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Research Article  |   March 2014
Comparison of Occupational Therapy Students’ Perceived Skills After Traditional and Nontraditional Fieldwork
Author Affiliations
  • Sarah Gat, OT, MA, is Community Fieldwork Coordinator, Department of Occupational Therapy, School of Health Professions, Tel Aviv University, Tel Aviv 69978 Israel; gatsarah@gmail.com
  • Navah Z. Ratzon, Prof. OT, is Associate Professor, Department of Occupational Therapy, School of Health Professions, Tel Aviv University, Tel Aviv, Israel
Article Information
Education of OTs and OTAs / Education
Research Article   |   March 2014
Comparison of Occupational Therapy Students’ Perceived Skills After Traditional and Nontraditional Fieldwork
American Journal of Occupational Therapy, March/April 2014, Vol. 68, e47-e54. doi:10.5014/ajot.2014.007732
American Journal of Occupational Therapy, March/April 2014, Vol. 68, e47-e54. doi:10.5014/ajot.2014.007732
Abstract

We studied students’ perceptions regarding their professional and personal skills and compared the findings for those who completed community fieldwork (CF) with those completing traditional fieldwork (TF). We also compared the perceptions of CF students whose placement settings had an active occupational therapist present versus those whose settings did not. Results showed no significant differences in perceptions of professional and personal skills between the students involved in CF and those involved in TF. However, students who completed CF in a setting without an active occupational therapist present scored significantly higher in their perception of their personal responsibility, cultural competence, and overall personal skills than students whose fieldwork location had an active occupational therapist present. Our study indicates the value of using various supervisory strategies for occupational therapy students during fieldwork. Further studies are warranted.

Clinical education has long been recognized as a critical component of student learning in occupational therapy and has been identified as an essential bridge between the classroom and the service setting (Jung, Sainsbury, Grum, Wilkins, & Tryssenaar, 2002). Clinical education enables students to learn and practice in a real-life setting so that they may integrate theory with practice to demonstrate their professional and personal skills (Cavanaugh & Cohen, 2012; Holmes et al., 2010; Mackenzie, 2002; Mulholland & Derdall, 2005; Rodger, Fitzgerald, Davila, Millar, & Allison, 2011). The occupational therapy literature often refers to fieldwork placements as either traditional or nontraditional (Flecky, 2011; Moffett & Garbarini, 2004; Mulholland & Derdall, 2005). In traditional fieldwork (TF), students typically are supervised directly by an occupational therapist and perform tasks within well-established roles. In nontraditional fieldwork, no occupational therapy services may be available on site. Instead, students are supervised using various supervisory models and are challenged to explore the potential role of an occupational therapist within a new setting where the roles are not as clearly defined as in TF (Moffett & Garbarini, 2004; Mulholland & Derdall, 2005).
Many nontraditional types of practice are performed within community-based service. Scaffa (2001)  observed that community-based practice “includes a broad range of health-related services: prevention and health promotion, acute and chronic medical care, habilitation and rehabilitation, and direct and indirect services, all of which are provided in community settings” (p. 9). Meyers (2010)  noted that “we could define community practice by considering practice location, … elements of professional autonomy, or social justice” (p. 16). Community-based practice takes place in different settings, some of which employ occupational therapists and others of which operate without active occupational therapists on site (Crist, 2011; Velde, Davis, & Grant, 2011).
Recent changes in health care systems, the expansion of community-based practice, and the lack of occupational therapists in community placements have given rise to the need for more occupational therapists in community settings. In addition to the important services such settings provide to the community, they present unique, valuable, and challenging practice experiences for students and educators (Moffett & Garbarini, 2004; Mulholland & Derdall, 2005). To meet this need, educators must prepare students to work in community settings and encourage their placement in community fieldwork (CF) settings (Moffett & Garbarini, 2004; Mulholland & Derdall, 2005; Scott, 2004).
CF placement encourages students to develop special strategies for the community setting; they are required to work both collaboratively and independently while focusing on solving community problems. In addition, they can practice leadership, management, and consultation skills (Crist, 2011; Gitlow, 2011; Moffett & Garbarini, 2004; Scott, 2004). Moreover, students in CF learn how to propose, develop, and implement occupational programs at community sites (Flecky, 2011; Scott, 2004). CF also has been found to provide students with opportunities to explore different cultures and overcome stereotypical thinking concerning minority populations (Black & Wells, 2007; Bourke & Hudson, 2005; Doll, 2011; Forwell, Whiteford, & Dyck, 1997; Gitlow, 2011; MacRae, 2012; Moffett & Garbarini, 2004; Morton, 2012; Perrin & Wittman, 2001; Velde & Wittman, 2001).
The benefits of CF have received considerable attention, but limited evidence-based data are available comparing fieldwork experiences across placements. Moreover, the students’ point of view has seldom been studied (Hoppes & Hellman, 2007; Mulholland & Derdall, 2007).
