Concerns regarding fieldwork placement shortages have been identified nationally and internationally, including increased demand for placements from academic programs and challenges related to supervision (Roberts & Simon, 2012; Thomas et al., 2007; Stutz-Tanenbaum, Hanson, Koski, & Greene, 2015). As key stakeholders, fieldwork educators—people who supervise occupational therapy students—provide valuable insights into organizational and professional factors influencing their willingness to provide fieldwork placements. A qualitative study of 10 occupational therapists revealed concerns about time, space, productivity, and preparedness to assume the role of fieldwork educator (Hanson, 2011). Jensen and Daniel (2010)  conducted qualitative focus groups in four urban hospital settings and found that both personal and professional factors influenced occupational therapists’ willingness to accept students, with facility constraints identified as the primary reason for declining student placements. Fieldwork educators’ concerns regarding student readiness and professional behaviors for Level II fieldwork have also been documented (Bell, Cox, & Marcangelo, 2014; James & Musselman, 2006). In addition, novice occupational therapists have expressed concerns about their readiness to undertake fieldwork supervision because of a lack of confidence in their own practice skills (Hunt & Kennedy-Jones, 2010).

To add to an already tenuous situation, increasing enrollment trends have been on the horizon nationally and internationally for almost a decade (American Occupational Therapy Association [AOTA], 2014a; Roberts & Simon, 2012; Thomas et al., 2007). As the number of occupational therapy and occupational therapy assistant programs in the United States continues to grow, the potential number of licensed practitioners who could serve as fieldwork educators per enrollee has decreased by 21% (Roberts, Evenson, Kaldenberg, Ozelie, & Barnes, 2015).

The need for academic programs to provide resources in terms of fiscal, organizational development, and pedagogical support for fieldwork education has been described in the literature from the perspective of fieldwork educators (Hanson, 2011), academic fieldwork coordinators (AFWCs; Stutz-Tanenbaum et al., 2015), and the profession (AOTA, 2012). Further understanding of fieldwork site capacity and fieldwork educator needs is necessary. This study aimed to answer the following questions: What site factors influence the current supply of fieldwork placements, including available qualified supervisors, available settings, and preferences for supervision models and time frames? What benefits and challenges do practitioners identify associated with providing fieldwork placements? What supports can academic programs provide to ensure successful fieldwork experiences?

This study used a descriptive, nonexperimental exploratory design approved by the Tufts University institutional review board. Participants were provided information about the purpose of the study, assurance of confidentiality, and contact information for the primary investigators (authors Evenson, Roberts, Kaldenberg, and Barnes). Consent to participate was demonstrated by participants completing the electronic survey.

A pilot survey was distributed electronically to fieldwork sites in the south central region of the United States during spring 2013; 104 surveys were opened, and 80 responses were received. A revised national survey was distributed in fall 2013. An AOTA Commission on Education–appointed task group composed of fieldwork coordinators from four different academic institutions requested that AFWCs at 48 additional academic programs across 41 states and the District of Columbia in the continental United States distribute an online survey via email to their affiliated fieldwork sites. Survey respondents were encouraged to forward the survey link to colleagues. All surveys completed within 3 wk of distribution were included in the study.

An electronic link to a Qualtrics™ survey (Qualtrics, Provo, UT) was sent to participants, and a snowball sampling procedure (Handcock & Gile, 2011) was used. The online survey was open for 3 wk.

A pilot survey was designed using the framework of the Queensland Occupational Therapy Fieldwork Collaborative Survey 2006–OT Student Fieldwork Placements with permission (Broadbridge et al., as cited in Thomas et al., 2007), along with guiding questions for a pilot student research project. After electronic distribution of the pilot survey, the primary investigators reviewed the data and made revisions to the survey.

The revised online survey consisted of 49 items, including descriptive questions about the respondent and the respondent’s workplace. The survey also included questions about the average number of occupational therapy and occupational therapy assistant students accepted for fieldwork placement per year. Closed-ended questions were used to investigate the site’s preferred time frames and models of supervision for students. A 4-point Likert scale with a nonapplicable option addressed the respondents’ preferred supports offered by educational programs, modes of communication with the academic site, and perceived benefits and challenges associated with training students. Qualtrics survey software (Version 1.055s; Qualtrics, Provo, UT) was used to analyze survey results. The quantitative data were analyzed with descriptive statistics to answer study objectives.

