Kern, Navarro-Walker, Walsh, etc.

1. Understanding the Impact of a Systematic Method of Decision Making in Developing Practice
Habits & Professional Identity
Stephen B. Kern, PhD, OTR/L, FAOTA; Lydia Navarro-Walker, OTR/L; Robert W. Walsh, M.S., OTR/L
Tina DeAngelis, Ed.D., OTR/L; E. Adel Herge, OTD, OTR/L, FAOTA; Caryn R. Johnson, MS, OTR/L, FAOTA; Arlene Lorch, OTD, OTR/L, CHES;
Roseann C. Schaaf, Ph.D., OTR/L, FAOTA; Susan Toth-Cohen, Ph.D., OTR/L; Cynthia Haynes, OTD, OTR/L; Amy Carroll, OTD, OTR/L
Thomas Jefferson University, Department of Occupational Therapy, Philadelphia, PA
Introduction
Why PrEMO
The Department of Occupational Therapy faculty was concerned
with how students were being trained at their fieldwork (FW) sites.
There was a disconnect between the program curricular design and
what students were reporting about practice habits at their
fieldwork sites. Simultaneously, a method of teaching post
professional students enrolled in our “advanced practice certificate”
programs, called Data Driven Decision Making (DDDM), was yielding
remarkable results reshaping the way licensed occupational
therapists were approaching their practice.
As a Faculty, we decided to partner with the clinical community to
help redesign the way care was provided by developing exemplary,
best practice sites that use a systematic, data driven, evidence-
based and occupation centered model of care – or Promoting
Environments that Measure Outcomes (PrEMO).
PrEMO: Faculty partner with organizations to:
– Promote best practice environments that measure outcomes
– Develop new occupational therapy programs
– Design FW experiences that guide students’ use of evidence
and outcomes in daily practice; and develop their clinical
reasoning
– Collaborate in clinical research to measure outcomes
– Build capacity
– Involve students into service provision
– Shape the future of OT practice
Purpose: To understand the impact of a level II fieldwork
placement at a PrEMO site on students’ development of practice
habits and professional identity.
Focus group questions sought to gather data about students’
fieldwork experiences
- To understand and describe the use of DDDM in all phases of
treatment
- Understand the development of practice habits using DDDM
- Describe the development of professional identity as an
Evidence-Based Practitioner
Results
Conclusion
The development of PrEMO FW sites is providing our students a
practice environment where they can perform in a way that they are
learning in the classroom. They report developing practice habits in
use of systematic approach to decision making, use of evidence, and
outcomes measurement.
While these results are promising in demonstrating the positive
impact of DDDM training on the students’ practice habits and
professional development, it is unclear if this is a result of all level II
FW training. Future studies will need to be completed. Additional
focus groups will help us understand the impact of DDDM training &
practice and how professional development is experienced by
students. Additionally, in the future we will need to study and
compare experiences of students at PrEMO and non-PrEMO sites.
References
Schaaf, R. & Maillox, Z. (2015). Clinicians guide for implementing Ayres sensory integration.
Bethesda, MD. AOTA Press
Discussion
Methods
Students who had participated in Level II FW at PrEMO sites were
invited to participate in a focus group. Informed consent was
obtained from six students who completed level II FW at a PrEMO site
and a traditional site volunteered to participate in a 90-minute
audiotaped focus group.
Following accepted iterative qualitative research methodology, the
audiotaped data was transcribed and analyzed by the research team
members individually, and as a group to achieve consensus &
trustworthiness.
These findings are promising. They indicate that students completing
level II FW are benefitting in several areas as a result of training and
practice using a systematic decision making process.
A major reason for the PrEMO initiative was to develop “best practice”
training sites for our students. These result demonstrate that
students placed at PrEMO sites are systematically approaching every
phase of the OT process in a focused and meaningful way.
Participants reported that the design of the FW experience
contributed to their developing immediate and future practice
habits.
Theme
Benefits of DDDM Instruction & Training
• Requires learning new terminology
• Repetition of instruction
• Reminds you what is important to think about as a professional
• Recommend integrate DDDM into entire curriculum
OT Processes
(Evaluation, Intervention, Outcomes,(AOTA, 2014))
• DDDM helps structure my thinking about the OT process
• Step by step; piece by piece – which theory, which assessment(s) to use
• Which is the best intervention to use
• Prioritizing (OT) problems; breaking down to smaller factors being
impacted
• Think about each process in a meaningful way
Immediate Habit Development
• Communication; Assertiveness
• Organization of thinking; organization of processes; “think ahead, be
organized, planning”
• Being Systematic
• Structure, Establish Baseline, “Staying on Track”
• Quality of Documentation
• Focus/organization
• Use of measurements
• Prioritization of Goals/Outcomes; Tracking progress
• Holistic
• Resource Utilization (i.e. evidence, experts, protocols, etc.)
• Collaboration with Team Members
• Link to classroom learning
Future Habits
• Analysis of quality & appropriateness of evidence
• Selecting & using best outcome measures (proximal and distal)
• Advocacy; Contextualizing care; what’s meaningful to the patient/site
• Remaining focused and prioritized [when pulled in various directions]
Professional Identity
• Felt the development of my clinical reasoning
• Being treated like a colleague
• Successes helped me feel like a professional therapist
(Schaaf & Maillox, 2015)
DDDM Process
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