Teaching Participation in Occupations to First Year Occupational Therapy Students: An Action Research Study
Ghul, Rayya, Marsh, Ian, British Journal of Occupational Therapy
The context of this study is the first year of an occupational therapy degree programme at Canterbury Christ Church University. The programme was due for revalidation in 2003 and, during the preceding year, the programme team reviewed the curriculum in terms of content, teaching and learning style, and underpinning philosophy. In line with the changing discourses in occupational therapy (Yerxa 1990, Pierce 2001), the team decided to revalidate using 'occupation' and the importance of occupation to health and wellbeing as the central philosophy and all the modules were revised or written from this perspective.
In the previous validation (degree courses are typically reviewed and revalidated every 5 years), students first took a module in Occupational Therapy Theory and then one drawing on psychology and sociology called 'Psychosocial Aspects of Health, Disease and Disability' (PAHDD). The present authors had taken over module leader responsibility for PAHDD and of rewriting it from an occupational perspective. While it was easy to adapt the theory module to incorporate new knowledge from occupational science, PAHDD posed some problems.
The PAHDD module content was traditional psychology and sociology, expanded to include content from disability studies. It had been taught as a series of discrete topics, such as 'motivation', 'personality', 'culture' and 'social policy', using a didactic teaching style with lectures and seminars. The summative assessment required the students to bring together the various concepts into a coherent understanding of how they related to occupational therapy. The quality of the student work was often disappointing as they struggled to synthesise the information and ended up using it in a shallow way For example, Parson's work on the 'sick role' (1951) would be referred to as describing a patient (for example, he would not cooperate because he was adopting the 'sick role') rather than understood as a transaction arising within a social relationship of power. As a result, important concepts such as the social and medical models of disability and their link to clinical practice were only understood superficially.
This disquiet was compounded by the experiences we had brought from clinical practice, in particular dismay at the too easy willingness of occupational therapists to privilege knowledge and practices from medicine, psychology and psychiatry over occupational therapy. Ideas from occupational science (Yerxa 1990) and theoretical models such as the Model of Human Occupation (Kielhofner 2002) and the Canadian Model of Occupational Performance (Canadian Association of Occupational Therapists 2002) seemed to provide a better foundation for understanding the personal and social factors affecting occupation.
As the theory module had been renamed 'Introduction to Human Occupation' and presented theoretical concepts of occupation, we decided to move away completely from PAHDD and instead focus on participation, which allowed us then to consider the personal and social factors (context of participation) from an occupational perspective. This module was called 'Participation in Occupations' (2003-2008) and then 'Participation in Occupations through the Lifespan' (2009-2012). The aim of the module was/is 'to provide foundation knowledge and methods of analysis to develop students' understanding of the personal, interpersonal and sociocultural factors that promote or limit participation in occupations'.
As this was an entirely new approach to teaching foundation knowledge for occupational therapy, we adopted a research-focused model of module development from the outset in order to monitor closely the students' engagement, understanding and attainment.
We adopted an action research (AR) process that has continued over the 8 years that the module has been running. AR is deep inquiry into one's professional practice, involving a systematic reflective study of one's actions, and the effects of these actions, in a workplace context (Riel 2010). …