill areas.

This study explored the impact of teaching empathy to occupational therapy students through the close reading of literary narratives. The study defined empathy as a dynamic process involving Theory of Mind (ToM), emotional resonance, and empathy as a willful act. Empathy is an espoused value of occupational therapy challenged by the modern demands of the market-driven health care system, and research suggests reading literary narratives, or stories with qualities of literature, facilitates greater empathy. Prior studies have also indicated that practicing with greater empathy improves health outcomes and makes occupational therapy sessions more client centered. In this study, a quasi-experimental design was used on occupational therapy students (n = 31) in a graduate level rehabilitation course that involved the close reading, or critical reflection, of literary narratives to teach empathy. Close reading is a teaching process through which students critically read and reflect on literary narratives through instructor-guided reflection. Study findings on the pre and post-test surveys of students found a statistically significant improvement in scores (p < .05) on the Jefferson Scale of Empathy (JSE). No differences were found between pre and post-test surveys of the Reading the Mind in the Eyes Test (RMET). The JSE measures empathic awareness, while the RMET measures aspects of empathic performance. Study limitations included mid-course changes due to the COVID-19 pandemic and the potential impact of social desirability on perceptions of empathy. Study findings suggest the close reading of literary narratives may be an effective learning tool to teach empathic-centered care to occupational therapy students.

In order to be a successful practitioner, an occupational therapist must have proper knowledge for treating diverse populations, including clients who are transgender. However, many occupational therapy (OT) programs do not teach content that is specific to the transgender population. This study utilized a complementary mixed-methods design to determine how prepared occupational therapy students perceived themselves to be for working with transgender clients. Entry-level masters and doctoral level occupational therapy students from accredited OT programs across the United States that had completed at least their first Level II fieldwork were recruited to participate. Eighty-five occupational therapy students completed the quantitative survey, and a subsequent six students participated in the phone interview for the qualitative portion of the study. Nearly all of the participants reported that their educators prepared them “not at all” or “some” to work with clients who are transgender. The majority of the participants reported having had contact with members of the transgender community. However, only about a third of participants reported having any transgender content in their courses. The themes that emerged from the qualitative data were limited knowledge about the topic, patient as the educator, self-directed training, and awareness of barriers the transgender community faces. These findings suggest that academic accreditation standards need to be updated to include marginalized populations, including transgender content, to decrease barriers and improve overall care provided to clients.

A fieldwork education model is used in occupational therapy to develop competency of professional skills, including evidence-based practice (EBP) and clinical reasoning. This quantitative study explored factors influencing implementation rates of EBP in New Zealand registered occupational therapists to better understand students’ experience of evidence-based practice while on fieldwork. An online survey exploring beliefs and practices related to clinical competence, professional reasoning and EBP was conducted. The survey included questions about related beliefs, the measure of Evidence Informed Professional Thinking (EIPT; Benfield & Johnston, 2020), and the Implementation Climate Scale (ICS; Ehrhart et al., 2014). The mean scores on the scales were entered into a linear regression model and backward stepwise regression was used to build a predictive model ascertaining primary influences for EBP implementation. On the measure of EIPT respondents reported infrequent engagement in clinical reasoning and EBP activities. Scores on the ICS results indicate some support of EBP practices in respondents’ workplaces. Habits of critical reflection have the strongest relationship to habits of implementing EBP in daily practice The only other factors significant in the predictive model were focus on EBP, and respondents’ level of education. Habits of critical reflection on practice and clinical reasoning activities have the strongest relationship with EBP engagement. Fieldwork students are likely to observe fieldwork educators who are infrequently engaging in critical activities of reflection and EBP. Development of strategies to enhance and habitualize critical reflection and clinical reasoning will increase EBP implementation rates. Pragmatic strategies between fieldwork educators, educational institutions, and students will likely enhance students’ learning and ultimately enhance overall EBPs in the profession.