The study described in this article compared the perceptions of students participating in CF with those of students participating in TF, focusing on the acquisition of professional and personal skills. In addition, the study examined whether the perceptions of CF students differed depending on the presence of an active occupational therapist at the fieldwork site. Specifically, we hypothesized that students participating in CF would have a more favorable perception of their professional and personal skills compared with students in TF and that students participating in CF at sites without an active occupational therapist present would have a more favorable perception of their professional and personal skills compared with students at sites with an active occupational therapist present.
Method
Research Design
This retrospective study compared the perceptions of students who did fieldwork at 33 TF and 15 CF settings. Eight CF settings had an active occupational therapist on site, and 7 did not.
We sent questionnaires as an attachment by email asking students questions referring to fieldwork done between 2008 and 2011. The study was approved by the ethical committee of Tel Aviv University. All participants included in the study signed an informed consent form.
Participants
The participants were bachelor of occupational therapy degree candidates at or graduates from Tel Aviv University who had completed their first, second, or third fieldwork placements in diverse community and traditional settings. We asked 32 students who completed CF to participate in the study; 28 (all female) returned completed questionnaires (87.5% response rate). We matched these students to control students who did their fieldwork in a traditional setting. To recruit the control group, we sent questionnaires by email to 63 students who had done TF; 28 returned completed questionnaires (44.4% response rate). We used the following criteria for matching: sequence of the fieldwork (first, second, or third placement), students’ scores on the fieldwork performance evaluation (within a 6-point range), and type of fieldwork (10 matched students in 5 different physical rehabilitation fieldwork placements, 24 matched students in 12 different pediatric fieldwork placements, and 12 matched students in 6 mental health fieldwork placements). No match was found for 4 students who did CF. One male CF student and 3 female TF students were excluded because their scores on their fieldwork performance evaluation did not meet the criteria.
Instrument
To measure students’ self-perception regarding their personal and professional skills, we developed a three-part questionnaire addressing personal skills (10 questions), professional skills (15 questions), and general questions (4 questions). All questions were answered using a 5-point scale ranging from 1 = strongly disagree to 5 = strongly agree.
The questionnaire items were based on two sources. The first source was the unpublished “Fieldwork Performance Evaluation for Occupational Therapy Students” document that is in use in the Department of Occupational Therapy at Tel Aviv University. The second source was themes from a literature review we conducted to locate instruments that might be appropriate for assessing students’ perceptions of fieldwork in general and of skills they needed for fieldwork in particular (Derdall, Olson, Janzen, & Warren, 2002; Forwell et al., 1997; Hoppes & Hellman, 2007; Miller, Bossers, Polatajko, & Hartley, 2001; Mulholland & Derdall, 2005). In the literature review, we considered both quantitative and qualitative data relating to students’ perceptions regarding fieldwork. We integrated the data presented in the literature with our previous experience in supervising students to develop this questionnaire. In building the questionnaire, we used a combination of closed- and open-ended questions, in-depth interviews, focus groups, and self-report techniques to explore the students’ experiences in fieldwork and documented the skills they were asked to demonstrate during their fieldwork.
Three experts in clinical fieldwork settings evaluated a draft questionnaire containing 29 questions that they were asked to rate as 1 = very important, 2 = not so important, or 3 = unimportant. They determined its content validity and confirmed that it was suitable for its designated use in this study. In addition, they were asked whether any questions needed to be added or deleted. At the end of the process, one question was deleted and one was added. The questionnaire was found to have good internal reliability (Cronbach’s αs = .69–.86). The general questions had the lowest reliability (.69); after the withdrawal of one question from the general questions section, the lowest Cronbach’s α rose to .75 (see Table 1).
Table 1.
Internal Reliability of the Study Questionnaire
Internal Reliability of the Study Questionnaire×
PartCronbach’s α
Overall personal skills.837
Overall professional skills.862
General questions.691
Table 1.
Internal Reliability of the Study Questionnaire
Internal Reliability of the Study Questionnaire×
PartCronbach’s α
Overall personal skills.837
Overall professional skills.862
General questions.691
×
Procedures and Data Collection
In 2008, the Department of Occupational Therapy at Tel Aviv University established a clinical program for training students in community-based practice. Community organizations in 15 communities with at-risk populations were located and provided with training and instruction; they subsequently qualified to accept occupational therapy fieldwork students. The fieldwork program included only specific, recognized groups in the community (e.g., municipalities, nonprofit organizations).
