Abstract
Introduction
Without a strong understanding of occupation, first nurtured and developed in educational programs, occupational therapists are limited in realizing the profession's potential to collaboratively improve occupational lives and contribute to a more just society (Fisher, 2013; Krishnagiri et al., 2017). There are differences in how occupation and an occupational perspective—how one views the world through an occupational lens—are defined, applied, and learned across countries. While research situated in the Global North has explored how occupation is taught and evaluated in occupational therapy education from educators’ perspectives, research within the Canadian context is limited. This study aims to begin to address this gap.
Background
Occupational Perspective
An occupational perspective is a way of understanding how occupational therapists view the world and their practice through an occupational lens. While it is commonly used in research and education, an occupational perspective lacks a universal definition, which can make it difficult to describe and apply in education and practice (Njelesani et al., 2014). Njelesani et al. proposed a definition of an occupational perspective as a “way of looking at or thinking about human doing” (p. 226). This definition leaves room for the use of different theories and models of occupation, where each occupational therapist can develop a unique occupational perspective that falls within this general definition. Occupational therapists must reflexively consider personal and contextual factors that shape their occupational perspectives (Laliberte Rudman et al., 2022; Njelesani et al., 2014).
Occupational therapists’ professional identities are shaped by their occupational perspectives—viewing people as occupational beings, use of occupation-focused models, and knowledge of occupation (Ashby et al., 2016). So, a strong occupational perspective can contribute to a similarly strong professional identity (Ashby et al., 2016; Ford et al., 2022). It can mitigate practice stress, burnout, role blurring, and extend career longevity (Ashby et al., 2016; Ford et al., 2022). This highlights the importance of understanding how occupational therapy educators teach and evaluate an occupational perspective.
Occupation and an Occupational Perspective in Education
Research is growing on how occupation is taught and evaluated in occupational therapy education (Di Tommaso et al., 2019; Hooper et al., 2015; Krishnagiri et al., 2017; Krishnagiri et al., 2019; Price et al., 2017). Krishnagiri et al. (2017) examined how the concept of occupation was taught in occupational therapy programs in the United States. They found that occupational therapy educators did not always make occupation explicit in their teaching—that at times it was implicit or even absent. When occupation is not made visible in teaching, occupation can be lost or watered down, often becoming synonymous with adjacent concepts such as function and activity (Fisher, 2013; Krishnagiri et al., 2019).
Occupation-centred education can mitigate the absence or implicit nature of occupation in occupational therapy curricula (Hooper et al., 2015). It refers to occupation being the foundation of all learning and teaching experiences (Hooper et al., 2015; Yerxa, 1998). Indeed, a common shift in accreditation standards, led by the World Federation of Occupational Therapists, requires occupational therapy educational programs to facilitate the development of occupation-centred education globally (Di Tommaso et al., 2019; Hocking & Erik Ness, 2004). Occupation-centred education can “enrich new occupational therapy practitioners to grasp the purpose of the profession and reason clinically in complex learning environments” (Hooper et al., 2015, p. 1).
Research on teaching and learning occupation and an occupational perspective has largely focused on American and Australian occupational therapy education (Di Tommaso et al., 2019; Hooper et al., 2015; Krishnagiri et al., 2017; Krishnagiri et al., 2019). Canadian research has explored practitioners’ and new graduates’ understandings of occupation (Aiken et al., 2011; Cho et al., 2023). Across Canada there are 14 accredited occupational therapy university programs. Accreditation standards are overseen by the Canadian Association of Occupational Therapists (CAOT), which “accepts the master's degree in occupational therapy as the minimal educational requirement for entry-level education in Canada” (2022, Canadian Association of Occupational Therapists). It is important to add a Canadian contextualized understanding of how an occupational perspective is taught and evaluated to this body of literature due to the differences in accreditation standards, practice competencies, and educational norms across countries. Furthermore, given global nuances in how occupation is defined, and what conceptual models, beliefs, and values are foundational to occupational therapy, a Canadian perspective may lead to new understandings that are of value outside of Canada.
This study has two aims: (1) to understand how, in Canada, educators in entry-level master of occupational therapy programs teach an occupational perspective and (2) to explore how, in Canada, educators in entry-level master of occupational therapy programs evaluate, both formatively and summatively, the development and establishment of student occupational perspectives.
