Occupational Therapy In Health Care, 29(2):139–152, 2015 C 2015 by Informa Healthcare USA, Inc. Available online at http://informahealthcare.com/othc DOI: 10.3109/07380577.2015.1017897
Exploring the Complexity of the Academic Fieldwork Coordinator Role Patricia Stutz-Tanenbaum1 , Debra J. Hanson2 , Jeanette Koski3 , & David Greene1 1
Occupational Therapy Department, Colorado State University, Fort Collins, Colorado, USA, 2 Department of Occupational Therapy, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA, 3 Division of Occupational Therapy, University of Utah, Salt Lake City, Utah, USA
ABSTRACT. A nation-wide survey was conducted of occupational therapy and occupational therapy assistant academic fieldwork coordinators (AFWCs) to describe demographic characteristics and tasks of the role. From the data, 10 clusters of role tasks of the AFWC are described. AFWCs view the position as a final career goal although the majority of respondents reported 5 years or less experience. Administrative assistant support and hours dedicated to fieldwork tasks are higher at the professional level than for occupational therapy assistant AFWCs. AFWCs reported difficulty accomplishing tasks in a 40-h work week and limited time for research and scholarship. Recommendations are provided for recruitment and retention through development of a systematic training program and establishment of a national fieldwork education research agenda. KEYWORDS. education
Faculty member roles, Fieldwork education, Occupational therapy
The academic fieldwork coordinator (AFWC) is an individual who orchestrates student fieldwork placements, bridging academia with clinical practice. The AFWC also navigates the world of curricular design, and ensures that internships reflect the scope, sequence, and culture of the professional healthcare program. As such, the AFWC is specifically responsible for the program’s compliance with fieldwork requirements of the Accreditation Council of Occupational Therapy Education Standards Section C (ACOTE, 2012) by developing and refining level I and level II fieldwork experiences in cooperation with academic faculty and fieldwork educators to support the curriculum design. Additionally, AFWCs are responsible for preparing students for the fieldwork environment, mentoring fieldwork educators for an educator role, and providing ongoing support for students and fieldwork Address correspondence to: Patricia Stutz-Tanenbaum, Academic Fieldwork Coordinator, Occupational Therapy Department, Colorado State University, Occupational Therapy Building #206, Fort Collins, CO 80523, USA (E-mail: [email protected]). (Received 07 September 2014; accepted 08 February 2015)
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educators during the placement. The AFWC is a visible representative of the academic program to the public and is often called upon to intervene in difficult situations, such as working with struggling students and preparing the fieldwork site to accept and work with students who have disabilities. Although the AFWC position is crucial to the program, there are little data describing the responsibilities and characteristics of the people performing in the role. As a result, academic programs do not have research data to guide recruitment, role delineation, training, and retention of the AFWC. This study describes the tasks that make up the role and relevant demographic characteristics of occupational therapy assistant and occupational therapy AFWCs. COMPLEXITY OF THE ROLE Those outside the academic environment do not universally understand the role of the AFWC. Moreover, there is very little research about the usefulness and capability of the position within the occupational therapy academic community. Therefore, literature was reviewed from related health professions including social work, physical therapy, medicine, physician assistant, athletic training, and nursing. Buccieri and Brown (2006) describe the role of the physical therapy academic clinical coordinator of education as unique, straddling academic and clinical worlds that warrant a clear distinction from the traditional academic faculty member due to the variability of the workload. Their study found that the majority of academic clinical coordinators were not tenure eligible, partly due to the extensive demands of the position, and recommend their effectiveness be evaluated differently and by those with whom they interact the most when carrying out tasks (Buccieri and Brown 2006). Similarly, Sobralske and Naegele (2001) describe the nurse practitioner clinical coordinator role as complex, acknowledging that the value of the role is not clearly understood by administrators or by clinical coordinators themselves. They propose that the difficulty in understanding is due to associated multifaceted duties and the competencies needed for effectiveness (i.e., clinical, academic, and scholarship competence), as well as personal qualities such as creativity, flexibility, and communication skills. The struggle of clinical education faculty to fit into academic departments with non-clinical faculty peers has been documented in several health-related professions. Social work field directors are often hired without a doctoral degree, and the position has been associated with limited job status, influence in the department, seniority, and advancement opportunities (Lyter, 2012). Accordingly, Hoch et al. (2009) found that program directors of athletic training programs expressed ambivalence about delegating administrative tasks for athletic training students to the clinical education coordinator and other faculty. Salzman (2009) found that physical therapy directors of clinical education reported not being fully integrated into academia. There is a lack of structured training, as well as limited support and mentorship, provided for novice clinical education coordinators to learn their roles. In a survey of emergency room clinical directors, only 14.4% received extensive mentorship or written guidelines to conduct job duties (Coates et al., 2005). Orell et al. (1999) described an “on the job” learning process for clinical education coordinators and
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asserted that this is due to the “lack of coordinated professional support” (p. 75). The lack of role preparation may limit successful acculturation for clinicians who are transitioning into the educator role. As new academic faculty cope with the unfamiliar environment, relying on intuition and on-the-job orientation to start academic careers, role stress may result due to “ambiguity, incongruity (person and role fit are problematic), conflict, and overload” (Clark et al., 2010, p. 106). In addition to the complexities of the academic world, AFWCs navigate the complex demands of the healthcare environment (Bithell et al., 2010). Continually changing national policies make the highly regulated and legalistic healthcare system difficult to track when charged with decision-making to minimize liability and risks (Bithell et al., 2010, pp. 61–62). AFWCs must be current with, and conform to, the shifting demands for student fieldwork site prerequisites to address regulatory constraints. For example, the Joint Commission of Hospitals mandates that students and volunteers “who work in the same capacity as staff who provide care, treatment, and services, would be expected to have criminal background checks verified when required by law and regulation” (“The Joint Commission”, 2014). This means that the AFWC needs to monitor state laws, regulations, and organization policy to ensure compliance across every location where students complete fieldwork placements. Increased responsibilities for tracking risk management issues add to the complexity of the role. There is no published data on the longevity of occupational therapy AFWCs, although evidence of limited longevity exists across several healthcare professions. A survey of emergency room clinical director practice indicates that most are junior faculty and have been in the role for less than 5 years; only 22.4% held the position longer than 5 years (Coates et al., 2005). The 2009 Physician Assistant Education Association reported an average longevity of 4.9 years (Snyder et al., 2010). A Social Work Field Director Report identified that over half of those surveyed had been 5 years or less in the position (Lyter, 2012). Clouten (1994) reported that physical therapy directors of clinical education are more likely to consider their positions as “trial or entry-level” positions. TASKS OF THE ROLE In a survey of clinical directors representing several different medical specialty areas, there was similarity across fields with demographics and academic productivity, despite variability in the daily clinical routines and clerkship activities (Ephgrave et al., 2010). Strickler’s (1991) survey of physical therapy academic clinical coordinators of education found they spend 24% of their time in the classroom teaching, 52% on clinical education activities, and 24% on clinical practice, scholarship, and service. Additionally, 64% of Stickler’s survey participants did not have written job descriptions, role tasks, or functions (Strickler, 1991, p. 6). Nurse practitioner clinical coordinator responsibilities include working with students and clinical faculty to resolve conflict, which entails communication skills, flexibility, and creativity (Sobralske and Naegele, 2001). Although the tasks of the AFWC appear similar across academic programs, there are no data to explore how the tasks and roles compare across the United States in the 356 (159 occupational therapy and 177 occupational therapy
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assistant) accredited program locations (AOTA, 2012). The purpose of this study was to identify the tasks associated with the role AFWC in occupational therapy and occupational therapy assistant programs, to describe the position, and the demographics of individuals in these roles.
METHODS Sample Participants for the study were recruited using the American Occupational Therapy Association’s (AOTA) AFWC Listserv, which is a voluntary e-mail distribution list dedicated to networking, resource sharing, and support for occupational therapy and occupational therapy assistant program AFWCs in the US. The AFWC Listserv had 245 subscribers at the time of the initial survey request (V. Njoroge, personal communication, March 5, 2012). University human subjects’ committee approval was granted at each author’s institution, and all participants provided informed consent.
