How Occupation Is Taught and Assessed in Occupational Therapy Education: A Scoping Review

Abstract

Importance:

Because occupation is the core concept of the profession, it is imperative that students have deep knowledge of the various facets of occupation and how it serves as both therapeutic mode and objective for clients. Despite the importance, how occupation is taught and assessed is not well understood.

Objective:

To identify existing literature and gaps in professional dialogue surrounding how knowledge of the concept of occupation is taught and assessed.

Method:

The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guided this review.

Data Sources:

Electronic databases included PubMed/MEDLINE, Embase, Scopus, Web of Science, PsycINFO, and CINAHL.

Study Selection and Data Collection:

The study explored peer-reviewed publications from 1993 to 2023 and included articles that met the following criteria: occupational therapy or occupational science is represented; the concept of occupation is present; and teaching, learning, or assessment of occupation is described. Data extraction points included perspective of occupation evoked in teaching/learning, knowledge about occupation represented in teaching/learning, and instruction and assessment strategies represented.

Findings:

A total of 54 articles were included for final data extraction. Occupation as a way of seeing practice was the most common educational perspective, teaching of occupation as a concept unto itself and separate from practice was very prominent, and experiential learning was a frequently occurring instructional approach.

Conclusions and Relevance:

Educators need to deepen their knowledge about occupation and intentionally use authentic instructional approaches that foster student learning in transformative ways.

Plain-Language Summary

This review explored literature that describes or investigates how knowledge about the profession’s core concept of occupation is taught and assessed. The articles included for final review discussed multiple perspectives of occupation, recognized teaching of occupation as independent of therapy as the most common, identified experiential learning as the main teaching strategy, and noted that assessment of occupation was much less represented. Results of the review indicate a need for educators to be more knowledgeable about occupation and to create more authentic, transformative learning experiences to strengthen student knowledge about occupation.

This review explored literature that describes or investigates how knowledge about the profession’s core concept of occupation is taught and assessed.

Occupational therapy education is centered around the concept of occupation, the profession’s core subject (Hooper et al., 2015, Yerxa, 1998b) and the guiding principle of therapeutic intervention (Yerxa, 1998a). Although occupation has historically served as both a therapeutic means and an end in occupational therapy practice for over a century (Gray, 1998; Trombly, 1995), its role and presence in occupational therapy education curriculum design and delivery have been less studied. In her Eleanor Clarke Slagle Lecture, “Education as Engine,” Mitcham (2014) described the essential need for “learners to explicitly see, listen, and think about occupation through our professional filter” (p. 642). Despite its fundamental role in the profession, evidence of student learning about and knowledge of occupation from their professional education, as well as how teaching can promote deep learning (Asikainen & Gijbels, 2017) about occupation, remains understudied and unclear.

Fortune and Kennedy-Jones (2014) suggested that occupation in the context of its relationship to health and source of purpose is the threshold concept for the profession. Threshold concepts are critical for deep learning because they often generate cognitive dissonance and lead to significant and irreversible shifts in student perspectives about content and how to apply their knowledge in practice (Meyer & Land, 2003). Threshold concepts are therefore transformative, suggesting not only a cognitive shift but also a change in perspective. Interest in describing how transformative learning occurs has contributed to ongoing discourse about disciplinary threshold concepts such as occupation. Mezirow (2000) conceptualized transformative learning as a process of reflecting on prior understandings to construe new meaning and guide future actions. Transformative learning centers on change, particularly through a process of questioning existing frames of reference as a way of reevaluating one’s beliefs and biases (Van Schalkwyk et al., 2019). Transformation nudged by learning threshold concepts provides a potential framing for curriculum design and delivery that facilitates student knowledge of the intricate connections between occupation, health, and well-being.

