Teaching and Learning Forum 2000 [ Proceedings Contents ] Creating opportunities for growth and change for the student, practitioner and academic Adina Quattrini and Ruth Marquis School of Occupational Therapy Curtin University of Technology This paper will describe the development, delivery and evaluation of a unit within the undergraduate curriculum in the School of Occupational Therapy that demonstrates academic leadership. The unit titled Gerontology 244 was developed in collaboration with representatives from practice, fieldwork coordinators and academics. This collaborative process has helped establish a collegial relationship that maximises student learning and enhances professional development of the supervising practitioner. Evaluation of the programme indicates that this process facilitates and maintains dialogue between the academic and practitioner. Students develop the potential to be change agents that can influence the development and quality of services for older persons. The unit is designed to motivate students to value studies in gerontology and integrate academic learning with parallel fieldwork experiences in an aged care service. The unit lays down guiding values and principles for practice and is designed to challenge assumptions and stereotypes surrounding ageing through guided examination of empirical and phenomenological literature and participation in experiential learning sessions. Consciousness is raised through the exploration of ethical dilemmas for current and future practice. Fieldwork and university activities combine to encourage students to reflect both personally and professionally and create the environment for students to have the ability to positively influence the lives of older persons.

Introduction

Social and economic resources available to older adults are directly related to the value attributed to them by the public. As demands for funding of services to this group are likely to significantly increase over the next three decades, older adults with physical and cognitive impairments may be vulnerable to reduced service quality due to the increasing demands made on the welfare dollar by the provision of humanitarian care. Methods used for determining benefits such as, clinical outcomes, cost benefit analysis and cost-effectiveness, may discriminate against older people. Discriminatory practices and attitudes may permeate almost every aspect of the lives of older people as the young and old are locked in fierce competition for public funds.

Gerontology 244, a unit in the fourth semester of the Occupational Therapy undergraduate degree at Curtin University of Technology, presents older adults as valued and contributing members of society and promotes Occupational Therapists as change agents and advocates for the rights of older adults. The unit has an "ideal" focus and challenges students towards influencing the development of services by presenting innovative solutions towards meeting current and future needs for this population of health and human service users.

Setting expectations for older adults which acknowledges their potential for personal development and societal contribution is embedded in occupational therapy ethics and remains highly conscious throughout the teaching/learning process. Students are encouraged to take a critical approach in discussing the 'ideal' and the 'actuality' of service related issues and develop a vision for future good practice.

Unit development and design

Assumptions and stereotypes surrounding the process of ageing are challenged and students are guided through the examination of relevant empirical and phenomenological research literature.

The unit has been developed in collaboration with Occupational Therapy practitioners, students, fieldwork coordinators and academics. This collaborative process establishes a link between the academic and practitioner which enables the unit to remain dynamic and responsive to the changing needs of the practice areas.

Unit structure

A series of interactive lectures are designed to stimulate discussion, challenge stereotypical attitudes towards older adults and critique current service models and practice. In addition, they provide a strong foundation of knowledge on the diverse biological, psychological, physical and social changes experienced in the normal and abnormal ageing process

Tutorials are both experiential and self directed. Students work in groups and choose from a selection of topics and issues relevant to current practice and social issues influencing practice. The tutorial is divided into two parts. Part one is designed to provide information and rationale for therapeutic interventions and part two is developed around the debate of a related ethical issue e.g. euthanasia, the use of restraints, elder abuse, driving and ageing, sexuality. Students are encouraged to research and critique current therapeutic interventions on the basis of informed consent, autonomy and evidence based research. Students leading tutorials provide readings, information packages/handouts and references for their peers as part of their assessment. Tutorials also provide a platform for discussion of problems encountered in fieldwork and students are encouraged to bring fieldwork issues into discussion and share these with the group.

The fieldwork practicum offers students opportunities to integrate theory with practice and apply theory and skills learned in the academic context to real life situations. The semester programme consists of two days of fieldwork preparation held in the first two weeks of semester, followed by twelve weeks of fieldwork experience comprising of one day per week in a residential facility. The integration of the fieldwork practicum in the academic programme enables ongoing communication between the practitioner and academic. This is further enhanced through Curtin regional fieldwork coordinators who coordinate and support student clinical placements.