Instrumentation An online survey tool was developed based on author experience and a review of accreditation documents outlining the AFWC role (AOTA, 2013; ACOTE, 2012). Four categories were identified: administration, teaching and advising, service, and scholarship/research. The administration category was based on a unique feature of the AFWC job differentiating it from other faculty positions. Demographic information requested included personal issues (e.g., career goals), professional practice experience (e.g., years of experience), AFWC experience (e.g., years as AFWC, academic rank, tenure status), and workload effort (e.g., placement numbers, hours worked). Participants were also asked to identify other tasks in their AFWC role not listed in the survey. After the initial development of categories and tasks, the survey was piloted. Nine AFWCs identified as experts reviewed the pilot survey to establish expert validity. Reviewers critiqued the clarity of task wording, length of the survey, and whether tasks listed were representative of the AFWC role. The survey was revised accordingly.
Procedures The online survey was conducted using Survey Monkey (www.surveymonkey.com) and was open from November 2011 to February 2012. Participants indicated which tasks were applicable to their job, and they rated the level of professional reward (role valuation) for each task using a Likert scale. The data generated from the perception of professional reward will be presented with its analysis in another study. The survey provides an in-depth picture of the scope of complexity of the AFWC position spanning multiple practice environments and collaborating with a variety of stakeholders with different perspectives, needs, and motivations related to fieldwork education.
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Data Analysis Data from AFWCs in occupational therapy assistant programs were separated from those in occupational therapy programs for comparisons between these two groups. Descriptive statistics were used to determine the percentage of participation for each task. Principal components analysis of the role valuation data was used in an effort to collapse the many items of the survey to facilitate discussion of the characteristics of the AFWC role. This type of factor analysis provides a method to reduce the number of items in a survey to a fewer number of categories without losing information. The appropriateness of the analysis was confirmed via preliminary tests (Kaiser-Meyer-Olkin Measure of Sampling Adequacy [KMO] of 0.586 and Bartlett’s Test of Sphericity, p ≤ 0.001). Varimax rotation was employed to minimize the number of variables with high loadings on each factor, thereby presenting a clearer factor structure. A value of 0.40 or greater was considered significant for items loading into a factor (Portney and Watkins, 2009), and only factors displaying an eigenvalue greater than 1.00 contributed to our interpretation. Given the exploratory nature of this study, the number of factors was not restricted in the analysis to allow consideration of as many items in the survey as possible, to facilitate full characterization of the AFWC role. The factor analysis yielded 10 factors or clusters, accounting for 72.4% of the total variance.
RESULTS Demographics A combined total of 128 AFWCs participated in the survey (52% of AOTA Listserv). Sixty-three percent of respondents (n = 80) were AFWCs in occupational therapy, and 37% (n = 48) represented the occupational therapy assistant level. Most respondents (91%, n = 116, 6–21+ years) had practice experience in addition to experience as a fieldwork educator (53%, n = 68, 6–21+ years) prior to assuming the AFWC role. The majorities of respondents from both levels of programs served 5 years or less in their AFWC role at the time of the survey (see Figure 1). Figure 2 illustrates the educational level of the participants and Figure 3 shows the academic rank. There were both contrasts and similarities in the time use of AFWCs across both levels of programs. Occupational therapy assistant program AFWCs reported fewer hours dedicated to fieldwork per week (55%, n = 26, 11–30 h/week) and fewer level II placements created per year (54%, n = 26, 31–60 placements/year) compared to professional level AFWC (70%, n = 56, 21–40 h/week and 66% n = 53, 61–150 level IIs/ year). Consistent with a lesser workload, only 50% (n = 23) of occupational therapy assistant program compared to 92% (n = 70) of occupational therapy AFWCs reported having administrative assistant support. Of those with administrative support, the majority (83% n = 35) of occupational therapy assistant AFWCs reported 1–5 h/week, whereas 40% (n = 31) of professional level AWCFs reported 16–40 h, and 54% (n = 42) reported 1–10 h of administrative support. The majority of all AFWCs (69% [n = 54] professional and 68% [n = 30] assistant) reported being unable to accomplish their work in a 40-h week.
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FIGURE 1. Percentage of occupational therapy (OT) and occupational therapy assistant (OTA) academic fieldwork coordinators (AFWC) with various years (yr) of experience (exp) in the AFWC role.
FIGURE 2. Percentage of occupational therapy (OT) and occupational therapy assistant (OTA) academic fieldwork coordinators with various highest degrees earned.
FIGURE 3. Percentage of occupational therapy (OT) and occupational therapy assistant (OTA) academic fieldwork coordinators with various academic ranks.
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Tasks of the Role The factor analysis of the valuation of tasks associated with the occupational therapy AFWC role revealed new insights and perspectives. Upon analysis of the data, the traditional faculty role categories, teaching/advising, research, and service, became refined as the themes of clustered items were explored. The 10 clusters and the items comprising them, including frequency of participation in these tasks, are listed in Table 1.Two items were omitted due to lack of response (perform budget and financial management; grant writing).
DISCUSSION Data generated through this study provide a foundational description of the myriad tasks making up the role of the AFWC. The research provides a picture of the frequency of participation of AFWCs in specific responsibilities to meet institutional and Accreditation Council for Occupational Therapy Education (ACOTE) Standards (Table 1). A review of the tasks reveals that some of the work is accomplished from a procedural perspective, but many tasks require more advanced thinking skills of analysis, evaluation, and synthesis as the AFWC customizes the learning resources for each situation. The data also provide a baseline to compare the roles between occupational therapy and occupational therapy assistant programs. The proportion of occupational therapy and occupational therapy assistant program AFWCs with less than 5 years’ experience in the role parallels that of the emergency room clinical director and the social work field director (Coates and Jordan, 2005; Lyter, 2012). In contrast to physical therapy director of clinical education, most of whom saw their role as transitional to other academic positions, the majority of occupational therapy AFWCs considered their positions a final career goal. Factors that might limit longevity in the role include the complexity of the role, workload factors, and challenges in role assimilation (Buccieri and Brown, 2006). Tasks in the AFWC Role This study illustrates that, in many instances, the AFWC is responsible for teaching, professional presentations, and journal publications responsibilities which are similar to other faculty members. In addition to traditional faculty role responsibilities, the AFWC must pay attention to the relational aspects of their role with respect to fieldwork educators and fieldwork sites, and balance those responsibilities with numerous procedural duties. The evidence also supports that the AFWC role has different characteristics of complexity as compared to a traditional academic faculty member such as interacting with a broad range of stakeholders from various contexts of practice. The diversity of tasks reflected in the clusters of Fieldwork Site Management, Behind-The-Scenes Fieldwork Management, and Fieldwork Teaching and Consultation suggest a broad framework is needed to fulfill responsibilities of the position, including the skills of anticipatory thinking, analysis, synthesis, and the ability to prioritize. The scope of AFWC tasks include negotiating affiliation agreements, recruiting and evaluating fieldwork sites, and advising students struggling with
