Fieldwork Evaluation Overview

Throughout their fieldwork placement, students receive ongoing feedback from their preceptors regarding their performance through both regularly scheduled and spontaneous feedback sessions. Formal evaluation occurs both at midterm and at the end of the placement with the completion of the Competency Based Fieldwork Evaluation for Occupational Therapists (CBFE-OT).*

Students are required to purchase the Competency Based Fieldwork Evaluation for Occupational Therapists (CBFE-OT) manual in term 1. An electronic copy of the CBFE-OT will be made available to students after purchasing the manual. Students will then forward the electronic copy of the CBFE-OT to their preceptor for use during the placement. The CBFE-OT will be completed at both the midterm point of placement and at the end of placement, by inputting comments and scores for each competency. Signed copies must be submitted by the student electronically through Quercus at the end of placement. The student’s preceptor(s) must also submit a copy of the final CBFE-OT directly to the fieldwork administrative assistant at ot.fieldworkevals@utoronto.ca.

Students must ensure that all required preceptor and student signatures are present on pages 1 and 16 of the CBFE-OT form after the completion of each fieldwork placement before submission through Quercus. Students should make copies of completed CBFE-OT forms for their own personal use and reference.

Evaluation for the Introductory Fieldwork Experience

The evaluation for Introduction to Fieldwork has been adapted specifically for this placement based on the CBFE-OT. For the purposes of this placement, only certain components of key competencies will be evaluated: This specialized evaluation form will be provided by the university fieldwork office. Students are not required to develop their own learning objectives within this evaluation.

Evaluation for Fieldwork 1, 2, 3, and 4

As part of the fieldwork orientation, the preceptor and student(s) should discuss the evaluation forms and timeframes and processes for completion. At both midterm and final, students must complete a self-evaluation, providing comments and examples of how they think they have demonstrated the expected behaviours under each competency area. Students do not include scores during this process. Students then forward their self-evaluation to their preceptor for review along with any additional comments and a score for each competency area.

At midterm, the completed CBFE-OT outlining the student’s performance thus far and progression on the specific learning objectives that have been identified within the competencies are reviewed.

All of the CBFE-OT competencies must be scored by the preceptor by circling/choosing whole numbers. All seven competencies on the CBFE-OT must be scored and commented on, even if a personal learning objective is not identified within that competency.

In addition, an overall score must be provided where indicated on the evaluation form. The preceptor and student meet to discuss the evaluation form and the completed the online ‘Student Report on Fieldwork Placement’(please see the following section). The reports are discussed and signed by both the fieldwork preceptor(s) and student. The CBFE-OT comment section is highly valued by both students and faculty. It is important that all comments be specific and objective and clearly describe the student’s performance. The comment section is beneficial to the University Fieldwork Instructor in monitoring each student’s progress.

The student’s performance should be considered satisfactory at midterm if the student is performing at the required level of competency for the corresponding stage of development (as per the CBFE-OT manual and the Course Outline) and the student is reasonably on their way to meeting the course learning objectives and their personal learning objectives. If, however, the student has been experiencing significant difficulty during the first half of the placement and has not achieved the required level of competency for the stage of development for that placement, performance should be rated as unsatisfactory and this should be noted.

If the student’s performance has been rated as unsatisfactory at midterm, the University Fieldwork Instructor must be promptly informed and will meet with the preceptor and student to discuss strategies to help the student improve her/his performance. Please see ‘Procedures for Unsatisfactory Fieldwork Performance’ for a full explanation of the process required when a student’s fieldwork performance does not meet required standards.

At the end of the placement (final evaluation), the evaluation process is repeated. Additionally, the preceptor(s) will recommend that the student passes or fails the placement. Unsatisfactory performance will be rated as a failure. Poor performance may result in course failure as determined by the University Fieldwork Instructor.

If the student’s performance is rated as a failure, the University Fieldwork Instructor must be contacted by the preceptor immediately. Additionally, students and preceptors should refer to ‘Policy on Unsatisfactory Performance’ and ‘Procedures for Unsatisfactory Performance’ in this manual and to the “Policies and Regulations” section of the MScOT Graduate Student Handbook.

Students should keep copies of all fieldwork evaluations for their records. Facilities must obtain the student’s consent in order to maintain a copy of the CBFE-OT. Please note that the CBFE-OT is copyrighted and so preceptors are not permitted to keep the CBFE-OT template on their computer unless they themselves have purchased the CBFE-OT manual.

