Full text of DOI:10.1177/000841740006700406

Exploration of a group model in fieldwork education
•
SUSAN FARROW • BARBARA GAIPTMAN • DEBORAH RUDMAN
Susan Farrow, HBA, B.Sc. (OT), OT(C),
OTR, at the time of writing, was
Department of Occupational Therapy,
University of Toronto,Toronto, Ontario
at the time of writing. She is currently
KEY WORDS
Fieldwork education, occupational therapy
Assistant Professor in the Department
Personnel management
of Occupational Therapy, University of Vice President,Training Solutions and
Students, occupational therapy
Toronto, Academy Associate,
Marketing, Horn and Associates,
Toronto, Ontario.
Wightman-Berris Academy, Faculty of
Medicine, University of Toronto, and
Staff occupational therapist.,
Deborah Rudman, B.Sc.(OT),
Department of Occupational Therapy,
M.Sc. (OT), OT(C), is a Ph.D. student in
The Toronto Hospital,Toronto, Ontario. the Department of Community
She is currently Co-Director,Toronto
Training, Canadian Group
Health, University of Toronto and a
Lecturer in the Department of
Occupational Therapy, University of
Toronto, 256 McCaul St.,
Copyright of articles published in the Canadian Journal of Occupational
Therapy (CJOT) is held by the Canadian Association of Occupational
Therapists.Permission must be obtained in writing from CAOT to photo-
copy,reprint,reproduce (in print or electronic format) any material pub-
Psychotherapy Association.
lished in CJOT.There is a per page,per table or figure charge for commer- Barbara Gaiptman, B.O.T., M.Ed.,
Toronto, Ontario. M5T 1W5.
cial use.When referencing this article,please us APA style,citing both the
date retrieved from our web site and the URL.For more information,
please contact:copyright@caot.ca.
OT(C), was Assistant Professor and
E-mail: debbie.rudman@utoronto.ca.
Fieldwork Coordinator in the
ABSTRACT
RÉSUMÉ
Objective. Organizational changes, such as program man-
Objectif : En raison de changements organisationnels tels la gestion par
programme et la gestion de cas ainsi que des fluctuations dans la
disponibilité des ressources, il devient de plus en plus difficile d’offrir des
stages en milieu clinique.Dans cette étude,on a comparé un modèle de
supervision de groupe à un modèle de supervision individuelle afin de
déterminer leur effet respectif sur les étudiants et les superviseurs en
ergothérapie.
agement and managed care, and fluctuations in resources
present challenges to the effective provision of fieldwork
placements.This study compared an innovative group model
with a traditional 1:1 supervision model to determine their
effect on students and supervisors.
Method:The two models were implemented at an urban clin-
ical facility in several areas of practice over a 2 year period.
Questionnaires were used to assess student skill develop-
ment, student and supervising therapist satisfaction, and
impact on supervising therapists’ use of time. Focus groups
were used to explore the advantages and disadvantages of
each model.
Results. There were few statistically significant differences in
students’ (n=26) and supervising therapists’ (n=28) ratings
when the two models were compared. The qualitative find-
ings suggest that the advantages of one model often relate
to the disadvantages of the other model. In addition, super-
vising therapists and students offered several suggestions for
how to improve implementation of the group model.
Conclusion: When the results of the study are compared to
the objectives established for the group model, it appears
that many of the objectives outlined for the model were par-
tially achieved. Several issues, such as the student-supervisor
relationship and the evaluation process, need to be
addressed with participants to ensure successful implemen-
tation of the group model.
239
Méthode : Les deux modèles ont été mis en oeuvre dans plusieurs
champs de pratique d’un établissement clinique en milieu urbain, sur
une période de 2 ans. À partir de questionnaires, on a procédé à l’évalu-
ation de l’acquisition des habiletés par l’étudiant, de la satisfaction de
l’étudiant et du superviseur et de l’effet du modèle sur la façon dont le
superviseur utilisait le temps de supervision. Des groupes de discussion
ont permis de cerner les avantages et les désavantages de chaque mod-
èle.
Résultats : En comparant les deux modèles, on a observé peu de dif-
férences significatives entre les scores des étudiants (n=26) et des super-
viseurs (n=28).Les résultats qualitatifs indiquent que les avantages d’un
modèle sont souvent en rapport avec les désavantages de l’autre mod-
èle. En outre, les superviseurs et les étudiants ont fait plusieurs sugges-
tions en vue d’améliorer la mise en oeuvre du modèle de supervision de
groupe.
Conclusion : La comparaison des résultats de l’étude aux objectifs étab-
lis pour le modèle de groupe a indiqué que les objectifs étaient partielle-
ment atteints.Plusieurs aspects, dont la relation étudiant-superviseur et
le processus d’évaluation devront être examinés avec les participants
pour faciliter la mise en oeuvre du modèle de groupe.