Methods
Research Design
A constructivist epistemological perspective guided this study (Denzin & Lincoln, 2005; Guba & Lincoln, 2005). It acknowledges multiple realities where knowledge is gained through understanding the cumulative experiences of individuals and groups within a given social and cultural context (Carpenter & Suto, 2008; Guba & Lincoln, 2005). For this study, the social and cultural context was in Canada, adding to literature from the Global North. This study used a descriptive qualitative study design with an interpretive approach (Sandelowski, 2000), conducive to an inquiry about how and what is involved in teaching and evaluating an occupational perspective, as told by educators. Ethics approval was obtained from the University of British Columbia Behavioural Research Ethics Board (ethics ID number H20–03025).
Participants
Inclusion criteria required participants to be English-speaking (the research team was English-speaking, and there was no funding for translation services) and faculty members of Canadian entry-level master of occupational therapy programs that teach occupation-focused content. Faculty members were defined as core, clinical, or adjunct, who are involved in the curricular design, instruction, and evaluation of occupational therapy students.
Positionality
Two occupational therapy student researchers (Wheeler and Honeybourne) and two occupational therapy faculty (Lee Bunting and Forwell) comprised the research team, who identify as white-settlers, cis-women, and non-disabled. The student researchers were developing their own occupational perspectives during this study; insights gained throughout the research process influenced the trajectory, interpretation, and expression of their occupational perspectives. The research team engaged in reflexive reflection and discussion throughout the research process, mindful of the power inequities between faculty and student researchers. To mitigate this power inequity, a relational approach was centred, foregrounding care and compassion, with collaborative decision-making practiced (Schwartz, 2019; Schwartz & Holloway, 2012). The aim of reflexivity was to identify, acknowledge, and process how the researchers’ lived experiences may shape the research.
Recruitment and Consent
Purposive and snowball sampling methods were used. An invitation letter was emailed to members of the Academic Education Committee of the Association of Canadian Occupational Therapy University Programs, which consists of curricular leads across the 14 entry-level master of occupational therapy programs in Canada and to professional contacts of the principal investigator (the first author). Those contacted were asked to consider the invitation letter personally and to share it to other potential participants within their professional networks. Once potential participants contacted the research team, they received details of the study and could ask questions. All participants provided both written and verbal informed consent.
Data Collection and Management
The student researchers conducted semi-structured individual interviews to facilitate both breadth and depth of information to be explored (Carpenter & Suto, 2008). Interviews were completed using a secure connection on the online platform Zoom. Participants received a unique password-protected link to access the meeting. Each participant either chose or was assigned a pseudonym. Interview lengths ranged from 30 to 60 min and were recorded with cloud options turned off. Strategies for enhancing privacy and security in a virtual setting were on the consent forms and reviewed with participants before the interviews.
An interview guide was used with open-ended questions, follow-up questions, and probes. The research team developed the interview guide to align with the study aims, study epistemology, and methodology. Interview guide questions included the following: “In your own words, please define an occupational perspective.”; “What educational theories do you use to inform your teaching of students’ occupational perspectives?”; “What pedagogies and learning activities do you use to deliver this content?”; and “How do you know when a student has developed an occupational perspective?”. The student researchers engaged in strategies (e.g., notes on initial thoughts, debriefing, reflexive journaling) to explore and, at times mitigate, the impact of contextualized personal factors (e.g., assumptions, positionality as student occupational therapists, interview styles, etc.) on data collection.
Data Analysis
Reflexive thematic analysis (TA), guided by the Braun and Clarke six-phase process, was used (Braun & Clarke, 2006; Braun & Clarke, 2021). Reflexive TA is a systematic process that names, interprets, and reports patterns (themes) within data (Braun & Clarke, 2021). The six-phases include the following: (1) data familiarization and writing familiarization notes; (2) systematic data coding; (3) generating initial themes from coded and collated data; (4) developing and reviewing themes; (5) refining, defining, and naming themes; and (6) writing the report (Braun & Clarke, 2021, p. 4). Braun and Clarke (2021) assert that this phased approach is not prescriptive and provides a flexible, yet structured approach for interpreting data. It aligns with constructivist epistemology through centring the views and information provided by the participants to describe themes. It also aligns with a descriptive qualitative method, which aims to present data in a manner that depicts the original language and testimony of those speaking about their experience (Sandelowski, 2000).