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TABLE 1. Occupational Therapy (OT)/Occupational Therapy Assistant (OTA) Academic Fieldwork Coordinator Role Clusters and Tasks Role Clusters and Tasks Fieldwork Data Management 1. Ensure that students meet health record and other fieldwork prerequisites 2. Track student academic registration/institution requirements for fieldwork coursework 3. Manage records and database for fieldwork Fieldwork Site Management 1. Develop and negotiate affiliation agreements, clinical training agreements, or MOUs 2. Schedule and confirm student placements 3. Check on student status during a fieldwork rotation 4. Recruit fieldwork sites (in person or e-mail/phone) Laying the Groundwork for Fieldwork 1. Advise and assign students to fieldwork sites 2. Prepare students for expectations of fieldwork 3. Inform fieldwork educators regarding OT/OTA role delineation 4. Supervise staff and/or student workers Behind-the-Scenes Fieldwork Management 1. Develop and update fieldwork educator handbooks and fieldwork course syllabi 2. Manage online discussion boards with students or fieldwork educators 3. Explore/request reasonable accommodations for students with disabilities Curriculum Analysis and Application 1. Act as liaison between academic faculty and fieldwork educators to integrate fieldwork with academic curricula 2. Collect and interpret data for program assessment (i.e., SEFWE) Fieldwork Teaching and Consultation 1. Collaborate with fieldwork educators to design learning experiences specific to their sites 2. Advise fieldwork educators who are working with a struggling student 3. Educate/coach/mentor students during fieldwork 4. Conduct courses/meetings to teach students about fieldwork and integrate fieldwork with academic coursework 5. Advise students struggling with fieldwork Departmental and Institutional Requirements 1. Attend departmental or program meetings 2. Communicate curricular content and sequence to fieldwork educators 3. Provide service related to academic program or institution (departmental, college, or university committees) Targeted Teaching Tasks 1. Provide public relations for fieldwork program and academic department 2. Teach courses unrelated to fieldwork Scholarship and Accreditation 1. Professional presentations (local, regional, national, or international)
% OT AFWC % OTA AFWC Factor (na ) (na ) Loadingd
98.8 (79)
100 (48)
.839
92.5 (74)
93.7 (45)
.786
100 (80)
100 (48)
.810
97.5 (78)
100 (48)
.630
100 (79b ) 98.8 (79) 100 (79b )
100 (48) 100 (48) 100 (48)
.605 .575 .723
100 (80) 100 (80) 87.5 (70)
100 (48) 100 (48) 100 (48)
.666 .558 .573
87.3 (69b )
66.7 (32)
.739
100 (79b )
100 (48)
.505
81.3 (65)
70.8 (34)
.825
97.5 (78)
87.2 (41c )
.376
98.8 (79)
97.9 (47)
.631
100 (80)
95.7 (45c )
.791
100 (80)
100 (48)
.487
100 (79b )
97.9 (47)
.813
98.7 (78b ) 98.8 (79)
97.9 (47) 97.9 (47)
.681 .508
100 (80)
100 (48)
.810
98.7 (78b ) 100 (80)
97.9 (47) 100 (48)
.814 .776
98.7 (78b )
97.9 (47)
.498
97.5 (77b )
95.8 (46)
.504
87.3 (69b )
95.7 (45c )
.872
96.3 (77)
79.2 (38)
.533
(Continued on next page)
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TABLE 1. Occupational Therapy (OT)/Occupational Therapy Assistant (OTA) Academic Fieldwork Coordinator Role Clusters and Tasks (Continued) Role Clusters and Tasks 2. Written publications (professional journals, book chapters, other publications) 3. Conduct or assist in research projects 4. Develop protocol or procedures to ensure program compliance with ACOTE Standards and prepare for accreditation Service and Education to the Profession 1. Provide continuing education opportunities for fieldwork educators to develop supervisory, education, and evaluation skills 2. Provide service related to the profession (planning or hosting fieldwork conferences, serving as an officer in a state or national association, serving as an advisory board member, mentorship of other professionals, etc.) a d
% OT AFWC % OTA AFWC Factor (na ) (na ) Loadingd 82.3 (65)
39.6 (19)
.837
78.8 (63) 100 (80)
52.1 (25) 100 (48)
.739 .535
97.6 (78)
87.5 (42)
.849
97.6 (78)
93.8 (45)
.777
Different total n values per item reflect respondents skipping the item; b total n for item = 79; c total n for item = 47; a value of 0.40 or greater was considered significant for items loading into a factor (Portney and Watkins, 2009).
fieldwork. These task clusters are likely spread out over time, dispersed throughout the year. Other clusters may be specific to occurrence and timing, such as Fieldwork Data Management. In some instances, the AFWC tracks student registration, health records, and related responsibilities through database systems designed to make the complex job more efficient. Thus, with the multiple roles, an AFWC needs to be able to shift perspectives throughout a given day as well as over time, fine-tuning the demands of the role to address time-sensitive requirements. Organizational management appears to play a key role in the AFWC position as evidenced by all three management clusters having high percentage responses. The facets of AFWC management range from scheduling and confirming placements to managing online discussion boards. The AFWC must deftly handle the complex scope of managing a fieldwork program that includes tracking student records to skillful public relations to recruit fieldwork sites in a highly competitive fieldwork arena. Additionally, the AFWC must stay informed of fieldwork site staff turnover as well as keeping abreast of legislative issues such as Medicare regulations, and corporate takeovers influencing implementation of scheduled placements. The results of this study show that the tasks of Laying the Groundwork for Fieldwork are major elements of the position. The majority of AFWCs advises both the students and the fieldwork educators, and informs fieldwork educators about occupational therapy/occupational therapy assistant role delineation. AFWCs interact with students, fieldwork educators, administrators, and academic faculty and are expected to shift gears to negotiate each stakeholder’s different perspectives and interests, demonstrating the complexity of the role to relate to a broad group of stakeholders who have interrelated, although different, needs. Tasks under Curriculum Analysis and Application, completed by nearly all participants, requires AFWC knowledge of the curriculum and ability to create a liaison role between fieldwork educators and faculty, translating and applying program threads into fieldwork practice settings, thus serving as an important pathway
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to facilitate integration of academics and practice. The relational aspect of the role, showing a high percentage of participants in several clusters, occurs through individual interactions, rather than groups, as is more common with traditional faculty teaching roles. Workload The survey shows a common experience of the AFWC not being able to accomplish their workload in a 40-h week. A number of factors may contribute to workload distributions, making it difficult to untangle the mutual influence of each factor and determine an appropriate workload expectation for the role. Although the number of level I and II placements may contribute (professional programs reporting higher numbers), the hours per week dedicated to the role is likely another contributing factor. Workload expectations are further complicated by the diverse nature of role tasks and multitasking of responsibilities. For example, the fieldwork management tasks of site preparation, student planning, and fieldwork educator planning all vary in time demands, focus, and scope. The tasks range from tracking student performance difficulties and implementing non-traditional supervisory models to managing increasing numbers of prerequisite requirements for each placement (Bithell et al., 2010). It is likely that, because of the lack of availability of seasoned faculty members in the AFWC role (programs typically employ only one AFWC), learning the AFWC role or problem-solving in situations for the inexperienced AFWC takes more time. All of these factors may contribute to the difficulty an AFWC experiences in completing all role tasks within a “normal” work week. Administrative assistant support, when provided, appears to be low (5 h or less per week) for most occupational therapy assistant program AFWCs and is reported as 10 h a week or less with occupational therapy programs. The ability to manage routine tasks could free up time to develop the lesser performed areas of scholarship and community outreach. Those AFWCs with increased administrative assistant support may be better situated to manage the full scope of roles and responsibilities. Challenges in Role Assimilation Data from this study revealed AFWCs are likely to have both clinical and fieldwork educator experience prior to assuming the role. In that capacity, the novice AFWC might have a practical knowledge base of fieldwork management from the perspective of the facility, but would likely need additional experience and training to be prepared for more complex academic tasks such as integrating fieldwork into the curriculum (Salzman, 2009). Although the novice AFWC with experience as a fieldwork educator might have benefited from working with an AFWC on tasks related to academic fieldwork activities, the tasks would be understood from the perspective of the fieldwork site rather than the academic program. Regarding more academic aspects of the job, educational institutions generally provide training for new instructors; so new AFWCs might have access to teaching and learning courses to improve performance with public relations, professional presentations, and teaching courses that represent the more traditional academic categories of teaching, scholarship, and service.