Two types of CF site were used: with and without an active occupational therapist at the location. Students were supervised accordingly either by an occupational therapist who worked on site or by a coordinator appointed by the university. In addition, some sites in the fieldwork program employed occupational therapists who wanted to promote community-based programs for specific populations even though the occupational therapy unit lacked experience in community-based practice; in these cases, the local occupational therapists were supervised by the community coordinator of the university’s occupational therapy department to ensure that a community practice model was used. Supervision of students in CF placements included a prefieldwork phase, in which introductory meetings with members of the population and community agencies were held, fulfilling the requirement of identification, and a specific program was developed for the community. In addition, the fieldwork program included weekly observations of the students’ performance, weekly personal meetings with the supervisor, and group supervision meetings. For students at sites with no occupational therapist present, a local coordinator was appointed (e.g., social worker, psychologist, counselor) who was available for communication and consultation via email and phone calls.
Our study examined 48 fieldwork settings, 33 TF and 15 CF; of the 15 CF settings, 8 had an active occupational therapist on site and 7 did not. The CF students performed interventions in the community’s own environment that emphasized health promotion and primary, secondary, and tertiary prevention.
Data Analysis
SPSS Version 17.0 (SPSS, Inc., Chicago) was used to process the data. Students’ perceptions regarding their professional and personal skills (see Table 2) were the dependent variables, and the independent variables included CF or TF placement, presence or absence of an active occupational therapist in CF placements, sequence of fieldwork (first, second, or third), and type of fieldwork (pediatric, mental health, or physical).
Table 2.
Traditional and Community Fieldwork Students’ Perceptions of Their Personal Skills, Professional Skills, and Satisfaction With the Fieldwork Experience
Traditional and Community Fieldwork Students’ Perceptions of Their Personal Skills, Professional Skills, and Satisfaction With the Fieldwork Experience×
Community (N = 27)
Traditional (N = 23)
QuestionMSDMSDZp
Personal skills
 Self-awareness4.410.6944.350.775−0.186.426
 Assessment of strengths and weaknesses4.190.6813.960.928−0.738.230
 Personal responsibility4.590.7974.300.974−0.143.765
 Self-efficacy4.300.8234.130.869−0.725.234
 Communication skills4.110.8013.701.146−1.158.123
 Development of skills I would otherwise have lacked3.891.0503.780.998−0.406.342
 Initiative4.520.7533.911.164−2.028.021
 Creativity4.440.9744.130.815−1.732.041
 Improvisation4.410.8884.170.937−1.086.139
 Coping with personal frustration4.260.9844.130.757−0.861.194
Professional skills
 Problem-solving skills4.190.9624.090.733−0.770.220
 Empathy4.300.8234.040.878−1.042.148
 Understanding of the occupational therapy role4.110.9744.260.752−0.344.365
 Integration and implications of theoretical knowledge3.670.9613.911.164−1.049.147
 Clinical reasoning4.000.9614.480.665−1.837.033
 Critical thinking3.590.9313.611.076−0.071.471
 Cultural competence4.301.0313.701.222−1.989.023
 Independence4.700.6694.350.714−2.359.009
 Learning about professional boundaries3.961.0183.961.065−0.031.487
 Coping with professional frustration4.370.8394.090.733−1.546.061
 Professional identity3.741.1633.651.071−0.383.351
 Competence in facilitating change4.410.8883.870.757−2.613.004
 Professional interaction3.781.0.134.090.793−1.108.134
 Professional knowledge3.811.0394.220.951−0.1551.060
 Performance management3.781.1883.351.152−1.525.063
General questions
 Level of challenge4.740.5264.390.891−1.619.052
 Adequacy of supervision4.151.1994.221.347−0.672.251
 Appropriateness of duration3.891.2814.261.137−1.241.107
 General satisfaction with fieldwork4.410.7974.451.011−0.666.252
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
Table 2.