Interview recordings were transcribed verbatim by the student researchers, which allowed for deeper familiarization (phase one) with the data. Each student researcher then independently coded (phase 2) the first two interview data sets: immersing themselves in the transcripts and moving line by line to code chunks of data that captured salient, interesting, or intriguing meanings. The research team then met to review both sets of initial codes; they engaged in discussion to process, explore, and critically unpack commonalities and differences in coding. The team iteratively returned to the transcripts to bring context and centre participant voices. Reflexivity called on each research team member to pay attention to how their intersecting identities shaped where they saw meaning and value in codes. Justification and rationale for analysis decisions were presented and explored with shared curiosity. The aim, in line with this study's epistemology, was to reflexively question and explore coding decisions, rather than to land on uniformity. This process was resolved once the team decided there was a shared appreciation for decisions made and integrity of the participants’ voices. The student researchers then divided up the remaining data sets and coded primarily independently, with regular and iterative reflexive dialogue and discussion with each other and the research team. In phase 3, the student researchers used an institutional secure Microsoft One Drive folder to cluster codes, with supporting participant quotes, and to describe initial themes. The first and last author reviewed initial thematic descriptions and provided feedback, prompts, and suggestions collaboratively through the shared Mircrosoft One Drive folder. Numerous research team discussions were held via the secure online platform Zoom, to engage in collective revising and refinement of theme descriptions, while ensuring that analysis informed the study aims and was grounded in participant voices (phases 4 and 5). Additionally for phase 5, in collaboration with the research team, the first author led a final review, refinement, and revision of the themes, going back to transcript data to integrate salient and illustrative participant quotes. This ensured that the described themes aligned with the study aims and captured the richness of participant experiences and insights. Further, this final review of themes strived to ensure that each theme, as described, provided a meaningful, cogent, and distinct account of the data, with a unifying narrative across all themes (Bryne, 2021).
Findings
Twelve participants from eight out of the 14 Canadian entry-level master of occupational therapy programs participated in the study. The length of teaching experience ranged from 5 to 30 years and practice experience from 15 to 58 years. The small number of occupational therapy programs in Canada precluded further descriptive data collection to uphold participant anonymity.
Five themes were described. Each theme is unique, yet all are inextricably linked by the centrality of occupation. Participants described that no matter what content they are teaching they intentionally connect it to the meaning, value, and transformative power of the occupation. As Sophie said, occupation—“it's everywhere, it's in everything that we do and teach.”
Theme 1: Occupational Perspectives as Pedagogy
Participants described intentionally applying their occupational perspectives to underpin their teaching. In discussing her own occupational perspective, Stacey noted, “…I don’t think it became as explicit for me as once I started having to teach in the program.” They framed this process as a pedagogical choice where they intentionally conveyed their occupational perspectives and role modeled to students an openness for reflection and integration of new ideas. To effectively use their occupational perspectives as pedagogical tools, participants said they first had to appreciate how their own occupational perspectives had changed with the evolving profession. Many participants highlighted the work of Canadian occupational therapy scholar Dr. Liz Townsend, namely, the conceptualization of occupational justice, as formative in shaping their occupational perspectives. They described this as a turning point in how occupation was perceived by themselves and the profession in Canada, which led to an expansion of their occupational perspectives to be inclusive of occupational justice aims and outcomes.
As they gained experience, participants described “becoming more comfortable with the complexity of occupation” (Nicole). They also spoke of a continuous deepening and broadening of their occupational perspectives over time. This comfort with complexity and change enhanced their ability to engage in the role modeling previously described and to model humility and curiosity when challenged by students. As part of this pedagogical practice, participants described the need to be critically reflexive and open to challenging their own occupational perspectives. In Melissa's teaching she intentionally models critical reflexivity with her occupational perspective by sharing with students that “…this is my way I am looking at it in this period of time and looking at it in this way in the world” and is transparent with students in how she critically uses occupational therapy theory and models. In shaping an occupational perspective that considers the systems-level impacts, participants expressed the importance of them keeping up with current research and societal changes. They valued when students’ question their occupational perspectives, as it reflexively challenged participants’ prior knowledge and helped develop students’ critical reflexivity skills.