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RECOMMENDATIONS The Occupational Therapy/Occupational Therapy Assistant Academic Fieldwork Coordinator (AFWC) Role Clusters and Tasks (Table 1) may be useful for designing job descriptions representing the scope of work activities of not only AFWCs but also clinical coordinators in other health professions. It is quite likely that some tasks making up the role have not been fully described, as evidenced by some clusters being comprised of only two items. There is a need for further study to describe and define the role of the AFWC and, more specifically, identify differences in the role comparing occupational therapy with occupational therapy assistant programs. It would be valuable to correlate time in the role with role characterization and role valuation. Similar to other healthcare professions, the unique nature of the role warrants a definition distinct from the traditional academic faculty and unique considerations for tenure and promotion (Buccieri and Brown, 2006, Strickler, 1991). Like other faculty, AFWCs desire respect for their unique skill set, training, and experience (Gappa et al., 2007). They are more likely to be attracted to, and remain in, positions offering administrative assistant support for procedural tasks. Administrators would be wise to recognize tasks requiring analysis, evaluation, and creativity aligning well with the AFWC’s expertise and support professional role development. These are tasks worth allotting dedicated time. Accreditation agencies are encouraged to develop guidelines for the time needed to carry out the role, giving AFWCs leverage to advocate for support with local program administration. There is a dearth of scholarship on the topic of fieldwork education, and a particular lack of resources speaking directly to the tasks of the AFWC role. The novice AFWC is likely to learn less familiar tasks through a process of trial and error (Roberts, 2013, Smith et al., 2010, pp. 75–77). Networking with colleagues within the department and across academic settings, which has been identified as central to role satisfaction, could be an important source for development of skills for the role and counteract isolation (Salzman, 2009). Therefore, the AFWC must be intentional in remaining visible and deliberately seek support and collaboration with other faculty. For example, AFWCs should consider involving another faculty member when advising a struggling student, collaborating on a course, or integrating fieldwork with academic coursework. Given the diversity of the role, new AFWCs would benefit from a systematic training and mentoring program to be prepared for the diversity of the role and its challenges. Faculty development programs positively influence role retention (Reed, 2006). The Curtin University Academic Leadership online fieldwork coordinator program, although directed toward fieldwork education as it occurs in an industrial or technology environment, offers a promising model that could be adapted for AFWCs and others who occupy a similar role in healthcare education (Curtin University Academic Leadership, 2014). The lack of scholarship in the occupational therapy profession on the topic of fieldwork education may be related to the lack of dedicated time for scholarship at both the occupational therapy assistant and occupational therapy levels of education. The struggle of AFWCs to fit into academic departments alongside nonclinical, traditional faculty is another important consideration for role assimilation.
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Much of the AFWC role has a heavy service orientation, diverting time from collaboration with faculty colleagues in more research-oriented academic settings. Conversely, it may be challenging for AFWCs to participate in research as a low percentage have completed a doctoral degree. This is particularly evident in the reported responses to the Scholarship and Accreditation cluster, the lowest percentage of responses in both occupational therapy and occupational therapy assistant programs. AFWCs employed in professional programs are more likely to participate in scholarship activities than those working within assistant-level programs. While more time for scholarship may serve to increase motivation, this would likely be viewed differently by AFWCs in occupational therapy versus occupational therapy assistant programs. AFWCs consistently collect data from students, fieldwork educators, and academic colleagues, and often are the conduit between the academic and clinical settings. The establishment of national research priorities and resources for fieldwork education research and a national database for data storage would enable AFWCs to use the data they already have to inform their work process. Dissemination of analysis and interpretation of fieldwork data would contribute to informing processes and programs nationally. Clearly, those who identify the AFWC position as a final career goal and succeed in the role must become experts at crisis management, navigating the many tasks, contexts, and stakeholders of the position. They need to learn to ask for assistance and support from other faculty, but must systematically and persistently attempt to align their professional identity with a unique educator and scholar skill-set to achieve their deserved respect in the academic environment (Gappa et al., 2007). LIMITATIONS This research was conducted using the AOTA AFWC Listserv and, therefore, may not be reflective of the views of those who do not participate in this venue. The response rate was especially low for respondents in occupational therapy assistant programs and the use of forced choice may have limited the responses in some categories. Similarly, there was not a way to compare data from institutions offering both occupational therapy and occupational therapy assistant degrees with those offering only one entry-level program. CONCLUSION The AFWC position is complex and diverse, including activities reflective of multiple role clusters. This study examined the tasks associated with the AFWC role in occupational therapy and occupational therapy assistant programs. The data provide a description of 10 role clusters comprising the position. The majority of AFWCs reports five years or less experience, yet views it as a final career position. AFWCs have difficulty accomplishing tasks in a 40-h work week, leaving limited time for scholarship. Recommendations have been provided to enhance AFWC recruitment and retention including the development of a systematic training program, unique considerations for promotion and tenure, dedicated time for fieldwork tasks, administrative assistant support, inter-professional collaboration, and
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the need to establish a national fieldwork education research agenda combined with resources for fieldwork education scholarship. Given the many similarities between the roles and responsibilities of academic clinical coordinators across healthcare professions, these findings have application beyond the field of occupational therapy. The AFWC is a valued faculty member; further research as well as publications about the AFWC is warranted to educate others about the complexity of the role. Declaration of interest: The author reports no conflict of interest. The authors alone are responsible for the content and writing of the paper. ABOUT THE AUTHORS Patricia Stutz-Tanenbaum, MS, OTR/L, Assistant Professor, Academic Fieldwork Coordinator, Colorado State University Occupational Therapy Department, Fort Collins, Colorado. Debra J. Hanson, PhD, TR/L, Associate Professor, Academic Fieldwork Coordinator, Department of Occupational Therapy, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota. Jeanette Koski, MS, OTR/L, Academic Fieldwork Coordinator, Assistant Professor, Clinical, University of Utah, Division of Occupational Therapy, Salt Lake City, Utah. David Greene, PhD, OTR, Associate Professor, Colorado State University Occupational Therapy Department, Fort Collins, Colorado. REFERENCES Accreditation Council for Occupational Therapy Education. (2012). 2011 Accreditation Council R ) Standards. American Journal of Occupafor Occupational Therapy Education (ACOTE tional Therapy, 66, S6–S74. Accreditation Council for Occupational Therapy Education. (2013, October 14). 2011 AccrediR ) Standards and Interpretive tation Council for Occupational Therapy Education (ACOTE Guide (effective July 31, 2013) December 2012 Interpretive Guide Version. Retrieved from http://www.aota.org/∼/media/Corporate/Files/EducationCareers/Accredit/Draft-Standards/ 2011%20Standards%20and%20Interpretive%20Guide%20-%20December%202012%20Version.ashx. American Occupational Therapy Association. (2012). Program director news. Spring. American Occupational Therapy Association. (2009). Specialized knowledge and skills of occupational therapy educators of the future. American Journal of Occupational Therapy, 63, 804–818. doi:10.5014/ajot.63.6.804. Bithell C, Bowles W, & Christensen N. (2010). 6. Issues in design and management of fieldwork education. In: L McAllister, M Paterson, L Higgs, & C Bithell (Eds.), Innovations in allied health fieldwork education a critical appraisal (pp. 61–73). Rotterdam/Boston/Taipei: Sense Publishers. Buccieri K, & Brown R. (2006). Evaluating the performance of the academic coordinator of clinical education in physical therapist education: Determining appropriate criteria and assessors. Journal of Physical Therapy Education, 20(2), 17–28. Clark N, Alcala-Van Houten L, & Perea-Ryan M. (2010). Transitioning from clinical practice to academia: University expectations on the tenure track. Nurse Educator, 15(1), 105–109. Clouten N. (1994). The academic coordinator of clinical education: Career issues. Journal of Physical Therapy Education, 8(1), 32–38. Coates W, Gill A, & Jordan R. (2005). Emergency medicine clerkship directors: Defining the characteristics of the workforce. Annals of Emergency Medicine, 45(3), 262–268.