A comprehensive fieldwork manual has been developed which sets out a range of clinical experiences relevant to gerontology practice. The manual's range of activities act as a stimulus for students to share their theoretical knowledge with their fieldwork supervisors and discuss their reflections on the interface of theory/practice. Students are also encouraged to maintain a reflective journal throughout the four years of the course

Student assessment

Tutorial presentations are worth fifty percent of the assessment and are undertaken in groups of two or three students. A combination of peer and tutor review of the presentation and resources provided comprises the mark for this area of assessment.

The fieldwork assessment involves a major assignment which is designed to raise consciousness on the effects of institutionalisation. Students compare and contrast the living environment of and older person living in the community with that of an older person in an aged care facility in terms of safety issues in the physical environment using a comprehensive assessment schedule. Narrative data is also collected on occupations, relationships and objects of meaning and future life expectations from the perspectives of interviewees. Comparison is then made based on quality of life literature.

Unit evaluation

An end of semester evaluation has been designed to provide information for future unit development. A combination of quantitative and qualitative data obtained from students, academic tutors, regional fieldwork coordinators and occupational therapy practitioners provide another data source. A university wide evaluation is also administered, namely the Student Evaluation of Educational Quality (SEEQ).

Discussing the results of the unit evaluation surveys and reports provides an ongoing commitment of continuos improvement as well as a means of acknowledging the positive outcomes that have been achieved. This makes visible the growth and change that is occurring for all those participating in the programme.

Student outcomes

• Students value the reality-based integration of theory and fieldwork on a weekly basis. They are able to observe and judge situations and discuss their experiences in tutorials.

  
  A lot of the theory discussed was evidenced during the fieldwork experience

  Every week at fieldwork I noticed something we had discussed the week before

  Very good to have learning backed continuously be experience-the best way to learn

• Other units taught in second year also benefit. Observation of clinical conditions and their effects on function enhance the integration of materials taught in clinical medicine and anatomy and kinesiology.

• The unit raises awareness of cultural, social and environmental influences on quality of life experiences.

• Students begin to develop personal beliefs regarding practice philosophies and ethical issues related to clinical reasoning.

• Semi structured interviews conducted with fieldwork coordinators indicate that overall students display contrasting characteristics to previous students who had completed the fieldwork placements.

• Students are more comfortable with less direct supervision by the occupational therapist.

  
  Much more enquiring than other students in 3rd or 4th year where they tend to follow the therapist.

• Students challenge therapists by initiating discussion on discrepancies between their theory and practice.

  
  They are more enquiring, display a more critical approach to their experience, question what they see.

• The parallel fieldwork/theory experience encourages reflective practice. The unit's activities are designed to be experiential; reality based and foster deep learning.

• Students relate to residents and staff in the setting with a strong awareness of ethical behaviour, in particular the issue of dignity for older people.

Summary

The unit is structured so that all stakeholders can have a participative role in the review and ongoing development of the unit in terms of teaching and learning processes. Hence, it is dynamic and responsive to the issues and needs raised by the student, practitioner, and academic.

Academic leadership is about learning that is not only directed towards meeting current situational contexts but needs to be visionary towards continuous improvement. Students are encouraged to have a vision, not only for the development of the profession, but also for the contribution they can make towards building a socially inclusive and healthy community. Kummerow (1999) calls this an 'ethical vision, that is, ideas of how the world should be and how our work contributes to improving the world, energises teaching and learning'.

The course promotes the development of life long learners and reflective practitioners through the use of learning portfolios and self directed learning across the four years of the course. The reflective journal is one way that students can reflect on action (Schon, 1983). The journal can be used to explore issues triggered by critical incidents during clinical practice, to reflect on their actions and decisions and consequences facilitates a greater understanding of themselves. The journal also is a record of personal development and developing personal philosophies for practice.

References

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Kummerow, M. (1999). Ethical vision in teaching and research. In K. Martin, N. Stanley and N. Davison (Eds), Teaching in the Disciplines/ Learning in Context, 205-209. Proceedings of the 8th Annual Teaching Learning Forum, The University of Western Australia, February 1999. Perth: UWA. http://cleo.murdoch.edu.au/asu/pubs/tlf/tlf99/km/kummerow.html

Missiuna, C., Polatajko, H., & Ernest-Conibear, M.E. (1992). Skill acquisition during fieldwork placements in occupational therapy. Canadian Journal of Occupational Therapy, 59(1), 28-39.

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Commonwealth Department of Health and Aged Care (1999). Background Paper on the National Strategy for an Ageing Australia. http://www.health.gov.au/acc/nsaa/bkground.htm

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