Occupation is a deceptively complex and nuanced concept that can be difficult for students, educators, practitioners, and even scientists to understand and apply. Students are typically presumed to have sufficient understanding and mastery of the concept of occupation when they complete their professional education and embark on their careers as practitioners. That presumption, however, is not supported by evidence, and the literature exploring the topic is sparse. To date, only a few studies highlight the need for instructors to gain deeper knowledge of occupation and teach it as a concept unto itself, as well as explore how occupational therapy educators design and deliver an occupation-centered education, whether in the United States or elsewhere (Hooper, 2006; Hooper, Molineux, & Wood, 2020; Krishnagiri et al., 2019; Price et al., 2017). Mernar and Herzberger (2024) explored the Accreditation Council for Occupational Therapy Education (ACOTE^®) standards to identify the levels of learning complexity of occupation and found a trend of reduced number of standards at both lower and higher level cognitive skills. There is even less research available on what students truly comprehend about occupation and its use in practice (Di Tommaso et al., 2019; Roberts et al., 2022). Without knowing what students are truly grasping about occupation, educators are hampered in developing and delivering more effective teaching methods for this threshold concept. For students, possible implications include surface learning in which they do not experience the struggle, or desirable difficulty (Bjork & Bjork, 2011; Brown et al., 2014), inherent in making sense of complex ideas that allow for connection and integration. Desirable difficulty refers to conditions of instruction that create challenges for learners but actually enhance long-term retention and transfer of knowledge (Bjork & Bjork, 2011). An incomplete understanding of the various ways occupation and its many facets influence health and well-being can result in limited professional reasoning, incongruent treatment planning, and use of activities that are unconnected to the purpose, meaning, and identities of clients. In other words, if a student cannot coherently pull together the many disparate concepts related to an individual’s doing and being within their context into a whole picture, their ability to accurately and cohesively create a potent intervention as an autonomous professional is diminished (Hooper et al., 2014; Mernar & Herzberger, 2024). More important, the possible consequences of this lack of knowledge extend downstream beyond the learner to the consumer of our services. Hooper et al. (2014) asserted that when students are not clearly versed on the core concept of their profession, the formation of their professional identity can be impaired, and advocacy on behalf of their profession to policymakers, payers, and consumers may be flawed or absent.

Given the historic lack of study of occupation in occupational therapy curriculum design and delivery, Hooper and colleagues (Hooper et al., 2018; Krishnagiri et al., 2017, 2019; Price et al., 2017, 2021; Taff et al., 2018) conducted the first comprehensive national study of how occupation is addressed in occupational therapy education. This work prompted us to ask what students know about occupation, how occupation is taught, and how knowledge of occupation is assessed. To fully engage those questions, we determined the need to explore literature from the past 30 years to identify what has been published on student learning and knowledge about occupation. A scoping review method (Arksey & O’Malley, 2005) was selected because of its utility in both summarizing research findings and identifying gaps in the evidence base as a necessary first step to inform our design of an empirical education research study.

Method

We conducted a preliminary search of MEDLINE, the Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis and identified no current or ongoing systematic reviews or scoping reviews on the topic. The methodological framework suggested by Arksey and O’Malley (2005) guided the five stages of this scoping review: (1) identifying the research question; (2) identifying relevant studies/articles; (3) selecting studies/articles; (4) charting the data; and (5) collating, summarizing, and reporting the results.

Identifying the Research Question

The question for this scoping review was as follows: For the population of occupational therapy students and educators, how is the core professional concept of occupation taught and assessed in the context of higher education and research in English-language occupational therapy programs?

Identifying Relevant Studies and Articles

The standards and guidelines for conducting and reporting scoping reviews set forth by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR; Tricco et al., 2018), the JBI Scoping Review Network (Peters et al., 2022), and the STORIES approach (Gordon & Gibbs, 2014) guided the creation of the search strategies and process criteria for the review. This study explored English-language peer-reviewed publications from 1993 to 2023. The rationale for the date range was influenced by the emergence of occupational science in the early 1990s as a distinct discipline focused on the features and complexities of the concept of occupation in theory and practice (Pierce, 2001, 2014; Yerxa, 1990). A research librarian developed and executed the search strategy.