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Curtin University Academic Leadership. (2014, November 9). Retrieved from http://academicleadership.curtin.edu.au/ALFCP/overview/index.cfm. Ephgrave K, Margo K, White C, Hammoud M, Brodkey A, Painter T, Juel V, Shaw D, & Ferguson K. (2010). Core clerkship directors: Their current resources and the rewards of the role. Academic Medicine, 85(4), 710–715. Gappa JM, Austin AE, & Trice AG. (2007). Re-thinking faculty work. San Francisco: Wiley & Sons. Hoch J, White K, Starkey C, & Krause A. (2009). Delegation and empowerment in CAATE accredited athletic training education program. Athletic Training Education Journal, 4, 139–143. Lyter S. (2012). Field Note Potential of field education as signature pedagogy: The field director role. Journal of Social Work Education, 48, 179–188. Orell J, Cooper L, & Jones R. (1999). 7. Managing real world placements examples of good practice. In: L McAllister, M Paterson, L Higgs, & C Bithell (Eds.), Innovations in allied health fieldwork education a critical appraisal (p. 75). Rotterdam/Boston/Taipei: Sense Publishers. Portney LG, & Watkins MP. (2009). Foundations of clinical research: Application to practice (3rd ed.). Upper Saddle River, NJ: Pearson/Prentice Hall. Reed LE. (2006). Determinants of faculty job satisfaction and potential implications for physician assistant program personnel. Journal of Physician Assistant Education, 17, 30–35. Roberts M. (2013, October). An International Systematic Mapping Review of Occupational Therapy Fieldwork Education. Presentation at AOTA/NBCOT Education Summit Atlanta, GA. Salzman A. (2009). Portraits of persistence: Professional development of successful directors of clinical education. Journal of Physical Therapy Education, 23(1), 44–54. Smith M, Burgess C, & Hummell J. (2010). 7. Managing real world placements examples of good practice. In: L McAllister, M Paterson, L Higgs, & C Bithell (Eds.), Innovations in allied health fieldwork education a critical appraisal (pp. 75–83). Rotterdam/Boston/Taipei: Sense Publishers. Snyder J, Lucich J, Zorn J, Enking P, Barnett J, & Fahringer D. (2010). Clinical coordination and the experiential year in physician assistant education. The Journal of Physician Assistant Education, 21, 23–29. Sobralske M, & Naegele L. (2001). Worth their weight in gold: The role of clinical coordinator in a family nurse practitioner program. Journal of the American Academy of Nurse Practitioners, 13(12), 537–544. Strickler EM. (1991). The academic coordinator of clinical education: Current status, questions, and challenges for the 1990’s and beyond. Journal of Physical Therapy Education, 5(1), 3–9. The Joint Commission Standards FAQ Details. (2014, November 3). Retrieved from http://www. jointcommission.org/standards information/jcfaqdetails.aspx?StandardsFaqId=258&ProgramId=47.
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Exploring the Complexity of the Academic Fieldwork Coordinator Role Patricia Stutz-Tanenbaum1 , Debra J. Hanson2 , Jeanette Koski3 , & David Greene1 1
Occupational Therapy Department, Colorado State University, Fort Collins, Colorado, USA, 2 Department of Occupational Therapy, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA, 3 Division of Occupational Therapy, University of Utah, Salt Lake City, Utah, USA
ABSTRACT. A nation-wide survey was conducted of occupational therapy and occupational therapy assistant academic fieldwork coordinators (AFWCs) to describe demographic characteristics and tasks of the role. From the data, 10 clusters of role tasks of the AFWC are described. AFWCs view the position as a final career goal although the majority of respondents reported 5 years or less experience. Administrative assistant support and hours dedicated to fieldwork tasks are higher at the professional level than for occupational therapy assistant AFWCs. AFWCs reported difficulty accomplishing tasks in a 40-h work week and limited time for research and scholarship. Recommendations are provided for recruitment and retention through development of a systematic training program and establishment of a national fieldwork education research agenda. KEYWORDS. education
Faculty member roles, Fieldwork education, Occupational therapy
The academic fieldwork coordinator (AFWC) is an individual who orchestrates student fieldwork placements, bridging academia with clinical practice. The AFWC also navigates the world of curricular design, and ensures that internships reflect the scope, sequence, and culture of the professional healthcare program. As such, the AFWC is specifically responsible for the program’s compliance with fieldwork requirements of the Accreditation Council of Occupational Therapy Education Standards Section C (ACOTE, 2012) by developing and refining level I and level II fieldwork experiences in cooperation with academic faculty and fieldwork educators to support the curriculum design. Additionally, AFWCs are responsible for preparing students for the fieldwork environment, mentoring fieldwork educators for an educator role, and providing ongoing support for students and fieldwork Address correspondence to: Patricia Stutz-Tanenbaum, Academic Fieldwork Coordinator, Occupational Therapy Department, Colorado State University, Occupational Therapy Building #206, Fort Collins, CO 80523, USA (E-mail: [email protected]). (Received 07 September 2014; accepted 08 February 2015)
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educators during the placement. The AFWC is a visible representative of the academic program to the public and is often called upon to intervene in difficult situations, such as working with struggling students and preparing the fieldwork site to accept and work with students who have disabilities. Although the AFWC position is crucial to the program, there are little data describing the responsibilities and characteristics of the people performing in the role. As a result, academic programs do not have research data to guide recruitment, role delineation, training, and retention of the AFWC. This study describes the tasks that make up the role and relevant demographic characteristics of occupational therapy assistant and occupational therapy AFWCs. COMPLEXITY OF THE ROLE Those outside the academic environment do not universally understand the role of the AFWC. Moreover, there is very little research about the usefulness and capability of the position within the occupational therapy academic community. Therefore, literature was reviewed from related health professions including social work, physical therapy, medicine, physician assistant, athletic training, and nursing. Buccieri and Brown (2006) describe the role of the physical therapy academic clinical coordinator of education as unique, straddling academic and clinical worlds that warrant a clear distinction from the traditional academic faculty member due to the variability of the workload. Their study found that the majority of academic clinical coordinators were not tenure eligible, partly due to the extensive demands of the position, and recommend their effectiveness be evaluated differently and by those with whom they interact the most when carrying out tasks (Buccieri and Brown 2006). Similarly, Sobralske and Naegele (2001) describe the nurse practitioner clinical coordinator role as complex, acknowledging that the value of the role is not clearly understood by administrators or by clinical coordinators themselves. They propose that the difficulty in understanding is due to associated multifaceted duties and the competencies needed for effectiveness (i.e., clinical, academic, and scholarship competence), as well as personal qualities such as creativity, flexibility, and communication skills. The struggle of clinical education faculty to fit into academic departments with non-clinical faculty peers has been documented in several health-related professions. Social work field directors are often hired without a doctoral degree, and the position has been associated with limited job status, influence in the department, seniority, and advancement opportunities (Lyter, 2012). Accordingly, Hoch et al. (2009) found that program directors of athletic training programs expressed ambivalence about delegating administrative tasks for athletic training students to the clinical education coordinator and other faculty. Salzman (2009) found that physical therapy directors of clinical education reported not being fully integrated into academia. There is a lack of structured training, as well as limited support and mentorship, provided for novice clinical education coordinators to learn their roles. In a survey of emergency room clinical directors, only 14.4% received extensive mentorship or written guidelines to conduct job duties (Coates et al., 2005). Orell et al. (1999) described an “on the job” learning process for clinical education coordinators and
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asserted that this is due to the “lack of coordinated professional support” (p. 75). The lack of role preparation may limit successful acculturation for clinicians who are transitioning into the educator role. As new academic faculty cope with the unfamiliar environment, relying on intuition and on-the-job orientation to start academic careers, role stress may result due to “ambiguity, incongruity (person and role fit are problematic), conflict, and overload” (Clark et al., 2010, p. 106). In addition to the complexities of the academic world, AFWCs navigate the complex demands of the healthcare environment (Bithell et al., 2010). Continually changing national policies make the highly regulated and legalistic healthcare system difficult to track when charged with decision-making to minimize liability and risks (Bithell et al., 2010, pp. 61–62). AFWCs must be current with, and conform to, the shifting demands for student fieldwork site prerequisites to address regulatory constraints. For example, the Joint Commission of Hospitals mandates that students and volunteers “who work in the same capacity as staff who provide care, treatment, and services, would be expected to have criminal background checks verified when required by law and regulation” (“The Joint Commission”, 2014). This means that the AFWC needs to monitor state laws, regulations, and organization policy to ensure compliance across every location where students complete fieldwork placements. Increased responsibilities for tracking risk management issues add to the complexity of the role. There is no published data on the longevity of occupational therapy AFWCs, although evidence of limited longevity exists across several healthcare professions. A survey of emergency room clinical director practice indicates that most are junior faculty and have been in the role for less than 5 years; only 22.4% held the position longer than 5 years (Coates et al., 2005). The 2009 Physician Assistant Education Association reported an average longevity of 4.9 years (Snyder et al., 2010). A Social Work Field Director Report identified that over half of those surveyed had been 5 years or less in the position (Lyter, 2012). Clouten (1994) reported that physical therapy directors of clinical education are more likely to consider their positions as “trial or entry-level” positions. TASKS OF THE ROLE In a survey of clinical directors representing several different medical specialty areas, there was similarity across fields with demographics and academic productivity, despite variability in the daily clinical routines and clerkship activities (Ephgrave et al., 2010). Strickler’s (1991) survey of physical therapy academic clinical coordinators of education found they spend 24% of their time in the classroom teaching, 52% on clinical education activities, and 24% on clinical practice, scholarship, and service. Additionally, 64% of Stickler’s survey participants did not have written job descriptions, role tasks, or functions (Strickler, 1991, p. 6). Nurse practitioner clinical coordinator responsibilities include working with students and clinical faculty to resolve conflict, which entails communication skills, flexibility, and creativity (Sobralske and Naegele, 2001). Although the tasks of the AFWC appear similar across academic programs, there are no data to explore how the tasks and roles compare across the United States in the 356 (159 occupational therapy and 177 occupational therapy
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assistant) accredited program locations (AOTA, 2012). The purpose of this study was to identify the tasks associated with the role AFWC in occupational therapy and occupational therapy assistant programs, to describe the position, and the demographics of individuals in these roles.