Footnote

*Bossers, A., Miller, L.T., Polatajko, H.J., & Hartley, M. (2007). Competency Based Fieldwork Evaluation for Occupational Therapy CBFE-OT. Toronto, ON: Nelson Education.

Unsatisfactory Student Performance

Supervised fieldwork is an integral component of the professional education of occupational therapy students. Learning in fieldwork education is viewed as a dynamic process in which learning from one placement is built upon in subsequent placements. Students progress through fieldwork placements in sequence and are expected to perform at progressively higher levels of competence and independence. Students will evolve from an entry-level student to an entry-level occupational therapist.

The Department of Occupational Science and Occupational Therapy sets learning objectives for students to meet at each level of fieldwork education within the fieldwork course outline. The university Fieldwork Course Instructor is contacted immediately in the event of a possible failure of a student in a fieldwork placement and at least by midterm. This ensures that the student, fieldwork preceptor, on-site fieldwork coordinator (if present at the facility) and the university are fully aware of the performance of the student and that specific teaching/learning strategies are developed to help the student to improve her/his performance.

If there is documented evidence that learning strategies have been implemented and the student’s performance remains unsatisfactory (after a period deemed sufficient by the Fieldwork Course Instructor for evidence of improved performance) and/or the preceptor/fieldwork site report client safety, professional or ethical concerns, or there is significant disruption to team functioning the university may withdraw the student from the placement and the student may be considered to have failed the fieldwork course. Any student whose performance has been identified as unsatisfactory who is withdrawn at the mid-term of the placement or later will be considered to have failed the fieldwork course.

The Department of Occupational Science and Occupational Therapy at all times retains the ultimate decision for the pass/failure of the student in fieldwork courses. Students must successfully complete each fieldwork course prior to proceeding to subsequent fieldwork courses.

For further consequences related to failure in any course, fieldwork or academic, refer to the departmental MScOT Graduate Student Handbook.

Procedures for Unsatisfactory Fieldwork Performance

When unsatisfactory performance by the student is noted by the preceptor prior to and/or at midterm, the following steps should be taken:

The preceptor or on-site fieldwork coordinator should contact the Director of Clinical Education/University Fieldwork Course Instructor.
The preceptor must provide the student with verbal and written documentation of performance and behaviours that indicate unsatisfactory performance and potential failure of the placement.
The University Fieldwork Course Instructor will meet with the student, the preceptor and the on-site fieldwork coordinator to identify problems. Utilizing the Fieldwork Course outline learning objectives and the CBFE-OT form (with learning objectives included), objectives and specific strategies to meet the objectives are developed.
The University Fieldwork Instructor will maintain contact as necessary with both the fieldwork preceptor and the student to monitor student performance throughout the remainder of the placement.
The University Fieldwork Instructor will attend midterm/interim/final evaluations as necessary.

When unsatisfactory performance is noted after midterm, the same procedure is to be followed as in the preceding section. If the failure is identified by the preceptor at a time that is too late to implement remediation strategies, the preceptor must document:

the reasons that precluded the preceptor from noting the problems earlier, and/or
the emergence of new behaviours/problems that led to failure late in the placement.

At any stage when a student is observed to be having serious problems in fieldwork practice, the Director of Clinical Education/University Fieldwork Course Instructor must be contacted immediately.

Fieldwork Course Learning Objectives

Personal Learning Objectives

Personal learning objectives are to be included in the CBFE-OT form and are developed by the student following a thorough orientation to the site/program to which she/he is assigned. The learning objectives reconcile the requirements from the University and the facility with the learner’s own goals and objectives. These should be discussed with the preceptor during the first week of placement. The preceptor reviews the learning objectives and changes are negotiated. The learning objectives outline specific skills that the student will learn, how this will be accomplished, within what time period and the specific criteria for evaluating each objective.

The following guidelines are recommended for the development of the learning objectives:

The student receives a thorough orientation to their placement prior to determining their learning objectives;
The student identifies her/his own learning needs;
The student develops a total of three or four learning objectives relating to the competencies outlined in the CBFE-OT. There should not be more than one learning objective under the same competency. Students in a group model will develop both individual and shared learning objectives;
For each objective, the student specifies their specific learning resources/strategies;
The student specifies what the evidence will be that indicates achievement of each objective;
The student and preceptor specify how the evidence will be evaluated;
The student’s learning is evaluated by the student, their peers and clients (if appropriate) and the preceptor.
When in a split supervision placement, students must complete a total of three to four learning objectives between the two preceptors.