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Farrow et al.
ealth care systems in both Canada and the United
Stated are undergoing significant changes and reform,
particularly in the way services are being delivered
ducted by Avi-Itzhak and Kellnor (1995) perceived advan-
tages to the group model, 74% of students in their Level II
placement perceived advantages. Jung et al. (1994) noted
that all 10 students involved in a shared supervision model
indicated that they had successfully met their learning objec-
tives and were exposed to a broad variety of learning experi-
ences. The authors stressed the importance of ensuring that
the roles and responsibilities of all participants in the model
were clearly delineated. Hengel and Romero (1995), used a
group approach to mental health fieldwork, and noted that
some supervising therapists identified that they initially
missed the closeness of the 1:1 supervisory relationship.
However,this appeared to dissipate with increased participa-
tion in the group approach. The authors also noted that the
group model provided a learning experience that promoted
the development of clinical reasoning skills, and encouraged
students to appreciate the different approaches to interven-
tion and to learn to develop their own unique styles.Wagstaff
(1989) noted that students achieved satisfaction with their
placement and that supervision time was reduced by one-
half when students were assigned to teams of three students
to one clinical educator, and provided with clearly defined
roles.
H
(
Abreu, 1996; Brayman, 1996; Chilton, 1995; Gage, 1995;
Landry & Knox, 1996; Shackleton & Gage, 1995). Reduced
funding, amalgamations and new models of care present
major challenges to clinical practice and to the education of
occupational therapy students.
Organizational changes and fluctuations in resources
have been perceived as having a negative impact on the
availability of fieldwork placements (Backman, 1994;Tiberius
&
Gaiptman, 1985). The resulting concern regarding a short-
age of clinical placements for occupational therapy students
has tended to be a key aspect of the rationale provided in the
literature to support the importance of alternate models of
fieldwork. Although the need to maintain and increase the
number of fieldwork placements may continue, the rationale
for the development of innovative approaches to fieldwork
education has shifted to the need to prepare students to
meet the changing demands within health care services (Avi-
Itzhak & Kellner, 1995; Backman, 1994; Gaiptman & Forma,
1
991; Jung, Martin, Graden & Awrey, 1994).
In response to the need to develop innovative
approaches,an interest and commitment to the group model
of supervision arose at the University of Toronto,
Occupational Therapy education program. Community
based practice, program management, the need to justify
practice through outcome measures, managed care, change
from rotation systems in hospitals and an increased trend
toward specialization for therapists in tertiary care facilities,
were just some of the issues impacting on fieldwork educa-
tion (Gage 1995; Taylor, Andriuk, Langlois, & Provost, 1995).
Stanton (1994) states that as health care changes,so too must
fieldwork change, and this change means more than just
changing the setting where fieldwork occurs; it means
restructuring the objectives and the models applied in field-
work. She suggests redesigning fieldwork to enable students
to acquire the skills that will help them anticipate changes.
Our new graduates will be expected to participate in organi-
zational restructuring and team collaboration, employ alter-
nate payment structures, increase utilization of support staff,
and assume consultative and leadership roles. The group
model was selected as an approach that would be especially
appropriate to facilitate a reflective, analytic aproach to prac-
tice as well as the development of necessary skills.
Issues to consider when utilizing a group approach in
supervision have been suggested by several authors.
Nolinske (1995) suggested that multiple mentoring by sever-
al fieldwork supervisors resulted in students’ learning needs
being addressed more fully than by one fieldwork educator
alone.Mckeachie (1992) noted the importance of feedback in
the group model and suggested that educators need to
encourage students to self-critique, provide feedback to one
another, and evaluate each other ’s work. Perhaps the most
important issue to consider in the development of alterna-
tive models of supervision is the application of a variety of
supervisory strategies appropriate to these models (Tiberius
& Gaiptman, 1985).
240
The purpose of this paper is threefold: to describe a
group model of supervision, to present the results of a study
that compared a group model with a traditional model, and
to identify the issues that need to be addressed with both
students and supervisors when implementing a group
model of supervision.
Description of the group model developed at
the University of Toronto, Occupational
Research focussing on a group approach to supervision
suggests numerous possible outcomes. Avi-Itzhak & Kellnor
Therapy Program
(1995) reported that the use of a group facilitated students’
Based on literature pertaining to group models (Avi-Izhak &
Kellner, 1995; Cohn, 1989; Gaiptman & Forma, 1994; Hengel &
Romero, 1995; Nolinske, 1995; & Wagstaff, 1989) and the
authors’experiences in fieldwork planning,a group model for
fieldwork supervision was developed. Objectives and critical
elements make up the main components of the model.
abilities to interact with each other and to learn to give and
receive feedback from one another. Their findings suggest
the importance of considering the previous fieldwork experi-
ences of students who participate in this model. While only
2
6% of students in their Level I placement in the study con-
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Farrow et al.