The literature was searched using the controlled vocabulary of each database, and plain language was used to create a search strategy for the terms concept formation, curriculum, learning, adult learning, implicit learning, incidental learning, intentional learning, self-regulated learning, student learning outcomes, occupational therapy, occupational science, and the wildcard term concept. These strategies were executed in PubMed/MEDLINE, Elsevier Embase, Scopus, Web of Science, PsycINFO, and CINAHL databases. The same search string was used across all databases, tailored to each database’s structure and controlled vocabulary or keyword system. Scopus and Web of Science are keyword-based databases, whereas PubMed, Embase, CINAHL, and PsycINFO use their own controlled vocabularies or indexing terms to describe concepts in the search strategy. Therefore, indexing terms were applied for the same concepts in each database, based on its specific controlled language. In addition, the entire content of these databases was searched, not just titles and abstracts. The research librarian used the duplicate finder in EndNote, and 10,683 duplicates were assumed to be accurately identified and removed, for a total of 13,859 unique citations. An additional 616 duplicates were identified by Covidence, resulting in a total of 13,243 articles retrieved.

Selecting Studies and Articles

The titles and abstracts of the 13,243 articles were entered into the Covidence systematic review management system (Veritas Health Innovation, Melbourne, Victoria, Australia). Initial screening of the titles and abstracts was completed by using the following inclusion criteria: (1) must include occupational therapy and/or occupational science, (2) the concept of occupation was present, and (3) at least two of the following were present: teaching, learning, threshold concepts, assessment, or assessing learning. We excluded clinical trials, basic science research, theses/dissertations, book chapters, conference abstracts, and policy statements. Although book chapters undergo an editorial process that provides feedback, that process is not equivalent to the peer review required for refereed journals. Clinical trials were excluded because they rarely evoke education-focused theoretical or philosophical considerations in study design, measurement, implementation, or interpretation (Colquhoun et al., 2013).

The initial screening resulted in 212 articles included for full-text review. Each article was reviewed by at least two members of the review team, with conflicts resolved through a third review. Full-text review resulted in a total of 54 articles included for data extraction. A hand search of the reference lists of five randomly selected articles was performed, with no additional relevant articles identified (Arksey & O’Malley, 2005).

Charting the Data

A data extraction tool based on the research question was developed and piloted by using five randomly selected articles. Each member of the review team independently coded the five articles using the extraction tool, followed by a group discussion in which intercoder agreement was established and minor revisions were made to the tool for final extractions. The 54 articles were divided up among the review team and coded by using the revised extraction tool. Data points extracted included journal title, year of publication, article type (research, editorial, etc.), whether teaching/assessment of occupation was present, educational context (curriculum, instructional strategies, assessment of learning), perspective of occupation evoked in teaching/learning (way of seeing self, way of seeing others, way of seeing the profession, way of seeing academic content, way of seeing practice; Price et al., 2017), student knowledge about occupation represented in teaching/learning (occupation as synonymous with other concepts, occupation as implicit and coupled with therapy, occupation as explicit and coupled with therapy, occupation as explicit and independent from therapy, and challenges to learning occupation; Krishnagiri et al., 2017), and foundational professional context for teaching/learning (occupational therapy, occupational science, both, or other). Findings from Price et al. (2017), Krishnagiri et al. (2017), and other studies of occupation in occupational therapy education informed the design of our scoping review data extraction tool and the application of findings from the scoping review to design an empirical study that builds on previous education research on teaching and learning occupation.

Collating, Summarizing, and Reporting the Results

The database search yielded 13,243 publications after duplicate removal. Title and abstract screening narrowed the pool to 212 publications. Full-text review resulted in 54 publications included for data extraction. See Figure 1 for a PRISMA-ScR flow diagram that illustrates the publication selection steps.

Figure 1.

Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow of articles through the study.

Data from the extraction forms were collated onto a centralized form, with instances of each of the data points summarized and frequencies calculated. A basic content analysis approach (Elo & Kyngäs, 2008; Hsieh & Shannon, 2005) was used to discern emergent themes or ideas. Results of the data extraction synthesis are presented descriptively and organized into categories of analysis. Summaries of included studies can be found in Table A.1 in the Supplemental Material (available online with this article at https://research.aota.org/ajot).