METHODS Sample Participants for the study were recruited using the American Occupational Therapy Association’s (AOTA) AFWC Listserv, which is a voluntary e-mail distribution list dedicated to networking, resource sharing, and support for occupational therapy and occupational therapy assistant program AFWCs in the US. The AFWC Listserv had 245 subscribers at the time of the initial survey request (V. Njoroge, personal communication, March 5, 2012). University human subjects’ committee approval was granted at each author’s institution, and all participants provided informed consent.
Instrumentation An online survey tool was developed based on author experience and a review of accreditation documents outlining the AFWC role (AOTA, 2013; ACOTE, 2012). Four categories were identified: administration, teaching and advising, service, and scholarship/research. The administration category was based on a unique feature of the AFWC job differentiating it from other faculty positions. Demographic information requested included personal issues (e.g., career goals), professional practice experience (e.g., years of experience), AFWC experience (e.g., years as AFWC, academic rank, tenure status), and workload effort (e.g., placement numbers, hours worked). Participants were also asked to identify other tasks in their AFWC role not listed in the survey. After the initial development of categories and tasks, the survey was piloted. Nine AFWCs identified as experts reviewed the pilot survey to establish expert validity. Reviewers critiqued the clarity of task wording, length of the survey, and whether tasks listed were representative of the AFWC role. The survey was revised accordingly.
Procedures The online survey was conducted using Survey Monkey (www.surveymonkey.com) and was open from November 2011 to February 2012. Participants indicated which tasks were applicable to their job, and they rated the level of professional reward (role valuation) for each task using a Likert scale. The data generated from the perception of professional reward will be presented with its analysis in another study. The survey provides an in-depth picture of the scope of complexity of the AFWC position spanning multiple practice environments and collaborating with a variety of stakeholders with different perspectives, needs, and motivations related to fieldwork education.
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Data Analysis Data from AFWCs in occupational therapy assistant programs were separated from those in occupational therapy programs for comparisons between these two groups. Descriptive statistics were used to determine the percentage of participation for each task. Principal components analysis of the role valuation data was used in an effort to collapse the many items of the survey to facilitate discussion of the characteristics of the AFWC role. This type of factor analysis provides a method to reduce the number of items in a survey to a fewer number of categories without losing information. The appropriateness of the analysis was confirmed via preliminary tests (Kaiser-Meyer-Olkin Measure of Sampling Adequacy [KMO] of 0.586 and Bartlett’s Test of Sphericity, p ≤ 0.001). Varimax rotation was employed to minimize the number of variables with high loadings on each factor, thereby presenting a clearer factor structure. A value of 0.40 or greater was considered significant for items loading into a factor (Portney and Watkins, 2009), and only factors displaying an eigenvalue greater than 1.00 contributed to our interpretation. Given the exploratory nature of this study, the number of factors was not restricted in the analysis to allow consideration of as many items in the survey as possible, to facilitate full characterization of the AFWC role. The factor analysis yielded 10 factors or clusters, accounting for 72.4% of the total variance.
RESULTS Demographics A combined total of 128 AFWCs participated in the survey (52% of AOTA Listserv). Sixty-three percent of respondents (n = 80) were AFWCs in occupational therapy, and 37% (n = 48) represented the occupational therapy assistant level. Most respondents (91%, n = 116, 6–21+ years) had practice experience in addition to experience as a fieldwork educator (53%, n = 68, 6–21+ years) prior to assuming the AFWC role. The majorities of respondents from both levels of programs served 5 years or less in their AFWC role at the time of the survey (see Figure 1). Figure 2 illustrates the educational level of the participants and Figure 3 shows the academic rank. There were both contrasts and similarities in the time use of AFWCs across both levels of programs. Occupational therapy assistant program AFWCs reported fewer hours dedicated to fieldwork per week (55%, n = 26, 11–30 h/week) and fewer level II placements created per year (54%, n = 26, 31–60 placements/year) compared to professional level AFWC (70%, n = 56, 21–40 h/week and 66% n = 53, 61–150 level IIs/ year). Consistent with a lesser workload, only 50% (n = 23) of occupational therapy assistant program compared to 92% (n = 70) of occupational therapy AFWCs reported having administrative assistant support. Of those with administrative support, the majority (83% n = 35) of occupational therapy assistant AFWCs reported 1–5 h/week, whereas 40% (n = 31) of professional level AWCFs reported 16–40 h, and 54% (n = 42) reported 1–10 h of administrative support. The majority of all AFWCs (69% [n = 54] professional and 68% [n = 30] assistant) reported being unable to accomplish their work in a 40-h week.
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FIGURE 1. Percentage of occupational therapy (OT) and occupational therapy assistant (OTA) academic fieldwork coordinators (AFWC) with various years (yr) of experience (exp) in the AFWC role.
FIGURE 2. Percentage of occupational therapy (OT) and occupational therapy assistant (OTA) academic fieldwork coordinators with various highest degrees earned.
FIGURE 3. Percentage of occupational therapy (OT) and occupational therapy assistant (OTA) academic fieldwork coordinators with various academic ranks.
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Tasks of the Role The factor analysis of the valuation of tasks associated with the occupational therapy AFWC role revealed new insights and perspectives. Upon analysis of the data, the traditional faculty role categories, teaching/advising, research, and service, became refined as the themes of clustered items were explored. The 10 clusters and the items comprising them, including frequency of participation in these tasks, are listed in Table 1.Two items were omitted due to lack of response (perform budget and financial management; grant writing).