The Learning Objectives Evaluation Guide and a Learning Objectives template are included in Appendix M. Students should refer to their OCT1132H course notes to ensure that they are writing their learning objectives in the correct manner with the expected level of detail.

Presentations/Projects

Students are required to complete a presentation or project during each of Fieldwork 2, Fieldwork 3 and Fieldwork 4. Please note that although the CBFE-OT form asks students to indicate their project “if applicable”, the OS&OT department considers the project mandatory for Fieldwork 2, 3, and 4. Students in a split supervision placement should only complete one project for that placement.

Projects / presentations are reviewed by preceptors and feedback is provided, although there is no formal marking scale required by the university.

Students in Fieldwork 2, Fieldwork 3 and Fieldwork 4 should choose a subject for their presentation that is pertinent to their current fieldwork practice, is of benefit to the facility, and will aid them in their application of theory and practice. Examples of projects/presentations are:

a comparison of alternate treatment approaches for a given client population;
a comparison of individual clients within a client population and implications for treatment;
a case presentation of an individual client (suggested guidelines on following pages);
a project pertinent to occupational therapy and beneficial to facility.

The purpose of these presentations is to help students develop the skills to:

Apply academic knowledge to clinical problems;
Demonstrate an understanding of the role of Occupational Therapy in the placement context;
Present in an organized, clear and professional manner;
Stimulate discussion and sharing of information.

Case Presentations – Guidelines

When preparing case presentations, students are expected to follow the 7 Stages of the Occupational Performance Process as outlined in Enabling Occupation (1997, 2002). The Canadian Practice Process Framework (CPPF) should also be taken into account (CAOT, 2007).

1. Name, Validate and Prioritize Occupational Performance Issues (Screening)

Pertinent information about occupational performance is gathered with the client and others, e.g., family, community, etc. This may include an interview, use of the Canadian Occupational Performance Measure (COPM), community visits, environmental assessments, etc. Occupational Performance issues are confirmed with the client, then prioritized. If there are no occupational performance issues, the process ends.

2. Select a Theoretical Approach(es)

A conceptual system is selected which will guide decision-making throughout the process. Approach is a general term used here to include models, tested theories, frameworks, etc. McColl, Law and Stewart (1993) provide annotated bibliographies for six categories of specific theoretical approaches which are consistent with the Canadian model of occupational performance. The theoretical approaches within the categories can be selected to guide practice with clients.

The six categories, with examples of theoretical approaches that fall within these categories are as follows:

Physical rehabilitative: anatomy, physiology, kinesiology, biomechanics, orthopedics
Neurointegrative: NDT, sensory integration, sensory stimulation, perceptual motor, PNF, neuro rehabilitation
Psycho-emotional: behavioural, psychoanalytical, cognitive, social learning
Socioadaptive: role theory, feminist theory, group theory, anthropology, sociology
Developmental: cognitive development (Piaget), social development (Erikson), moral development (Kohlberg)
Environmental: architecture and planning, general systems theory, economics, ecology, socio-political theory

3. Identify Occupational Performance and Environmental Conditions

Occupational performance components and environmental conditions that are relevant to the occupational performance issue(s) are assessed. Decisions about what one assesses and how one does it are guided by the theoretical approach that has been selected. Methods used to assess occupational performance components and environmental conditions can include: observations, a review of documents, standardized tools, etc. Findings are analyzed as they relate to occupational performance.

4. Identify Strengths and Resources

Personal strengths and environmental resources are identified. Personal strengths lie within any one of the three performance components: physical, cognitive or affective, while resources lie within any one of the four environmental conditions: physical, social, cultural, or institutional.

5. Negotiate Targeted Outcomes, Develop Action Plan

Priorities are determined in conjunction with the client, then targeted outcomes defined. The targeted outcomes should specify behaviours that can be observed and/or measured, and be realistic, understandable and achievable. Interim or short-term goals/objectives are developed, enabling the client to progress through graded steps. They should include the same features as the targeted outcome.

Action plans are then developed to meet the targeted outcomes. Changes to the theoretical approach can be reviewed at this time, and changed if necessary. Action plans may include strategies to: develop, restore, maintain or promote occupational performance, or prevent occupational performance dysfunction. Action plans can be designed to enhance occupational performance components e.g., increase knowledge about safety, increase muscle strength through meaningful occupations, enhance communication skills or overcome environmental barriers e.g., provide adaptations, purchase devices, seek funding for environmental changes, provide education to a corporation or system.

