Amanda K. Giles, Nancy E. Carson, Hazel L. Breland, Patty Coker-Bolt, Peter J. Bowman; Use of Simulated Patients and Reflective Video Analysis to Assess Occupational Therapy Students’ Preparedness for Fieldwork. Am J Occup Ther 2014;68(Supplement_2):S57–S66. https://doi.org/10.5014/ajot.2014.685S03
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© 2020 American Occupational Therapy Association
Educators must determine whether occupational therapy students are adequately prepared for Level II fieldwork once they have successfully completed the didactic portion of their coursework. Although studies have shown that students regard the use of video cameras and simulated patient encounters as useful tools for assessing professional and clinical behaviors, little has been published in the occupational therapy literature regarding the practical application of simulated patients or reflective video analysis. We describe a model for a final Comprehensive Practical Exam that uses both simulated patients and reflective video analysis to assess student preparedness for Level II fieldwork, and we report on student perceptions of these instructional modalities. We provide recommendations for designing, implementing, and evaluating simulated patient experiences in light of existing educational theory.
We believe that the occupational nature of humans drives the framework for the educational program by creating and promoting opportunities for the following: (1) active participation and quiet reflection, (2) exploration and mastery of the human and nonhuman environments, and (3) respect for all peoples of the world and their occupational needs. (p. 3)
It made you review classes you hadn’t had in a while and practice skills that may have been a little rusty.
I now feel very prepared for Level II experiences.
The practical exam forced me to review material that I had intended on reviewing, but likely would have not reviewed due to lack of time.
It was beneficial to me to practice being under pressure with the stopwatch and the videotape.
It tests what we will actually be doing as a future occupational therapist rather than just a written examination.
It was a great way to see my actual performance and how it related to the preconceived opinion I had of myself as a student therapist.
You may think that you act one way and then you watch the video and realize how you are actually coming across.
I was able to clearly see the mistakes I made on the video, which helped me realize areas that I could improve in prior to my fieldwork.
Really great way for professors to see how well you are doing and give you valuable feedback.
Faculty gave very constructive criticism and didn’t make me feel like the mistakes I made were things that would keep me from becoming a great occupational therapist.
It allowed me to see how capable I really am!
I feel like it gave me a chance to work out my clinical butterflies before fieldwork began.
It made me feel better knowing that I can think of activities on the spot and handle situations that might arise.
My anxiety levels were definitely higher than they needed to be!
I think it’s important to stress that this is not a “do or die” situation and it is OK to remediate a portion.
Video was helpful but I know personally I would have liked to see my face/body language from the front.
Excellent way to prepare for fieldwork and wish we would have done it more.
To add valuable feedback for students, educators can recruit experienced nonfaculty occupational therapists to perform as simulated patients. Students reported a high appreciation for the feedback provided by experienced nonfaculty clinicians. Experienced clinicians may require less training time and are often willing to volunteer for this role, which can eliminate the cost of a paid actor.
To nurture a compassionate approach to future clients, the score sheet should reflect the student’s ability to respond to the patient’s emotional and psychosocial needs (Teherani, Hauer, & O’Sullivan, 2008).
To preserve the meaningfulness of feedback, feedback and videos for reflective video analysis should be provided as soon as possible, perhaps by scheduling ahead of time appointments for viewing video and meeting with faculty: “Capitalizing on a teaching moment shortly following a meaningful interaction with faculty could provide a more optimal opportunity to edify the teaching and learning points” (Garner, Gusberg, & Kim, 2014, p. 391).
To maximize learning, educators should provide descriptive feedback and opportunities for remediation so that the CPE is viewed as an assessment for learning rather than an assessment of learning. Effective feedback motivates students and provides information to help them correct performance (Crooks, 1988; Kluger & DeNisi, 1996).
To promote independence in self-reflection as a strategy for lifelong learning, all students should be required to perform a reflective video analysis, regardless of CPE performance. Student reflections should be combined with faculty and therapist feedback. Research has shown that when students are in control of and use feedback to modify their own performance, they are more self-regulated, resourceful, confident, and higher achieving (Chappuis & Chappuis, 2007).
To increase interrater reliability, scoring mechanisms should allow for clarity of student expectations (Tai & Chung, 2008). Checklists should have objective, measurable criteria that meet minimum satisfactory standards aligned with the AOTA Fieldwork Performance Evaluation for the Occupational Therapy Student (AOTA, 2002).
To support the significance of the CPE, the CPE can either be integrated into an existing course or constitute its own one-credit course (McWilliam & Botwinski, 2010).
To provide meaning and understanding to didactic course content, additional simulation and reflection experiences should be staggered throughout the curriculum in increasing levels of complexity (Fenwick, 2003).
To ensure the overall success of the CPE, adequate time should be allowed for the development of objectives, case scenarios, and grading criteria and for the training of simulated patients, reflection time, and faculty feedback (McWilliam & Botwinski, 2010).
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