Traditional and Community Fieldwork Students’ Perceptions of Their Personal Skills, Professional Skills, and Satisfaction With the Fieldwork Experience
Traditional and Community Fieldwork Students’ Perceptions of Their Personal Skills, Professional Skills, and Satisfaction With the Fieldwork Experience×
Community (N = 27)
Traditional (N = 23)
QuestionMSDMSDZp
Personal skills
 Self-awareness4.410.6944.350.775−0.186.426
 Assessment of strengths and weaknesses4.190.6813.960.928−0.738.230
 Personal responsibility4.590.7974.300.974−0.143.765
 Self-efficacy4.300.8234.130.869−0.725.234
 Communication skills4.110.8013.701.146−1.158.123
 Development of skills I would otherwise have lacked3.891.0503.780.998−0.406.342
 Initiative4.520.7533.911.164−2.028.021
 Creativity4.440.9744.130.815−1.732.041
 Improvisation4.410.8884.170.937−1.086.139
 Coping with personal frustration4.260.9844.130.757−0.861.194
Professional skills
 Problem-solving skills4.190.9624.090.733−0.770.220
 Empathy4.300.8234.040.878−1.042.148
 Understanding of the occupational therapy role4.110.9744.260.752−0.344.365
 Integration and implications of theoretical knowledge3.670.9613.911.164−1.049.147
 Clinical reasoning4.000.9614.480.665−1.837.033
 Critical thinking3.590.9313.611.076−0.071.471
 Cultural competence4.301.0313.701.222−1.989.023
 Independence4.700.6694.350.714−2.359.009
 Learning about professional boundaries3.961.0183.961.065−0.031.487
 Coping with professional frustration4.370.8394.090.733−1.546.061
 Professional identity3.741.1633.651.071−0.383.351
 Competence in facilitating change4.410.8883.870.757−2.613.004
 Professional interaction3.781.0.134.090.793−1.108.134
 Professional knowledge3.811.0394.220.951−0.1551.060
 Performance management3.781.1883.351.152−1.525.063
General questions
 Level of challenge4.740.5264.390.891−1.619.052
 Adequacy of supervision4.151.1994.221.347−0.672.251
 Appropriateness of duration3.891.2814.261.137−1.241.107
 General satisfaction with fieldwork4.410.7974.451.011−0.666.252
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
×
Because multiple comparisons were performed and the questionnaire included 29 questions, a Bonferroni correction was needed (.05/29), and therefore the significance level for the analysis was p < .001. The Mann–Whitney U test was used to determine whether students’ perceptions regarding their professional and personal skills differed according to CF (n = 27) versus TF placement (n = 23). The Mann–Whitney U test was also used to compare the perceptions of CF students in placements with (n = 15) versus without (n = 12) an active occupational therapist on site. In addition, an independent-sample t test was done twice to compare students’ scores on the personal, professional, and general questions within the same groups. The Kruskal–Wallis one-way analysis of variance was used for comparisons among the three fieldwork sequences (first, second, or third) and the three fieldwork types (pediatric, mental health, or physical).
Results
Results were analyzed for 50 students who had completed the full questionnaire (no missing data); 27 had completed CF, and 23 had completed TF. In the CF group, 13 students had completed their third fieldwork placement, 10 students their second, and 4 their first. In the TF group, 12 students had completed their third fieldwork placement, 7 their second, and 4 their first. Both groups completed the same number of hours: Those who had completed their third fieldwork logged 390 hr; those who had completed their second, 315 hr; and those who had completed their first, 280 hr. The students’ age range was 20–40 yr (mean = 23.5 yr, standard deviation = 3.3).
A detailed analysis of questionnaire responses revealed that after Bonferroni correction, students who had completed CF did not demonstrate a more favorable perception of their overall personal or professional skills compared with students who had completed TF. In addition, no significant difference was found in overall perception of professional (t[48] = 0.44, p = .66) and personal (t[48] = 1.59, p = .20) skills between students who had completed CF and those who had completed TF. The results are displayed in Table 2.
Regarding the perceptions of CF students with and without an occupational therapist on site, those whose settings did not have an active occupational therapist on site evaluated their personal responsibility (Z = −2.930, p = .001) and cultural competence (Z = −3.045, p = .001) as significantly higher than those whose settings had an active occupational therapist on site. The results are displayed in Table 3. In addition, CF students in a placement without an occupational therapist present had a significantly higher overall perception of their personal skills than those in a placement with an active occupational therapist on site (t[48] = −2.289, p = .031), but the two groups’ perception of their professional skills did not differ significantly (t[48] = −1.704, p = .101). The Kruskal–Wallis one-way analysis of variance revealed no significant differences among the three different times of fieldwork (first, second, or third; Z = −0.184) or the three types of fieldwork (pediatric, mental health, or physical; Z = −0.142).
Table 3.
Perceptions of Community Fieldwork Students Placed in Settings With and Without an Active Occupational Therapist On Site
Perceptions of Community Fieldwork Students Placed in Settings With and Without an Active Occupational Therapist On Site×
No Active Occupational Therapist Present (n = 15)
Active Occupational Therapist Present (n = 12)
QuestionMSDMSDZp
Personal skills
 Self-awareness4.570.5144.250.866−0.933.175
 Assessment of strengths and weaknesses4.360.6334.000.739−1.269.102
 Personal responsibility5.000.0004.171.030−2.930.001
 Self-efficacy4.710.4693.830.937−2.648.004
 Communication skills4.210.8934.000.739−0.739.230
 Development of skills I would otherwise have lacked3.930.9973.831.193−0.135.446
 Initiative4.500.8554.500.674−0.269.389
 Creativity4.860.5354.001.206−2.374.009
 Improvisation4.860.3633.921.084−2.795.002
 Coping with personal frustration4.290.9144.171.115−0.174.431
Professional skills
 Problem-solving skills4.500.7603.831.115−1.671.047
 Empathy4.430.7564.250.866−0.512.304
 Understanding of the occupational therapy role4.211.0514.170.718−0.497.309
 Integration and implications of theoretical knowledge3.930.9173.330.985−1.858.031
 Clinical reasoning4.140.9493.831.030−0.822.205
 Critical thinking3.790.6993.251.055−1.547.610
 Cultural competence4.860.5353.671.155−3.045.001
 Independence4.860.3634.580.900−0.750.226
 Learning about professional boundaries3.861.0994.080.996−0.513.304
 Coping with professional frustration4.640.6334.000.953−1.966.024
 Professional identity3.571.4534.000.739−0.561.287
 Competence in facilitating change4.790.4264.001.128−2.111.017
 Professional interaction3.710.9943.751.055−0.082.467
 Professional knowledge3.931.0723.830.937−0.467.320
 Performance management4.290.6113.171.467−2.048.020
General questions
 Level of challenge4.860.3634.580.669−1.192.116
 Adequacy of supervision4.071.3284.420.900−0.432.332
 Appropriateness of duration3.931.2074.001.348−0.411.340
 General satisfaction with fieldwork4.641.2074.001.348−1.601.054
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
Table 3.