Journals Represented

The included articles were published in various peer-reviewed journals, with the American Journal of Occupational Therapy (n = 12, 22%), Journal of Occupational Science (n = 8, 15%), and Occupational Therapy in Healthcare (n = 7, 13%) being the most prominent. Four (7%) of the articles were published in journals not specifically focused on occupational therapy or occupational science, such as the Journal of Experiential Education and Action Learning: Research and Practice.

Year of Publication

The included articles ranged in publication date from 1996 to 2023, with consistent topic representation over that period (only 1997, 1999, 2002, and 2012 lacked a publication). Although many of the articles (n = 34) were published before 2017 when the first articles from the one large-scale study were published, over half (n = 28, 52%) of the articles were published in the time range of 2015 to 2021.

Article Type

Most (n = 31; 57%) of the included articles described various types of research studies. Qualitative methodologies were most common (n = 16), followed by quantitative methods (including surveys and descriptive studies; n = 11) and mixed methods (n = 2). Other article types included theoretical/philosophical discussions (n = 6), editorial/position papers (n = 3), curriculum review/analysis (n = 3), curriculum development (n = 3), and systematic review, program development, program evaluation, teaching innovation, educational framework, evaluation report, case study, and an Eleanor Clarke Slagle lecture, all with one mention each.

Presence of Teaching/Assessing Occupation

Eighty percent (n = 43) of the included articles were focused on instruction or assessment of student learning about occupation. The remaining 20% (n = 11) focused on teaching and learning methods for practice, framing occupation as purposeful activity, curriculum design, or how certain instructional strategies were used more broadly in education without specific links to or discussion of occupation.

Perspective of Occupation Evoked in Teaching and Learning

Perspectives of occupation evoked in the articles were relatively equivalent across the five different categories; however, most articles elicited more than one perspective. Occupation as a way of seeing practice (n = 31) was the most common, with occupation as a way of seeing others (n = 29), as a way of seeing the profession (n = 28), as a way of seeing academic content (n = 23), and as a way of seeing self (n = 20) also represented.

Occupation as Represented in Teaching and Learning

Instruction about occupation as a concept unto itself in an explicit manner and independent from therapy (n = 23) was the most represented, followed by explicit and coupled with therapy (n = 19), implicit and coupled with therapy (n = 15), and synonymous with other concepts such as purposeful activity (n = 12). Student knowledge about occupation was not specified in 13 articles, and challenges to learning occupation were only mentioned in 5 articles.

Methods for Instruction and Assessment of Occupation

A wide variety of instructional methods were evoked, often in combination, including experiential/fieldwork (n = 24), reflection and self-directed learning activities (n = 24), discussion-based instruction (n = 19), learning in groups (n = 16), readings/flipped classroom approaches (n = 14), and lecture-based instruction (n = 10). Theory-informed pedagogies (n = 16) such as transformational learning, situated learning, adult learning, constructivism, experiential learning theory, sociocultural learning theory (Vygotsky), and cultural responsiveness were also present. Elements of occupational therapy–focused practice models (e.g., Model of Human Occupation, Occupational Therapy Intervention Process Model, Cognitive Orientation to daily Occupational Performance) and skills (task analysis) were also used as instructional aids.

Assessment of student learning related to occupation was discussed less frequently in comparison with instructional methods, with summative assessment (exams, quizzes; n = 14), journaling/reflection (n = 12), projects (n = 11), presentations (n =10), and papers/essays (n = 7) all represented. Additional assessment methods included peer assessment (n = 1), a questionnaire (n = 1), and discussion-based observation (n = 1).

Foundational Professional Context for Teaching and Learning

Both occupational science and occupational therapy were the professional teaching/learning context for 52% (n = 28) of the articles. Occupational therapy alone was the context for 39% (n = 21) of the articles, and occupational science was the sole context for 9% (n = 5).