Finally, action plans are finalized including determining location, schedule, frequency, materials, and estimated duration of implementation.

6. Implement Plans Through Occupation

Actions are implemented in accordance with the plan. The occupational therapist continually adapts and grades occupations to enable progress towards the targeted outcomes. Throughout implementation of the plan, the occupational therapist monitors the client’s satisfaction with the process and outcomes, and makes changes to enhance satisfaction when needed.

The extent to which all occupational performance issues are resolved, relative to the targeted outcomes, is assessed on an ongoing basis with each client. Even though a targeted outcome may remain the same, the methods for reaching the target may vary from day to day as conditions change. When changes are made, they are communicated to team members and others. The occupational therapist strives to ensure that the best methods available for resolving or minimizing the occupational performance issue(s) are used.

7. Evaluate Occupational Performance Outcomes

The occupational therapist determines whether targeted outcomes have been met by comparing targeted outcomes with actual outcomes. Evaluation may also measure the degree of change in occupational performance over time, or in different settings. Evaluation methods can include any or all of the methods used in Stage 3.

The occupational therapist must also evaluate the process by documenting what was and was not done, with the reasoning for decisions. This may include who was involved, what actions took place, how occupational performance issues were prioritized, how theoretical approaches were selected, how strengths and resources in occupational performance were identified, and the availability of environmental resources and support services.

If targeted outcomes have been met, the occupational performance process is complete, unless other occupational performance issues are identified. If the targeted outcomes have not been met, the process continues.

References

Canadian Association of Occupational Therapists. (2007). Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being, & Justice through Occupation. Ottawa ON: CAOT Publications ACE.

Canadian Association of Occupational Therapists. (2002). Enabling Occupation: An Occupational Therapy Perspective (Rev.ed.). Ottawa ON: CAOT Publications ACE.

Canadian Association of Occupational Therapists. (1997). Enabling Occupation: An Occupational Therapy Perspective. Ottawa ON: CAOT Publications ACE.

McColl, M.A., Law, M. & Stewart, D. (1993). Theoretical Basis of Occupational Therapy: An Annotated Bibliography of Applied Theory in the Professional Literature. Thorofare, NJ: Slack.

Student Report on Fieldwork Placement

At midterm and the end of the placement, students must complete the online ‘Student Report on Fieldwork Placement’ form. The completed report will give the preceptor and facility feedback on the supervisory process, orientation, student resources, learning climate, etc. and enable them to enhance their teaching and student program. The ability to give feedback effectively is a component of the Professional Interactions Competency of the CBFE-OT and students are encouraged to provide professional and constructive in their feedback, as appropriate.

Students should complete report individually and present it to their preceptor at the same meeting time as the discussion of CBFE-OT given by the preceptor (that is, at both midterm and final meeting times). Students are encouraged to bring any concerns about the process of completing the “Student Report on Fieldwork Placement” to the attention of their fieldwork instructor and site fieldwork coordinator, as appropriate.

The ‘Student Report on Fieldwork Placement’ must be completed, reviewed and signed copy by both the student and preceptor before submission electronically by the student through Quercus.

Placement Coding and Fieldwork Record Tool

Students should make use of the ‘Fieldwork Record’ tool to independently keep track of their placements and the coding associated with them. If the student would like to request a change in coding for any of their placements, they must send an email to the Fieldwork Course Instructor, copying their preceptor, giving details about caseload and assessments and treatments administered. This request must be submitted via email no later than one week after completion of the placement. Students must consult the descriptions of the codes (see Appendix N) prior to making the request to ensure that the placement is represented accurately by the newly suggested coding. The request must be verified by the preceptor and on-site fieldwork coordinator and a final decision regarding coding will be made by the University Fieldwork Instructor and communicated to the student. Electronic fieldwork records regarding the placement will be changed as indicated.

Issues or Conflicts During Fieldwork

Occasionally, issues or concerns may arise between the student and his/her preceptor. These issues need to be addressed in a professional and sensitive manner. Students and preceptors are advised to establish methods and times for open communication where such issues can be dealt with. If further assistance is required in solving an issue, the student and/or preceptor should speak with the on-site fieldwork coordinator. Further help can, and at times should, be obtained from the University Fieldwork Instructor. Please see Appendix L for flow charts that outline appropriate courses of action with regard to any issues or concerns arising on placement.