Perceptions of Community Fieldwork Students Placed in Settings With and Without an Active Occupational Therapist On Site
Perceptions of Community Fieldwork Students Placed in Settings With and Without an Active Occupational Therapist On Site×
No Active Occupational Therapist Present (n = 15)
Active Occupational Therapist Present (n = 12)
QuestionMSDMSDZp
Personal skills
 Self-awareness4.570.5144.250.866−0.933.175
 Assessment of strengths and weaknesses4.360.6334.000.739−1.269.102
 Personal responsibility5.000.0004.171.030−2.930.001
 Self-efficacy4.710.4693.830.937−2.648.004
 Communication skills4.210.8934.000.739−0.739.230
 Development of skills I would otherwise have lacked3.930.9973.831.193−0.135.446
 Initiative4.500.8554.500.674−0.269.389
 Creativity4.860.5354.001.206−2.374.009
 Improvisation4.860.3633.921.084−2.795.002
 Coping with personal frustration4.290.9144.171.115−0.174.431
Professional skills
 Problem-solving skills4.500.7603.831.115−1.671.047
 Empathy4.430.7564.250.866−0.512.304
 Understanding of the occupational therapy role4.211.0514.170.718−0.497.309
 Integration and implications of theoretical knowledge3.930.9173.330.985−1.858.031
 Clinical reasoning4.140.9493.831.030−0.822.205
 Critical thinking3.790.6993.251.055−1.547.610
 Cultural competence4.860.5353.671.155−3.045.001
 Independence4.860.3634.580.900−0.750.226
 Learning about professional boundaries3.861.0994.080.996−0.513.304
 Coping with professional frustration4.640.6334.000.953−1.966.024
 Professional identity3.571.4534.000.739−0.561.287
 Competence in facilitating change4.790.4264.001.128−2.111.017
 Professional interaction3.710.9943.751.055−0.082.467
 Professional knowledge3.931.0723.830.937−0.467.320
 Performance management4.290.6113.171.467−2.048.020
General questions
 Level of challenge4.860.3634.580.669−1.192.116
 Adequacy of supervision4.071.3284.420.900−0.432.332
 Appropriateness of duration3.931.2074.001.348−0.411.340
 General satisfaction with fieldwork4.641.2074.001.348−1.601.054
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
×
Discussion
The purpose of this study was to examine whether students’ perceptions regarding their professional and personal skills differed depending on whether they completed CF versus TF. A further aim was to examine whether CF students’ perceptions would differ depending on whether an active occupational therapist was present at the site. We hypothesized (1) that students participating in CF would have a more favorable perception of their professional and personal skills than students in TF and (2) that students participating in CF without an active occupational therapist at the placement site would have a more favorable perception of their professional and personal skills than those who did have an active occupational therapist on site. The first hypothesis was not verified; students who completed CF did not rate their perception of their personal or professional skills higher than students who completed TF. The second hypothesis was partially verified; students who completed CF in a placement without an active occupational therapist on site rated their personal responsibility, cultural competence, and overall personal skills significantly higher than those in placements with an active occupational therapist present. Students who did CF, especially those in placements without an active occupational therapist on site, showed a (nonsignificant) tendency to score higher on statements concerning personal growth, such as creativity and improvisation skills, and professional growth, such as competence to facilitate change.
The results of this study indicate that from the students’ viewpoint, the most effective contributor to personal and professional development was CF without supervision by an on-site occupational therapist. These results are consistent with those of other studies (e.g., Gitlow, 2011; Mulholland & Derdall, 2005; Perrin & Wittman, 2001) that found that fieldwork without an active occupational therapist present enhanced students’ ability to work with populations and individuals from different cultures and diverse backgrounds, as well as with various agencies and interdisciplinary teams. Moreover, such fieldwork provides a greater number and variety of difficult situations, which in turn offer the possibility of flexibility in learning and present learning opportunities that are not always available in TF. The lack of direct on-site supervision by an occupational therapist and the absence of an occupational therapy model in the community fostered students’ reflection and developed their personal growth.