The group model, as defined for the purpose of this
study, involves a group of students (2 or more) being jointly
supervised by a group of therapists (3 or more) who work in
related areas of practice. The group model is based on the
principles of collaborative and self-directed learning.
Collaborative learning principles emphasize the value of
team approaches to learning, incorporating multiple per-
spectives and opinions (Kidd, 1973). Self-directed learning
principles shift the responsibility for the direction of the edu-
cation process from the supervisor to the student (Knowles,
resources and meeting their own learning needs. Because
students are expected to work together, they are asked to
develop and address shared learning objectives as well as
identify individual learning needs.
Students are offered a broad exposure to the role of
occupational therapy.Learning emphasizes the acquisition of
generic, professional skills. Students are encouraged to focus
on assessment skills, interviewing practices and techniques,
interpersonal communication, clinical reasoning skills, pro-
gram planning and intervention, as well as the ability to eval-
uate honestly both self and peers.
1
975).
Objectives of the Group Model
The group of educators who developed the model defined
an initial list of central objectives designed to address the
needs of students and supervisors. These objectives outline
the rationale for the implementation of the group model in
the context of this study.They are to:
Methodology
A quasi-experimental study was conducted over a two year
period involving three different fieldwork placements at one
teaching hospital located in a large urban area. Data collec-
tion occurred in each of the three placement periods, and
supervising therapists and students participated either in a
group supervision model or in a 1:1 supervision model.
A verbal description of the objectives and critical ele-
ments of the group model was provided to supervisors and
students. While no specific training was provided to partici-
pants who used either model, support was available from
both university and facility fieldwork coordinators. Data col-
lection occurred at the end of the fieldwork placement, with
quantitative methods being used in all three phases and
qualitative methods being used in the second and third
phases.
1
2
. Increase the breadth and diversity of clinical experience.
. Encourage collaborative work amongst students to pre-
pare them for their roles as multidisciplinary team
members.
3
4
5
. Respond to the increasing demands on clinicians by lim-
iting the time individual clinicians spend in the supervi-
sion of students.
. Involve clinicians whose part-time practice may have
prevented them from assuming sole responsibility for
the supervision of students.
. Continue to maintain and increase the number of clini-
cal placements offered to students.
The objectives of this exploratory study were
to:
Critical elements of the Group Model
Several critical elements were defined for the group model to
distinguish it from more traditional models of supervision.
These include: collaboration among students; collaboration
among supervising therapists; student responsibility for
learning; and broad exposure to clinical practice. Students
work collaboratively with one another, and provide each
other with peer support and feedback.They are also expect-
ed to participate in self and peer evaluation.The structure of
supervision includes supervision from therapists as well as
peer supervision. Specific times are identified in students’
schedules for students to meet with each other to problem
solve, provide support and evaluate one another.
1
. Compare the group model with a 1:1 model in terms of:
student exposure to occupational therapy roles and
clinical areas; supervising therapists’ and students’ satis-
faction; supervising therapists’ and students’ percep-
tions regarding skills developed; and supervising thera-
pists’ability to manage time and activities.
241
2
3
4
. Explore students’ perspectives regarding the advan-
tages and disadvantages of a group model and a 1:1
model.
. Explore supervising occupational therapists’ perspec-
tives regarding the advantages and disadvantages of a
group model and a 1:1 model.
Supervising therapists make a commitment to work col-
laboratively with their colleagues in organizing and facilitat-
ing the supervisory process.Regular meeting time is set aside
to discuss student performance and supervisory strategies.
As therapists jointly supervising students in this model may
not regularly work together, it is important for them to com-
municate regularly about process and content issues.
Students identify individual and shared learning objec-
tives, and take on greater responsibility for identifying
. Identify the issues that need to be addressed when
developing and implementing a group model.
Sampling
During the two year period, 26 students were assigned
to fieldwork placements at the facility where the study was
conducted, through a computer matching service with no
criteria for assignment to the group or 1:1 model.The assign-
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Farrow et al.
ment of the 28 supervising therapists to the group or 1:1
model depended on the following factors: number of stu-
dents assigned to a particular practice area, the number of
therapists working in a practice area, and whether therapists
were full-time or part-time employees. Participating supervi-
sors and students had no previous exposure to the group
model, but were familiar with the 1:1 model.
(see Table 1), data collected during the three fieldwork peri-
ods were combined and analyzed.