Occupation-centered course design allows occupational therapy (OT) educators to differentiate ourselves from other professions while communicating the distinct value of occupation to our students. While there have been numerous calls to action for centering occupation in the OT classroom and proposed models to approach course design, there is limited literature on occupation-centered course design in specific courses, notably foundational science courses like anatomy and applied biomechanics. In this study, we outline our course design process in two courses taught concurrently, as well as our prospective study to determine if an occupation-centered course design allowed students to meet objectives and the effect of undergraduate preparation on objective achievement. We also explored students’ agreement with importance of occupation-centered instruction, and our ability to stay occupation-centered. Fifty-five students completed pre and post course surveys rating their ability to perform the five objectives for each course and their level of agreement about the role of occupation in these courses. We found statistically significant increases in all objective ratings, with some ratings more than doubling. Post-course ratings among students with different undergraduate backgrounds were similar despite being statistically different at baseline. Students placed high value in occupation-centered course design at both time points. Students rated the ability to stay occupation-centered lowest in the first few weeks, with Anatomy rated lower than Applied Biomechanics in all weeks. This suggests that the incremental improvements made in the course delivery were effective; however, it was more challenging to create an occupation-centered course in Anatomy.

Many occupational therapy programs use hybrid instruction methods that include virtual learning. To ensure active learning techniques, instructors must alter and adapt traditional instruction methods to the virtual environment. This article explores the use of a virtual Makerspace to create adaptive equipment used throughout online intervention course experiences. Thirty-seven first year occupational therapy students participated in an exclusively online, synchronous course focusing on interventions for adults with physical disabilities. A Makerspace was created to allow students to have access to adaptive equipment (AE) and teach students how to fabricate low-cost AE for future clients. During class, guided instruction was provided to fabricate a sock aide and a universal cuff. This AE was then used throughout the course to provide hands on learning opportunities. Summative assessments were used at midterm and at the conclusion of the course. Students noted enjoyment and preference for hands on activities such as Makerspace, acknowledging how this connected with roleplaying and client interactions. Students were observably engaged throughout the course and integrated AE into learning scenarios throughout. Student feedback supported the use of a virtual Makerspace and reinforces the notion of the maker movement as shared ideas and space to build community. This not only provides a learning opportunity but offers connection in virtual environments. Makerspace activities can also be used to build competence and confidence in OT intervention. A Makerspace is an active learning opportunity that can be successful in person or virtual environments.

Fieldwork education is an essential component of occupational therapy (OT) curriculum; yet national shortages and the COVID-19 pandemic have affected fieldwork availability. To combat the shortage, some academic programs implemented simulation-based Level I fieldwork experiences. The objective of this research study was to compare the perceived knowledge, confidence, and attitude of OT students that completed a virtual simulation-based Level I fieldwork to those that completed a traditional Level I fieldwork. This study involved a sample of 26 doctorate of OT students that completed a traditional or virtual simulation-based Level I fieldwork. Students completed pre-and-post fieldwork surveys regarding their perceived knowledge, confidence, and attitude. Mann Whitney and Wilcoxin signed rank tests were used for comparative analysis. There was no statistically significant difference in knowledge or confidence between the two groups (p = .734, p = .303). Students that completed a virtual simulation-based fieldwork experienced increased attitude (p = .021) and both groups experienced an increase in perceived knowledge (p = .012, p = .003) following their fieldwork experience. This study adds to the growing body of knowledge regarding the utilization of simulations in OT curricula and proposes an alternative Level I fieldwork model to assist with the national shortage of fieldwork availability.

Observation is a critical skill that deserves increased attention in occupational therapy education programs as it can directly affect patient care. Art has been used as a pedagogical tool to explicitly teach observational skills in medical and allied health programs. The use of art has a positive effect on the clinical skills needed for patient care. The purpose of this descriptive study was to examine how students’ observation skills changed using Visual Thinking Strategies (VTS) with works of art. This quasi-experimental, single-group, pretest-posttest design included 33 occupational therapy students who observed four different works of art using an observation log and the Observation Skills Questionnaire-modified (OSQ-m) before and after the session. Data were analyzed using descriptive statistics and paired t-tests. The results showed that most of the post-OSQ-m scores significantly improved, most notably the areas of remembering and the need for instruction surrounding observation. Students did report decreased ability to critically analyze what they saw. Themes were identified from the students’ responses to reflection questions using manifest content analysis and results showed that they felt it was a positive experience. Overall, the students felt that learning how to observe was beneficial to them and to their future as practitioners.