Academic journal article Journal of Allied Health

Impact of the Changing Health Care Environment on Fieldwork Education

Academic journal article Journal of Allied Health

Impact of the Changing Health Care Environment on Fieldwork Education

Article excerpt

Perceptions of Occupational Therapy Educators

To investigate how clinical fieldwork educators and academic fieldwork coordinators view the impact of the changing health care environment on student fieldwork education, current practice, and future of the profession, a 48-item questionnaire assessing the influence of recent changes in the health care system on fieldwork education was sent to 125 occupational therapy fieldwork educators and coordinators (response rate 62.4%). Differences between fieldwork educators and coordinators were analyzed statistically using nonparametric methods. [alpha] level was set at p < 0.01 for all statistical comparisons. Fieldwork educators and coordinators agreed productivity expectations, number of hours worked, and time spent in documentation have increased, while job security, time for continuing education, and Quality of patient care under the current reimbursement system have decreased, but diverged on several other issues. Fieldwork educators believed reimbursement issues did not affect their ability to accept fieldwork students, whereas academic coordinators believed declining reimbursement had negatively affected fieldwork educators' ability to accept students. Factors thought to facilitate the fieldwork shortage included cost reductions, changes in reimbursement, and increased productivity demands on clinicians. J Allied Health. 2003; 32:246-251.

FIELDWORK IS THE COMPONENT of health professionals' curriculum that bridges academic education and the practical application of knowledge and skills. The fieldwork experience allows students the opportunity to test theories and facts learned in academic study and to refine skills through client interaction under the supervision of qualified personnel.1,2 The availability of fieldwork placements reportedly has decreased more recently across allied health disciplines due to several factors.3-5 Cost containment has forced health care reforms, which have reduced the number of therapists working within some departments and increased therapist productivity expectations.3 The implications for students in allied health are fewer traditional fieldwork opportunities and diminished quality of supervision.6

According to the American Occupational Therapy Association's Education Data Survey Final Report,7 97% of academic programs reported cancellations of level II fieldwork sites, and two thirds of level II fieldwork placements reported refusals to continue to accept future students on assignment. Fieldwork shortages have been reported across allied health disciplines, including physical therapy, speech and language therapy, respiratory therapy, occupational therapy, and nursing.8-11 Adding to the shortage of adequate fieldwork sites is the increase in the number of students and educational programs since the 1970s. In 1970, 3,958 occupational therapy students were enrolled in 1 of 37 accredited entry-level occupational therapy educational programs.7 By 1997, 15,803 students were enrolled in 104 accredited programs. As of January 2001, there were 141 accredited programs according to the Secretary of the American Occupational Therapy Association's Department of Education (Nijoroge V, personal communication, March 7, 2001). This infusion of students coupled with adherence to a one-to-one model of supervision has created a severe logjam because there are not enough fieldwork opportunities to meet the demands of increased numbers of students.12

The Balanced Budget Act, which was enacted by Congress in 1997, mandating the prospective payment system for skilled nursing facilities and freestanding outpatient centers, also has contributed to the putative shortage of fieldwork placement sites. The prospective payment system seems to have negatively affected the amount of services provided in allied health, time spent in therapy, reimbursement for clinical services, and accessibility to develop quality functional maintenance programs for chronically disabled patients. …

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