DISCUSSION Data generated through this study provide a foundational description of the myriad tasks making up the role of the AFWC. The research provides a picture of the frequency of participation of AFWCs in specific responsibilities to meet institutional and Accreditation Council for Occupational Therapy Education (ACOTE) Standards (Table 1). A review of the tasks reveals that some of the work is accomplished from a procedural perspective, but many tasks require more advanced thinking skills of analysis, evaluation, and synthesis as the AFWC customizes the learning resources for each situation. The data also provide a baseline to compare the roles between occupational therapy and occupational therapy assistant programs. The proportion of occupational therapy and occupational therapy assistant program AFWCs with less than 5 years’ experience in the role parallels that of the emergency room clinical director and the social work field director (Coates and Jordan, 2005; Lyter, 2012). In contrast to physical therapy director of clinical education, most of whom saw their role as transitional to other academic positions, the majority of occupational therapy AFWCs considered their positions a final career goal. Factors that might limit longevity in the role include the complexity of the role, workload factors, and challenges in role assimilation (Buccieri and Brown, 2006). Tasks in the AFWC Role This study illustrates that, in many instances, the AFWC is responsible for teaching, professional presentations, and journal publications responsibilities which are similar to other faculty members. In addition to traditional faculty role responsibilities, the AFWC must pay attention to the relational aspects of their role with respect to fieldwork educators and fieldwork sites, and balance those responsibilities with numerous procedural duties. The evidence also supports that the AFWC role has different characteristics of complexity as compared to a traditional academic faculty member such as interacting with a broad range of stakeholders from various contexts of practice. The diversity of tasks reflected in the clusters of Fieldwork Site Management, Behind-The-Scenes Fieldwork Management, and Fieldwork Teaching and Consultation suggest a broad framework is needed to fulfill responsibilities of the position, including the skills of anticipatory thinking, analysis, synthesis, and the ability to prioritize. The scope of AFWC tasks include negotiating affiliation agreements, recruiting and evaluating fieldwork sites, and advising students struggling with
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TABLE 1. Occupational Therapy (OT)/Occupational Therapy Assistant (OTA) Academic Fieldwork Coordinator Role Clusters and Tasks Role Clusters and Tasks Fieldwork Data Management 1. Ensure that students meet health record and other fieldwork prerequisites 2. Track student academic registration/institution requirements for fieldwork coursework 3. Manage records and database for fieldwork Fieldwork Site Management 1. Develop and negotiate affiliation agreements, clinical training agreements, or MOUs 2. Schedule and confirm student placements 3. Check on student status during a fieldwork rotation 4. Recruit fieldwork sites (in person or e-mail/phone) Laying the Groundwork for Fieldwork 1. Advise and assign students to fieldwork sites 2. Prepare students for expectations of fieldwork 3. Inform fieldwork educators regarding OT/OTA role delineation 4. Supervise staff and/or student workers Behind-the-Scenes Fieldwork Management 1. Develop and update fieldwork educator handbooks and fieldwork course syllabi 2. Manage online discussion boards with students or fieldwork educators 3. Explore/request reasonable accommodations for students with disabilities Curriculum Analysis and Application 1. Act as liaison between academic faculty and fieldwork educators to integrate fieldwork with academic curricula 2. Collect and interpret data for program assessment (i.e., SEFWE) Fieldwork Teaching and Consultation 1. Collaborate with fieldwork educators to design learning experiences specific to their sites 2. Advise fieldwork educators who are working with a struggling student 3. Educate/coach/mentor students during fieldwork 4. Conduct courses/meetings to teach students about fieldwork and integrate fieldwork with academic coursework 5. Advise students struggling with fieldwork Departmental and Institutional Requirements 1. Attend departmental or program meetings 2. Communicate curricular content and sequence to fieldwork educators 3. Provide service related to academic program or institution (departmental, college, or university committees) Targeted Teaching Tasks 1. Provide public relations for fieldwork program and academic department 2. Teach courses unrelated to fieldwork Scholarship and Accreditation 1. Professional presentations (local, regional, national, or international)
% OT AFWC % OTA AFWC Factor (na ) (na ) Loadingd
98.8 (79)
100 (48)
.839
92.5 (74)
93.7 (45)
.786
100 (80)
100 (48)
.810
97.5 (78)
100 (48)
.630
100 (79b ) 98.8 (79) 100 (79b )
100 (48) 100 (48) 100 (48)
.605 .575 .723
100 (80) 100 (80) 87.5 (70)
100 (48) 100 (48) 100 (48)
.666 .558 .573
87.3 (69b )
66.7 (32)
.739
100 (79b )
100 (48)
.505
81.3 (65)
70.8 (34)
.825
97.5 (78)
87.2 (41c )
.376
98.8 (79)
97.9 (47)
.631
100 (80)
95.7 (45c )
.791
100 (80)
100 (48)
.487
100 (79b )
97.9 (47)
.813
98.7 (78b ) 98.8 (79)
97.9 (47) 97.9 (47)
.681 .508
100 (80)
100 (48)
.810
98.7 (78b ) 100 (80)
97.9 (47) 100 (48)
.814 .776
98.7 (78b )
97.9 (47)
.498
97.5 (77b )
95.8 (46)
.504
87.3 (69b )
95.7 (45c )
.872
96.3 (77)
79.2 (38)
.533
(Continued on next page)
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TABLE 1. Occupational Therapy (OT)/Occupational Therapy Assistant (OTA) Academic Fieldwork Coordinator Role Clusters and Tasks (Continued) Role Clusters and Tasks 2. Written publications (professional journals, book chapters, other publications) 3. Conduct or assist in research projects 4. Develop protocol or procedures to ensure program compliance with ACOTE Standards and prepare for accreditation Service and Education to the Profession 1. Provide continuing education opportunities for fieldwork educators to develop supervisory, education, and evaluation skills 2. Provide service related to the profession (planning or hosting fieldwork conferences, serving as an officer in a state or national association, serving as an advisory board member, mentorship of other professionals, etc.) a d
% OT AFWC % OTA AFWC Factor (na ) (na ) Loadingd 82.3 (65)
39.6 (19)
.837
78.8 (63) 100 (80)
52.1 (25) 100 (48)
.739 .535
97.6 (78)
87.5 (42)
.849
97.6 (78)
93.8 (45)
.777
Different total n values per item reflect respondents skipping the item; b total n for item = 79; c total n for item = 47; a value of 0.40 or greater was considered significant for items loading into a factor (Portney and Watkins, 2009).
fieldwork. These task clusters are likely spread out over time, dispersed throughout the year. Other clusters may be specific to occurrence and timing, such as Fieldwork Data Management. In some instances, the AFWC tracks student registration, health records, and related responsibilities through database systems designed to make the complex job more efficient. Thus, with the multiple roles, an AFWC needs to be able to shift perspectives throughout a given day as well as over time, fine-tuning the demands of the role to address time-sensitive requirements. Organizational management appears to play a key role in the AFWC position as evidenced by all three management clusters having high percentage responses. The facets of AFWC management range from scheduling and confirming placements to managing online discussion boards. The AFWC must deftly handle the complex scope of managing a fieldwork program that includes tracking student records to skillful public relations to recruit fieldwork sites in a highly competitive fieldwork arena. Additionally, the AFWC must stay informed of fieldwork site staff turnover as well as keeping abreast of legislative issues such as Medicare regulations, and corporate takeovers influencing implementation of scheduled placements. The results of this study show that the tasks of Laying the Groundwork for Fieldwork are major elements of the position. The majority of AFWCs advises both the students and the fieldwork educators, and informs fieldwork educators about occupational therapy/occupational therapy assistant role delineation. AFWCs interact with students, fieldwork educators, administrators, and academic faculty and are expected to shift gears to negotiate each stakeholder’s different perspectives and interests, demonstrating the complexity of the role to relate to a broad group of stakeholders who have interrelated, although different, needs. Tasks under Curriculum Analysis and Application, completed by nearly all participants, requires AFWC knowledge of the curriculum and ability to create a liaison role between fieldwork educators and faculty, translating and applying program threads into fieldwork practice settings, thus serving as an important pathway
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to facilitate integration of academics and practice. The relational aspect of the role, showing a high percentage of participants in several clusters, occurs through individual interactions, rather than groups, as is more common with traditional faculty teaching roles. Workload The survey shows a common experience of the AFWC not being able to accomplish their workload in a 40-h week. A number of factors may contribute to workload distributions, making it difficult to untangle the mutual influence of each factor and determine an appropriate workload expectation for the role. Although the number of level I and II placements may contribute (professional programs reporting higher numbers), the hours per week dedicated to the role is likely another contributing factor. Workload expectations are further complicated by the diverse nature of role tasks and multitasking of responsibilities. For example, the fieldwork management tasks of site preparation, student planning, and fieldwork educator planning all vary in time demands, focus, and scope. The tasks range from tracking student performance difficulties and implementing non-traditional supervisory models to managing increasing numbers of prerequisite requirements for each placement (Bithell et al., 2010). It is likely that, because of the lack of availability of seasoned faculty members in the AFWC role (programs typically employ only one AFWC), learning the AFWC role or problem-solving in situations for the inexperienced AFWC takes more time. All of these factors may contribute to the difficulty an AFWC experiences in completing all role tasks within a “normal” work week. Administrative assistant support, when provided, appears to be low (5 h or less per week) for most occupational therapy assistant program AFWCs and is reported as 10 h a week or less with occupational therapy programs. The ability to manage routine tasks could free up time to develop the lesser performed areas of scholarship and community outreach. Those AFWCs with increased administrative assistant support may be better situated to manage the full scope of roles and responsibilities. Challenges in Role Assimilation Data from this study revealed AFWCs are likely to have both clinical and fieldwork educator experience prior to assuming the role. In that capacity, the novice AFWC might have a practical knowledge base of fieldwork management from the perspective of the facility, but would likely need additional experience and training to be prepared for more complex academic tasks such as integrating fieldwork into the curriculum (Salzman, 2009). Although the novice AFWC with experience as a fieldwork educator might have benefited from working with an AFWC on tasks related to academic fieldwork activities, the tasks would be understood from the perspective of the fieldwork site rather than the academic program. Regarding more academic aspects of the job, educational institutions generally provide training for new instructors; so new AFWCs might have access to teaching and learning courses to improve performance with public relations, professional presentations, and teaching courses that represent the more traditional academic categories of teaching, scholarship, and service.
