Developing an Observed Practice Programme for Occupational Therapists and Physiotherapists: Reporting the First Phase of an Action Research Study
Morley, Mary, Petty, Nicola J., British Journal of Occupational Therapy
Observed practice has been used as a developmental strategy for staff working in education for many years (Gosling 2002, Shortland 2004). In this paper, 'observed practice' refers to the direct observation of clinical practice by a colleague, with the aim of enhancing clinical skills and knowledge. It includes peer observation, which involves peers observing each other's practice in order to facilitate personal and professional development (Shortland 2004), as well as observed practice with more experienced or senior practitioners often as a supervisory tool. The value of observed practice has been cited as a tool for professional development and for promoting reflective practice (Beaty and McGill 1995, Hammersley-Fletcher and Orsmond 2005, Peel 2005, Hatzipanagos and Lygo-Baker 2006). Occupational therapists working in higher education have acknowledged the benefits of peer observation to their professional development as lecturers (Davys et al 2008). There is also discussion of the potential benefits of peer observation in clinical settings (Davys and Jones 2007, Petty and Morley 2009). However, there is little empirical evidence of its practical application within occupational therapy and physiotherapy.
Several authors argue the value of a practitioner with higher levels of expertise enhancing the practice of someone less experienced through direct observation (Eraut 1994, 2004, Fish and Twinn 1997, Daloz 1999, Titchen 2001). Observed practice enables specific feedback of performance to the clinician. Furthermore, clinical experts within physiotherapy have highlighted how working with patients, in the presence of an expert guide and teacher, enabled them powerfully to enhance their practice (Jensen et al 1999). Practice knowledge that is hidden (Argyris and Schon 1974, Fish and Coles 1998), difficult or impossible to articulate (Eraut 1994, Fish 1998, Titchen and Ersser 2001) is revealed through observation. The subsequent challenge and support by the observer can raise the practitioner's awareness of his or her hidden, and perhaps taken for granted, knowledge, and potentially lead to its transformation and enhancement (Brookfield 1987, Johns 1994). Being able critically to reflect on practice is considered an essential attribute for professional development and the prevention of obsolescence.
The opportunity to observe a colleague with expertise may also be a valuable learning experience (Bandura 1997, Titchen 2001). Senior practitioners struggle to articulate their clinical reasoning (Schon 1987) and demonstration and description through role modelling bridges the theory-practice divide. Observation may raise awareness of a much higher level of practice and professional behaviour, triggering a need to learn and inspiring subsequent professional development.
Observed practice is essentially work based. The primacy of workplace learning in a 'community of practice' (Lave and Wenger 1991) has been highlighted in the United Kingdom (UK) (Eraut 2006), Canada (Toal-Sullivan 2006) and Australia (Billett 2001, McInstry 2005). Health practitioners' professional identities are confirmed in the work setting and appropriate professional behaviours require practice, role models and feedback (Eraut et al 2003, Miller and Blackman 2003, Maben et al 2006, Hodgetts et al 2007). Learning occurs through deliberate reflection-on-action and is enhanced through feedback from peers (Schon 1987). Self-awareness is essential to this reflective practice (Eraut 1994, Burns and Bulman 2000).
Newly qualified and more experienced practitioners
Observation and feedback are considered an important part of the growth and development of newly qualified practitioners (McInstry 2005, Toal-Sullivan 2006, Morley 2007a). Morley (2007a, 2009a) incorporated opportunities for formal observation of practice by a more senior practitioner in a preceptorship programme for newly qualified occupational therapists. …