Discussion

The results of this scoping review showed a consistent presence of articles on teaching occupation over the course of approximately 27 years of literature. However, of the total articles assessed for data extraction (N = 54), 52% of those were published in the past 8 years (i.e., 2015–2023), suggesting an increased focus on studying teaching and learning occupation that may coincide with several broader professional focuses on education and education research. Yet in the final set of articles examined in this scoping review, most articles described a singular curricular innovation or described findings from a small-scale scholarship of a teaching and learning project that used a convenience sample from the researcher’s own educational program. However, several articles included in this scoping review of how the concept of occupation is taught and assessed shared findings from the one large-scale study on how occupation is taught in occupational therapy education programs in the United States (Hooper et al., 2018; Krishnagiri et al., 2017, 2019; Price et al., 2017, 2021). An increase in publications in occupational therapy education research studying teaching occupation and the emergence of research using a national sampling frame may reflect an evolution of research in occupational therapy education and occupational science. Both the Society for the Study of Occupation: USA and the American Occupational Therapy Association (AOTA) have offered new professional development events focused on education in recent years, and in 2017 the Journal of Occupational Therapy Education began publication. Furthermore, to meet the increased demand for occupational therapists, there has been a proliferation of professional education programs in the United States (ACOTE, n.d.) and abroad (World Federation of Occupational Therapists, n.d.) requiring trained and qualified educators. The requirement to meet educational standards with a shortage of adequately trained faculty because of the larger numbers of programs is one factor that led to the profession wanting to self-examine what we are teaching, how we are teaching it, and what students know and can apply, to provide professional development for instructors. Concomitantly, there has been an increase in the number of PhD (doctor of philosophy) programs in occupational therapy and occupational science producing trained researchers, and some faculty earning doctorates in other fields. According to the data collected by ACOTE annually (K. Brown, personal communication, September 19, 2025), there have been significant increases in recent years in the number of faculty reporting earned PhD, EdD (doctor of education), DSc (doctor of science), or DHSc (doctor of health science) degrees. The profession’s goal to improve the quality of professional education by training the educators on teaching and learning practices and the increased number of trained researchers set the stage for an increased focus on education research. Given that occupation is the core subject of occupational therapy, it is reasonable that there is empirically based research being published.

Article Type

Results of this scoping review showed that knowledge of teaching and learning occupation is disseminated through a range of article types. This may reflect the continuum from scholarly teaching to scholarship of teaching and learning to education research. The qualitative methods used in much of the research, along with surveys and descriptive studies, are appropriate to where occupational therapy is with regard to knowledge development on this topic. That is, descriptive research to identify and name basic concepts, constructs, and relationships is the first step in knowledge generation (Polit & Beck, 2021). Similarly, initial theoretical and philosophical papers, position papers, and work on global curricular issues are apt at this stage of knowledge development.

Perspective of Occupation Evoked in Teaching and Learning

Most articles elicited more than one perspective of occupation; occupation as a way of seeing practice was the most common in these publications. This makes sense because occupation is the central concept for framing occupational therapy practice and therefore occupational therapy education. Given that occupation is central to the profession of occupational therapy and is considered a threshold concept, as noted earlier, it is not surprising that all five ways of seeing occupation were evoked in these articles on teaching and learning. The use of occupation as a lens to view self and others, as well as to understand academic content, the profession, and practice, was present in the reviewed articles. This may reflect an emergence of a taxonomy to describe and label ways of seeing occupation in educational processes.

Occupation as Represented in Teaching and Learning

In this scoping review, many articles focused on teaching occupation as a concept apart from practice compared with application of occupation in practice. This finding makes sense given the current state of development in occupational therapy scholarship. That is, educational scholars need to first understand what is being taught and what students understand about the concept prior to studying how particular levels of understanding relate to application in practice. Based on the principles of occupational therapy and the extensive writings on occupation, from Yerxa (1998b), Wilcock (2007), Dickie (2010), Pierce (2001), and many others, it makes sense that teaching a student to fully understand the occupational perspective of self and others as occupational beings is a prerequisite to truly grasping occupation as a way of seeing practice. Price et al. (2017) recommended that educators teach occupation as a complex, multidimensional, contextually situated concept unto itself, both separate from and as applied in occupational therapy in practice.