Results
Sample
A description of the participants involved in each phase and
the number of participants completing each type of data col-
lection is provided in Table 1. Two supervisors and two stu-
dents did not return completed questionnaires.
Data collection
Two questionnaires, one for students and one for supervi-
sors, were developed for the study.The majority of questions
were close-ended and involved rating satisfaction and per-
ceptions using Likert-type rating scales. Items were devel-
oped by reviewing literature related to fieldwork evaluation.
The student questionnaire consisted of three parts which
addressed:type and scope of placement; satisfaction with 12
aspects of the placement; and perception of student skill
development in 13 areas. In addition to addressing the three
parts covered in the student questionnaire, the four-part
supervisor questionnaire addressed the effect of the place-
ment on their ability to manage time and activities. Neither
questionnaire was pilot-tested.
All students had participated in a minimum of 240 hours
of fieldwork experience prior to the study.Therapists partici-
pating in both models had a wide range of years of work
experience, and both models were implemented in a range
of practice areas. The group model was not implemented in
psychiatry as there were a limited number of therapists locat-
ed at different sites practicing in this area in the hospital
where the study occurred.
Questionnaires
The questionnaires described above were completed by stu-
dents and supervisors during the final week of fieldwork place-
ments. The findings pertaining to students’ perspectives are
summarized in Table 2, while the findings pertaining to super-
vising therapists’perspectives are summarized in Table 3.
Student responses: The responses of students in the
group model were compared to the responses of students in
the 1:1 model (see Table 2). No significant differences were
found between the two models with respect to the number
of occupational therapy roles and clinical areas of practice
students perceived they had experienced. Greater than 60%
of all of the students reported that they were exposed to the
following roles: assessor (n=24), discharge planner (n=18),
and program planner (n=16).
Focus groups were conducted in phases 2 and 3 in order
to explore students’ and supervisors’ perspectives regarding
the advantages and disadvantages of each model. In each
phase, separate discussion groups were conducted with stu-
dents in the group model, students in the 1:1 model, super-
visors in the group model, and supervisors in the 1:1 model.
The student discussion groups were facilitated by the hospi-
tal ’s occupational therapy education coordinator, while the
supervisor discussion groups were facilitated by a university
faculty member. Each facilitator used a list of open-ended
questions to facilitate the group discussion. Some questions
addressed general issues regarding fieldwork learning, and
some questions addressed model specific issues, to identify
characteristics perceived to be unique to the group or 1:1
model. All discussions were transcribed from notes to facili-
tate openness. Confidentiality was assured and names were
not included in transcripts of the discussions.
242
There were no statistically significant differences in level
of satisfaction between the two models. One difference
approached significance (p≤0.05), indicating that students in
the 1:1 model tended to rate satisfaction with their relation-
ship with their supervisor higher than students in the group
model. Overall, using a 7-point scale with 1 indicating ‘not at
all satisfied’and 7 indicating ‘very satisfied ’, median ratings of
≥5 were provided for 100% of the 12 satisfaction items by all
students.
Data Analysis
Questionnaire data were analyzed using basic descriptive
statistics, such as means and standard deviations, and non-
parametric inferential statistics, such as chi-square and
Mann-Whitney U for the discussion of results.Tables 2 and 3
report medians and non-parametric Mann-Whitney U values
only. The level of significance was set at p≤0.01 as supervis-
ing therapists and students were asked to rate multiple items
and the analysis involved multiple comparisons. Transcripts
of the discussion groups were inductively analyzed to identi-
fy major topics and prevalent advantages and disadvan-
tages. Due to the small number of participants in each phase
There were also no statistically significant differences in
perceived skill development.One difference approached sig-
nificance (p≥0.05), in favor of the 1:1 model. Students in the
1:1 model tended to rate improvement in their ability to
receive feedback higher than the group model students.
Overall, using a 7-point scale with 1 indicating that skills did
not improve and 7 indicating that skills improved a great
deal, median ratings of ≥5 were provided for 100% of the 13
skill items by all students.
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Table 1
Characteristics of study sample and data sources
Student Data
N=26)
Supervising Therapist Data
(
(N=28)
Model of Supervision Phase
Area of
Practice
Level of
Experience
Question-
naires
Focus
Group
(n=16)
Years Work
Experience
(range)
Question-
naires
(n=26)
Focus
Groups
(n=16)
a
b
c
c
(n=24)
Group Model
1
2
MSK
II
2
3
-
6 - 8
3
5
-
Cardio.
Gen. Med.
Neuro.
III
2
1 - 11
6
6
3
1
Hands
MSK
Neuro.
