Compendium on Continuing Education in Occupational Therapy: An Overview
Creating a comprehensive, high-quality system of care for children and youth with special health care needs (CYSHCN) is a key priority for many state health policy leaders. This article provides an overview of continuing education in occupational therapy, highlighting its importance in addressing the evolving needs of CYSHCN and the role of digital learning in advancing professional competency.
The Importance of Systems of Care for CYSHCN
Nearly 20 percent of all US children up to 18 years (more than 14 million) have chronic and/or complex health care needs (e.g., asthma, diabetes, spina bifida) requiring health care services and supports beyond what children require normally. Among them, about 3 million children have complex health care needs (representing about 0.5 percent of all US children and their numbers are growing) and require the highest levels of need. Key national stakeholders participating in the National Consensus Framework for Improving Quality Systems of Care for Children and Youth with Special Health Care Needs project identified optimal capacity and performance benchmarks for systems of care serving CYSHCN, resulting in the National Standards for Systems of Care for CYSHCN, to help state leaders transform and improve systems of care for CYSHCN and their families.
Since its publication in 2014, the National Standards have been used by national, state, and local stakeholder groups, including state Title V CYSHCN programs, health plans, state Medicaid and CHIP agencies, pediatric provider organizations, children’s hospitals, insurers, health services researchers, families, consumers, and others.
Quality measurement is a critical component of many state programs, including Medicaid, the Children’s Health Insurance Program (CHIP), and state Title V CYSHCN programs. The federal Title V MCH Services Block Grant program requires states to report annually on a set of National Performance Measures and the Centers for Medicare & Medicaid Services asks states to voluntarily report on the Child Core Set of measures on an annual basis. In 2024, states will be required to report on all measures in the Child Core Set. Measuring the quality of care that CYSHCN receive is a growing priority for state and national health policymakers and public and private health plans and providers. As states implement health system reforms, including linking performance and quality to payment for services, interest in quality measurement for programs serving specialized populations, including children with chronic and complex health care needs, is increasing. States’ increased use of Medicaid managed care delivery systems to serve CYSHCN also presents an opportunity to hone and refine quality measurement strategies. Identification of data and quality measures that align with the National Standards can help states better implement the standards and evaluate how well their systems of care are serving CYSHCN.
This measures compendium is designed to provide states and other key stakeholders with a reference tool that highlights relevant quality measures aligned with key domains of the National Standards for CYSHCN. It compiles current data and quality measures - and avoids creating new measures - given the availability of numerous existing measure sets and states’ limited capacity and infrastructure to design or test new measures. The measures listed in this compendium summarize relevant measures from the most applicable and widely used measure sets, and are not intended to be an exhaustive list of all available measures or to provide quality measures that focus on specific medical conditions.
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The Role of Occupational Therapy in Transition and Beyond
Occupational therapy practitioners increasingly serve clients at critical times of transition as people experience planned and unplanned transitions throughout their lifespan. Aligned with the Occupational Therapy Practice Framework, this work explores the various transitions people experience and the ways in which occupational therapy can facilitate better intervention outcomes as clients face changes and challenges in their lives. Chapters discuss transition-related issues, evidence, and intervention strategies, and through case examples and questions, challenge readers to promote learning and encourage best practices.
Occupation, theory-driven, evidence-based, and client-centered practice continue to be the core of the profession and is the central focus of Occupational Therapy Essentials for Clinical Competence, Third Edition. A person-centered, recovery-oriented, and occupation-based approach to mental health across the lifespan guides you through an evidence-based approach to helping clients with mental health disorders on their recovery journey by participating in meaningful occupations.
As the profession of occupational therapy continues to mature and expand its practice, the measurement of occupational performance is one of the key avenues that all practicing clinicians will need to explore and master. Professionalism Across Occupational Therapy Practice provides an overview of the wide-ranging knowledge, skills, and attitudes that encompass professionalism across the occupational therapy profession. Advanced therapies and technologies, new service delivery methods, and care upgrades in underserved areas are translating into improved quality of life for millions with disabilities. Occupational therapy parallels this progress at the individual level, balancing short-term recovery and adaptation with long-term independence and well-being. This text builds on its ground-breaking predecessor by modelling current clinical standards rooted in scientific evidence-based practice. Essential Concepts of Occupation for Occupational Therapy is an accessible introduction to concepts in occupational science for the occupational therapy practitioner or student. It invites therapists to view and understand their clients differently--by using an "occupational lens" to focus on the lives of their clients as everyday doers. Social justice, inclusion, and person-centredness are the cornerstones of occupational therapy but despite this, the experiences and inequities faced by Black and minoritised populations in health and social care often go unseen and unattended in occupational therapy practice.
Digital Learning in Occupational Therapy Education
Digital learning is a rapidly advancing method for teaching and learning in professional health education. Digitalization has become a new opportunity and challenge for higher education today, and many educators and learners are participating in educational activities involving digitalization. Digital learning is a popular and rapidly advancing learning method for teaching and learning in professional health education. It provides learning content to improve individual learners’ knowledge and skills and effective teaching methods through a variety of modalities using information and communication technologies such as computer-assisted, mobile, and digital simulation-based learning. Digital learning design can be largely divided into blended and distance learning, such as a full e-learning course. Blended learning is a learning design that combines face-to-face (F2F) and online teaching with synchronous learning (provided in real-time, F2F or online) and asynchronous learning (provided in flexible time and online). Distance learning is a completely online learning design.