Personal Skills
Students’ perceptions of their personal development were reflected in their personal responsibility scores (which differed significantly between groups) and in their overall scores, which included items on self-efficacy, creativity, and improvisation skills. These results are consistent with those of other studies describing the unique learning opportunities and challenges afforded by community placements in general and by those without an occupational therapy model in particular (Alter, 2011; Bossers, Cook, Polatajko, & Lane, 1997; Meyers, 2009; Mulholland & Derdall, 2005; Velde et al., 2011). This type of fieldwork enabled changes in students’ attitudes that were a reflection of personal values, a high level of self-esteem, and a sense of responsibility.
Professional Skills
Students who did CF without an active occupational therapist present reported a higher perception of their cultural competence than students at placements with an active occupational therapist present. Studies addressing self-perceptions of professional skills are difficult to compare because of variation in the way professional skills are defined. Many studies have addressed cultural awareness and understanding as a professional skill, and it is often mentioned as a skill that tends to improve with a community-based experience (e.g., Black & Wells, 2007; Doll, 2011; Gitlow, 2011; Meyers, 2009; Morton, 2012; Perrin & Wittman, 2001; Scott, 2004; Velde & Wittman, 2001; Velde, Wittman, & Mott, 2007). Black and Wells (2007)  indicated that every clinical interaction involves multiple cultures and cited Fitzgerald (1992), who observed that in clinical interaction at least three cultures are involved: the personal culture of the provider, the personal culture of the client, and the culture of the primary medical system.
Israel is a multicultural society; students and clients come from different backgrounds and face the challenges of multicultural interaction. In our study, the students did their fieldwork in communities that were culturally diverse and engaged in activities that challenged their cultural values and beliefs. Most students who participated in CF without an active occupational therapist present intervened in communities with at-risk populations, such as Ethiopian immigrants, foreign workers, or refugees from Africa, whose cultures were very different from the students’ Western culture. The clients who originally came from African countries differed from the students in their patterns of perceiving the world; behaviors; beliefs; and attitudes about disability, treatment, therapy, and maternal and child health. These students’ experiences were consistent with those of students described in the literature who were involved with African-American populations, whose culture required the students to become more culturally competent (e.g., Black & Wells, 2007; Perrin & Wittman, 2001). Moreover, the literature contains reports about the success of higher education experiences in communities as a viable learning approach and as a teaching tool to promote cultural competence (Doll, 2011; Meyers, 2009; Velde & Wittman, 2001).
In contrast to the study’s hypotheses, we found no significant differences in student perceptions of their professional skills between students who completed CF and those who completed TF. Other studies have reported that students involved in CF improved their professional skills, such as knowledge of the community, crystallization of professional identity, professional communication skills, and understanding of occupations and occupational performance (Gitlow, 2011; Klinger & Bossers, 2009; MacRae, 2012; Moffett & Garbarini, 2004; Perrin & Wittman, 2001; Scott, 2004). A tentative explanation for our unexpected results is that previous studies did not have a control group; rather, most researchers focused their comparison on students’ skills before and after CF (e.g., Derdall et al., 2002; MacRae, 2012; Perrin & Wittman, 2001; Velde et al., 2011).
Velde et al. (2011), who like us found no difference in student perceptions after CF versus TF, believed that these findings reflected not necessarily a lack of difference but rather the limitation of the questionnaires in measuring changes. Likewise, our questionnaire may not have been sensitive enough to accurately identify change in knowledge and skills.
Limitations and Future Research
This study was retrospective, which might have introduced a recall bias. Moreover, the study did not follow the development of the participants’ personal and professional skills through the years before and after the study period, preventing examination of differences in their attitudes before and after their fieldwork experiences.
A limited number of communities matched our inclusion criteria, so the restricted number of potential placements may have limited our sample size. To generalize the study’s results and conclusions, more research should be carried out using the questionnaire with a greater number of students from a variety of countries and cultures.
Implications for Occupational Therapy Education
The findings of this study have the following implications for TF and CF placements:
  • CF and TF result in similar student perceptions regarding their personal and professional skills.

  • Students who complete CF in a setting that does not have an active occupational therapist on site but who do have access to outside supervision may experience higher perceptions of their personal skills, including personal responsibility and cultural competence, compared with students who complete CF in a setting with an active occupational therapist on site.

  • Effective strategies are available for supervising occupational therapy fieldwork students in settings where no occupational therapist is available on site.

  • CF settings expand students’ learning opportunities and contribute to their professional and personal growth.

  • Further studies comparing different kinds of fieldwork from the student’s point of view are warranted.