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RECOMMENDATIONS The Occupational Therapy/Occupational Therapy Assistant Academic Fieldwork Coordinator (AFWC) Role Clusters and Tasks (Table 1) may be useful for designing job descriptions representing the scope of work activities of not only AFWCs but also clinical coordinators in other health professions. It is quite likely that some tasks making up the role have not been fully described, as evidenced by some clusters being comprised of only two items. There is a need for further study to describe and define the role of the AFWC and, more specifically, identify differences in the role comparing occupational therapy with occupational therapy assistant programs. It would be valuable to correlate time in the role with role characterization and role valuation. Similar to other healthcare professions, the unique nature of the role warrants a definition distinct from the traditional academic faculty and unique considerations for tenure and promotion (Buccieri and Brown, 2006, Strickler, 1991). Like other faculty, AFWCs desire respect for their unique skill set, training, and experience (Gappa et al., 2007). They are more likely to be attracted to, and remain in, positions offering administrative assistant support for procedural tasks. Administrators would be wise to recognize tasks requiring analysis, evaluation, and creativity aligning well with the AFWC’s expertise and support professional role development. These are tasks worth allotting dedicated time. Accreditation agencies are encouraged to develop guidelines for the time needed to carry out the role, giving AFWCs leverage to advocate for support with local program administration. There is a dearth of scholarship on the topic of fieldwork education, and a particular lack of resources speaking directly to the tasks of the AFWC role. The novice AFWC is likely to learn less familiar tasks through a process of trial and error (Roberts, 2013, Smith et al., 2010, pp. 75–77). Networking with colleagues within the department and across academic settings, which has been identified as central to role satisfaction, could be an important source for development of skills for the role and counteract isolation (Salzman, 2009). Therefore, the AFWC must be intentional in remaining visible and deliberately seek support and collaboration with other faculty. For example, AFWCs should consider involving another faculty member when advising a struggling student, collaborating on a course, or integrating fieldwork with academic coursework. Given the diversity of the role, new AFWCs would benefit from a systematic training and mentoring program to be prepared for the diversity of the role and its challenges. Faculty development programs positively influence role retention (Reed, 2006). The Curtin University Academic Leadership online fieldwork coordinator program, although directed toward fieldwork education as it occurs in an industrial or technology environment, offers a promising model that could be adapted for AFWCs and others who occupy a similar role in healthcare education (Curtin University Academic Leadership, 2014). The lack of scholarship in the occupational therapy profession on the topic of fieldwork education may be related to the lack of dedicated time for scholarship at both the occupational therapy assistant and occupational therapy levels of education. The struggle of AFWCs to fit into academic departments alongside nonclinical, traditional faculty is another important consideration for role assimilation.
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Much of the AFWC role has a heavy service orientation, diverting time from collaboration with faculty colleagues in more research-oriented academic settings. Conversely, it may be challenging for AFWCs to participate in research as a low percentage have completed a doctoral degree. This is particularly evident in the reported responses to the Scholarship and Accreditation cluster, the lowest percentage of responses in both occupational therapy and occupational therapy assistant programs. AFWCs employed in professional programs are more likely to participate in scholarship activities than those working within assistant-level programs. While more time for scholarship may serve to increase motivation, this would likely be viewed differently by AFWCs in occupational therapy versus occupational therapy assistant programs. AFWCs consistently collect data from students, fieldwork educators, and academic colleagues, and often are the conduit between the academic and clinical settings. The establishment of national research priorities and resources for fieldwork education research and a national database for data storage would enable AFWCs to use the data they already have to inform their work process. Dissemination of analysis and interpretation of fieldwork data would contribute to informing processes and programs nationally. Clearly, those who identify the AFWC position as a final career goal and succeed in the role must become experts at crisis management, navigating the many tasks, contexts, and stakeholders of the position. They need to learn to ask for assistance and support from other faculty, but must systematically and persistently attempt to align their professional identity with a unique educator and scholar skill-set to achieve their deserved respect in the academic environment (Gappa et al., 2007). LIMITATIONS This research was conducted using the AOTA AFWC Listserv and, therefore, may not be reflective of the views of those who do not participate in this venue. The response rate was especially low for respondents in occupational therapy assistant programs and the use of forced choice may have limited the responses in some categories. Similarly, there was not a way to compare data from institutions offering both occupational therapy and occupational therapy assistant degrees with those offering only one entry-level program. CONCLUSION The AFWC position is complex and diverse, including activities reflective of multiple role clusters. This study examined the tasks associated with the AFWC role in occupational therapy and occupational therapy assistant programs. The data provide a description of 10 role clusters comprising the position. The majority of AFWCs reports five years or less experience, yet views it as a final career position. AFWCs have difficulty accomplishing tasks in a 40-h work week, leaving limited time for scholarship. Recommendations have been provided to enhance AFWC recruitment and retention including the development of a systematic training program, unique considerations for promotion and tenure, dedicated time for fieldwork tasks, administrative assistant support, inter-professional collaboration, and
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the need to establish a national fieldwork education research agenda combined with resources for fieldwork education scholarship. Given the many similarities between the roles and responsibilities of academic clinical coordinators across healthcare professions, these findings have application beyond the field of occupational therapy. The AFWC is a valued faculty member; further research as well as publications about the AFWC is warranted to educate others about the complexity of the role. Declaration of interest: The author reports no conflict of interest. The authors alone are responsible for the content and writing of the paper. ABOUT THE AUTHORS Patricia Stutz-Tanenbaum, MS, OTR/L, Assistant Professor, Academic Fieldwork Coordinator, Colorado State University Occupational Therapy Department, Fort Collins, Colorado. Debra J. Hanson, PhD, TR/L, Associate Professor, Academic Fieldwork Coordinator, Department of Occupational Therapy, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota. Jeanette Koski, MS, OTR/L, Academic Fieldwork Coordinator, Assistant Professor, Clinical, University of Utah, Division of Occupational Therapy, Salt Lake City, Utah. David Greene, PhD, OTR, Associate Professor, Colorado State University Occupational Therapy Department, Fort Collins, Colorado. REFERENCES Accreditation Council for Occupational Therapy Education. (2012). 2011 Accreditation Council R ) Standards. American Journal of Occupafor Occupational Therapy Education (ACOTE tional Therapy, 66, S6–S74. Accreditation Council for Occupational Therapy Education. (2013, October 14). 2011 AccrediR ) Standards and Interpretive tation Council for Occupational Therapy Education (ACOTE Guide (effective July 31, 2013) December 2012 Interpretive Guide Version. Retrieved from http://www.aota.org/∼/media/Corporate/Files/EducationCareers/Accredit/Draft-Standards/ 2011%20Standards%20and%20Interpretive%20Guide%20-%20December%202012%20Version.ashx. American Occupational Therapy Association. (2012). Program director news. Spring. American Occupational Therapy Association. (2009). Specialized knowledge and skills of occupational therapy educators of the future. American Journal of Occupational Therapy, 63, 804–818. doi:10.5014/ajot.63.6.804. Bithell C, Bowles W, & Christensen N. (2010). 6. Issues in design and management of fieldwork education. In: L McAllister, M Paterson, L Higgs, & C Bithell (Eds.), Innovations in allied health fieldwork education a critical appraisal (pp. 61–73). Rotterdam/Boston/Taipei: Sense Publishers. Buccieri K, & Brown R. (2006). Evaluating the performance of the academic coordinator of clinical education in physical therapist education: Determining appropriate criteria and assessors. Journal of Physical Therapy Education, 20(2), 17–28. Clark N, Alcala-Van Houten L, & Perea-Ryan M. (2010). Transitioning from clinical practice to academia: University expectations on the tenure track. Nurse Educator, 15(1), 105–109. Clouten N. (1994). The academic coordinator of clinical education: Career issues. Journal of Physical Therapy Education, 8(1), 32–38. Coates W, Gill A, & Jordan R. (2005). Emergency medicine clerkship directors: Defining the characteristics of the workforce. Annals of Emergency Medicine, 45(3), 262–268.
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