II
II
8
7
8
-
1 - 20
5 - 30
8
7
1
:1 Model
Cardio
-
Hands
Geriatrics
Neuro.
Psychiatry
2
3
Hands
III
II
2
2
2
4
7 - 20
1 - 30
1
2
2
2
Psychiatry
Gen. Med.
Psychiatry
a
b
c
MSK = musculoskeletal; cardio. = cardiology; gen. med. = general medicine; and neuro. = neurosciences.
Level II indicates 240 - 600 hours of fieldwork experience; level III indicates greater than 600 hours of fieldwork experience.
Focus groups were only conducted in Phases 2 and 3.
243
Supervising therapists’responses: While there was no
and for 92% of items by 1:1 supervisors.
significant difference in supervisors’ perceptions of the num-
ber of roles students were exposed to in the two models,
supervisors in the group model perceived that students were
exposed to a statistically significantly greater number of clin-
ical areas (p<0.001) (see Table 3). Supervising therapists
reported that at least 60% of students in both models were
exposed to the roles of assessor (n=26), discharge planner
Supervising therapists’perceptions of the degree of stu-
dent skill development did not significantly differ between
the two models. One difference approached significance
(p≤0.05) indicating that supervisors in the 1:1 model tended
to perceive a greater degree of development in the student’s
ability to evaluate him or herself. Using the same rating scale
as students, median ratings of ≥5 were provided for 100% of
13 skills items by all supervisors.
(n=18), consultant (n=18) and program planner (n=17).
In terms of supervising therapist satisfaction,there was a
statistically significant difference for one of twelve items.
Supervisors in the 1:1 model rated their satisfaction with
opportunities to observe student(s) higher than supervisors
in the group model (p<0.001). In addition, three other satis-
faction items tended to be rated higher by supervisors in the
There were no statistically significant differences in
supervisors’ratings of the effect of being a clinical supervisor
on their ability to manage their caseload or schedule, or to
participate in professional development, research, and com-
mittee activities.
1
:1 model (p≤0.05): relationship(s) with student(s), quality of
Discussion Groups
contact with student(s), and responsibility for evaluation.
Using the same rating scale as students, median ratings of ≥5
were provided for 83% of items by group model supervisors
Seven major topic areas emerged from the discussion groups
conducted with students and with supervisors.These includ-
ed: relationships; evaluation; students’ exposure to a variety
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Table 2
Students’ ratings of satisfaction and skill development
Variable
Group model (n=13)
1:1 model (n=11 )
Mann-Whitney U
U
Median
Range
Median
Range
Scope:
Number of roles
Number of service areas
4
3
2-6
2-5
5
2
3-7
1-6
94.5
95.0
a
Satisfaction:
Relationship with supervisor(s)
Comfort to approach supervisor(s)
Learning objectives identified
Learning objectives met
Learning opportunities
Use of time
Learning climate
Availability of clients
Quantity of feedback
Quality of feedback
Evaluation of performance
Degree of challenge
6
6
6
6
7
6
6
6
6
6
6
6
4-7
4-7
5-7
4-7
5-7
5-6
4-7
4-7
4-7
4-7
5-7
4-7
7
6
6
6
6
6
7
5
6
7
6
6
6-7
5-7
5-7
4-7
5-7
4-7
6-7
3-7
5-7
6-7
5-7
6-7
106.5*
101.0
81.0
93.0
97.5
77.5
90.5
84.5
84.5
104.0
95.0
77.0
b
Skill development:
Communcation
Problem-solving
Conducting assessments
Analyzing assesments
Program planning
Working collaboratively
Charting
Technical
Observation
Time management
Self evaluation
Provide feedback
Receive feedback
5
5
6
6
5
6
6
6
6
6
5
5
5
4-7
3-7
4-7
4-7
3-6
4-7
5-7
4-7
4-7
4-6
4-6
3-7
4-7
6
6
6
5
5
5
6
6
6
6
5
6
6
4-7
5-7
4-7
4-7
4-7
4-7
5-7
2-7
5-7
4-6
4-7
4-7
5-7
97.5
85.5
74.0
78.5
86.0
83.0
82.0
56.5
93.0
79.0
74.0
99.5
109.0*
244
a
Students rated their degree of satisfaction using a 7-point scale ranging from 1=not all satisfied to 7=very satisfied.
b
Students rated the development of their skills over the course of the placement using a 7-point scale ranging from 1=did not improve to
7
*
=improved a great deal.
= 0.05>p>0.01; All others are not significant.
of occupational therapist ’s roles; learning opportunities for stu-
dents; expectations regarding roles and responsibilities; collab-
oration/competition; and organization. In addition, supervising
therapists also addressed the issue of communication.
areas of practice, multiple roles, and multiple therapists’
styles were an advantage of the group model, while a disad-
vantage of the 1:1 model was that exposure is limited to one
therapist ’s practice.