A scoping study aimed to identify the digital learning designs used in occupational therapy (OT) education and review the effectiveness, learner perceptions, clinical skills integrated, and technology-based learning strategies used to facilitate learning. Four databases were searched using subheadings and terms relating to digital learning, occupational therapy, and education. Twenty-two studies were included in this review, most of which were qualitative, observational, or mixed studies of the two designs. The digital learning designs identified in OT education were flipped, blended, hybrid, and distance learning, including e-learning and massive open online courses (MOOC). Among the components of clinical skills, professional reasoning and procedural knowledge were the most integrated into digital learning, and covered various OT subjects. Digital learning designs were reported to be equivalent to or more effective than the traditional face-to-face (F2F) class in learning outcomes of knowledge and skill acquisition, enhancing learning participation, reflection, and collaboration between learners. In OT digital learning, appropriate learning subjects, the arrangement of clinical skill components that can be well integrated into digital learning, and the selection of appropriate technologies for effective learning are important.
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The professional occupational therapy (OT) program fosters culturally sensitive and evidence-based clinical competency by allowing learners to participate actively in the collaborative process between students, clients, and educators. Therefore, learners should be able to integrate academic knowledge, professional reasoning, and self-reflection through active learning through various experiences both inside and outside the classroom. Digital learning design in OT and physical therapy (PT) education has not been based on theoretical learning and has been frequently adjusted from a short perspective, although Bajpai et al. suggested guidelines for the theory of digital learning in professional health education. Previous reviews have suggested that the effectiveness of blended learning, flipped learning, and e-learning in healthcare education is equivalent or superior to traditional class teaching methods. Ødegaard et al. also reported that blended learning and distance learning in PT education are equally or more effective than traditional teaching methods. In terms of planning digital learning in OT education, it is necessary to determine how to design digital learning to achieve learning outcomes and what clinical skills and subjects can be integrated into digital learning.
Methodology of Scoping Review
Studies have applied various digital learning designs in OT education. However, a recent review of digital learning design has not been conducted, so it is necessary to explore the digital learning design studies conducted so far in OT education and to map and summarize the evidence for the applied digital learning design. A scoping review methodology based on the process outlined by Arksey and O’Malley was adopted. Applicable research terms and database identifications were included to identify the relevant studies. The data search included Medline Complete, Embase, CINAHL, Scopus, and an additional search of grey literature using Google and Google Scholar. A target-hand search of discipline-specific journals was also conducted. These journals include the American Journal of Occupational Therapy, Journal of Occupational Therapy Education, Open Journal of Occupational Therapy, Journal of Physical Therapy Education, Health Professions Education, and Journal of Allied Health. The basic search included keywords related to ‘digital learning’, ‘occupational therapy’, and ‘education’.
The inclusion criteria were quantitative, qualitative, or mixed method study designs, full-text articles, English language, and material that met the following criteria for facilitating learning: those focused on digital learning design (e.g., blended learning, distance learning) or the use of technology-based learning strategies (e.g., peer learning group work, gamify online learning); a study population of OT students in bachelor’s/undergraduate, MOT (Master of Occupational Therapy), OTD (Occupational Therapy Doctorate), and occupational therapists participating in OT continuing education programs and reported on the outcomes of exams on knowledge and skills, usefulness, and students’ perceptions (e.g., satisfaction with learning, self-efficacy). In addition, the publication period was limited to January 2000 - February 2022. Since the application of digital learning using technologies was limited before 2000 in OT education, the search was limited to studies published after 2000. The exclusion criteria were protocol studies, expert opinion studies, theses, dissertations, conference abstracts, education not for OT students or occupational therapists, and studies in which digital learning technologies were not used as part of a learning strategy. The authors agreed to include only studies that explicitly used digital learning designs in this scoping review through an iterative review process at the time of full-text review. Two researchers independently extracted data from the included studies using an extraction form.
Key Clinical Skills Components
Clinical skills included physical examination skills, practical procedures, communication skills, and management. It also comprises basic scientific knowledge, procedural knowledge, and professional reasoning. Several terms have been used for digital learning. Blended learning refers to a mixed system of education involving the mobilization of learning contexts such as face-to-face and online learning. It also focuses on the integration of different teaching methods, the interaction of different technological tools, and the adoption of virtual spaces in the educational process. Mixed learning by adding online learning materials and activities to offline classes is not intended to replace traditional F2F classes. Some students attend classes in person, whereas others attend classes virtually at the location of their choice. Educators use tools such as video-conferencing hardware and software to teach remote and F2F students simultaneously. The method of interaction between students and the learning content in traditional classes is reversed. This is a form of distance learning that allows learners access from different geographic locations. Various elements of the education strategy (e.g., animations, graphics, videos, forums, chats, quizzes) are delivered in an electronically structured course. Students and instructors can use e-learning systems both asynchronously and synchronously. A form of e-learning that has emerged with the use of mobile devices in education, typically used outside the classroom. “MOOC integrates the connectivity of social networking, the facilitation of an acknowledged expert in a field of study, and a collection of freely accessible online resources”.