Theme 2: It's a Process, Not an End State
Intentionally structuring occupational therapy curricula was done to best support students’ learning of an occupational perspective. The history of occupational therapy and occupation-focused theories, models, frames of reference, and practice processes are intentionally taught early in programs, as a foundation for an occupational perspective. As Stacy noted, “…[we are] really trying to get our students to understand the value and the power of occupation” early on. This supports students’ occupational perspectives to develop in complexity over time, as more knowledge and experience are gained. Participants noted that often students come back to tell them how valuable and relevant it was to be taught these foundations of occupation so early in their education, as it helped anchor their thinking and practice in occupation.
While this was a clear starting point in learning an occupational perspective, participants said that students learn their occupational perspectives through an ongoing and evolving process. Lacy captured this as follows, “I mean [learning an occupational perspective] is absolutely a process. It's not an end state. Even now… my understanding of an occupational perspective continues to evolve today.” Participants described a range of periods in which students’ occupational perspectives are developed, ranging from the end of the first year to beyond graduation. As Lauren said, “I do expect [an occupational perspective] to change, and I know it does.” Given the relatively short time of occupational therapy programs, there was an inherent fragility to one's occupational perspective recognized by participants. Mary described this as: “It will go up and down. It's not this static kind of piece. It's actually fairly fragile to some extent, depending on where [new graduates] go into.” Participants recognized that practice contexts shape new graduates’ occupational perspectives. Graduates may lose or not consistently apply an occupational perspective in practice, due to practice factors such as lack of funding and high workloads. Nicole described it as follows: [You’re] just kind of be trying to survive your job, and just doing what you need to do to get through…And so, I think that there's the balancing the idealistic with the realistic.
Thus, participants viewed fluctuations in an occupational perspective after graduation as part of the normal process in developing an occupational perspective, with career-long potential for integrating new understandings. As part of their teaching, participants normalized, discussed, and addressed these tensions and changes for students. As Rita said, “the world is changing continuously, all the time. So, we tell students… what you learn in the program today is not necessarily what occupational therapy is going to be.” Educators must be transparent about balancing the idealistic classroom environment with the realities of practice.
Theme 3: “Everybody Is Involved”: A Community of Educators
Participants framed the learning of an occupational perspective as a social endeavor, with a range of people involved in developing students’ occupational perspectives. Shelly described that “wherever students are, I think the folks they’re most connected to are the ones that are having an influence in terms of developing that occupational role,” This included students themselves. Participants emphasized that students must be active participants in the process of developing their occupational perspectives. Students’ personal experiences, opportunities, and relationships contributed to the timing and development of their occupational perspectives. Participants described how this personal contextualizing can enhance students’ understanding of the power, meaning, significance, and value of occupation. It helps students understand themselves as occupational beings. This aligns with transformative learning theory (Mezirow, 2000), which was referenced by participants as the primary educational theory underpinning curriculum delivery across their respective programs. Students’ peers, friends, and family can also help students see the meaning of occupation in diverse contexts. Educators valued how peers, friends, and family can point out changes in the student as they begin to develop and apply an occupational perspective. “Feedback from family and friends often makes it more apparent to the students that they are developing that [occupational] lens” (Jaclyn).
Participants noted the valuable teaching of fieldwork preceptors: “they are totally integral, that's real world” (Shawn). Preceptors demonstrated the application of an occupational perspective and provided opportunities for students to do the same. Students could begin to learn the significance of occupation when given the opportunity to witness how occupation (or lack of) impacts clients. “It's really in placement where it all comes together…I love when [students] come back from placement. They’re so full of energy and I can just see all these neural synapses are starting to make connections and they’re like oh I’m getting it” (Stacy). Accordingly, clients also play a vital role in facilitating students’ development of an occupational perspective. With clients, students witness, integrate, and understand the significance of occupation from the perspective of the people, families, and groups with whom they work.