Overall, the advantages of the group model from stu-
dents’perspectives appear to relate to exposure to a variety of
opportunities, while the disadvantages relate to the difficul-
ties in dealing with multiple supervisors and managing a vari-
ety of expectations.The advantages of the 1:1 model relate to
individual attention and managing a 1:1 relationship, while
the disadvantages relate to limitations in opportunities.
Students
The major topics discussed and the main advantages and dis-
advantages that emerged across the student discussion
groups are summarized in Table 4.Many of the advantages of
one model relate to the disadvantages of the other model.
For example, students expressed that exposure to multiple
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Table 3
Supervising therapists’ ratings of personal satisfaction and student skill development
Variable
Group model (n=16)
1:1 model (n=10)
Median Range
Mann-Whitney U
U
Median
Range
Scope:
Number of roles
Number of service areas
4
3
2-7
2-6
4.5
1
1-8
1-3
87.0
143.0
a
Satisfaction:
Relationship with student(s)
Learning objectives of student(s)
Learning objectives met by student(s)
Students’use of time
5.5
5
5
3-6
4-7
4-6
3-7
4-7
3-7
3-7
2-6
3-6
2-6
3-7
3-7
6
6
6
6
6
6
6
6
6
4-7
4-7
5-7
4-7
4-7
5-7
5-7
6-7
5-7
5-7
5-6
3-6
118.0*
97.5
98.5
94.0
95.5
109.5*
127.0
149.5
112.5
121.0*
105.0
87.0
6
Overall learning experience for student(s) 6
Quantity of contact with student
Quality of contact with student
Opportunities to observe student
Responsiblity for learning experience
Responsiblity for evaluation
5
5
4
5.5
5.5
5
6
5.5
4.5
Ability to use time for clinical purposes
Ability to use time for other purposes
4
b
Student skill development:
Communication
Problem-solving
Conducting assessments
Analyzing assesments
Program planning
Working collaboratively
Charting
Technical
Observation
Time management
Self evaluation
Provide feedback
Receive feedback
5
5.5
5.5
5
4.5
5.75
5.5
5
5.5
6
5
5
5.75
3.5-6.5
4-7
4-7
5
5
5.5
4.5
5
6
5
5.5
6
6
4-6
4-7
4-7
4-6
4-6
5-6
5-7
4-7
4-7
5-6
5-7
4-6
5-6
89.5
56.5
72.5
60.0
106.5
83.0
79.5
107.5
96.0
4-7
3-6.5
3.5-7
4-6.5
3-6
4-6
3-7
2-6
3-6
4-6.5
89.0
245
6
6
6
95.5*
110.0
91.0
a
Superivising therapists rated their degree of satisfaction using a 7-point scale ranging from 1=not all satisfied to 7=very satisfied.
b
Superivising therapists rated the development of student skills over the course of the placement using a 7-point scale ranging from 1=did not
improve to 7=improved a great deal.
= 0.05>p>0.01; All others are not significant.
*
Supervising therapists
sure students received, and the variety of opportunities asso-
ciated with the group model. Many of the disadvantages of
the group model discussed by supervisors related to changes
in the supervisor-student relationship and the effort and
time required for supervising therapists to work together.The
advantages of the 1:1 model discussed by supervisors were
similar to the advantages discussed by students and tended
to relate to individual attention and managing a 1:1 relation-
ship. Many of the disadvantages of the 1:1 model discussed
by supervisors related to limitations in student opportunities
and the time associated with 1:1 supervision.
The supervising therapists also suggested that the advan-
tages of one model often relate to the disadvantages of the
other model (see Table 5).For example,supervising therapists
expressed that because the group model involves multiple
relationships there is less chance of breakdown in communi-
cation due to supervisor-student conflict. Similarly, a disad-
vantage of the 1:1 model is that communication can be sig-
nificantly effected when the supervisor and student have dis-
similar styles.