The thematic information identified and extracted from each study was tabulated based on the type of digital learning design, integrated subject, context, comparison group, detailed learning activities, and key findings. Textual descriptions were created after analysis according to the digital design type.
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Study Results
Twenty-two studies were included with 2143 participants (sample size range between min = 10; max = 1009). The participants were occupational therapists (n = 1), OTD program students (n = 5), MOT program students (n = 7), integrated BS/MS OT program students (n = 1), OT undergraduate students (n = 8), and the occupational therapy assistant (OTA) program (n = 1). In addition to students majoring in OT, students majoring in physical therapy, speech and language pathology, medicine, nursing, dentistry, dental hygiene, and nutrition were also included in the studies. The study design was used to investigate the effects of digital learning on academic performance and participants’ perceptions of digital learning experiences. Mixed methods (n = 9) were the most common, followed by qualitative methods (gathered interview and focus group data) (n = 5), quasi-experimental (n = 3), randomized controlled trial (n = 1), descriptive (n = 3), and analytical (n = 1) methods.
The identified key clinical skills components included basic scientific knowledge (n = 1), procedural knowledge (n = 6), professional reasoning (n = 3), and combined procedural knowledge and professional reasoning (n = 7). One study included a basic science knowledge component, and 3D anatomy software was used for the anatomy course. Studies that included procedural knowledge components addressed theories, frames of reference, adaptive equipment, psychosocial dysfunction, communication partner training for adult aphasia, and interprofessional team skills. Studies involving both procedural knowledge and professional reasoning addressed ergonomics, autonomy, activity analysis, and other OT subjects, adult practice, mental health, fieldwork training, interprofessional team skills in childhood, school practice, do-live-well framework, and problem-based learning (OTA:) scenarios.
The variables used to measure the outcomes of digital learning were academic performance (e.g., course grades, exam scores, course objective achievement) (n = 11), professional reasoning skills (n = 4), class participation (n = 3), satisfaction with learning (n = 2), preference for instructional methods (n = 2), usefulness (n = 2), cognitive and emotional empathy (n = 1), a sense of belonging, acquired skills, practice setting, and leadership (n = 1), metacognition of learning (n = 1), and self-efficacy with computer technologies (n = 1).
Digital Learning Designs in Practice
Blended learning was used in seven studies. Barillas used 3D anatomy software with F2F sessions on human anatomy subjects; the blended group showed higher learning outcomes than the F2F group, and students reported that the software was helpful in understanding the course concept. Grant used game software for the use and fitting of adaptive equipment during classes. The participants showed high participation in game-based learning and increased confidence in the practice of adaptive equipment. Other studies using blended learning have integrated synchronous or asynchronous online sessions with F2F sessions and addressed various course subjects. Howard addressed OT theory: the F2F group showed significantly higher academic performance than the blended group, and the blended group reported that online sessions required a lot of busy work. However, in the study by Simons et al., students reported that blended learning in OT theory was effective, efficient, and satisfactory, as expected before the course. Murphy et al. addressed case-based professional reasoning; the blended group showed a significant improvement in overall reasoning in the pre-test and post-test, unlike the F2F group. In the study by Barnard-Ashton et al., the subject was problem-based learning scenario lecturers, and students reported that blended learning facilitated active learning (improved communication and efficient use of time and learning resources). Carbonaro et al. addressed interprofessional skills for undergraduate health science students composed of several majors.
Hybrid learning was adopted in two studies. Feldhacker et al. provided all OTD courses for one semester in two delivery types: hybrids and F2F. After completion of the course, both the hybrid and F2F groups showed similar improvements in learning outcomes, and students reported that tasks linked to real-life experiences facilitated active learning, regardless of course delivery type. A flipped classroom design was used in two studies. Henderson et al. compared the flipped course group with the subject of adult practice and the group involved in the flipped course design; both groups showed equal effects on learning outcomes and professional reasoning skills. Students participating in the study by Lewis-Kipkulei et al.
Ten studies used e-learning courses. In three studies with a F2F comparison group, there were no significant differences between the e-learning and F2F groups in course satisfaction or academic performance. The course subjects of these studies were psychosocial dysfunction, the communication partner training (CPT) program for adults with aphasia, and the DLW framework, which were delivered by e-learning and F2F. Six studies included course subjects without the F2F comparison group. Gee et al. addressed case-based professional reasoning for sensory processing, and students trained in the professional reasoning process showed high achievement in professional reasoning. Compared with the control group, significantly higher knowledge of aphasia in online and F2F groups (online vs. control: p = 0.000; F2F vs. control: p = 0.002), knowledge of facilitative strategies (online vs. control: p = 0.000; F2F vs. control: p = 0.002), and positive attitudes towards aphasia (online vs.
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