Participants described student self-reflection, peer, friend, and family feedback and fieldwork debriefing as teaching approaches to support students making sense of these varied sources of information. Further, a community of educators facilitates critical reflexivity and invites students to teach or share knowledge with others.
Theme 4: Thinking Critically
All participants, when speaking to the development of students’ occupational perspectives, emphasized the importance of students’ ability to develop their critical thinking skills throughout their education and post-graduation. Having strong critical thinking skills was seen as vital to students’ learning their own occupational perspectives that are responsive to the contextual shifts that occur throughout their careers. As Rita shared, “If we can be critical about what we’re reading, what we’re seeing, what we’re understanding, we understand something far more deeply.”
Participants spoke to the importance of teaching critical reflection and reflexivity (i.e., considering the impact of one's own positionality) skills throughout students’ education. Critical thinking and critical reflexivity were seen as necessary practice skills that facilitate a responsive and relevant occupational perspective. This was valued as supporting best practice with clients. As found in theme 2, students must be aware of how practice contexts can shape their occupational perspectives and be able to self-manage these impacts. Critical appraisal helps students see and be curious about these contextual factors.
Participants used strategies and exercises to facilitate student reflection on their occupational perspectives to help mitigate practice challenges that can threaten new graduates’ occupational perspectives. This reflection allowed for growth and adaptation as an occupational therapist. Mary noted, “reflection is one of the best gifts we have to develop our real skills and abilities as OTs. If we don’t reflect, we’re not going to be very useful in practice.” Melissa described the approach she uses with students while teaching different models through a critical lens: I think what we do is like we teach students to learn rather than to think about it… they don’t have to adopt the model, they can critique the model and take what works out of the model and don’t take what doesn’t work and add to it. So to see them as less rigid.
Participants talked about creating learning spaces where students are supported to reflexively consider what they are reading, seeing, and thinking and integrating those experiences through a critical lens. This, some participants asserted, can allow for deeper learning and the development of a more responsive and nuanced occupational perspective. Nicole stated: You need to think about who benefits from the ways that things are framed. Who is silenced or marginalised by the way that things are framed? You know who is this policy potentially going to harm? Even if it's viewed positively as benefiting some. And so using that kind of critical approach.
Teaching critical reflection and reflexivity skills extends throughout the program, providing students with the tools to self-manage their occupational perspective when they enter practice. Shawn described how imperative it is that students graduate with a flexible and responsive occupational perspective: “ … I swear that we are the only profession that pulls it together in that holistic way. So, I think it's critical that [new graduates] have that to begin with.” This highlights the importance of fostering the confidence of students’ abilities to articulate and start to define their own occupational perspective before they get out into practice. Participants underscored the need for students to examine and have awareness of when and how they are using their occupational perspective.
Theme 5: “Hard to Evaluate”
An occupational perspective is not developed at one point in time or contained within a particular course. As such, participants spoke of how hard it is to evaluate when a student has learned an occupational perspective. As described in theme 2, an occupational perspective is constantly shifting and evolving throughout the education process and after. Students may be at varied places in their development, at different points in time. In theme 3, participants described how students learn from a community of educators to gain a collective picture of what it means to have and use an occupational perspective. This is precisely what makes it difficult to evaluate through traditional approaches to student assessment of learning. Participants said how they only witness a piece of the journey that students undergo while developing an occupational perspective. Some participants said that evaluating students’ occupational perspectives at a single point in time raises tensions, since there is no distinct outcome to assess. Mary called into question traditional approaches to grading: “I think part of it is that we’re stuck in an academic structure that requires grades. I don’t know how you grade what's an A occupational perspective versus a B occupational perspective. That doesn’t work.” Melissa shared, “So, what I really like to do is eliminate the grades and just have pass or fail for everything, because I find that focusing on a grade really interferes with the thinking about it [an occupational perspective].”
Participants recounted how they use assessments to get glimpses into students’ occupational perspectives. This may be by assessing students’ professional reasoning skills and application of an occupational therapy practice process, making inferences to decide if, how, and how effectively students are using their occupational perspectives. Meredith described her informal formative evaluation approach in the classroom as, “I go up to groups and… I’ll ask students to show me, to tell me, to explain. And again [I look for] if they can talk about it, if they can identify it.”