Supervising therapists also highlighted the broad expo-
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Table 4
Students’ perceptions of advantages and disadvantages of each model
Group Model
1:1 Model
TOPIC
Advantages
Disadvantages
Advantages
Disadvantages
Relationships
- personality issues/
conflict minimized
- can be difficult to adapt - get individual attention
- placement tied to
quality of relationship
with supervisor which
is a disadvantage
when relationship is
poor
to multiple supervisors
- harder to establish rap-
port with each therapist
- feel safe
-
form relationships with
number of therapists
Evaluation
- get different points
of view
- comparison with other
students may feel
intimidating
- no comparison to
other students
- little opportunity for
peer evaluation
Students’
Exposure
- exposed to multiple
areas of practice, roles,
and therapists’styles
- variety may feel
overwhelming
- exposure limited to
one therapist ’s practice
Learning
opportunities
for student
- opportunity to develop
own style (versus adopting
therapist ’s style)
- opportunities depen-
dent on therapist’s
caseload and unit
-
promotes initiative and
problem-solving
Expectations
regarding roles
- unclear expectations
may lead to feelings of
being overwhelmed
- easy to figure out
expectations of one
therapist
&
responsibilities
Collaboration/
Competition
- opportunity to work
collaboratively with peers
- no element of
competition
- little opportunity for
collaboration with
other students
Organization
- model works well when
have a set schedule
- when schedule is
unclear, difficult to
organize daily activities
- organization fairly easy
as dealing with one
therapist ’s schedule
246
-
have to deal with
schedules of
multiple supervisors
plete tasks independently. Other supervisors and students
thought the model would work most effectively with stu-
dents in their first placements, who would benefit from
numerous opportunities for observation. Supervisors high-
lighted two additional factors: the number of students that
the group of therapists can supervise effectively and the
need for supervising therapists to spend time organizing the
placement prior to the arrival of students.
Issues identified by students and supervising
therapists in the group model
Both supervisors and students participating in the group
model stressed the need to discuss expectations at the
beginning of the placement in order to come to a common
understanding of participants’ roles. The need to put struc-
tures in place, such as weekly meetings between supervisors
and between supervisors and students, to facilitate effective
communication also emerged in both supervisor and stu-
dent discussion groups.There was divided opinion about the
level of student for which this model would be most appro-
priate. Some supervisors and students indicated that the
group model could work effectively with students in their
final placements who have the skills and knowledge to com-
Discussion
The findings of this exploratory study need to be interpreted
within the limitations of the method. The questionnaire was
not standardized and its reliability and validity were not
assessed. Assignment of students and supervising therapists
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Table 5
Supervising therapists’ perceptions of advantages and disadvantages of each model
Group Model
1:1 Model
TOPIC
Advantages
Disadvantages
Advantages
Disadvantages
Relationships
- personality issues/
conflict minimized
- relationship with each
student less personal
- able to facilitate 1:1
mentor relationship
- get to know
- student may be too
‘protected’by
supervisor
-
student has opportunity
to form multiple
relationships
tudent personally
- may feel
overwhelmed due
to amount of contact
with student
Evaluation
- increased confidence
regarding accuracy
- evaluation process
can be very time
- can focus on one
student and get a
-
increased ability
consuming
good picture of him/her
- based on what
Supervising therapist
observes, rather than
what other therapists’
to deal with problems
- difficult for any one
therapist to get full pic-
ture of each student
-
difficult to deal with
various therapists’opinions report
Students’
Exposure
-exposed to various roles
and areas of practice
- discomfort may result
when inconsistencies in
practice between therapists
highlighted
- only exposed to one
supervisor ’s area and
style
Learning
opportunities
- increased opportunity
for client contact
- less opportunities to
develop specialized
assessment and
-supervisor can match
individual student
needs with opportunities
- if supervisor’s
caseload is low it can
have significant
impact on student’s
opportunities
-
increased opportunity
for developing
professional skills
intervention skills
Expectations
regarding roles
- provides students with
a real world experience
- unclear expectations
may cause students
to feel overwhelmed
- easy for therapist to
convey expectations
&
responsibilities
247
Collaboration/
Competition
- students have opportunity - stronger students may
to work collaboratively
with peers
assume greater responsibility
during the placement
Organization
- if effectively organized,
students demand is less
on each therapist ’s time
- first time preparation
is time consuming
- not a great deal of time
needs to be put into
planning once placement consuming
established
- planning and initial
weeks can be time
Communication - less chance of breakdown - need to schedule time
- able to constantly
communicate with
- effectiveness can be
in communication due to
therapist-student conflict
to meet together
significantly lessened
when therapist and
student do not have
similar styles
(with other therapists and student
with students) to success-
fully monitor students’
activities
to the models was not random and,in turn,there was no con-
trol over variables such as students’ skill level upon entering
the placements and therapists’ experience supervising stu-
dents. As well, the number of supervising therapists and stu-
dents participating in each model was small and not all par-
ticipants attended the discussion groups or completed ques-
tionnaires.