Another possible explanation for the finding is the increased knowledge of teaching and learning approaches on the part of occupational therapy educators. For example, as previously mentioned, AOTA has increased professional development offerings focused on education and held its first Education Summit in 2015 in Denver, Colorado, creating a venue for occupational therapy educators, researchers, and practitioners to disseminate education-focused scholarship. It is possible that the result from this scoping review of an increase in publications since 2015 reflects a broader professional focus on education research through venues such as AOTA’s Education Summit that may have bolstered dissemination.

It is also possible that instructors are more consistently scaffolding the concept so that students more deeply grasp the concept of occupation first and then learn to apply it. This last possibility, however, cannot be confidently concluded, because most articles that described assignments did not always identify where in the curriculum occupation was taught.

The finding that much of the research evoked the teaching of occupation apart from practice could also reflect an evolution in levels of faculty knowledge about occupation as a complex concept unto itself. That is, faculty are attending more deeply to the concept and the occupational nature of humans, which then enables them to make a more explicit translation of the concept for instruction. This may reflect the development of pedagogical content knowledge (Zepke, 2013), with better delivery of occupation-related content with more explicit instructional methods. The findings may also indicate an evolution in instruction in framing occupation as a threshold concept. Threshold concepts may hold a degree of transformative power alone, but they need to be supported by instruction and assessment that prompt the dissonance and experiential reflection inherent to deep learning (Nicola-Richmond et al., 2019).

Instruction and Assessment of Occupation

Relatively few articles specifically examined the challenges and complexity of teaching occupation. That said, various instructional methods used to teach occupation were identified in the reviewed articles. Many were focused on experiential learning, including fieldwork experiences; reflection and self-directed learning were also prominent. The theory-informed pedagogies identified within the articles were reflective of multiple occupational therapy conceptual models as well as a wide variety of educational theories, a finding consistent with Hooper et al. (2018). In addition, the instructional methods illustrated were consistent with adult learning principles and theories, such as experiential and transformative learning. Given the nature of a practice profession, the identified instructional methods were reflective of and appropriate to the type of content typically found in professional curricula, but they also indicated a need for educators to add more direct or modeled instruction on occupation and provide a stronger foundation before moving to the more applied aspects. With respect to the methods of teaching occupation, very few disorienting dilemmas (DeAngelis, 2022) were named as a method. Disorienting dilemmas, the foundational first step in the transformative learning process, are unsettling experiences that contradict existing assumptions and prompt learners to reflect and reframe their worldview (Mezirow, 2000). Given the more traditional methods described in multiple articles, the question arises on whether there is enough desirable difficulty (Bjork & Bjork, 2011; Brown et al., 2014) encountered by students as they learn about occupation. Examples of desirable difficulty include spacing instructional events, varying the types of learning activities, interleaving (instead of blocked) practice/application, and providing intermittent feedback.

Fewer articles examined assessment of student learning of occupation in comparison with describing instructional methods that teach occupation. In this scoping review, research on what level of knowledge students have regarding occupation, whether deep or more superficial, was not evident. A general lack of depth and breadth in assessment of student knowledge of occupation was evident. Of the few assessments referred to in these articles, most were typically journaling/reflection or projects (occupational analysis of film, books, or photos; generating a poster from occupational interviews of three people; presentation of an iteratively developed group definition of occupation). Of the assessments mentioned, 14 can be considered summative and 11 formative. These findings are consistent with that of Price et al. (2021), which showed that when assessment was present in the artifacts gathered, knowledge of occupation was mostly coupled with and often subsumed by practice knowledge, with little explicit assessment of student knowledge of occupation itself. They found that student knowledge of occupation was not assessed as its own learning outcome and that assignments used fewer direct and more indirect approaches, and the assessments that were present varied greatly in their consistency with established criteria of robust assessments.

Because of the nature of the search strategy used and the inclusion criteria in this scoping review, detailed specifics (e.g., grading rubrics, assignment instructions) regarding how explicitly student knowledge of occupation was assessed versus subsumed by other concepts were not identified. This is also reflective of a gap in the state of the literature and therefore an opportunity for future research. One reason this type of information on assessments was not found may be that the focus on assessment is typically more on application of occupation, and faculty take the students’ understanding of the concept for granted. Concomitant with this, the development of scholarship on assessment is still nascent in occupational therapy education. Another more pragmatic reason may be limitations in journal article length. It may also be that the focus on just teaching was extensive, and adding details on assessments was not feasible. On the other hand, based on the findings by Price et al. (2021) across 25 programs, it may be that both researchers and instructors have not focused on assessment strategies that explicitly measure student knowledge of occupation.