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Table 1.
Internal Reliability of the Study Questionnaire
Internal Reliability of the Study Questionnaire×
PartCronbach’s α
Overall personal skills.837
Overall professional skills.862
General questions.691
Table 1.
Internal Reliability of the Study Questionnaire
Internal Reliability of the Study Questionnaire×
PartCronbach’s α
Overall personal skills.837
Overall professional skills.862
General questions.691
×
Table 2.
Traditional and Community Fieldwork Students’ Perceptions of Their Personal Skills, Professional Skills, and Satisfaction With the Fieldwork Experience
Traditional and Community Fieldwork Students’ Perceptions of Their Personal Skills, Professional Skills, and Satisfaction With the Fieldwork Experience×
Community (N = 27)
Traditional (N = 23)
QuestionMSDMSDZp
Personal skills
 Self-awareness4.410.6944.350.775−0.186.426
 Assessment of strengths and weaknesses4.190.6813.960.928−0.738.230
 Personal responsibility4.590.7974.300.974−0.143.765
 Self-efficacy4.300.8234.130.869−0.725.234
 Communication skills4.110.8013.701.146−1.158.123
 Development of skills I would otherwise have lacked3.891.0503.780.998−0.406.342
 Initiative4.520.7533.911.164−2.028.021
 Creativity4.440.9744.130.815−1.732.041
 Improvisation4.410.8884.170.937−1.086.139
 Coping with personal frustration4.260.9844.130.757−0.861.194
Professional skills
 Problem-solving skills4.190.9624.090.733−0.770.220
 Empathy4.300.8234.040.878−1.042.148
 Understanding of the occupational therapy role4.110.9744.260.752−0.344.365
 Integration and implications of theoretical knowledge3.670.9613.911.164−1.049.147
 Clinical reasoning4.000.9614.480.665−1.837.033
 Critical thinking3.590.9313.611.076−0.071.471
 Cultural competence4.301.0313.701.222−1.989.023
 Independence4.700.6694.350.714−2.359.009
 Learning about professional boundaries3.961.0183.961.065−0.031.487
 Coping with professional frustration4.370.8394.090.733−1.546.061
 Professional identity3.741.1633.651.071−0.383.351
 Competence in facilitating change4.410.8883.870.757−2.613.004
 Professional interaction3.781.0.134.090.793−1.108.134
 Professional knowledge3.811.0394.220.951−0.1551.060
 Performance management3.781.1883.351.152−1.525.063
General questions
 Level of challenge4.740.5264.390.891−1.619.052
 Adequacy of supervision4.151.1994.221.347−0.672.251
 Appropriateness of duration3.891.2814.261.137−1.241.107
 General satisfaction with fieldwork4.410.7974.451.011−0.666.252
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
Table 2.
Traditional and Community Fieldwork Students’ Perceptions of Their Personal Skills, Professional Skills, and Satisfaction With the Fieldwork Experience
Traditional and Community Fieldwork Students’ Perceptions of Their Personal Skills, Professional Skills, and Satisfaction With the Fieldwork Experience×
Community (N = 27)
Traditional (N = 23)
QuestionMSDMSDZp
Personal skills
 Self-awareness4.410.6944.350.775−0.186.426
 Assessment of strengths and weaknesses4.190.6813.960.928−0.738.230
 Personal responsibility4.590.7974.300.974−0.143.765
 Self-efficacy4.300.8234.130.869−0.725.234
 Communication skills4.110.8013.701.146−1.158.123
 Development of skills I would otherwise have lacked3.891.0503.780.998−0.406.342
 Initiative4.520.7533.911.164−2.028.021
 Creativity4.440.9744.130.815−1.732.041
 Improvisation4.410.8884.170.937−1.086.139
 Coping with personal frustration4.260.9844.130.757−0.861.194
Professional skills
 Problem-solving skills4.190.9624.090.733−0.770.220
 Empathy4.300.8234.040.878−1.042.148
 Understanding of the occupational therapy role4.110.9744.260.752−0.344.365
 Integration and implications of theoretical knowledge3.670.9613.911.164−1.049.147
 Clinical reasoning4.000.9614.480.665−1.837.033
 Critical thinking3.590.9313.611.076−0.071.471
 Cultural competence4.301.0313.701.222−1.989.023
 Independence4.700.6694.350.714−2.359.009
 Learning about professional boundaries3.961.0183.961.065−0.031.487
 Coping with professional frustration4.370.8394.090.733−1.546.061
 Professional identity3.741.1633.651.071−0.383.351
 Competence in facilitating change4.410.8883.870.757−2.613.004
 Professional interaction3.781.0.134.090.793−1.108.134
 Professional knowledge3.811.0394.220.951−0.1551.060
 Performance management3.781.1883.351.152−1.525.063
General questions
 Level of challenge4.740.5264.390.891−1.619.052
 Adequacy of supervision4.151.1994.221.347−0.672.251
 Appropriateness of duration3.891.2814.261.137−1.241.107
 General satisfaction with fieldwork4.410.7974.451.011−0.666.252
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
×
Table 3.