Overall, there were few significant differences in the
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Farrow et al.
quantitative ratings provided by participants in the two mod-
els.Median ratings of all participants tended to be high as did
perceptions of student skill development. It is not surprising
that few significant differences were found due to the ten-
dency for participants to choose a rating of 5 or higher on a
ules, caseloads, and other activities. However, no difference
was found between the perceptions of group model supervi-
sors and 1:1 supervisors. This failure to find a difference may
have resulted because supervisors were asked to consider
the effect over the entire time period of the fieldwork place-
ment.However,supervisors’comments indicate that the time
commitment varies across the placement. Thus, supervising
therapists’ perceptions of the time commitment during vari-
ous stages of the placement need to be investigated to
examine if there is a difference between the two models.
It was also hypothesized that the learning experience in
the group model emphasizes the acquisition of generic, pro-
fessional skills, such as problem solving and managing time,
as opposed to specialized assessment and intervention tech-
niques. Supervising therapists in the group model indicated
that students had more opportunities for the development
of professional skills compared to students they had previ-
ously supervised using a 1:1 model. Supervisors also per-
ceived that students in the group model had fewer opportu-
nities to develop specialized assessment and intervention
skills and indicated that this may be a disadvantage of the
model. The intent of the group model to facilitate generic,
professional skills needs to be discussed with supervising
therapists and students prior to implementation of the
model so that the rationale is understood in the context of
the current health care environment.
7
-point scale combined with the small sample size. However,
the combination of quantitative and qualitative findings sug-
gests differences between the two models as well as issues
that need to be addressed when implementing a group
model.
As outlined previously, one of the objectives of the
group model was to increase the breadth and diversity of
clinical experiences. This advantage was noted by students
who participated in a previous study (Jung et al., 1994) and
also emerged in this study. The one significant difference in
favour of the group model pertained to the number of clini-
cal areas to which students were exposed. Qualitative com-
ments by both supervising therapists and students indicated
that exposure to a variety of roles, clinical areas, and thera-
pists’ styles were advantages of the group model. Moreover,
students in the 1:1 model noted that having one supervising
therapist could limit the diversity of placements.
Another objective of the group model was to encourage
student collaboration. Although there was no significant dif-
ference in ratings assigned to the skill item related to the abil-
ity to work collaboratively, both supervising therapists and
students indicated that the opportunity for students to work
collaboratively with peers was an advantage of the group
model. As well, students in the 1:1 model noted that the lack
of opportunity to work collaboratively with peers was a dis-
advantage. It is also important to note that the qualitative
findings suggest that the group model may involve some
feelings of competition between the students.
Another critical element of the group model was for
supervising therapists to make a commitment to work col-
laboratively with their colleagues.The importance of this ele-
ment was highlighted in the discussion with supervising
therapists who participated in the group model. They felt
that collaboration can have positive outcomes, and that it
requires a commitment in terms of time and willingness to
organize and communicate. Student comments suggest the
need for supervisors to collaborate in order to ensure consis-
tent student expectations. Both supervisors and students
reinforced the importance of collaboration among supervis-
ing therapists and between supervisors and students.
248
While student collaboration was viewed as an advan-
tage, the comments of supervisors and students participat-
ing in the group model suggest that collaboration may not
have been part of the evaluation process. Although the pro-
vision of peer feedback was a critical element of the group
model, it does not appear that the model was structured by
participants in this study to allow significant opportunities
for students to provide feedback to and evaluate each other.
Indeed, in contrast to previous findings that suggest a group
model can facilitate students’ abilities to receive and give
feedback (Azi-Itzhak & Kellnor, 1995), no significant differ-
ences were found in students’and supervisors’ratings of stu-
dents’ skill development in the ability to give and to receive
feedback. These findings highlight the need to facilitate the
opportunity for student involvement in the feedback and
evaluation process when implementing the group model.
Based on previous research (Wagstaff, 1989), it was
hypothesized that clinicians in a group model would spend
less time supervising students and that there would be less
of a negative effect on their ability to manage their sched-
The importance of clearly establishing participants’roles
and responsibilities in the group model (Jung et al. ,1994) is
reinforced by this study ’s findings. Both supervising thera-
pists and students indicated that unclear expectations can
cause students to feel overwhelmed and indicated that roles
need to be discussed at the beginning of the placement.
The findings suggest that the nature of the student-
supervisor relationship needs to be addressed when imple-
menting a group model. Many of the differences approach-
ing significance in favour of the 1:1 model pertain to the stu-
dent-supervisor relationship. Both students and supervising
therapists commented on the nature of this relationship, and
it is evident that there are advantages and disadvantages for
each model. When shifting from a 1:1 model to a group
model,it appears that both students and supervisors need to
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Farrow et al.
be prepared to enter into a relationship that is less personal
and need to address the challenges associated with estab-
lishing and maintaining multiple relationships.
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Acknowledgements
The authors gratefully acknowledge the contributions and
dedicated work of the staff occupational therapists at The
Toronto Hospital and the occupational therapy students at
the University of Toronto.
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