The survey was opened by 1,101 respondents and completed by 817, for a response rate of 74%. As noted earlier, the respondents represented 41 states and the District of Columbia. Respondents were asked to self-identify whether they served as the contact person for fieldwork education at their site, and responses were used to uniquely identify practice settings. All practice settings within a facility were listed, so categories were not mutually exclusive. The most frequently represented practice setting was physical medicine (41%, outpatient; 31%, inpatient acute care; 17%, skilled nursing; 28%, inpatient rehabilitation), followed by pediatrics (27%, school-based practice; 17%, early intervention; 9%, inpatient hospitals). Mental health settings included inpatient acute care (15%) and inpatient psychiatric rehabilitation (6%). Other reported practice settings included home health care (10%), adult day programs (6%), and long-term acute care hospitals (3%).

Fifty-nine percent of respondents reported that they were the person primarily responsible for coordinating student fieldwork placements, 54% identified their settings as teaching institutions, and 96% reported that they supervise fieldwork students. Eighty-eight percent of respondents reported that they had supervised an occupational therapy or occupational therapy assistant student at some point in their careers; 12% reported they had never supervised a fieldwork student. A majority reported that they typically supervise two or fewer occupational therapy students per year, and 82% reported supervising two or fewer occupational therapy assistant students per year (Table 1). A small percentage had trained occupational therapy doctorate students (13%), and a few reported supervising one or two occupational therapy doctorate students per year (11%).

A majority of respondents reported they had three or more full-time occupational therapists eligible to provide Level II supervision (59%). Eighty-seven percent reported that they had two or fewer eligible occupational therapy assistant supervisors. Twenty-four percent of sites reported that they have sent only one occupational therapist to the AOTA Fieldwork Educators Certificate Program (FWECP; Johnson & Stutz-Tanenbaum, 2009), and 55% reported sending zero. Six percent reported they had sent only one occupational therapy assistant, and 92% had sent zero. Of note, 61% of respondents reported that they were not aware of the AOTA fieldwork education resources available to members on the AOTA website. Sites were asked which models of supervision they provided to occupational therapy students for Level II fieldwork. Some sites used more than one model; thus, categories were not mutually exclusive (see Table 1). Sites reported preferred time frames for Level II fieldwork as fall (58%), winter (54%), spring (53%), and summer (29%). These time-frame selections were not mutually exclusive.

Sites reported they generally preferred midsemester schedules for Level I fieldwork (40%) or had no preference (37%). Respondents reported preferred Level I schedules to be weeklong (53%) versus weekly (41%). These categories were not mutually exclusive. Regarding the shared responsibility for education and training between the fieldwork site and the academic program, respondents were asked to select on a sliding scale ranging from 1% to 100% what percentage of applied practice skills should be learned in school versus during fieldwork. On average, respondents indicated 55% of applied practice skills should be taught in academic programs, with 45% to be learned during fieldwork.

In terms of perceived benefits of participating in fieldwork education (Table 2), respondents placed professional development and altruistic ideals in the top five (Table 2). When asked to rate the most challenging factors related to participating in fieldwork education, respondents were primarily concerned with having the necessary resources to support the fieldwork program and student readiness (Table 3). Respondents also rated the perceived value of supports provided by academic partners in fieldwork education (Table 4). When asked to identify specific items that ensure a successful fieldwork experience, respondents most frequently rated self-assessment tools for students (63%). Approximately half of respondents reported sample student objectives (54%), sample weekly schedules (51%), information on management of unprofessional behavior (51%), fieldwork educator self-assessments (49%), and remediation plans before student failure (49%) to be most helpful. When asked how AFWCs could best resolve conflicts or professional behavior issues with students, the most frequently identified practices were providing education to students on professional behavior before fieldwork (82%); availability of the AFWC to discuss potential problems (76%); and face-to-face meetings with the AFWC, student, and fieldwork educator if needed (70%). Respondents who did not supervise students reported that workload and time pressures (23%) would need to change for them to begin supervising students, which was selected more frequently than concern about supervisory skill readiness (11%).

The survey respondents are representative of the fieldwork education community across the United States, and more than half were the person responsible for student program administration; the respondents’ roles lend validity to the reported perceived benefits, challenges, and valued supports. Fieldwork placements are most frequently offered in traditional practice areas; the highest number of settings are physical medicine, followed by pediatrics. This finding is consistent with current workforce employment trends (AOTA, 2010). The low percentage of community-based fieldwork settings may be a consequence of the low number of practitioners available to supervise students, the lack of an administrative structure to support a student program, or the limited use of nontraditional fieldwork models for student placements.

Opportunities to increase fieldwork capacity may exist in traditional settings by strengthening the sustainability of year-round Level II fieldwork placements and implementing collaborative supervision models. Fieldwork facilities with established year-round Level II fieldwork programs could serve as models and share strategies, including how to build a sustainable administrative infrastructure. Finding ways to support training of more occupational therapy and occupational therapy assistant practitioners as fieldwork educators seems paramount because a limited number of facilities reported having trained staff via the AOTA FWECP.