Limitations

This review was limited by the parameters of the search focusing on electronic databases and peer-reviewed literature and including only articles published in English (one of the exclusion criteria). We recognize that there may be an emerging body of non-English literature on the intersection of occupation and occupational therapy professional education that was not included. We did not pursue translations of articles published in other languages because of the complexity of those searches (the definition of occupation and its role in practice is not agreed upon universally), spotty availability within the English-focused databases used, and uncertain accuracy in translation. The study was limited to the past 30 years, which may have prevented a more complete illustration of trends and patterns preceding the emergence of occupational science. In addition, the focus of this scoping review was on teaching and learning approaches related to occupation, and therefore articles describing larger influences on curriculum and course design, such as the ACOTE standards, may not have met inclusion criteria. Finally, we acknowledge that, while unlikely, the combination of the complexity of inclusion criteria, inconsistent use or definition of occupation in the literature, and unclear connections to professional practice, research, or education could have resulted in pertinent articles being unduly excluded.

Future Research

The information gathered from this scoping review provides the foundation (i.e., what questions to ask) for a comprehensive follow-up study examining the level and complexity of knowledge that students construct regarding occupation. That is, we hope to appraise what and how to ask about the learning activities and experiences that are relevant to students’ knowledge of this concept and to triangulate this information with artifacts garnered from participating programs. In recent years, some programs have begun to use subject-centered integrated learning principles to guide their curricular revisions and innovations. This means there is an intentional effort by the program to place occupation at the center of all teaching and learning activities in a curriculum. To understand the impact of this type of consistent teaching and connecting of concepts and the development of a community of learners who understand the centrality of occupation to health requires systematic study. Furthermore, a detailed comparison of learning outcomes from programs based on these subject-centered principles versus curricula designed around more traditional approaches, such as the developmental approach, could illuminate what teaching and learning practices are most beneficial for professional students in developing their occupational lens. Therefore, occupational therapy educators need to conduct and disseminate scholarship of teaching and learning (SoTL) studies that describe subject-centered integrated learning approaches as well as other approaches and their related learning outcomes. In addition, there may be an opportunity for scholarly teaching projects and SoTL studies comparing what students know about occupation and how student knowledge of occupation is assessed when accreditation standards guide curriculum design instead of subject-centered learning outcomes (Mernar & Herzberger, 2024).

Implications for Occupational Therapy Education

The results of this scoping review highlight gaps and disparities in how occupational therapy programs understand, represent, and integrate occupation in curricular content, instructional methods, and learner assessment. Some important implications for occupational therapy education include the following:

Professional education has only scratched the surface of how occupation serves as a transformative facilitator for learning and being as a developing professional. Therefore, more research is needed in diverse teaching and learning contexts.

Although educators must develop a larger repertoire of occupation-centered teaching methods, gaps in assessment of learner knowledge, application, and personal transformation present an even larger opportunity.

Conclusion

Occupation is the professional filter for occupational therapy and occupational science. As such, occupational therapy education programs must design and deliver curricula with occupation as the core subject and support educators in deepening their understanding of occupation as a concept unto itself. Learning experiences and assessments that make occupation explicit as the threshold concept of our profession are necessary to transform students’ knowledge, skills, and attitudes in enduring ways that better meet societies’ occupational needs. The implications of this transformative learning are far-reaching, from an impact on curricular design and delivery in all occupational therapy professional education programs to better and more effective teaching for the students of this education, and it is hoped, more effective occupation-based interventions for clients of occupational therapy. For occupational therapy education to meet these opportunities of transformative learning, our profession’s education research must mature and examine what student learners know about occupation and ultimately how this knowledge translates to better outcomes for recipients of occupational therapy services.