Participants noted that an occupational perspective cannot be observed like other concrete skills such as transfers or wheelchair seating assessment or directly measured. They must hear or read students’ use of occupation-based language and use this as evidence of application of an occupational perspective. Though participants described this uncertainty in knowing when a student had developed an occupational perspective, they noted that students themselves can often speak to the development of their occupational perspectives. They gave examples of students sharing stories about how they now view the world through their occupational perspective and how friends and family have noticed this perspective change in them. Yet, overall, participants stated that they cannot definitively say if students have developed an occupational perspective by graduation. Shelly said: Does that mean we have been successful though in helping students fully develop an occupational perspective? I don’t know. Because I wonder if you can kind of do all the tick boxes, play by the rules, and not fully take it on. I think that's a tough one, I’m not sure. We’d like to think that everybody drinks the Kool Aid by the time we’re done, but I don’t know.
Teaching and evaluating an occupational perspective in Canadian entry-level master of occupational therapy programs involves the intentional and reflexive pedagogical application of educator occupational perspectives and is an ongoing and iterative process that can extend beyond graduation. Further, it requires innovation in teaching and learning, through embracing a community of educators that extends to those beyond traditional educator roles, the valuing and nurturing of critical appraisal and critical reflexivity skills, and consideration of how an occupational perspective perhaps evades traditional assessment methods.
Discussion
Teaching an Occupational Perspective
Given the complexity of occupation, it is important for students to gain a foundational understanding of occupation early (Aldrich et al., 2022; Miller & Roberts, 2020; Price et al., 2017; Yerxa, 1998). This seems to be similar in Canada, as participants taught students of occupational therapy's culture, values, and philosophy early in the curriculum. As students learn and apply their occupational perspectives, teaching and learning activities are designed for students to articulate their reasoning, integrating occupation-based language previously learned, which reinforces their occupational perspectives. The critical value of understanding occupation was highlighted by Cho et al. (2023): “participants described strengthening their own understanding of occupational theory and frameworks as a key aspect of reinforcing their ability to better describe occupation” (p.8) and use it in practice. Building on this, Aldrich et al. (2022) highlighted the value of supporting students’ nascent occupational perspectives early on in their education as a means of facilitating responsiveness to intersecting health and social problems. This study highlighted how educators use their own occupational perspectives pedagogically to foster this responsiveness.
Participants were clear that an occupational perspective is ever evolving. Indeed, recent graduates in Canada described the development of an occupational perspective as an on-going process that takes time and continues beyond graduation (Cho et al., 2023). Having a flexible and contextually nuanced occupational perspective that occupational therapists are comfortable articulating can help navigate the tensions of transitioning to practice (Cho et al., 2023). This resonates with participants’ calls for teaching critical reflection and reflexivity to help students in their ability to critically reflect and self-assess their occupational perspectives over time.
Educational Theory
Participants described, either explicitly or implicitly, the use of several educational concepts and theories: transformative learning theory, social constructivist learning theory, and critical pedagogy. Transformative learning theory was referenced as a common learning theory used across Canadian entry-level master of occupational therapy programs. It describes how students’ personal identities are transformed through active engagement in education, leading to changes in their attitudes, beliefs, and values (Maiese, 2017). It calls on educators to immerse students in educational experiences that challenge their worldviews (Mezirow, 2000). Participants described this when they spoke of how critical fieldwork education is to students’ occupational perspectives. This study found that this transformation occurs within variable time frames, and often there is oscillation between states of learning an occupational perpective, including temporary regression to an earlier status (Maiese, 2017).
Further, participants described the importance of a learning community (Minkler, 2002), where faculty, preceptors, clients, students, peers, and family and friends contributed to students' learning of an occupational perspective. This is in line with social constructivist learning theory, which affirms that “all knowledge is socially constructed” (Davis & Sumara, 2002, p. 411). Participants drew on this learning theory when they actively engaged students in reflection, critical thinking, and reflexivity, which challenge students to think differently by breaking up existing patterns of thought (Davis & Sumara, 2002).