Perceptions of Community Fieldwork Students Placed in Settings With and Without an Active Occupational Therapist On Site
Perceptions of Community Fieldwork Students Placed in Settings With and Without an Active Occupational Therapist On Site×
No Active Occupational Therapist Present (n = 15)
Active Occupational Therapist Present (n = 12)
QuestionMSDMSDZp
Personal skills
 Self-awareness4.570.5144.250.866−0.933.175
 Assessment of strengths and weaknesses4.360.6334.000.739−1.269.102
 Personal responsibility5.000.0004.171.030−2.930.001
 Self-efficacy4.710.4693.830.937−2.648.004
 Communication skills4.210.8934.000.739−0.739.230
 Development of skills I would otherwise have lacked3.930.9973.831.193−0.135.446
 Initiative4.500.8554.500.674−0.269.389
 Creativity4.860.5354.001.206−2.374.009
 Improvisation4.860.3633.921.084−2.795.002
 Coping with personal frustration4.290.9144.171.115−0.174.431
Professional skills
 Problem-solving skills4.500.7603.831.115−1.671.047
 Empathy4.430.7564.250.866−0.512.304
 Understanding of the occupational therapy role4.211.0514.170.718−0.497.309
 Integration and implications of theoretical knowledge3.930.9173.330.985−1.858.031
 Clinical reasoning4.140.9493.831.030−0.822.205
 Critical thinking3.790.6993.251.055−1.547.610
 Cultural competence4.860.5353.671.155−3.045.001
 Independence4.860.3634.580.900−0.750.226
 Learning about professional boundaries3.861.0994.080.996−0.513.304
 Coping with professional frustration4.640.6334.000.953−1.966.024
 Professional identity3.571.4534.000.739−0.561.287
 Competence in facilitating change4.790.4264.001.128−2.111.017
 Professional interaction3.710.9943.751.055−0.082.467
 Professional knowledge3.931.0723.830.937−0.467.320
 Performance management4.290.6113.171.467−2.048.020
General questions
 Level of challenge4.860.3634.580.669−1.192.116
 Adequacy of supervision4.071.3284.420.900−0.432.332
 Appropriateness of duration3.931.2074.001.348−0.411.340
 General satisfaction with fieldwork4.641.2074.001.348−1.601.054
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
Table 3.
Perceptions of Community Fieldwork Students Placed in Settings With and Without an Active Occupational Therapist On Site
Perceptions of Community Fieldwork Students Placed in Settings With and Without an Active Occupational Therapist On Site×
No Active Occupational Therapist Present (n = 15)
Active Occupational Therapist Present (n = 12)
QuestionMSDMSDZp
Personal skills
 Self-awareness4.570.5144.250.866−0.933.175
 Assessment of strengths and weaknesses4.360.6334.000.739−1.269.102
 Personal responsibility5.000.0004.171.030−2.930.001
 Self-efficacy4.710.4693.830.937−2.648.004
 Communication skills4.210.8934.000.739−0.739.230
 Development of skills I would otherwise have lacked3.930.9973.831.193−0.135.446
 Initiative4.500.8554.500.674−0.269.389
 Creativity4.860.5354.001.206−2.374.009
 Improvisation4.860.3633.921.084−2.795.002
 Coping with personal frustration4.290.9144.171.115−0.174.431
Professional skills
 Problem-solving skills4.500.7603.831.115−1.671.047
 Empathy4.430.7564.250.866−0.512.304
 Understanding of the occupational therapy role4.211.0514.170.718−0.497.309
 Integration and implications of theoretical knowledge3.930.9173.330.985−1.858.031
 Clinical reasoning4.140.9493.831.030−0.822.205
 Critical thinking3.790.6993.251.055−1.547.610
 Cultural competence4.860.5353.671.155−3.045.001
 Independence4.860.3634.580.900−0.750.226
 Learning about professional boundaries3.861.0994.080.996−0.513.304
 Coping with professional frustration4.640.6334.000.953−1.966.024
 Professional identity3.571.4534.000.739−0.561.287
 Competence in facilitating change4.790.4264.001.128−2.111.017
 Professional interaction3.710.9943.751.055−0.082.467
 Professional knowledge3.931.0723.830.937−0.467.320
 Performance management4.290.6113.171.467−2.048.020
General questions
 Level of challenge4.860.3634.580.669−1.192.116
 Adequacy of supervision4.071.3284.420.900−0.432.332
 Appropriateness of duration3.931.2074.001.348−0.411.340
 General satisfaction with fieldwork4.641.2074.001.348−1.601.054
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
×