What occupational therapists’ say about their competencies’ enactment, maintenance and development in practice? A two-phase mixed methods study

Abstract

Background: Understanding how professional competencies are actually enacted in clinical practice can help university programs better prepare their graduates. The study aimed to describe 1) the perceived competency level of occupational therapists holding an entry-to-practice master's degree 2) the factors perceived as impacting the enactment of competencies; and 3) the strategies used to maintain and further develop level of competency in the seven practice roles: expert in enabling occupation, communicator, collaborator, practice manager, change agent, scholarly practitioner and professional. Methods: Descriptive two-phase mixed methods sequential design. The quantitative phase consisted of an online survey sent to all occupational therapists holding an entry-to-practice master's degree in Quebec, Canada (n = 1196), followed by focus group discussions with a subset of participants. Analysis used descriptive statistics and the Framework Approach for content analysis of focus group data. Competencies were theoretically anchored into the Profile of Occupational Therapist Practice in Canada (an equivalent to CanMEDS framework) and we used the Theoretical Domain Framework to collect and describe perceived factors and strategies. Results: Response rate to Phase 1 was 26.5% (n = 317/1196). The communicator, collaborator and professional roles were perceived as highly solicited in practice, valued and were rated more frequently at a higher competency level as compared to the other four roles (expert, manager, change agent and scholar roles). Focus group participants (n = 16) mentioned that both individual and organisational factors influence enactment of competencies. Consulting colleagues was the preferred strategy to support the scholar role, often described as foundational for the development of expertise.

Exploring if and how evidence-based practice of occupational and physical therapists evolves over time: A longitudinal mixed methods national study

“…The decrease in the use of EBP could be explained by several individual and organizational factors. Findings from the current study and those from previous studies [57][58][59][60][61] converge to suggest that practitioners highly value their own personal practice experiences and those of their peers as a primary source of knowledge in making clinical decisions. With time and clinical acumen, practitioners' confidence in their abilities increases, and they appear to rely on their experiences as the only or primary source of evidence, especially when they have had successful past experiences in doing so [62,63].…”

Individual and organizational factors associated with evidence‐based practice among physical and occupational therapy recent graduates: A cross‐sectional national study

“…Condon et al 57 found that PTs relied on their peers' opinions rather than on recommendations from research (and moving through the five EBP steps) in making clinical decisions as did Rochette et al, 58 in their study of OTs who perceived that consulting peers was more effective than engaging, for example, in literature searches (one of the five EBP steps). As a note of caution, it is possible that such exchanges among peers may actually be about the nature of the evidence and/or its usefulness in clinical decision making.…”

“…As debates on the merits and challenges of EBP grow, 60‐62 clinicians may be turning to colleagues for discussions on topics such as the various conceptions of evidence, 63‐66 the legitimacy of patient narratives in the decision‐making process, 67 and case examples of when the evidence from gold standard designs such as randomized clinical trials conflict with patient choices and/or do not apply to their unique situation 17 . To address the issue of peer exchanges on matters pertaining to EBP, Rochette et al 58 suggested the use of professional networking to improve broader EBP competencies rather than targeting individual discrete skills. Communities of practice and mentorship by more seasoned professionals may also support professionals in this area once they enter practice 68‐70 …”

Acting as Change Agents: Insight Into Québec Occupational Therapists’ Current Practice: Actions menées à titre d’agents de changement : aperçu des pratiques actuelles parmi les ergothérapeutes du Québec

“…Not surprisingly, occupational therapists’ change agent practices include mainly communication and collaboration actions. According to Rochette and colleagues (2020) , recent occupational therapist graduates in Québec are very comfortable with enacting communicator and collaborator competencies in the clinical setting. Carrier and Beaudoin (2020) noted that the clinical configuration of the change agent role is more aligned with the usual work of occupational therapists, whereas the social configuration involves different types of knowledge and skills.…”

“…Furthermore, although previous empirical studies explored occupational therapists' reasons for advocacy actions (Dhillon et al, 2010) and experiences of advocacy activities (Dhillon et al, 2016), to our knowledge, no empirical study has investigated the clinical practice of occupational therapists to identify their concrete change agent actions. Since acting as change agents is considered uncomfortable for most occupational therapists, whether experienced (Finlayson, 2013;Restall & Ripat, 2008) or novice (Rochette et al, 2020), knowing more about what actually happens in practice is of particular interest. More specifically, results might inform educators and professional stakeholders regarding what the objective of future training efforts should be.…”