Lastly, participants were applying critical pedagogy when they spoke of the need for students to question current conceptualizations of occupation, critically explore contextual influences that shape one's occupational perspective, and question whom current conceptualizations of occupation benefit and make visible. Critical pedagogy is an approach that names education as innately political and calls on educators to facilitate learning that leads to emancipation from oppressive powers (Freire, 2000). Through its most humble applications, critical pedagogy calls on students to question and challenge the status quo, to make power visible. Critical pedagogy serves students well in promoting occupational participation within an unstable and changing geopolitical landscape (Aldrich et al., 2022).
Evaluating an Occupational Perspective
A particularly novel finding of this study was that given the fluid, evolving, communal, and critical aspects of learning an occupational perspective, participants underscored that a single point of evaluation and traditional methods of evaluation may not be effective. Educators must think outside the confines of traditional assessment methods. Engaging the teaching community identified in theme 3 offers an approach that may explore the holistic nature of an occupational perspective; engaging students, their peers, clients, and others, in addition to faculty and preceptors, in evaluating students’ learning of an occupational perspective may hold promise. Peer assessment of learning has robust research to support its efficacy (Double et al., 2020), as does the emerging approach of students as partners, where students take an equitable and active role in developing student learning and assessment (Mercer-Mapstone et al., 2017). Further, a summative approach such as student learning portfolios (Lai-Yeung, 2011) can offer an assessment approach that better captures the liminal, transformative, and evolving nature of an occupational perspective. A learning portfolio is also something new graduates can continue to engage with as their nascent occupational perspectives are challenged by the realities of practice (Cho et al., 2023). It is worth noting that in North America, occupational therapy university programs are shaped by neoliberalism (King & Cartney, 2023), where education becomes a transactional process, and university programs are increasingly publicly defunded (Harden, 2017). The resulting larger class sizes, relational distance between educators and students, and heavier workloads for both students and educators are certainly barriers to educators centering innovative, holistic, and relational approaches to assessment (Gravett & Winstone, 2022; Harden, 2017). Accordingly, occupational therapy educators may find value through intentionally fostering community to support resiliency and share knowledge and resources around assessment innovations. University centres for learning and teaching are often valuable resources for educational innovations and related community, support, and continuing education.
Limitations
While our study had representation from over half of the entry-level master of occupational therapy programs in Canada, hearing from a greater number of educators would further enhance our findings. Additionally, given budgetary constraints, we were unable to recruit Francophone educators and missed their valuable insights. Member-checking was also not completed, due to time constraints of the study, and thus participants did not contribute to shaping the findings.
Conclusion
This study built upon existing research on how occupation is taught and evaluated (Di Tommaso et al., 2019; Hooper et al., 2015; Hooper et al., 2020a, 2020b; Krishnagiri et al., 2017; Krishnagiri et al., 2019; Miller & Roberts, 2020; Price et al., 2017), by contributing a Canadian perspective. Educators should consider how to pedagogically apply their own occupational perspectives to model and normalize dynamic, responsive, and contextually relevant occupational perspectives. Clients, students, their peers, friends, and families, in addition to faculty and preceptors, all contribute to the transformative, social, and critical learning of an occupational perspective. Educators must innovate student assessment when evaluating an occupational perspective. Future research could explore how fieldwork shapes students’ occupational perspectives, from client, student, and preceptor perspectives. Lastly, a deeper exploration of specific educational theories, pedagogies and learning activities, and approaches to student assessment of learning, including a critical review of related artifacts, would serve to advance this research in Canada.
Key Messages
Teaching an occupational perspective is a communal endeavor. Educators, students, peers, friends, family, and clients are integral to learning an occupational perspective.
Critical appraisal and reflexivity are foundational skills that support the dynamic and evolving nature of an occupational perspective throughout students’ education.
Educators must be innovative in how they evaluate students’ occupational perspectives. Holistic, idiosyncratic, and innovative approaches to student assessment must be explored.
Footnotes
Acknowledgements
The authors would like to thank the participants who took time out of their demanding jobs to share their experiences with us. This study took place on the ancestral, traditional, and occupied lands of the xʷməθkʷəy̓əm (Musqueam) First Nation, to whom we are deeply grateful. We commit to the continued work of truth and reconciliation in what is now Canada.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