Study results related to the timing and structure of Level I and Level II fieldwork have provided valuable information to academic programs. Facilities that offer Level I fieldwork have reported flexible preferences for weeklong (condensed) and once-per-week schedule models, with a slight preference for mid-semester placements. The lack of summer Level II fieldwork placements may necessitate academic programs reevaluating their curriculum sequence. Preferences for timing of placements are an important consideration because they are likely based on available staffing, resources, and time.

Fieldwork educators regard their role to be significant in contributing to students’ acquisition of applied practice skills and entry-level competencies. Respondents ranked opportunities for professional development and being of service to the profession more highly than incentives such as tuition credit vouchers and access to online library resources (see Table 2). Results point to the personal-level benefits of being a fieldwork educator, coinciding with outcomes of a focus-group pilot study (Hanson, 2011).

The challenges identified by respondents were primarily extrinsic factors, including workload, cost of staff time, and student learner characteristics and competencies (see Table 3). Although practice patterns of staff productivity are not affected by the presence of a fieldwork student (Ozelie, Janow, Kreutz, Mulry, & Penkala, 2015), concerns about lack of time remain a theme for fieldwork educators (Hanson, 2011). Administrators and fieldwork educators with these concerns may respond to recent evidence suggesting that practitioners with requisite skills are able to meet their productivity expectations while serving as fieldwork educators (Ozelie et al., 2015).

Limited student capabilities were also reported as a perceived challenge, which is consistent with earlier findings (Hanson, 2011; Jensen & Daniel, 2010). Research to inform the best approaches to educating students for readiness for fieldwork and practice is lacking. Academic programs are increasingly implementing the use of simulation methods to assist with clinical preparedness (Bethea, Castillo, & Harvison, 2014). However, further research is needed to better understand learning outcomes related to simulation experiences.

In contrast to concerns, readiness and high-quality educational preparation of students were rated as the most valued supports from academic programs (see Table 4). Readily available support from AFWCs was also viewed as important. Integrating the needs and perspectives of the student and the fieldwork educator and the realities of the practice environment is part of the customization of the learning process (Stutz-Tanenbaum et al., 2015). The AFWC role requires the ability to manage conflict as well as to analyze student, fieldwork educator, and contextual elements of the learning environment.

The valued supports identified by respondents point to the need for AFWCs to have adequate time in their schedules along with sufficient resources to manage complex tasks and emotional situations to effectively collaborate with fieldwork educators. Self-assessment tools for students and fieldwork educators were identified as the most helpful tools, along with clear performance expectations. Criteria for student performance can be outlined using site-specific learning objectives and weekly schedules for skills progression as well as remedial learning plans for students who need extra support. More research is needed in the area of fieldwork education to develop versatile resources to support effective implementation of the AFWC role (Stutz-Tanenbaum et al., 2015).

The findings of this study are limited because the respondents were self-identified and not randomly selected. In addition, the survey was distributed and administered electronically, and respondents needed to have access to and knowledge of survey technology. Finally, snowball sampling does not allow for random selection. Therefore, it is not feasible to determine possible sampling error and make statistical inferences to the general population.

Interpretation of these data provides valuable information for the profession, notably academic programs, regarding needs and resources to foster collaborative relationships with fieldwork facilities to meet the growing need for fieldwork education. These study findings have the following implications for fieldwork education research, which relate to AOTA’s Education Research Agenda (AOTA, 2014b). Future fieldwork education research is needed to explore

• Pedagogical investigation of academic program methods and practices to prepare students for fieldwork, promoting readiness and professional behaviors

• Examination of frameworks and instructional methods related to fieldwork outcomes, including comparison of supervision models, sequence of content, and amount of time required to achieve targeted competencies

• Investigation of fieldwork educator resource challenges related to time and space to accommodate students in the workplace.

One intended outcome of this research is to provide a platform for future efforts to further understand barriers to therapists’ interest in and ability to assume the role of a fieldwork educator. Specifically, further research is needed to examine the group of therapists who do not participate in fieldwork education. Additional investigation of the perceived and tangible barriers that limit their willingness to supervise fieldwork students is needed.

The authors thank Robin Davis and her students at University of Mississippi who collaborated on the pilot study; our manuscript reviewers, Linda Tickle-Degnen, Deb Hanson, and Lisa Connor; the AOTA Commission on Education Fieldwork Capacity and Retention Survey Ad Hoc Committee members; and the respondents who completed the survey. This research was previously presented at the AOTA Academic Fieldwork Coordinators Forum in New Orleans, Louisiana, October 24, 2014, and at the AOTA Academic Leadership Council Meeting in Nashville, Tennessee, April 15, 2015.